1,023 research outputs found
Nasogastric tube drainage and pyloric intervention after oesophageal resection: UK practice variation and effect on outcomes
No full textBackground: Over 1500 patients with oesophageal cancer undergo a resection in the UK each year. At surgery, patients commonly have a nasogastric tube (NGT) placed and may undergo a pyloric intervention. There is conflicting evidence on the use of both NGTs and pyloric interventions during oesophageal resections. We performed a national survey of oesophageal centres and assessed practice variation.Material and methods: An electronic survey was distributed to all resection centres in England, Wales and Scotland. Variations in practice regarding NGTs and pyloric intervention were assessed, and compared to nationally reported centre volumes and length-of-stay data.Results: Most centres (31/39, 79%) responded to the survey. All centres reported routine NGT use. The majority of centres (19/31, 61%) did not perform pyloric interventions. When used, surgical pyloroplasty was the most frequent strategy (8/31, 26%). Routine post-operative radiological assessment was utilised in 9/31 (29%) of centres. Criteria for NGT removal and dietary progression was highly variable, with every centre reporting different protocols. There were no significant differences in practice between high and low volume centres. There were also no trends seen when comparing centres above vs at-or-below the median length-of-stay. The majority (68%) of centres were willing to take part in a trial assessing NGT use and pyloric interventions.Conclusions: Pyloric intervention use varies widely, with no clear link to outcomes. NGT use remains standard practice despite evidence for safe omission. Surgeons require and recognise the need for a trial to assess requirement for NGTs and pyloric intervention after oesophageal resection
Impact of Age on the Treatment and Survival in Esophagogastric Cancer
Full text linkAbstractBackground: The age-specific risks of mortality for patients with esophagogastric cancer and their probability of surgical treatment are not well-known.Methods: This population-based, nationwide cohort study included all patients with esophageal or gastric (esophagogastric) cancer in Sweden between 1990 and 2013, with follow-up evaluation throughout 2018. Age at diagnosis (exposure) was categorized into nine 5-year groups. The main outcome was 5-year all-cause mortality. The secondary outcomes were 90-day all-cause mortality, 5-year disease-specific mortality, 5-year disease-specific mortality excluding 90-day all-cause mortality, and non-operation. For mortality outcomes, Cox regression provided hazard ratios (HRs) with 95% confidence intervals (95% CIs) adjusted for confounders. For non-operation, logistic regression provided odds ratios (ORs) with 95% CIs.Results: Among 28,725 patients, 11,207 (39.0%) underwent surgery. For those who underwent surgery, the HRs of 5-year all-cause mortality were stable before the ages of 65 to 69 years. After that, it gradually increased for patients 65 to 69 years old (HR, 1.13; 95% CI, 1.01–1.26), patients 75 to 79 years old (HR, 1.29; 95% CI, 1.56–1.44), and patients older than 85 years (HR, 1.84; 95% CI, 1.60–2.11) compared with those younger than 50 years. Analyses of age as a continuous variable, other mortality outcomes and stratification by comorbidity and tumor type showed similar results. The odds of non-operation increased for patients 75 to 79 years old (OR, 2.09 [95% CI, 1.84–2.94] for patients 80 to 84 years old and OR, 5.00 [95% CI, 4.31–5.78] for patients ≥85 years old or older), compared with those younger than 50 years.Conclusion: Older age, starting from 65 years, is associated with worse survival after surgery for esophagogastric cancer, and from 75 years with lower odds of surgical treatment.Abstract
Background: The age-specific risks of mortality for patients with esophagogastric cancer and their probability of surgical treatment are not well-known.
Methods: This population-based, nationwide cohort study included all patients with esophageal or gastric (esophagogastric) cancer in Sweden between 1990 and 2013, with follow-up evaluation throughout 2018. Age at diagnosis (exposure) was categorized into nine 5-year groups. The main outcome was 5-year all-cause mortality. The secondary outcomes were 90-day all-cause mortality, 5-year disease-specific mortality, 5-year disease-specific mortality excluding 90-day all-cause mortality, and non-operation. For mortality outcomes, Cox regression provided hazard ratios (HRs) with 95% confidence intervals (95% CIs) adjusted for confounders. For non-operation, logistic regression provided odds ratios (ORs) with 95% CIs.
Results: Among 28,725 patients, 11,207 (39.0%) underwent surgery. For those who underwent surgery, the HRs of 5-year all-cause mortality were stable before the ages of 65 to 69 years. After that, it gradually increased for patients 65 to 69 years old (HR, 1.13; 95% CI, 1.01–1.26), patients 75 to 79 years old (HR, 1.29; 95% CI, 1.56–1.44), and patients older than 85 years (HR, 1.84; 95% CI, 1.60–2.11) compared with those younger than 50 years. Analyses of age as a continuous variable, other mortality outcomes and stratification by comorbidity and tumor type showed similar results. The odds of non-operation increased for patients 75 to 79 years old (OR, 2.09 [95% CI, 1.84–2.94] for patients 80 to 84 years old and OR, 5.00 [95% CI, 4.31–5.78] for patients ≥85 years old or older), compared with those younger than 50 years.
Conclusion: Older age, starting from 65 years, is associated with worse survival after surgery for esophagogastric cancer, and from 75 years with lower odds of surgical treatment
Picard - an electrostatic particle in cell simulation code
No full textThis is a particle-in-cell plasma code 'picard' that was developed
by Jesper Lindkvist and Herbert Gunell with start in 2016 using
resources provided by the Swedish National Infrastructure for
Computing (SNIC) at the High Performance Computing Center North
(HPC2N), Umeå University, Sweden. Jesper Lindkvist was funded by
the Swedish National Space Board (SNSB project 201/15) and
Herbert Gunell by the Swedish National Space Agency (SNSA
project 108/18).
A paper based on the first version was published in A&A .
The present version has been updated to include ionisation as a source of cometary ions, and hdf5 files are used for writing the output. The changes in this version were made by Herbert Gunell.
The files included are:
picard.tgz Package containing all source file, some matlab m-files
that can be used for plotting of the results, and an input
file that was used for a simulation that will be used in an
upcoming publication by Herbert Gunell and Charlotte Götz.
fig-cur.mp4 Videoclip showing results from the simulation defined by the input file, specifically
three-dimensional current paths from different angles.
@author : Jesper Lindkvist
Email : [email protected]
@author : Herbert Gunell
Email : [email protected]
Influence of obesity on the risk of esophageal disorders
No full textObesity is associated with an increased risk of esophageal disorders, including esophageal adenocarcinoma, Barrett esophagus and GERD. For reasons yet unknown, the association between obesity and esophageal adenocarcinoma seems to be stronger than that for other types of obesity-related cancers. Predominantly abdominal or intra-abdominal adiposity (representing visceral fat and other fat within the abdominal cavity), which is more frequently observed in men than in women, is more strongly linked with these esophageal disorders than BMI alone, a finding that might contribute to the striking male predominance of esophageal adenocarcinoma. Research has identified potential mechanisms underlying the strong link between obesity and esophageal conditions. These findings are summarized in this Review, but more research remains to be carried out before these mechanisms are established
Type Theory Unchained: Extending Agda with User-Defined Rewrite Rules
Full text linkDependently typed languages such as Coq and Agda can statically guarantee the correctness of our proofs and programs. To provide this guarantee, they restrict users to certain schemes a- such as strictly positive datatypes, complete case analysis, and well-founded induction a- that are known to be safe. However, these restrictions can be too strict, making programs and proofs harder to write than necessary. On a higher level, they also prevent us from imagining the different ways the language could be extended. In this paper I show how to extend a dependently typed language with user-defined higher-order non-linear rewrite rules. Rewrite rules are a form of equality reflection that is applied automatically by the typechecker. I have implemented rewrite rules as an extension to Agda, and I give six examples how to use them both to make proofs easier and to experiment with extensions of type theory. I also show how to make rewrite rules interact well with other features of Agda such as-equality, implicit arguments, data and record types, irrelevance, and universe level polymorphism. Thus rewrite rules break the chains on computation and put its power back into the hands of its rightful owner: Yours.Programming Language
"Här är vi alla udda fåglar" - En kvalitativ intervjustudie om motivationsfaktorer till fysisk aktivitet hos FaR-patienter
No full textFysisk aktivitet på recept (FaR) är en svensk metod inom hälso- och sjukvård som syftar till att förebygga och behandla bl.a. livsstilsrelaterade sjukdomar. Syftet med studien är att belysa och diskutera FaR-patienters upplevelser av ordinationen utifrån ett motivationsperspektiv i Skåne. Utifrån Self-determination theory’s grundläggande psykologiska behov autonomi, kompetens och samhörighet har FaR-patienters motivation till fysisk aktivitet analyserats. Empiriinsamlingen genomfördes via intervjuer med fyra FaR-patienter – en man och tre kvinnor (ålder M=58 år). Sex olika teman identifierades utifrån det empiriska underlaget: känsla av frihet, variation och anpassning, utveckling, hantera uppgifter effektivare, gemenskap samt trygghet. Resultaten från undersökningen påvisar att tillfredsställelse av de psykologiska behoven är av stor betydelse hos deltagarna för att hitta en inre motivation till fysisk aktivitet. Hälso- och sjukvårdspersonal samt aktivitetsledare har en central roll i tillfredsställelse av behoven. Utifrån den begränsade tillgängligheten i urvalet dras slutsatsen att tillfredsställelse av de grundläggande psykologiska behoven är betydelsefullt hos FaR-patienter för att skapa en inre motivation till fysisk aktivitet, vilket hälso- och sjukvården bör ta hänsyn till när preskriptionen skrivs ut. Antal deltagare i studien är bristfälligt och forskningen kan ha påverkats av författarnas subjektiva bedömning av det empiriska underlaget. Framtida forskning bör därför undersöka liknande fenomen och inkludera fler deltagare för vidare rekommendationer.Physical activity on prescription (FaR) is a Swedish healthcare method to prevent and treat non-communicable diseases. The purpose of this study is to illustrate and discuss motivational factors to physical activity among FaR-patients in Skåne. Using the concept of the basic psychological needs within Self-determination theory; autonomy, competence and relatedness, interviews from four patients were analyzed from a motivational perspective (1 man and 3 women, age M=58). Six different subthemes were found for intrinsic motivation: sense of freedom, variety and adaption, development, managing tasks more efficiently, feeling of community and feeling secure. The result of this study indicates that the satisfaction of the basic psychological needs is essential for FaR-patients to maintain a physical active behavior. Healthcare personnel and activity leaders play a significant part in the satisfaction of the basic psychological needs. The conclusion is thereby that the sex different identified subthemes all are someway important in the satisfaction of the basic psychological needs, which in turn is associated with a sustainable, intrinsic motivation. The process of satisfaction is dependent on a positive motivation climate created by health care personnel and activity leaders. This study has its limitations that should be recognized. Only four people were recruited for an interview for the study. The results may have been influenced by subjective judgment of the empirical data collection. Therefore, future research should include a larger sample and examine similar phenomena for further recommendations to FaR-patients and health care
Aspects of endoscopic interventions of the upper gastrointestinal tract
No full textInterventional endoscopy of the upper gastrointestinal tract is a rapidly evolving surgical discipline that minimizes the surgical trauma. Yet, complications occur that sometimes are severe. This thesis aims to improve upper gastrointestinal endoscopic therapeutic procedures by addressing aspects of their complications in three randomised clinical trials (paper I-III) and one prospective cohort study (paper IV).In distal oesophageal tumours the palliative placement of stent, against dysphagia, crosses the gastrooesophageal junction, thus possibly causing reflux-induced severe oesophagitis and aspiration. Therefore, in paper I, a multicentre trial was performed with the intention of improving the health-related quality of life (HRQL) by testing an anti-reflux stent after palliative stenting of patients with inoperable distal oesophageal cancer. The 65 patients included were randomised for an anti-reflux stent or a conventional stent. HRQL was measured using validated questionnaires assessing general and oesophageal-specific symptoms and functions (EORTC QLQ-C30 and QLQ-OES18) at baseline, and both one and three months after stenting. No statistically significant differences were found between the two types of stents.Some research has indicated that the antihypertensive angiotensin II receptor blocker (ARB) losartan might prevent acute pancreatitis. Therefore, in paper II, we conducted a placebo controlled trial that tested whether losartan prevents hyperenzymemia (a marker of acute pancreatitis) as assessed 24 hours after endoscopic retrograde cholangiopancreatography (ERCP). Among 76 randomised patients, there was no evidence of any preventive effect of losartan on such hyperenzymemia.A significant problem after insertion of nutritional percutaneous endoscopic gastrostomy (PEG) is peristomal infection. A standard antibiotic prophylaxis of 1.5 g cefuroxime (Zinacef®) given intravenously one hour before PEG insertion is generally recommended. In paper III, to develop and facilitate such prophylaxis, we tested whether antibiotic prophylaxis with 20 ml oral solution sulphamethoxazole/trimethoprim (Bactrim®) given in the newly inserted PEG catheter could replace the standard treatment. Among 234 randomised patients, 10 and 14 peristomal infections occurred in the sulphamethoxazole/trimethoprim and the cefuroxime group, respectively. The intention-to-treat and per-protocol analyses both revealed that the sulphamethoxazole/trimethoprim strategy was at least as effective as standard antibiotic prophylaxis.The risk factors for peristomal infections and early mortality after PEG insertion are uncertain. In paper IV we therefore conducted a hospital-based prospective cohort study addressing six potential risk factors for infectious complications or 30-day mortality after PEG insertion: age ≥ 65 years, BMI In summary, antireflux stents might not be superior to conventional stents in the palliation of dysphagia in patients with distal oesophageal cancer. Losartan does not seem to reduce hyperenzymemia after ERCP. A local solution of 20 ml sulphamethoxazole/trimethoprim can probably replace standard antibiotic prophylaxis during PEG insertion. Low albumin and high CRP are markers of increased risk of early mortality after PEG insertion.List of scientific papersI. John Blomberg, Urs Wenger, Jesper Lagergren, Urban Arnelo, Torhallur Agustsson, Erik Johnsson, Ervin Toth, Pernilla Lagergren. Anti-reflux stent versus conventional stent in the palliation of distal esophageal cancer - A randomised, multicenter clinical trial. Scandinavian Journal of Gastroenterology. 2010;45(2):208-16. https://doi.org/10.3109/00365520903443860 II. Tomas Sjöberg Bexelius, John Blomberg, Yunxia Lu, Hans-Olof Håkansson, Peter Möller, Carl-Eric Nordgren, Urban Arnelo, Jesper Lagergren, Mats Lindblad. Angiotensin II receptor blocker losartan and the prevention of hyperenzymemia after endoscopic retrograde cholangiopancreatography: a randomised clinical trial. [Submitted]III. John Blomberg, Pernilla Lagergren, Lena Martin, Fredrik Mattsson, Jesper Lagergren. Novel approach to antibiotic prophylaxis in percutaneous endoscopic gastrostomy (PEG): randomised controlled trial. British Medical Journal. 2010 Jul 2;341:c3115. https://doi.org/10.1136/bmj.c3115 IV. John Blomberg, Pernilla Lagergren, Lena Martin, Fredrik Mattsson, Jesper Lagergren. Albumin and C-reactive protein levels predict short-term mortality after percutaneous endoscopic gastrostomy (PEG) in a prospective cohort study. Gastrointestinal Endoscopy. [Accepted] https://doi.org/10.1016/j.gie.2010.09.012 </p
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