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- Brännström, Fredrik, et al.
(author)
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Multidisciplinary team conferences promote treatment according to guidelines in rectal cancer
- 2015
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In: Acta Oncologica. - : Informa Healthcare. - 0284-186X .- 1651-226X. ; 54:4, s. 447-453
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Journal article (peer-reviewed)abstract
- Background. Multidisciplinary team (MDT) conferences have been introduced into standard cancer care, though evidence that it benefits the patient is weak. We used the national Swedish Rectal Cancer Register to evaluate predictors for case discussion at a MDT conference and its impact on treatment.Material and methods. Of the 6760 patients diagnosed with rectal cancer in Sweden between 2007 and 2010, 78% were evaluated at a MDT. Factors that influenced whether a patient was discussed at a preoperative MDT conference were evaluated in 4883 patients, and the impact of MDT evaluation on the implementation of preoperative radiotherapy was evaluated in 1043 patients with pT3c-pT4 M0 tumours, and in 1991 patients with pN+ M0 tumours.Results. Hospital volume, i.e. the number of rectal cancer surgical procedures performed per year, was the major predictor for MDT evaluation. Patients treated at hospitals with < 29 procedures per year had an odds ratio (OR) for MDT evaluation of 0.15. Age and tumour stage also influenced the chance of MDT evaluation. MDT evaluation significantly predicted the likelihood of being treated with preoperative radiotherapy in patients with pT3c-pT4 M0 tumours (OR 5.06, 95% CI 3.08–8.34), and pN+ M0 (OR 3.55, 95% CI 2.60–4.85), even when corrected for co-morbidity and age.Conclusion. Patients with rectal cancer treated at high-volume hospitals are more likely to be discussed at a MDT conference, and that is an independent predictor of the use of adjuvant radiotherapy. These results indirectly support the introduction into clinical practice of discussing all rectal cancer patients at MDT conferences, not least those being treated at low-volume hospitals.
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- Halvorsen, Cecilia Pegelow, et al.
(author)
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A rapid smartphone-based lactate dehydrogenase test for neonatal diagnostics at the point of care
- 2019
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In: Scientific Reports. - : Nature Publishing Group. - 2045-2322. ; 9
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Journal article (peer-reviewed)abstract
- There is a growing recognition of the importance of point-of-care tests (POCTs) for detecting critical neonatal illnesses to reduce the mortality rate in newborns, especially in low-income countries, which account for 98 percent of reported neonatal deaths. Lactate dehydrogenase (LDH) is a marker of cellular damage as a result of hypoxia-ischemia in affected organs. Here, we describe and test a POC LDH test direct from whole blood to provide early indication of serious illness in the neonate. The sample-inresult- out POC platform is specifically designed to meet the needs at resource-limited settings. Plasma is separated from whole blood on filter paper with dried-down reagents for colorimetric reaction, combined with software for analysis using a smartphone. The method was clinically tested in newborns in two different settings. In a clinical cohort of newborns of Stockholm (n = 62) and Hanoi (n = 26), the value of R using Pearson's correlation test was 0.91 (p < 0.01) and the R-2 = 0.83 between the two methods. The mean LDH (+/- SD) for the reference method vs. the POC-LDH was 551 (+/- 280) U/L and 552 (+/- 249) U/L respectively, indicating the clinical value of LDH values measured in minutes with the POC was comparable with standardized laboratory analyses.
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- Tran, Hang T. T., et al.
(author)
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Hypothermic treatment for neonatal asphyxia in low-resource settings using phase-changing material : An easy to use and low-cost method
- 2021
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In: Acta Paediatrica. - : CSIRO Publishing. - 0803-5253 .- 1651-2227. ; 110:1, s. 85-93
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Journal article (peer-reviewed)abstract
- Aim: To evaluate whether phase-changing material can be used for therapeutic hypothermia of asphyxiated newborns in low-resource settings.Methods: Prospective interventional study of asphyxiated term infants fulfilling criteria for hypothermia treatment at Vietnam National Children's Hospital from September 2014 to September 2016. Hypothermia was induced within 6 hours after birth and maintained for 72 hours by a phase-changing material mattress with melting point of 32 degrees C. Rectal temperature was continuously measured, and deviations from target temperature range 33.5-34.5 degrees C were recorded.Results: In total 52 infants (mean gestational age 39.3 1.1 weeks) included and cooled, the median temperature at initiation of cooling was 35.3 (IQR 34.5-35.9)degrees C. The median time to reach target temperature was 2.5 (IQR 2-3) hours. The mean temperature during the cooling phase was 33.95 +/- 0.2 degrees C. Throughout the cooling phase, the target temperature range (33.5-34.5 degrees C) was maintained more than 80% of the time. Rate of rewarming was 0.5 +/- 0.14 degrees C/hour.Conclusion: Phase-changing material can be used as an effective cooling method. Though not a servo-controlled system, it is easy to induce hypothermia, maintain target temperature and rewarm infants in a slow and controlled manner without need for frequent changes and minimum risk of skin injury.
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- Waltzman, Rand, et al.
(author)
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In the requirements lies the power
- 2007
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In: 19th International Conference on Software Engineering and Knowledge Engineering, SEKE 2007. - 9781627486613 ; , s. 185-190
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Conference paper (peer-reviewed)abstract
- System requirements expressed as scenarios represent a rich source of knowledge about a system and the context in which it is used. This is because the scenarios are the result of extensive collaborative efforts of a wide variety of stakeholders and are in a form to which all can relate. Ideally, they serve to represent the interests of all stakeholders at each stage of the development life cycle. Our focus in this paper is system testing against requirements. In particular, we show (1) how the knowledge represented in scenarios (using ScenarioML) can be directly transformed into an operational knowledge base in a rule-based programming language (JESS), (2) how this knowledge base can be used in system testing to compute, manage, and compare expectations of system behavior to actual system behavior relative to the requirements, and (3) how this can be achieved in a manner that is transparent to all stakeholders. The power of this approach derives from the peculiarly reflective character of knowledge based systems and their explicit use of meta-information and meta-information processing. We demonstrate the viability of our approach by its application to the AquaLush system in which we detected several violations of the system's stated requirements.
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