| 1. |
- Kohl, A., et al.
(författare)
-
Two-year results of the randomized clinical trial DILALA comparing laparoscopic lavage with resection as treatment for perforated diverticulitis
- 2018
-
Ingår i: British Journal of Surgery. - : Oxford University Press (OUP). - 0007-1323 .- 1365-2168. ; 105:9, s. 1128-1134
-
Tidskriftsartikel (refereegranskat)abstract
- BackgroundTraditionally, perforated diverticulitis with purulent peritonitis was treated with resection and colostomy (Hartmann's procedure), with inherent complications and risk of a permanent stoma. The DILALA (DIverticulitis - LAparoscopic LAvage versus resection (Hartmann's procedure) for acute diverticulitis with peritonitis) and other randomized trials found laparoscopic lavage to be a feasible and safe alternative. The medium-term follow-up results of DILALA are reported here. MethodsPatients were randomized during surgery after being diagnosed with Hinchey grade III perforated diverticulitis at diagnostic laparoscopy. The primary outcome was the proportion of patients with one or more secondary operations from 0 to 24 months after the index procedure in the laparoscopic lavage versus Hartmann's procedure groups. The trial was registered as ISRCTN82208287. ResultsForty-three patients were randomized to laparoscopic lavage and 40 to Hartmann's procedure. Patients in the lavage group had a 45 per cent reduced risk of undergoing one or more operations within 24 months (relative risk 055, 95 per cent c.i. 036 to 084; P = 0012) and had fewer operations (ratio 051, 95 per cent c.i. 031 to 087; P = 0024) compared with those in the Hartmann's group. No difference was found in mean number of readmissions (137 versus 150; P = 0221) or mortality between patients randomized to laparoscopic lavage or Hartmann's procedure. Three patients in the lavage group and nine in the Hartmann's group had a colostomy at 24 months. ConclusionLaparoscopic lavage is a better option for perforated diverticulitis with purulent peritonitis than open resection and colostomy.
|
|
| 2. |
- Ottarsdottir, Kristin, et al.
(författare)
-
Longitudinal associations between sex hormone-binding globulin and insulin resistance
- 2020
-
Ingår i: Endocrine Connections. - : Bioscientifica. - 2049-3614. ; 9:5, s. 418-425
-
Tidskriftsartikel (refereegranskat)abstract
- Purpose: We aimed to investigate the association between SHBG and the homeostatic model assessment of insulin resistance (HOMA-Ir) in men and women in a prospective observational study. Methods: The Vara-Skovde cohort is a random population of 2816 participants living in southwestern Sweden, aged 30-74. It was recruited between 2002 and 2005, and followed up in 2012-2014. After excluding participants on insulin therapy or hormone replacement therapy, 1193 individuals (649 men, 544 women) were included in the present study. Fasting blood samples were collected at both visits and stored in biobank. All participants were physically examined by a trained nurse. SHBG was measured with immunoassay technique. Linear regressions were computed to investigate the association between SHBG and HOMA-Ir both in cross-sectional and longitudinal analyses, adjusting for confounding factors. Results: The mean follow-up time was 9.7 +/- 1.4 years. Concentrations of SHBG were significantly inversely associated with log transformed HOMA-Ir in all groups with estimated standardized slopes (95% CI): men: -0.20 (-0.3;-0.1), premenopausal women: -0.26 (-0.4;-0.2), postmenopausal women: -0.13 (-0.3;-0.0) at visit 1. At visit 2 the results were similar. When comparing the groups, a statistically significant difference was found between men and post-menopausal women (0.12 (0.0;0.2) P value = 0.04). In the fully adjusted model, SHBG at visit 1 was also associated with HOMA-Ir at visit 2, and the estimated slopes were -0.16 (-0.2;-0.1), -0.16 (-0.3;-0.1) and -0.07 (-0.2;0.0) for men, premenopausal and postmenopausal women, respectively. Main conclusion: Levels of SHBG predicted the development of insulin resistance in both men and women, regardless of menopausal state.
|
|
| 3. |
- Sandberg, Sofia, 1976, et al.
(författare)
-
Low anterior resection syndrome in a Scandinavian population of patients with rectal cancer: a longitudinal follow-up within the QoLiRECT study
- 2020
-
Ingår i: Colorectal Disease. - : Wiley. - 1462-8910 .- 1463-1318. ; 22:10, s. 1367-1378
-
Tidskriftsartikel (refereegranskat)abstract
- Aim: Low anterior resection syndrome (LARS) is common after low anterior resection. Our aim was to evaluate the prevalence and ‘bother’ (subjective, symptom-associated distress) of major LARS after 1 and 2years, identify possible risk factors and relate the bowel function to a reference population. Method: The QoLiRECT (Quality of Life in RECTal cancer) study is a Scandinavian prospective multicentre study including 1248 patients with rectal cancer, of whom 552 had an anterior resection. Patient questionnaires were distributed at diagnosis and after 1, 2 and 5years. Data from the baseline and at 1- and 2-year follow-up were included in this study. Results: The LARS score was calculated for 309 patients at 1year and 334 patients at 2years. Prevalence was assessed by a generalized linear mixed effects model. Major LARS was found in 63% at 1year and 56% at 2years. Bother was evident in 55% at 1year, decreasing to 46% at 2years. Major LARS was most common among younger women (69%). Among younger patients, only marginal improvement was seen over time (63–59%), for older patients there was more improvement (62–52%). In the reference population, the highest prevalence of major LARS-like symptoms was noted in older women (12%). Preoperative radiotherapy, defunctioning stoma and tumour height were found to be associated with major LARS. Conclusion: Major LARS is common and possibly persistent over time. Younger patients, especially women, are more affected, and perhaps these patients should be prioritized for early stoma closure to improve the chance of a more normal bowel function.
|
|
| 4. |
- Sandberg, Sofia, 1976, et al.
(författare)
-
Predicting life with a permanent end colostomy: A prospective study on function, bother and acceptance
- 2021
-
Ingår i: Colorectal Disease. - : Wiley. - 1462-8910 .- 1463-1318. ; 23:10, s. 2681-2689
-
Tidskriftsartikel (refereegranskat)abstract
- Aim: The factors that influence a patient's experience of a colostomy are not known. The aim of this study was to characterise stoma function, stoma-related bother and acceptance among patients operated for rectal cancer and to investigate if there were any preoperative personal factors with predictive impact on long-term stoma-related bother. Methods: The QoLiRECT (Quality of Life in RECTal cancer) study is a prospective multicentre study of patients with rectal cancer. This was a subgroup analysis of patients with a permanent colostomy with a 2-year follow-up. Penalised regression models with shrinkage estimation were used to predict the 1-and 2-year bother using baseline data. The predictive value and the importance of the included variables were evaluated using bootstrap resampling techniques. Results: A total of 379 patients were included. Overall stoma acceptance was high and a majority of patients were not bothered by their stoma; 77% and 83% at 1 and 2years, respectively. The subgroup of patients with stoma-related bother had a high prevalence of difficulties, especially fear of leakage, and a low stoma acceptance in daily life. Both clinical and personal factors were associated with stoma-related bother. The most important factors were quality of life and physical health, but the prediction accuracy was low. Conclusions: Stoma-related bother was associated with overall stoma dysfunction. As stoma-related bother is a multifactorial problem, it was not possible to predict which patients will experience stoma-related bother. It is therefore of importance to prevent stoma-related symptoms and optimise stoma function to reduce long-term bother and increase stoma acceptance.
|
|
| 5. |
- Sandberg, Sofia, 1976, et al.
(författare)
-
The impact of the anastomotic configuration on low anterior resection syndrome 3 years after total mesorectal excision for rectal cancer: a national cohort study
- 2023
-
Ingår i: Colorectal Disease. - : Wiley. - 1462-8910 .- 1463-1318. ; 25:6, s. 1144-1152
-
Tidskriftsartikel (refereegranskat)abstract
- Aim After low anterior resection, the bowel can be anastomosed in different ways. It is not clear which configuration is optimal from a functional and complication point of view. The primary aim was to investigate the impact of the anastomotic configuration on bowel function evaluated by the low anterior resection syndrome (LARS) score. Secondarily, the impact on postoperative complications was evaluated.Method All patients who had undergone low anterior resection from 2015 to 2017 were identified in the Swedish Colorectal Cancer Registry. Three years after surgery, patients were sent an extensive questionnaire and were analysed based on anastomotic configuration ('J-pouch/side-to-end anastomosis' or 'straight anastomosis'). Inverse probability weighting by propensity score was used to adjust for confounding factors.Results Among 892 patients, 574 (64%) responded, of whom 494 patients were analysed. After weighting, the anastomotic configuration had no significant impact on the LARS score (J-pouch/side-to-end OR 1.05, 95% confidence interval [CI] 0.82-1.34). The J-pouch/side-to-end anastomosis was significantly associated with overall postoperative complications (OR 1.43, 95% CI 1.06-1.95). No significant difference was seen regarding surgical complications (OR 1.14, 95% CI 0.78-1.66).Conclusion This is the first study investigating the impact of the anastomotic configuration on long-term bowel function, evaluated by the LARS score, in an unselected national cohort. Our results suggested no benefit for J-pouch/side-to-end anastomosis on long-term bowel function and postoperative complication rates. The anastomotic strategy may be based upon the anatomical conditions of the patient and surgical preference.
|
|
| 6. |
|
|
| 7. |
- Wallerstedt Lantz, Anna, et al.
(författare)
-
90-Day readmission after radical prostatectomy—a prospective comparison between robot-assisted and open surgery
- 2019
-
Ingår i: Scandinavian Journal of Urology. - : Medical Journals Sweden AB. - 2168-1805 .- 2168-1813. ; 53:1, s. 26-33
-
Tidskriftsartikel (refereegranskat)abstract
- Purpose: All types of surgery are associated with complications. The debate is ongoing whether robot-assisted radical prostatectomy can lower this risk compared to open surgery. The objective of the present study was to evaluate post-operative adverse events leading to readmissions, using clinical records to classify these adverse events systematically. Materials and methods: A prospective controlled trial of men who underwent robot-assisted laparoscopic (RALP) or retropubic radical prostatectomy (RRP) at 14 departments of Urology (LAPPRO) between 2008 and 2011. Data on all readmissions within 3 months of surgery were collected from the Patient registry, Swedish Board of Health and Welfare. For each readmission the highest Clavien-Dindo grade was listed. Results: A total of 4003 patients were included in the LAPPRO trial and, after applying exclusion criteria, 3706 patients remained for analyses. The results showed no statistically significant difference in the overall readmission rates (8.1 vs. 7.1%) or readmission due to major complications (Clavien-Dindo ≥3b, 1.7 vs. 1.9%) between RALP and RRP within 90 days after surgery. Patients subjected to lymph-node dissection (LND) had twice the risk for readmission as men not undergoing LND, irrespective RALP or RRP technique. Blood transfusion was significantly more frequent during and within 30 days of RRP surgery (16 vs. 4%). Abdominal symptoms were more common after RALP. Conclusions: There is a substantial risk for hospital readmission after prostate-cancer surgery, regardless of technique; although major complications are rare. Regardless of surgical technique, attention should be focused on specific types of complications.
|
|
| 8. |
- Andersson, Eva M., 1968, et al.
(författare)
-
Detection of Turning Points in Business Cycles
- 2004
-
Ingår i: Journal of Business Cycle Measurement and Analysis. ; 1:1, s. 93-108
-
Tidskriftsartikel (refereegranskat)abstract
- Methods for continuously monitoring business cycles are compared. A turn in a leading index can be used to predict a turn in the business cycle. Three likelihood based methods for turning point detection are compared in detail by using the theory of statistical surveillance and by simulations. One of the methods is a parametric likelihood ratio method. Another includes a non-parametric estimation procedure. The third is based on a Hidden Markov Model. Evaluations are made of several features such as knowledge of shape and parameters of the curve, types and probabilities of transitions and smoothing. Results on the expected delay time [of](to) a correct alarm and the predictive value of an alarm are discussed. The three methods are also used to analyze an actual data set (of) [for] a period of (the) Swedish industrial production. The relative merits of evaluation of methods by one real data set or by simulations are discussed.
|
|
| 9. |
- Andersson, Eva M., 1968, et al.
(författare)
-
Exploratory analysis of Swedish influenza data
- 2006
-
Rapport (övrigt vetenskapligt/konstnärligt)abstract
- Information about the stochastic properties of Swedish influenza data can be used for many purposes. In this report we describe and discuss statistical models that can be used in the construction of automated detection systems. Statistical models for influenza data, which are suggested in the literature, are reviewed and the possibility to use them for analyses of Swedish data is discussed. To describe how the influenza incidence changes from one week to another exponential functions are found to work better than earlier suggested models. Data are available for several periods and the parameters are estimated for each. The parameters are found to vary considerably. The conclusion is that non-parametric methods will be more robust to the variation between periods and should therefore be used in a detection system. However the spectrum of parametric models is useful to consider in the evaluations of the detection systems. Data on influenza-like illness (ILI) and data on laboratory diagnoses (LD) were available for several periods of influenza. The possibility of using different leading indicators is discussed. Special interest is given to whether ILI can be used as a leading indicator for LD. The conclusion is that the complicated relation between these variables (in the present form) hampers this. Automated detection systems could be developed for several purposes; the most obvious one is outbreak detection, but in search of new infectious diseases it could also be of interest to have a system for detecting decline in the “ordinary” influenza. For outbreak detection we focus on ILI data since the first indications of an outbreak can be expected to be in the ILI data. Very sparse data are available for non-epidemic periods in the present data sets. The lack of good baseline data is a serious problem for the detection of a change from a baseline. A detection system which relies on an estimate of the baseline level is very vulnerable to errors in the estimate. Instead, we suggest that the fact that there is a rise in level at the start of an epidemic is utilized. Thus, a detection system which utilizes the monotonicity property at a rise in level rather than an estimate of the non-epidemic level is suggested. It is concluded that the Gaussian distribution is not useful for ILI data at the outbreak phase but that the Poisson distributions can be used as a first approximation. For detection of the decline of the influenza we focus on LD data. We conclude that a Gaussian distribution can be used near the peak. It is suggested that the monotonicity properties of a peak is utilized. Some suggestions of how to predict the time and height of the peak of the influenza incidence are given.
|
|
| 10. |
|
|
| 11. |
- Andersson, Eva M., 1968, et al.
(författare)
-
Modeling influenza incidence for the purpose of on-line monitoring
- 2008
-
Ingår i: Statistical Methods in Medical Research. - : SAGE Publications. - 0962-2802 .- 1477-0334. ; 17:4, s. 421-438
-
Tidskriftsartikel (refereegranskat)abstract
- We describe and discuss statistical models of Swedish influenza data, with special focus on aspects which are important in on-line monitoring. Earlier suggested statistical models are reviewed and the possibility of using them to describe the variation in influenza-like illness (ILI) and laboratory diagnoses (LDI) is discussed. Exponential functions were found to work better than earlier suggested models for describing the influenza incidence. However, the parameters of the estimated functions varied considerably between years. For monitoring purposes we need models which focus on stable indicators of the change at the outbreak and at the peak. For outbreak detection we focus on ILI data. Instead of a parametric estimate of the baseline (which could be very uncertain,), we suggest a model utilizing the monotonicity property of a rise in the incidence. For ILI data at the outbreak, Poisson distributions can be used as a first approximation. To confirm that the peak has occurred and the decline has started, we focus on LDI data. A Gaussian distribution is a reasonable approximation near the peak. In view of the variability of the shape of the peak, we suggest that a detection system use the monotonicity properties of a peak.
|
|
| 12. |
- Andersson, Eva M., 1968, et al.
(författare)
-
Modeling influenza incidence for the purpose of on-line monitoring
- 2007
-
Rapport (övrigt vetenskapligt/konstnärligt)abstract
- We describe and discuss statistical models of Swedish influenza data, with special focus on aspects which are important in on-line monitoring. Earlier suggested statistical models are reviewed and the possibility of using them to describe the variation in influenza-like illness (ILI) and laboratory diagnoses (LDI) is discussed. Exponential functions were found to work better than earlier suggested models for describing the influenza incidence. However, the parameters of the estimated functions varied considerably between years. For monitoring purposes we need models which focus on stable indicators of the change at the outbreak and at the peak. For outbreak detection we focus on ILI data. Instead of a parametric estimate of the baseline (which could be very uncertain,), we suggest a model utilizing the monotonicity property of a rise in the incidence. For ILI data at the outbreak, Poisson distributions can be used as a first approximation. To confirm that the peak has occurred and the decline has started, we focus on LDI data. A Gaussian distribution is a reasonable approximation near the peak. In view of the variability of the shape of the peak, we suggest that a detection system use the monotonicity properties of a peak.
|
|
| 13. |
|
|
| 14. |
- Andersson, Eva M., 1968, et al.
(författare)
-
Some statistical aspects of methods for detection of turning points in business cycles
- 2006
-
Ingår i: Journal of Applied Statistics. - : Informa UK Limited. - 0266-4763 .- 1360-0532. ; 33:3, s. 257-278
-
Tidskriftsartikel (refereegranskat)abstract
- Methods for online turning point detection in business cycles are discussed. The statistical properties of three likelihood-based methods are compared. One is based on a Hidden Markov Model, another includes a non-parametric estimation procedure and the third combines features of the other two. The methods are illustrated by monitoring a period of the Swedish industrial production. Evaluation measures that reflect timeliness are used. The effects of smoothing, seasonal variation, autoregression and multivariate issues on methods for timely detection are discussed.
|
|
| 15. |
- Andersson, Eva M., 1968, et al.
(författare)
-
Statistical surveillance of cyclical processes with application to turns in business cycles
- 2005
-
Ingår i: Journal of Forecasting. - : Wiley. - 1099-131X .- 0277-6693. ; 24:7, s. 465-490
-
Tidskriftsartikel (refereegranskat)abstract
- On-line monitoring of cyclical processes is studied. An important application is early prediction of the next turn in business cycles by an alarm for a turn in a leading index. Three likelihood-based methods for detection of a turn are compared in detail. One of the methods is based on a hidden Markov model. The two others are based on the theory of statistical surveillance. One of these is free from parametric assumptions of the curve. Evaluations are made of the effect of different specifications of the curve and the transitions. The methods are made comparable by alarm limits, which give the same median time to the first false alarm, but also other approaches for comparability are discussed. Results are given on the expected delay time to a correct alarm, the probability of detection of a turning point within a specified time, and the predictive value of an alarm.
|
|
| 16. |
- Angenete, Eva, 1972, et al.
(författare)
-
Laparoscopic lavage is superior to colon resection for perforated purulent diverticulitis-a meta-analysis.
- 2017
-
Ingår i: International journal of colorectal disease. - : Springer Science and Business Media LLC. - 1432-1262 .- 0179-1958. ; 32:2, s. 163-169
-
Tidskriftsartikel (refereegranskat)abstract
- Perforated diverticulitis often requires surgery with a colon resection such as Hartmann's procedure, with inherent morbidity. Recent studies suggest that laparoscopic lavage may be an alternative surgical treatment. The aim of this study was to compare re-operations, morbidity, and mortality as well as health economic outcomes between laparoscopic lavage and colon resection for perforated purulent diverticulitis.PubMed, Cochrane, Centre for Reviews and Dissemination, and Embase were searched. Published randomized controlled trials and prospective and retrospective cohorts with laparoscopic lavage and colon resection as interventions were identified. Trial limitations were assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. Re-operations, complications at 90days classified according to Clavien-Dindo and mortality were extracted.Three randomized trials published between 2005 and 2015 were included in the analysis. The studies included a total of 358 patients with 185 patients undergoing laparoscopic lavage. At 12months, the relative risk of having a re-operation was lower for laparoscopic lavage compared to colon resection in the two trials that had a 12month follow-up. We found no significant differences in Clavien-Dindo complications classified more than level IIIB or mortality at 90days.The risk for re-operations within the first 12months after index surgery was lower for laparoscopic lavage compared to colon resection, with overall comparable morbidity and mortality. Furthermore, Hartmann's resection was more costly than laparoscopic lavage. We therefore consider laparoscopic lavage a valid alternative to surgery with resection for perforated purulent diverticulitis.
|
|
| 17. |
- Asplund, Dan, et al.
(författare)
-
Persistent perineal morbidity is common following abdominoperineal excision for rectal cancer.
- 2015
-
Ingår i: International journal of colorectal disease. - : Springer Science and Business Media LLC. - 1432-1262 .- 0179-1958. ; 30:11, s. 1563-1570
-
Tidskriftsartikel (refereegranskat)abstract
- Short-term complications related to the perineal wound after abdominoperineal excision (APE) are a well-known problem. Perineal morbidity in the longer term is an almost unexplored area. The aim of this cross-sectional study was to investigate the prevalence of perineal symptoms 3years after APE for rectal cancer, to identify potential risk factors and to explore the relationship between perineal morbidity and global quality of life.
|
|
| 18. |
- Asplund, Dan, et al.
(författare)
-
Pretreatment quality of life in patients with rectal cancer is associated with intrusive thoughts and sense of coherence
- 2017
-
Ingår i: International Journal of Colorectal Disease. - : Springer Science and Business Media LLC. - 0179-1958 .- 1432-1262. ; 32:11, s. 1639-1647
-
Tidskriftsartikel (refereegranskat)abstract
- Purpose Quality of life may predict survival. In addition to clinical variables, it may be influenced by psychological factors, some of which may be accessible for intervention. The primary objective of this study was to investigate the association of intrusive thoughts and the patients' sense of coherence with pretreatment quality of life in patients with newly diagnosed rectal cancer. Methods Patients were prospectively included in 16 hospitals in Sweden and Denmark. They answered an extensive questionnaire after receiving their treatment plan. Clinical data were retrieved from national quality registries for rectal cancer. Results Of 1248 included patients, a total of 1085 were evaluable. Pretreatment global health-related and overall quality of life was lower in patients planned for palliative compared with curative treatment (median 53 vs. 80 on the EuroQoL visual analogue scale, p < 0.001 and odds ratio 0.56, 95% confidence interval 0.36-0.88, respectively). Quality of life was associated with intrusive thoughts (odds ratio 0.33, 95% confidence interval 0.24-0.45) and sense of coherence (odds ratio 0.44, 95% confidence interval 0.370.52) irrespective of the treatment plan. Conclusions Pretreatment quality of life was influenced by the intent of treatment as well as by intrusive thoughts and the patients' sense of coherence. Interventions could modify these psychological factors, and future studies should focus on initiatives to improve quality of life for this group of patients.
|
|
| 19. |
- Axelsson, Anna, et al.
(författare)
-
Patient-reported QoL in anal cancer survivors 3 and 6 years after treatment-results from the Swedish national ANCA study
- 2022
-
Ingår i: Supportive Care in Cancer. - : Springer Science and Business Media LLC. - 0941-4355 .- 1433-7339. ; 30:5, s. 4169-4178
-
Tidskriftsartikel (refereegranskat)abstract
- Purpose The impact of anal cancer treatment for the patients is best evaluated by the patients themselves. The purpose of this study was to investigate quality of life (QoL) in patients with anal cancer at 3 and 6 years after treatment. Methods A Swedish national cross-sectional prospective cohort study with patients diagnosed with anal cancer between 2011 and 2013. Patients were invited to respond to a QoL questionnaire at 3 and 6 years, with focus on bowel, urinary and sexual function, social and mental function, co-morbidity, lifestyle, daily activities, personal characteristics, and perceived QoL. It also contained questions on the severity of the symptoms regarding occurrence, frequency, and duration and the level of "bother" experienced related to functional symptoms. QoL and prevalence of bother with urinary, sexual, bowel dysfunction, and anal pain were described. The prevalence of impaired QoL was compared with a healthy reference population. The association between QoL and experiencing bother was quantified by regression models. Results From an original cohort of 464 patients with anal cancer, 264 (57%) were alive and contacted at 3 years and 230 (50%) at 6 years. One hundred ninety-five (74%) patients responded to the 3-year and 152 (66%) to the 6-year questionnaire. Sixty percent reported low QoL at both 3 and 6 years. Impaired QoL was more prevalent among patients with major bother due to bowel dysfunction (at 3 years RR 1.42, 95% CI (1.06-1.9) p-value 0.020, at 6 years RR 1.52, 95% CI (1.03-2.24) p-value 0.034) and urinary dysfunction (at 6 years RR 1.44, 95% CI (1.08-1.91) p-value 0.013). There was a tendency to a positive relationship between the number of bodily functions causing bother and risk for impaired QoL. Conclusion Patients treated for anal cancer reported bother regarding several bodily functions as well as poor QoL both at 3 and 6 years without much improvement. Bother was also associated with low QoL indicating that function-related bother should be addressed.
|
|
| 20. |
- Bock, David, 1976, et al.
(författare)
-
Agreement between patient reported outcomes and clinical reports after radical prostatectomy - a prospective longitudinal study
- 2019
-
Ingår i: Bmc Urology. - : Springer Science and Business Media LLC. - 1471-2490. ; 19
-
Tidskriftsartikel (refereegranskat)abstract
- BackgroundIn clinical research information can be retrieved through various sources. The aim is to evaluate the agreement between answers in patient questionnaires and clinical reports in a study of patients after radical prostatectomy and patient characteristics associated with agreement between these two data sources.MethodsIn the prospective non-randomized longitudinal trial LAParoscopic Prostatectomy Robot Open (LAPPRO) 4003 patients undergoing radical prostatectomy at 14 centers in Sweden were followed. Analysis of agreement is made using a variety of methods, including the recently proposed Gwet's AC1, which enables us to handle the limitations of Cohen's Kappa where agreement depends on the underlying prevalence.ResultsThe incidence of postoperative events was consistently reported higher by the patient compared with the clinical reports for all outcomes. Agreement regarding the absence of events (negative agreement) was consistently higher than agreement regarding events (positive agreement) for all outcome variables. Overall impression of agreement depends on which measure used for the assessment. The previously reported desirable properties of Gwet's AC1 as well as the patient characteristics associated with agreement were confirmed.ConclusionThe differences in incidence and agreement across the different variables and time points highlight the importance of carefully assessing which source of information to use in clinical research.
|
|
| 21. |
- Bock, David, 1976
(författare)
-
Aspects on the Control of False Alarms in Statistical Surveillance and the Impact on the Return of Financial Decision systems
- 2008
-
Ingår i: Journal of Applied Statistics. ; 35:2, s. 213-227
-
Tidskriftsartikel (refereegranskat)abstract
- In systems for on-line detection of regime shifts, a process is continually observed. Based on the data available an alarm is given when there is enough evidence of a change. There is a risk of a false alarm and here two different ways of controlling the false alarms are compared: a fixed average run length until the first false alarm and a fixed probability of any false alarm (fixed size). The two approaches are evaluated in terms of the timeliness of alarms. A system with a fixed size is found to have a drawback: the ability to detect a change deteriorates with the time of the change. Consequently, the probability of successful detection will tend to zero and the expected delay of a motivated alarm tends to infinity. This drawback is present even when the size is set to be very large (close to 1). Utility measures expressing the costs for a false or a too late alarm are used in the comparison. How the choice of the best approach can be guided by the parameters of the process and the different costs of alarms is demonstrated. The technique is illustrated by financial transactions of the Hang Seng Index.
|
|
| 22. |
|
|
| 23. |
- Bock, David, 1976, et al.
(författare)
-
Assessing health, quality of life and urogenital function in a sample of the Swedish general population: a cross-sectional study
- 2018
-
Ingår i: Bmj Open. - : BMJ. - 2044-6055. ; 8:5
-
Tidskriftsartikel (refereegranskat)abstract
- Objective Evaluate the urinary, bowel and sexual function as well as stress symptoms and depression in a sample of the Swedish population. Design A random sample of Swedish men and women in age groups from 30 to 89 years, a total of 3000 individuals, were contacted and after receiving informed consent, a questionnaire was sent. Main outcome measures Measures of urinary, bowel, sexual function and quality of life. Results The questionnaire was sent to 2094 individuals who gave informed consent. The questionnaire was answered by 1078 individuals. Quality of life, stress symptoms and depressed mood were relatively constant across age groups for both men and women. Urinary function differed significantly across gender and age groups, but bowel function was relatively unaffected by age. Overall bowel dysfunction was slightly more prevalent among women compared with men. For both men and women, the frequency of intercourse or other sexual activities decreased with age, whereas sexually associated distress increased by age in men, but decreased among women. Conclusions In a general population, the urinary function varied across age and sex. Overall bowel dysfunction was slightly more prevalent among women compared with men. Sexually associated distress increased by age for men, but decreased for women.
|
|
| 24. |
- Bock, David, 1976
(författare)
-
Consequences of using the probability of a false alarm as the false alarm measure
- 2007
-
Ingår i: Proceedings of the International Workshop in Sequential Methologies, Auburn, Alabama.
-
Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- In systems for on-line detection of regime shifts, a process is continually observed. Based on the data available, we make repeated decisions such that when there is enough evidence of a change, an alarm is given. There is a risk of a false alarm and here two different ways of controlling the false alarms are compared: systems with a fixed average run length until the first false alarm, and systems with a fixed probability (<1) of any false alarm (fixed size). The effects of the two approaches are evaluated in terms of the timeliness of alarms. A system with a fixed size is found to have a drawback: the ability to detect a change deteriorates rapidly with the time of the change. Consequently, the probability of successful detection will tend to zero and the expected delay of a motivated alarm tends to infinity. This drawback is present even when the size is set to be very large (close to 1). Utility measures expressing the different costs for a false or a too late alarm are used in the comparison. How the choice of the best approach can be guided by the parameters of the process and the different costs of alarms is demonstrated. The technique is illustrated by a case study.
|
|
| 25. |
- Bock, David, 1976
(författare)
-
Consequences of using the probability of a false alarm as the false alarm measure
- 2007
-
Rapport (övrigt vetenskapligt/konstnärligt)abstract
- In systems for on-line detection of regime shifts, a process is continually observed. Based on the data available an alarm is given when there is enough evidence of a change. There is a risk of a false alarm and here two different ways of controlling the false alarms are compared: a fixed average run length until the first false alarm and a fixed probability of any false alarm (fixed size). The two approaches are evaluated in terms of the timeliness of alarms. A system with a fixed size is found to have a drawback: the ability to detect a change deteriorates with the time of the change. Consequently, the probability of successful detection will tend to zero and the expected delay of a motivated alarm tends to infinity. This drawback is present even when the size is set to be very large (close to 1). Utility measures expressing the costs for a false or a too late alarm are used in the comparison. How the choice of the best approach can be guided by the parameters of the process and the different costs of alarms is demonstrated. The technique is illustrated by financial transactions of the Hang Seng Index.
|
|
| 26. |
- Bock, David, 1976, et al.
(författare)
-
Do negative intrusive thoughts at diagnosis predict impaired quality of life, depressed mood and waking up with anxiety 3, 12 and 24 months after radical prostatectomy?–a longitudinal study
- 2020
-
Ingår i: Scandinavian Journal of Urology. - : Medical Journals Sweden AB. - 2168-1805 .- 2168-1813. ; 54:3, s. 220-226
-
Tidskriftsartikel (refereegranskat)abstract
- Objective: To evaluate the effect of intrusive thoughts at diagnosis on quality of life, depressed mood and waking up with anxiety up to two years after radical prostatectomy. Method: The Laparoscopic Prostatectomy Robot Open (LAPPRO) trial was a prospective, longitudinal multicenter study of 4003 patients undergoing radical prostatectomy. Questionnaire data were collected preoperatively, at 3, 12 and 24 months after surgery. Results: The group of patients with intrusive thoughts at diagnosis had a statistically significant higher postoperative prevalence of impaired quality of life, depressed mood and waking up with anxiety as compared with the group of patients with no or minor intrusive thoughts. The highest risk increase for impaired QoL, depressed mood and waking up with anxiety ≥1/week was at 12, 3 and 3 months, respectively, where the three outcomes increased by 38% (RR: 1.38; 95%CI: 1.27–1.49)), 136% (RR: 2.36; 95%CI: 1.74–3.19)) and 165% (RR: 2.65; 95%CI: 2.22–3.17)), respectively. Conclusions: The demonstrated link between intrusive thoughts and quality of life, depressed mood and waking up with anxiety deliver is further evidence to the idea that intrusive thoughts has potential as an endpoint for assessing and predicting psychological distress among men with prostate cancer diagnosis. Trial registration number: ISRCTN06393679 (www.isrctn.com). Date of registration: 07/02/2008. Retrospectively registered. © 2020, © 2020 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.
|
|
| 27. |
|
|
| 28. |
- Bock, David, 1976
(författare)
-
Evaluations of likelihood based surveillance of volatility
- 2007
-
Rapport (övrigt vetenskapligt/konstnärligt)abstract
- The volatility of asset returns are important in finance. Different likelihood based methods of statistical surveillance for detecting a change in the variance are evaluated. The differences are how the partial likelihood ratios are weighted. The full likelihood ratio, Shiryaev-Roberts, Shewhart and the CUSUM methods are derived in case of an independent and identically distributed Gaussian process. The behavior of the methods is studied both when there is no change and when the change occurs at different time points. The false alarms are controlled by the median run length. Differences and limiting equalities of the methods are shown. The performances when the process parameters for which the methods are optimized for differ from the true values of the parameters are evaluated. The methods are illustrated on a period of Standard and Poor?s 500 stock market index.
|
|
| 29. |
|
|
| 30. |
- Bock, David, 1976, et al.
(författare)
-
Explorative analysis of spatial aspects on the Swedish influenza data
- 2007
-
Rapport (övrigt vetenskapligt/konstnärligt)abstract
- The spatial aspects on the Swedish influenza data are analyzed. During the influenza period, reports on laboratory diagnosed cases and influenza-like-illness are obtained from viral and microbiological laboratories and from sentinel physicians, respectively, in different regions of Sweden. Information about the spatio-temporal patterns might give insight in the way the influenza spreads over Sweden. It might also be used in automated surveillance systems for outbreak and peak detection of the influenza. We describe the regional patterns in Swedish influenza data in different ways. Several natural hypotheses about geographical patterns are examined but can not be verified as consistent over the years. However, we find that, for a group of large cities, the outbreak of the influenza occurs at least four weeks earlier than for the rest of Sweden. The possibilities to utilize this in surveillance systems are briefly discussed.
|
|
| 31. |
- Bock, David, 1976, et al.
(författare)
-
Exploratory analysis of spatial aspects on the Swedish influenza
- 2006
-
Rapport (övrigt vetenskapligt/konstnärligt)abstract
- The spatial aspects on the Swedish influenza data are analyzed. During the influenza period, reports on laboratory diagnosed cases and influenza-like-illness are obtained from viral and microbiological laboratories and from sentinel physicians, respectively, in different regions of Sweden. Information about the spatio-temporal patterns might give insight in the way the influenza spreads over Sweden. It might also be used in automated surveillance systems for outbreak and peak detection of the influenza. We describe the regional patterns in Swedish influenza data in different ways. Several natural hypotheses about geographical patterns are examined but can not be verified as consistent over the years. However, we find that, for a group of large cities, the outbreak of the influenza occurs at least four weeks earlier than for the rest of Sweden. The possibilities to utilize this in surveillance systems are briefly discussed.
|
|
| 32. |
- Bock, David, 1976, et al.
(författare)
-
Habits and self-assessed quality of life, negative intrusive thoughts and depressed mood in patients with prostate cancer: a longitudinal study
- 2017
-
Ingår i: Scandinavian Journal of Urology. - : Medical Journals Sweden AB. - 2168-1805 .- 2168-1813. ; 51:5, s. 353-359
-
Tidskriftsartikel (refereegranskat)abstract
- Objective: The aim of this study was to evaluate the association of self-assessed preoperative physical activity, alcohol consumption and smoking with self-assessed quality of life, negative intrusive thoughts and depressed mood after radical prostatectomy.Materials and methods: The Laparoscopic Prostatectomy Robot Open (LAPPRO) trial was a prospective, controlled, non-randomized longitudinal trial of patients (n=4003) undergoing radical prostatectomy at 14 centers in Sweden. Validated patient questionnaires were collected at baseline, and 3, 12 and 24 months after surgery.Results: Preoperative medium or high physical activity or low alcohol consumption or non-smoking was associated with a lower risk of depressed mood. High alcohol consumption was associated with increased risk of negative intrusive thoughts. Postoperatively, quality of life and negative intrusive thoughts improved gradually in all groups. Depressed mood appeared to be relatively unaffected.Conclusions: Evaluation of preoperative physical activity, tobacco and alcohol consumption habits can be used to identify patients with a depressed mood in need of psychological support before and immediately after surgery. Quality of life and intrusive thoughts improved postoperatively.
|
|
| 33. |
- Bock, David, 1976, et al.
(författare)
-
Learning curve for robot-assisted laparoscopic radical prostatectomy in a large prospective multicentre study
- 2022
-
Ingår i: Scandinavian Journal of Urology. - : Medical Journals Sweden AB. - 2168-1805 .- 2168-1813. ; 56:3, s. 182-190
-
Tidskriftsartikel (refereegranskat)abstract
- Objective Differences in outcome after radical prostatectomy for prostate cancer can partly be explained by intersurgeon differences, where degree of experience is one important aspect. This study aims to define the learning curve of robot-assisted laparoscopic prostatectomy (RALP) regarding oncological and functional outcomes. Materials and methods Out of 4003 enrolled patients in the LAPPRO trial, 3583 met the inclusion criteria, of whom 885 were operated on by an open technique. In total, 2672 patients with clinically localized prostate cancer from seven Swedish centres were operated on by RALP and followed for 8 years (LAPPRO trial). Oncological outcomes were pathology-reported surgical margins and biochemical recurrence at 8 years. Functional outcomes included patient-reported urinary incontinence and erectile dysfunction at 3, 12 and 24 months. Experience was surgeon-reported experience before and during the study. The relationship between surgeon experience and functional outcomes and surgical margin status was analysed by mixed-effects logistic regression. Biochemical recurrence was analysed by Cox regression, with robust standard errors. Results The learning curve for positive surgical margins was relatively flat, with rates of 21% for surgeons who had performed 0-74 cases and 24% for surgeons with > 300 cases. Biochemical recurrence at 4 years was 11% (0-74 cases) and 13% (> 300 cases). Incontinence was stable over the learning curve, but erectile function improved at 2 years, from 38% (0-74 cases) to 53% (> 300 cases). Conclusions Analysis of the learning curve for surgeons performing RALP showed that erectile function improved with increasing number of procedures, which was not the case for oncological outcomes.
|
|
| 34. |
|
|
| 35. |
- Bock, David, 1976, et al.
(författare)
-
On statistical surveillance of Swedish influenza incidence. Peak detection.
- 2006
-
Rapport (övrigt vetenskapligt/konstnärligt)abstract
- A statistical surveillance system gives a signal as soon as data give enough evidence of an important event. We review and evaluate statistical methods for influenza surveillance. One important feature of the influenza cycle is the outbreak and another feature is the start of the decline (the peak). In this report we will discuss statistical methods for on-line peak detection. One reason why this is important is that a rise in the incidence of symptoms similar to those of influenza after a verified peak in the ordinary influenza might indicate that another health hazard has occurred. Surveillance systems are adapted for Swedish data on laboratory verified diagnoses of influenza. From an earlier explorative analysis of the Swedish data we conclude that the parameters of the influenza cycles in Sweden vary too much for parametric methods to be useful. We suggest a nonparametric method which is based on the monotonicity properties of the increase and decline around a peak. A Monte Carlo study indicates that this method might have useful properties for the Swedish situation. A user friendly computer program which performs the calculations is available. The method is applied to Swedish data on laboratory verified diagnoses of influenza for seven periods, namely 1998-1999 up to 2004- 2005.
|
|
| 36. |
- Bock, David, 1976
(författare)
-
Online testing for switching volatility.
- 2006
-
Ingår i: Advances in Financial Markets, Vol 2, Financial Markets: Principles of Modelling, Forecasting, and Decision-Making..
-
Bokkapitel (övrigt vetenskapligt/konstnärligt)
|
|
| 37. |
- Bock, David, 1976, et al.
(författare)
-
Similarities and differences between statistical surveillance and certain decision rules in finance
- 2007
-
Rapport (övrigt vetenskapligt/konstnärligt)abstract
- Financial trading rules have the aim of continuously evaluating available information in order to make timely decisions. This is also the aim of methods for statistical surveillance. Many results are available regarding the properties of surveillance methods. We give a review of financial trading rules and use the theory of statistical surveillance to find properties of some commonly used trading rules. In addition, a nonparametric and robust surveillance method is proposed as a trading rule. Evaluation measures used in statistical surveillance are compared with those used in finance. The Hang Seng Index is used for illustration.
|
|
| 38. |
- Bock, David, 1976, et al.
(författare)
-
Statistical Surveillance of Epidemics: Peak Detection of Influenza in Sweden
- 2008
-
Ingår i: Biometrical Journal. ; 50:1, s. 71-85
-
Tidskriftsartikel (refereegranskat)abstract
- A statistical surveillance system gives a signal as soon as data give enough evidence of an important event. We consider on-line surveillance systems for detecting changes in influenza incidence. One impor-tant feature of the influenza cycle is the start of the influenza season, and another one is the change to a decline (the peak). In this report we discuss statistical methods for on-line peak detection. One motive for doing this is the need for health resource planning. Surveillance systems were adapted for Swedish data on laboratory verified diagnoses of influenza. In Sweden, the parameters of the influenza cycles vary too much from year to year for parametric methods to be useful. We suggest a non-parametric method based on the monotonicity properties of the increase and decline around a peak. A Monte Carlo study indicated that this method has useful stochastic properties. The method was applied to Swedish data on laboratory verified diagnoses of influenza for seven periods.
|
|
| 39. |
- Bock, David, 1976, et al.
(författare)
-
Statistical Surveillance of Epidemics: Peak Detection of Influenza in Sweden
- 2007
-
Rapport (övrigt vetenskapligt/konstnärligt)abstract
- A statistical surveillance system gives a signal as soon as data give enough evidence of an important event. We consider on-line surveillance systems for detecting changes in influenza incidence. One important feature of the influenza cycle is the start of the influenza season, and another one is the change to a decline (the peak). In this report we discuss statistical methods for on-line peak detection. One motive for doing this is the need for health resource planning. Surveillance systems were adapted for Swedish data on laboratory verified diagnoses of influenza. In Sweden, the parameters of the influenza cycles vary too much from year to year for parametric methods to be useful. We suggest a non-parametric method based on the monotonicity properties of the increase and decline around a peak. A Monte Carlo study indicated that this method has useful stochastic properties. The method was applied to Swedish data on laboratory verified diagnoses of influenza for seven periods.
|
|
| 40. |
|
|
| 41. |
|
|
| 42. |
|
|
| 43. |
- Carlsson, Stefan, et al.
(författare)
-
Salvage radiotherapy after radical prostatectomy: functional outcomes in the LAPPRO trial after 8-year follow-up.
- 2023
-
Ingår i: Scandinavian journal of urology. - 2168-1813. ; 58, s. 11-19
-
Tidskriftsartikel (refereegranskat)abstract
- Radical prostatectomy reduces mortality among patients with localized prostate cancer, however up to 35% of patients will experience biochemical recurrence, often treated with salvage radiotherapy. The objective of the study was to investigate long-term effects of salvage radiotherapy.A prospective, controlled, non-randomized trial at 14 Swedish center's including 4,003 patients scheduled for radical prostatectomy 2008-2011. A target trial emulation approach was used to identify eligible patients that was treated with salvage radiotherapy. The control group received no salvage radiotherapy. Outcomes were assessed by patient questionnaires on ordinal scales and statistical group comparisons were made using ordered logit regression with adjustment for baseline outcome and confounding factors. The primary endpoints were bowel, urinary and sexual function and bothering due to dysfunction at 8 years.Eleven percent (330/3,139) of the analyzed study population received salvage radiotherapy. Fecal leakage, leakage of mucus and hematochezia were more common after receiving salvage radiotherapy compared with the control group; 4.5% versus 2.6% odds ratio (95% confidence interval [CI]): (1.90 [1.38; 2.62]), 6.8% versus 1.5% 4.14 (2.98; 5.76) and 8.6% versus 1.2% 4.14 (2.98; 5.76), respectively. Urinary incontinence, erectile dysfunction and hematuria were more common after receiving salvage radiotherapy, 34% versus 23% 2.23 (2.65; 3.00), 65% versus 57% 1.65 (1.18; 2.29) and 16% versus 1.6% 11.17 (5.68; 21.99), respectively.Salvage radiotherapy was associated with increased risk for fecal leakage, hematochezia, urinary incontinence and hematuria. Our results emphasize the importance of selecting patients for salvage radiotherapy to avoid overtreatment and to give high quality pre-treatment information to ensure patients' preparedness for late side-effects.
|
|
| 44. |
- Correa-Marinez, Adiela, et al.
(författare)
-
Methods of Colostomy Construction: No Effect on Parastomal Hernia Rate: Results From Stoma-const-A Randomized Controlled Trial
- 2021
-
Ingår i: National Center of Biotechnology Information. - 0027-8874. ; 273:4, s. 640-647
-
Tidskriftsartikel (refereegranskat)abstract
- Objective: The primary objective of this trial was to compare the parastomal hernia rates 1 year after the construction of an end colostomy by 3 surgical techniques: cruciate incision, circular incision in the fascia and using prophylactic mesh. Secondary objectives were evaluation of postoperative complications, readmissions/reoperations, and risk factors for parastomal hernia. Summary of background data: Colostomy construction techniques have been explored with the aim to improve function and reduce stoma complications, but parastomal herniation is frequent with an incidence of approximately 50%. Methods: A randomized, multicenter trial was performed in 3 hospitals in Sweden and Denmark; all patients scheduled to receive an end colostomy were asked to participate. Parastomal hernia within 12 months was determined by computed tomography of the abdomen in prone position and by clinical assessment. Complications, readmissions, reoperations, and risk factors were also assessed. Results: Two hundred nine patients were randomized to 1 of the 3 arms of the study. Patient demographics were similar in all 3 groups. Assessment of parastomal hernia was possible in 185 patients. The risk ratio (95% confidence interval) for parastomal hernia was 1.25 (0.83; 1.88), and 1.22 (0.81; 1.84) between cruciate versus circular and cruciate versus mesh groups, respectively. There were no statistically significant differences between the groups with regard to parastomal hernia rate. Age and body mass index were found to be associated with development of a parastomal hernia. Conclusion: We found no significant differences in the rates of parastomal hernia within 12 months of index surgery between the 3 surgical techniques of colostomy construction.
|
|
| 45. |
- Correa-Marinez, Adiela, et al.
(författare)
-
Stoma-related complications: a report from the Stoma-Const randomized controlled trial
- 2021
-
Ingår i: Colorectal Disease. - : Wiley. - 1462-8910 .- 1463-1318. ; 23:5, s. 1091-1101
-
Tidskriftsartikel (refereegranskat)abstract
- Aim: The impact of construction techniques on the development of stoma complications is partly undiscovered. The aim of this paper was to report and analyse the impact of the three surgical techniques in a randomized controlled trial Stoma-Const on stoma-related complications as well as identifying risk factors and patient-reported stoma function as a planned secondary analysis. Methods: This was a randomized, multicenter trial where all patients scheduled to receive an end colostomy were invited to participate. Patients were randomized to one of three techniques for stoma construction; cruciate fascial incision, circular incision or prophylactic mesh. Stoma complications were assessed by a surgeon and stoma care nurses within 1 year postoperatively. Results: Two hundred and nine patients were randomized. Patient demographics were similar in all three groups. Data on stoma-related complications were available for analysis in 201 patients. A total of 127 patients (63%) developed some type of stoma complication within 1 year after surgery. The risk ratio (95% CI) for stoma complications was 0.93 (0.73; 1.2) between cruciate vs. circular incision groups and 1.02 (0.78; 1.34) between cruciate vs. mesh groups. There were no statistically significant differences between the groups regarding parastomal hernia rate and no risk factors could be identified. Conclusion: This randomized trial confirmed a high prevalence of stoma-related complications but could not identify an impact of surgical technique or identify modifiable risk factors for stoma-related complications.
|
|
| 46. |
- Correa-Marinez, Adiela, et al.
(författare)
-
Stoma-related symptoms in patients operated for rectal cancer with abdominoperineal excision.
- 2016
-
Ingår i: International journal of colorectal disease. - : Springer Science and Business Media LLC. - 1432-1262 .- 0179-1958. ; 31:3, s. 635-41
-
Tidskriftsartikel (refereegranskat)abstract
- The primary aim of this study was to characterize the frequency, severity, and distress of symptoms from the colostomy and colostomy acceptance in rectal cancer patients. The secondary aims were to study the symptomatic parastomal herniation, its relationship to stoma-related symptoms, and potential risk factors for the development of symptomatic parastomal herniation.
|
|
| 47. |
- Correa-Marinez, Adiela, et al.
(författare)
-
The type of stoma mattersmorbidity in patients with obstructing colorectal cancer
- 2018
-
Ingår i: International Journal of Colorectal Disease. - : Springer Science and Business Media LLC. - 0179-1958 .- 1432-1262. ; 33:12, s. 1773-1780
-
Tidskriftsartikel (refereegranskat)abstract
- PurposeA loop colostomy may reduce the risk of severe intraabdominal complications in patients with obstructing colorectal cancer compared to an end colostomy. The aim of this study was to relate complications to the type of stoma, and a secondary aim was to evaluate whether the type of colostomy had an impact on time until oncological/surgical treatment.MethodsAll patients who underwent surgery and received a deviating colostomy due to obstructing colorectal cancer between January 2011 and December 2015 in five Swedish hospitals in Region Vastra Gotaland were included (n=289). Patient charts were reviewed retrospectively. Patients alive in the end of 2016 were contacted and were sent a questionnaire including questions about stoma function and health-related quality of life.ResultsSome 289 patients were included; 147 received an end colostomy and 140 a loop colostomy. Two patients were excluded from the analysis due to missing data. There was no difference in complications at 90days between the two groups, 44% (end colostomy) and 54% (loop colostomy) (odds ratio: 0.83 (95% CI: 0.49; 1.41). Time to start of treatment was similar in both groups. Patients with a loop colostomy had significantly higher stoma-related morbidity with retraction, prolapse, leakage and bandaging problems. No differences in quality of life were found.ConclusionThe hypothesis that a loop colostomy reduced complications could not be confirmed. An end colostomy should be the first choice in these patients particularly in patients who will have their colostomy for the remainder of their life to reduce stoma-related symptoms.
|
|
| 48. |
- Danielsen, Anne K, et al.
(författare)
-
Early Closure of a Temporary Ileostomy in Patients With Rectal Cancer: A Multicenter Randomized Controlled Trial.
- 2017
-
Ingår i: Annals of surgery. - 1528-1140. ; 265:2, s. 284-290
-
Tidskriftsartikel (refereegranskat)abstract
- The objective was to study morbidity and mortality associated with early closure (8-13 days) of a temporary stoma compared with standard procedure (closure after > 12 weeks) after rectal resection for cancer.A temporary ileostomy may reduce the risk of pelvic sepsis after anastomotic dehiscence. However, the temporary ileostomy is afflicted with complications and requires a second surgical procedure (closure) with its own complications. Early closure of the temporary ileostomy could reduce complications for rectal cancer patients.Early closure (8-13 days after stoma creation) of a temporary ileostomy was compared with late closure (>12 weeks) in a multicenter randomized controlled trial, EASY (www.clinicaltrials.gov, NCT01287637) including patients undergoing rectal resection for cancer. Patients with a temporary ileostomy without signs of postoperative complications were randomized to closure at 8 to 13 days or late closure (>12 weeks after index surgery). Clinical data were collected up to 12 months. Complications were registered according to the Clavien-Dindo Classification of Surgical Complications, and Comprehensive Complication Index was calculated.The trial included 127 patients in eight Danish and Swedish surgical departments, and 112 patients were available for analysis. The mean number of complications after index surgery up to 12 months follow up was significantly lower in the intervention group (1.2) compared with the control group (2.9), P < 0.0001.It is safe to close a temporary ileostomy 8 to 13 days after rectal resection and anastomosis for rectal cancer in selected patients without clinical or radiological signs of anastomotic leakage.This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0, where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially. http://creativecommons.org/licenses/by-nc-nd/4.0.
|
|
| 49. |
- Ehrencrona, Carolina, 1986, et al.
(författare)
-
Do beta-blockers reduce negative intrusive thoughts and anxiety in cancer survivors? – An emulated trial
- 2024
-
Ingår i: BMC Cancer. - 1471-2407. ; 24:1
-
Tidskriftsartikel (refereegranskat)abstract
- Background: High rates of negative intrusivethoughts have been reported among cancer patients. Prevalent users of beta-blocker therapy have reported lower levels of cancer related intrusive thoughts than non-user. The aim of this study is to investigate if initiation of beta-blocker therapy reduces the prevalence and severity of intrusive thoughts (co-primary endpoints) and the prevalence of anxiety, depressed mood, and low quality of life (secondary endpoints) in cancer survivors. Methods: Data on patient-reported outcomes from three cohort studies of Swedish patients diagnosed with colon, prostate or rectal cancer were combined with data on beta-blocker prescriptions retrieved from the Swedish Prescribed Drug Register. Two randomized controlled trials were emulated. Trial 1 had follow-up 1year after diagnosis, trial 2 had follow-up 2years after diagnosis, baseline in both trials was 12months before follow-up. Those who initiated beta-blocker therapy between baseline and follow-up was assigned Active group, those who did not was assigned Control group. All endpoints were analysed using Bayesian ordered logistic regression. Results: Trial 1 consisted of Active group, n = 59, and Control group, n = 3936. Trial 2 consisted of Active group, n = 87, and Control group, n = 3132. The majority of participants were men, 83% in trial 1 and 94% in trial 2. The prevalence and severity of intrusive thoughts were lower in the Active group in trial 1, but no significant differences between groups were found in either trial. The prevalence of depressed mood, worse quality of life and periods of anxiety were higher in the Active group in both trials with significant differences for quality of life in trial 1 and anxiety in trial 2. Conclusions: The emulated trials demonstrated no evidence of a protective effect of beta-blocker therapy against intrusive thoughts. The Active group had reduced quality of life and elevated anxiety compared to the Control group. Trial registration: The three cohort studies were registered at isrctn.com/clinicaltrials.gov (ISRCTN06393679, NCT02530593 and NCT01477229).
|
|
| 50. |
- Erestam, Sofia, et al.
(författare)
-
Associations between intraoperative factors and surgeons' self-assessed operative satisfaction.
- 2020
-
Ingår i: Surgical endoscopy. - : Springer Science and Business Media LLC. - 1432-2218 .- 0930-2794. ; 34:1, s. 61-68
-
Tidskriftsartikel (refereegranskat)abstract
- Little is known concerning what may influence surgeon satisfaction with a surgical procedure and its associations with intraoperative factors. The objective was to explore the relationships between surgeons' self-assessed satisfaction with performed radical prostatectomies and intraoperative factors such as technical difficulties and intraoperative complications as reported by the surgeon subsequent to the operation.We utilized prospectively collected data from the controlled LAPPRO trial where 4003 patients with prostate cancer underwent open (ORP) or robot-assisted laparoscopic (RALP) radical prostatectomy. Patients were included from fourteen centers in Sweden during 2008-2011. Surgeon satisfaction was assessed by questionnaires at the end of each operation. Intraoperative factors included time for the surgical procedure as well as difficulties and complications in various steps of the operation. To model surgeon satisfaction, a mixed effect logistic regression was used. Results were presented as odds ratios (OR) with 95% confidence intervals (CI).The surgeons were satisfied in 2905 (81%) and dissatisfied in 702 (19%) of the surgical procedures. Surgeon satisfaction was not statistically associated with type of surgical technique (ORP vs. RALP) (OR 1.36, CI 0.76; 2.43). Intraoperative factors such as technical difficulties or complications, for example, suturing of the anastomosis was negatively associated with surgeon satisfaction (OR 0.24, CI 0.19; 0.30).Our data indicate that technical difficulties and/or intraoperative complications were associated with a surgeon's level of satisfaction with an operation.
|
|
