| 1. |
- van Duinen, A. J., et al.
(författare)
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Caesarean section performed by medical doctors and associate clinicians in Sierra Leone.
- 2019
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Ingår i: British Journal of Surgery. - : Oxford University Press (OUP). - 0007-1323 .- 1365-2168. ; 106:2, s. e129-e137
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Many countries lack sufficient medical doctors to provide safe and affordable surgical and emergency obstetric care. Task-sharing with associate clinicians (ACs) has been suggested to fill this gap. The aim of this study was to assess maternal and neonatal outcomes of caesarean sections performed by ACs and doctors.METHODS: All nine hospitals in Sierra Leone where both ACs and doctors performed caesarean sections were included in this prospective observational multicentre non-inferiority study. Patients undergoing caesarean section were followed for 30 days. The primary outcome was maternal mortality, and secondary outcomes were perinatal events and maternal morbidity.RESULTS: Between October 2016 and May 2017, 1282 patients were enrolled in the study. In total, 1161 patients (90·6 per cent) were followed up with a home visit at 30 days. Data for 1274 caesarean sections were analysed, 443 performed by ACs and 831 by doctors. Twin pregnancies were more frequently treated by ACs, whereas doctors performed a higher proportion of operations outside office hours. There was one maternal death in the AC group and 15 in the doctor group (crude odds ratio (OR) 0·12, 90 per cent confidence interval 0·01 to 0·67). There were fewer stillbirths in the AC group (OR 0·74, 0·56 to 0·98), but patients were readmitted twice as often (OR 2·17, 1·08 to 4·42).CONCLUSION: Caesarean sections performed by ACs are not inferior to those undertaken by doctors. Task-sharing can be a safe strategy to improve access to emergency surgical care in areas where there is a shortage of doctors.
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| 2. |
- Baroffio, C. A., et al.
(författare)
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Combining plant volatiles and pheromones to catch two insect pests in the same trap : Examples from two berry crops
- 2018
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Ingår i: Crop Protection. - : ELSEVIER SCI LTD. - 0261-2194 .- 1873-6904. ; 109, s. 1-8
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Tidskriftsartikel (refereegranskat)abstract
- Most horticultural crops are attacked by more than one insect pest. As broad-spectrum chemical control options are becoming increasingly restricted, there is a need to develop novel control methods. Semiochemical attractants are available for three important horticultural pests, strawberry blossom weevil, Anthonomus rubi Herbst (Coleoptera: Curculionidae), European tarnished plant bug, Lygus rugulipennis Poppius (Hemiptera: Miridae) and raspberry beetle, Byturus tomentostts deGeer (Coleoptera: Byturidae). Traps targeting more than one pest species would be more practical and economical for both monitoring and mass trapping than traps for single-species. In this study we aimed to (1) improve the effectiveness of existing traps for insect pests in strawberry and raspberry crops by increasing catches of each species, and (2) test if attractants for two unrelated pest species could be combined to capture both in the same trap without decreasing the total catches. Field tests were carried out in four European countries and different combinations of semiochemicals were compared. A volatile from strawberry flowers, 1,4 dimethoxybenzene (DMB), increased the attractiveness of the aggregation pheromone to both sexes of A. rubi. The host-plant volatile, phenylacetaldehyde (PAA), increased the attraction of female L. rugulipennis to the sex pheromone, and, in strawberry, there was some evidence that adding DMB increased catches further. Traps baited with the aggregation pheromone of A. rubi, DMB, the sex pheromone of L rugulipennis and PAA attracted both target species to the same trap with no significant difference in catches compared to those single-species traps. In raspberry, catches in traps baited with a combination of A. rubi aggregation pheromone, DMB and the commercially available lure for B. tomentosus, based on raspberry flower volatiles, were similar to those in single-species traps. In both crops the efficiency of the traps still needs improvement, but the multi species traps are adequate for monitoring and should not lead to confusion for the user as the target species are easy to distinguish from each other.
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| 3. |
- Baroffio, C. A., et al.
(författare)
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Management of insect pests using semiochemical traps
- 2016
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Ingår i: Acta Horticulturae. - 9789462611221 ; , s. 121-127
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Konferensbidrag (refereegranskat)abstract
- In the absence of effective control measures, the strawberry blossom weevil (Anthonomus rubi) (SBW) and the raspberry beetle (Byturus tomentosus) (RB) cause large (10 - >80%) losses in yield and quality in organically grown raspberry. Attractive lures for both pests were combined into a single multitrap for the economical management of both of these pests at the same time. This is one of the first approaches to pest management of non-lepidopteran insect pests of horticultural crops using semiochemicals in the EU, and probably the first to target multiple species from different insect orders. The aim is to develop optimized lures and cost-effective trap designs for mass trapping and to determine the optimum density and spatial and temporal patterns of deployment of the traps for controlling these pests by mass trapping. The combination between an aggregation pheromone that attracts Anthonomus rubi and a raspberry flower volatile that attracts Byturus tomentosus seems to be the best combination.
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| 4. |
- Claassen, Yvette H. M., et al.
(författare)
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Treatment and survival of rectal cancer patients over the age of 80 years : a EURECCA international comparison
- 2018
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Ingår i: British Journal of Cancer. - : Nature Publishing Group. - 0007-0920 .- 1532-1827. ; 119:4, s. 517-522
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The optimal treatment strategy for older rectal cancer patients remains unclear. The current study aimed to compare treatment and survival of rectal cancer patients aged 80+.METHODS: Patients of >= 80 years diagnosed with rectal cancer between 2001 and 2010 were included. Population-based cohorts from Belgium (BE), Denmark (DK), the Netherlands (NL), Norway (NO) and Sweden (SE) were compared side by side for neighbouring countries on treatment strategy and 5-year relative survival (RS), adjusted for sex and age. Analyses were performed separately for stage I-III patients and stage IV patients.RESULTS: Overall, 19 634 rectal cancer patients were included. For stage I-III patients, 5-year RS varied from 61.7% in BE to 72.3% in SE. Proportion of preoperative radiotherapy ranged between 7.9% in NO and 28.9% in SE. For stage IV patients, 5-year RS differed from 2.8% in NL to 5.6% in BE. Rate of patients undergoing surgery varied from 22.2% in DK to 40.8% in NO.CONCLUSIONS: Substantial variation was observed in the 5-year relative survival between European countries for rectal cancer patients aged 80+, next to a wide variation in treatment, especially in the use of preoperative radiotherapy in stage I-III patients and in the rate of patients undergoing surgery in stage IV patients.
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| 7. |
- Seternes, A., et al.
(författare)
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Open Abdomen Treated with Negative Pressure Wound Therapy : Indications, Management and Survival
- 2017
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Ingår i: World Journal of Surgery. - : SPRINGER. - 0364-2313 .- 1432-2323. ; 41:1, s. 152-161
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Tidskriftsartikel (refereegranskat)abstract
- Open abdomen treatment (OAT) is a significant burden for patients and is associated with considerable mortality. The primary aim of this study was to report survival and cause of mortality after OAT. Secondary aims were to evaluate length of stay (LOS) in intensive care unit (ICU) and in hospital, time to abdominal closure and major complications. Retrospective review of prospectively registered patients undergoing OAT between October 2006 and June 2014 at Trondheim University Hospital, Norway. The 118 patients with OAT had a median age of 63 (20-88) years. OAT indications were abdominal compartment syndrome (ACS) (n = 53), prophylactic (n = 29), abdominal contamination/second look laparotomy (n = 22), necrotizing fasciitis (n = 7), hemorrhage packing (n = 4) and full-thickness wound dehiscence (n = 3). Eight percent were trauma patients. Vacuum-assisted wound closure (VAWC) with mesh-mediated traction (VAWCM) was used in 92 (78 %) patients, the remaining 26 (22 %) had VAWC only. Per-protocol primary fascial closure rate was 84 %. Median time to abdominal closure was 12 days (1-143). LOS in the ICU was 15 (1-89), and in hospital 29 (1-246) days. Eighty-one (68 %) patients survived the hospital stay. Renal failure requiring renal replacement therapy (RRT) (OR 3.9, 95 % CI 1.37-11.11), ACS (OR 3.1, 95 % CI 1.19-8.29) and advanced age (OR 1.045, 95 % CI 1.004-1.088) were independent predictors of mortality in multivariate analysis. The nine patients with an entero-atmospheric fistula (EAF) survived. Two-thirds of the patients treated with OAT survived. Renal failure with RRT, ACS and advanced age were predictors of mortality, whereas EAF was not associated with increased mortality.
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| 8. |
- van de Velde, Cornelis J H, et al.
(författare)
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EURECCA colorectal: Multidisciplinary management: European consensus conference colon & rectum.
- 2014
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Ingår i: European journal of cancer (Oxford, England : 1990). - : Elsevier BV. - 1879-0852 .- 0959-8049. ; 50:1
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Tidskriftsartikel (refereegranskat)abstract
- Care for patients with colon and rectal cancer has improved in the last 20years; however considerable variation still exists in cancer management and outcome between European countries. Large variation is also apparent between national guidelines and patterns of cancer care in Europe. Therefore, EURECCA, which is the acronym of European Registration of Cancer Care, is aiming at defining core treatment strategies and developing a European audit structure in order to improve the quality of care for all patients with colon and rectal cancer. In December 2012, the first multidisciplinary consensus conference about cancer of the colon and rectum was held. The expert panel consisted of representatives of European scientific organisations involved in cancer care of patients with colon and rectal cancer and representatives of national colorectal registries.
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| 9. |
- van de Velde, C. J. H., et al.
(författare)
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Experts reviews of the multidisciplinary consensus conference colon and rectal cancer 2012 : Science, opinions and experiences from the experts of surgery
- 2014
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Ingår i: European Journal of Surgical Oncology. - : Elsevier BV. - 0748-7983 .- 1532-2157. ; 40:4, s. 454-468
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Tidskriftsartikel (refereegranskat)abstract
- The first multidisciplinary consensus conference on colon and rectal cancer was held in December 2012, achieving a majority of consensus for diagnostic and treatment decisions using the Delphi Method. This article will give a critical appraisal of the topics discussed during the meeting and in the consensus document by well-known leaders in surgery that were involved in this multidisciplinary consensus process. Scientific evidence, experience and opinions are collected to support multidisciplinary teams (MDT) with arguments for medical decision-making in diagnosis, staging and treatment strategies for patients with colon or rectal cancer. Surgery is the cornerstone curative treatment for colon and rectal cancer. Standardizing treatment is an effective instrument to improve outcome of multidisciplinary cancer care for patients with colon and rectal cancer. In this article, a review of the following focuses; Perioperative care, age and colorectal surgery, obstructive colorectal cancer, stenting, surgical anatomical considerations, total mesorectal excision (TME) surgery and training, surgical considerations for locally advanced rectal cancer (LARC) and local recurrent rectal cancer (LRRC), surgery in stage IV colorectal cancer, definitions of quality of surgery, transanal endoscopic microsurgery (TEM), laparoscopic colon and rectal surgery, preoperative radiotherapy and chemoradiotherapy, and how about functional outcome after surgery?
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| 10. |
- Van den Broek, C. B. M., et al.
(författare)
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Differences in pre-operative treatment for rectal cancer between Norway, Sweden, Denmark, Belgium and the Netherlands
- 2014
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Ingår i: European Journal of Surgical Oncology. - : Elsevier BV. - 0748-7983 .- 1532-2157. ; 40:12, s. 1789-1796
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Tidskriftsartikel (refereegranskat)abstract
- Several studies have shown remarkable differences in colorectal cancer survival across Europe. Most of these studies lacked information about stage and treatment. In this study we compared short-term survival as well as differences in tumour stage and treatment strategies between five European countries: Norway, Sweden, Denmark, Belgium, and the Netherlands. For this retrospective cohort study all patients aged 18 years or older and operated on adenocarcinoma of the rectum without distant metastases and diagnosed in 2008 and 2009 were selected in national audit registries from Norway, Sweden, Denmark, Belgium, and the Netherlands. Differences in pre-operative treatment between the countries were compared using univariable and multivariable logistic regression. One year relative survival and one year relative excess risk of death (RER) were compared between the five countries. Large variation in the use of preoperative radiotherapy and chemoradiation was found between the countries. Even though, there was little variation in relative survival between the countries, except Sweden, which had a significant better one year RER of death among the elderly patients after adjustment. The differences in survival are expected to be caused by differences in pen-operative care, selection of patients, and especially management of elderly patients. The effects of preoperative treatment are expected to be seen on long term follow-up.
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