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- Arno, P., et al.
(author)
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Pilot Evaluation
- 2003
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Reports (other academic/artistic)
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- Borch, Kurt, 1944-, et al.
(author)
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Gastric carcinoids: biologic behavior and prognosis after differentiated treatment in relation to type
- 2005
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In: Annals of surgery. - : Ovid Technologies (Wolters Kluwer Health). - 0003-4932 .- 1528-1140. ; 242:1, s. 64-73
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Journal article (peer-reviewed)abstract
- OBJECTIVE: To analyze tumor biology and the outcome of differentiated treatment in relation to tumor subtype in patients with gastric carcinoid. BACKGROUND: Gastric carcinoids may be subdivided into ECL cell carcinoids (type 1 associated with atrophic gastritis, type 2 associated with gastrinoma, type 3 without predisposing conditions) and miscellaneous types (type 4). The biologic behavior and prognosis vary considerably in relation to type. METHODS: A total of 65 patients from 24 hospitals (51 type 1, 1 type 2, 4 type 3, and 9 type 4) were included. Management recommendations were issued for newly diagnosed cases, that is, endoscopic or surgical treatment of type 1 and 2 carcinoids (including antrectomy to abolish hypergastrinemia) and radical resection for type 3 and 4 carcinoids. RESULTS: Infiltration beyond the submucosa occurred in 9 of 51 type 1, 4 of 4 type 3, and 7 of 9 type 4 carcinoids. Metastases occurred in 4 of 51 type 1 (3 regional lymph nodes, 1 liver), the single type 2 (regional lymph nodes), 3 of 4 type 3 (all liver), and 7 of 9 type 4 carcinoids (all liver). Of the patients with type 1 carcinoid, 3 had no specific treatment, 40 were treated with endoscopic or surgical excision (in 10 cases combined with antrectomy), 7 underwent total gastrectomy, and 1 underwent proximal gastric resection. Radical tumor removal was not possible in 2 of 4 patients with type 3 and 7 of 9 patients with type 4 carcinoid. Five- and 10-year crude survival rates were 96.1% and 73.9% for type 1 (not different from the general population), but only 33.3% and 22.2% for type 4 carcinoids. CONCLUSION: Subtyping of gastric carcinoids is helpful in the prediction of malignant potential and long-term survival and is a guide to management. Long-term survival did not differ from that of the general population regarding type 1 carcinoids but was poor regarding type 4 carcinoids.
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- Sommer, S.M, et al.
(author)
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Toward a client-centred approach to fitness-to-drive assessment of elderly drivers
- 2004
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In: Scandinavian Journal of Occupational Therapy. - : Informa UK Limited. - 1103-8128 .- 1651-2014. ; 11:2, s. 62-69
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Journal article (peer-reviewed)abstract
- Demographic changes increase the need for fair and valid fitness-to-drive assessment in older drivers. In a self-report survey, 473 older drivers stratified by age (55-64, 65-74, > 74 years) were asked about their driving habits, crash history, compensatory driver behaviour, and attitude towards age-based reassessment. The results showed an increase in the proportions of subjects reporting crash involvement and the subjects reporting full legal responsibility for the latest crash in older age groups. The reported use of different compensatory strategies and adaptation techniques was also higher in the older age groups. Medical fitness-to-drive screenings are not able to deal with the complexity of this paradoxical finding, because medical diagnoses do not take into account adaptation and compensation in older drivers. Age-based reassessments limited to medical screenings therefore carry an increased likelihood of false positive classifications that would unnecessarily reduce the quality of life of sufficiently safe older drivers. This risk could, however, be reduced by a client-centred approach focused on practical fitness-to-drive, providing older drivers with the opportunity to show whether they are able to cope with functional deficits in more realistic driving settings. Such an approach is in line with theoretical occupational therapy foundations.
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