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Nissenin fundoplikaation pitkäaikaistulokset
No full textRefluksitaudista on tullut yleisin mahasuolikanavan sairaus länsimaissa. Tällä hetkellä valtamenetelmänä oleva kirurginen hoito, Nissenin fundoplikaatio, kehitettiin alun perin vuonna 1955, ja ensimmäinen tähystysavusteinen fundoplikaatio tehtiin vuonna 1991. Vaikka leikkausmenetelmä on jo 60 vuotta vanha, pitkäaikaistuloksia, jotka kuvaavat menetelmän käyttöä valikoimattomissa potilasaineistoissa, on julkaistu vähän. Pisimmät seurantatutkimukset rajoittuvat ylipäätään 20 vuoteen.
Tämä väitöskirjatyö koostuu neljästä vertaisarvioidusta alkuperäisartikkelista. Ensimmäisessä osatyössä (I) tavoitteemme oli kuvata leikkaushoidon aiheet, leikkaustekniikka sekä vuotuiset leikkausmäärät Kanta-Hämeen keskussairaalassa tähystysavusteisen leikkaustekniikan käyttöönoton jälkeen. Tuloksiemme mukaan leikkausmäärät lisääntyivät merkittävästi tähystysleikkausten myötä. Vaikka leikkausaiheena oli objektiivisilla tutkimusmenetelmillä todettu refluksitauti, leikkausmäärän kasvamisen katsottiin johtuvan leikkausaiheiden laajenemisesta koskemaan suurempaa potilasjoukkoa. Leikkaustekniikka kehittyi standardoidummaksi 90-luvun loppua kohti.
Toinen (II) ja kolmas (III) osatyömme käsittelivät Kanta-Hämeen keskussairaalassa tähystysavusteisesti fundoplikaatio-leikattujen potilaiden pitkäaikaistuloksia. Toisessa (II) osatyössä tavoitteemme oli määritellä leikkauspotilaiden elämänlaatu kymmenen vuotta leikkauksen jälkeen. Kolmannessa (III) osatyössä halusimme selvittää leikkaustuloksen kestävyyttä valikoimattomassa potilasaineistossa, fibriiniliiman vaikutusta leikkaustulokseen sekä potilaiden oireilua ja tyytyväisyyttä. Tutkimustemme mukaan leikkauspotilaiden elämänlaatu oli lähes vastaava kuin suomalaisella verrokkiväestöllä. Suurin osa potilaista oli tyytyväisiä leikkaustulokseen, mutta tyytymättömyys oli yhteydessä alentuneeseen elämänlaatuun. Ilmavaivat ja nielemisvaikeudet olivat yleisimpiä hoitoon liittyviä sivuvaikutuksia, ja nielemisvaikeudet olivat yleisin ongelma tyytymättömillä potilailla. Ehjiksi todettiin 89 % fundoplikaatio-manseteista, ja vain 6 % potilaista ilmoitti olevansa tyytymättömiä leikkaustulokseen. Subjektiivisten ja objektiivisten tulosten katsottiin olevan vastaavat kuin aiemmin raportoidut, pidemmälle erikoistuneista yksiköistä julkaistut tulokset. Ensimmäistä kertaa fibriiniliiman käytön vaikutus yhdistettiin leikkaustuloksen pettämistä vähentäväksi tekijäksi pitkäaikaisseurannassa.
Neljännessä (IV) osatyössä halusimme selvittää Tampereen yliopistollisessa sairaalassa yli kolmekymmentä vuotta aiemmin avomenetelmällä leikattujen potilaiden subjektiiviset leikkaustulokset, elämänlaadun sekä ennen tähystysaikakautta käytössä olleet leikkausaiheet. Tuloksemme antavat viitteitä siitä, että onnistuneen Nissenin fundoplikaatio leikkauksen jälkeen potilaat saattavat saada elinikäisen avun refluksioireiluun. Potilaiden elämänlaatu todettiin vastaavaksi kuin suomalaisen verrokkiväestön yli kolmekymmentä vuotta leikkauksen jälkeen. Leikkausaiheiden katsottiin heijastavan 80-luvulla vallinneita käytäntöjä. Suurimmalla osalla potilaista oli objektiivisesti varmistettu refluksitauti.
Tähystysavusteisella Nissenin fundoplikaatiolla on saavutettavissa kestävä leikkaustulos myös valikoimattomissa potilasaineistoissa. Onnistuneella leikkaustuloksella on mahdollisesti saavutettavissa elinikäinen helpotus refluksioireiluun, mutta leikkaukseen liittyvät potentiaaliset riskit ja sivuvaikutukset on otettava huomioon mietittäessä kirurgista hoitoa hoitovaihtoehtona. Sekä kirurgit että potilaat voivat hyödyntää tämän väitöskirjan tuloksia arvioidessaan hoitoon liittyviä hyötyjä ja haittoja.Gastroesophageal reflux disease has become the most common gastrointestinal disorder in the Western world. The currently prevailing surgical treatment, Nissen fundoplication, was originally developed in 1955, and the laparoscopic technique was utilized for the first time in 1991. There are few pragmatic studies presenting long-term results of laparoscopic Nissen fundoplication from routine clinical practice, and even though the treatment method is 60 years old, the longest follow-up studies are limited to 20 years.
This thesis consists of four independent articles. The aim of our first study (I) was to describe the indications, operative technique, and annual rates of antireflux surgery at Kanta-Häme Central Hospital after the dissemination of the laparoscopic technique. The results showed that, after the introduction of the laparoscopic technique, the number of antireflux operations rose markedly. Although only patients with objectively verified GERD were treated, the rise in the operation rates was considered to be a result of the broadening of the indications to include a wider range of patients. The operative technique became more standardized towards the end of the 1990s.
Our second (II) and third (III) articles concerned the long-term results of laparoscopic Nissen fundoplication at Kanta-Häme Central Hospital. In our second study (II), the aim was to define the ten-year results as regards the health-related quality of life of our patient cohort. The objective of our third study (III) was to describe the long-term durability of surgical results in routine clinical practice, the impact of fibrin glue on the incidence of surgical failure, and the subjective outcomes ten years after the operation. We found that the health-related quality of life of the patient cohort was close to that of the Finnish general population. The patient satisfaction was high, but dissatisfaction with the treatment was associated with the decreased health-related quality of life. Flatulence and dysphagia were the most common side effects of the treatment, while dysphagia was the most common problem among the dissatisfied. Eighty-nine percent of the fundoplication wraps were intact, and only 6% of the patients were unsatisfied with the results. The subjective and objective long-term results were comparable to those published from more specialized centers. For the first time, it was noted that the use of fibrin glue seemed to decrease the incidence of defective fundoplication wraps in the long term.
In our fourth (IV) article, we aimed to present almost lifelong follow-up (>30 years) after open Nissen fundoplication in terms of subjective outcomes and health-related quality of life and to describe the indications for antireflux surgery before the laparoscopic era. According to our results, a successful Nissen fundoplication may provide a lifelong control of reflux symptoms, and the health-related quality of life of the patients was comparable to that of the general population over 30 years after the operation. The indications for the procedure reflected the practices of the time, and, in most of the patients, GERD was objectively verified.
The results of this thesis suggest that laparoscopic Nissen fundoplication can provide durable surgical results in routine clinical practice as well. In the case of successful surgery, fundoplication may give the patient a lifelong relief of reflux symptoms, but the potential risks and treatment-related side effects should be weighed cautiously when considering operative treatment. These results provide information for physicians and patients when weighing the benefits and harms of the treatment
Going Beyond Counting First Authors in Author Co-citation Analysis
Get PDFThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Variations on the Author
Get PDF“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
Appropriate Similarity Measures for Author Cocitation Analysis
Get PDFWe provide a number of new insights into the methodological discussion about author cocitation analysis. We first argue that the use of the Pearson correlation for measuring the similarity between authors’ cocitation profiles is not very satisfactory. We then discuss what kind of similarity measures may be used as an alternative to the Pearson correlation. We consider three similarity measures in particular. One is the well-known cosine. The other two similarity measures have not been used before in the bibliometric literature. Finally, we show by means of an example that our findings have a high practical relevance.information science;Pearson correlation;cosine;similarity measure;author cocitation analysis
Dispelling the Myths Behind First-author Citation Counts
Get PDFWe conducted a full-scale evaluative citation analysis study of scholars in the XML research field to explore just how different from each other author rankings resulting from different citation counting methods actually are, and to demonstrate the capability of emerging data and tools on the Web in supporting more realistic citation counting methods. Our results contest some common arguments for the continued
use of first-author citation counts in the evaluation of scholars, such as high correlations between author rankings by first-author citation counts and other citation
counting methods, and high costs of using more realistic citation counting methods that are not well-supported by the ISI databases. It is argued that increasingly available digital full text research papers make it possible for citation analysis studies to go beyond what the ISI databases have directly supported and to employ more
sophisticated methods
koamabayili/VECTRON-author-checklist: VECTRON author checklist
No full textWe have done our best to complete the author checklist relating to the use of animals in the hut study. Note that the objective for the hut study was to evaluate the IRS treatment applications for residual efficacy against Anopheles mosquitoes, including the local An. coluzzii mosquito population. Cows were only used to attract mosquitoes into the huts and no tests were carried out directly on the cows. The author checklist is intended for use with studies where experiments are carried out on animals, which is why we have had such difficulty in completing this for the hut study, as many of the questions do not relate to how the cows were used
Author-wise bibliometric analysis based on entropy.
No full textAuthor-wise bibliometric analysis based on entropy.</p
Author Under Sail The Imagination of Jack London, 1893-1902
No full textIn Author Under Sail, Jay Williams offers the first complete literary biography of Jack London as a professional writer engaged in the labor of writing. It examines the authorial imagination in London's work, the use of imagination in both his fiction and nonfiction, and the ways he defined imagination in the creative process in his business dealings with his publishers, editors, and agents. In this first volume of a two-volume biography, Williams traverses the years 1893 to 1902, from London's "Story of a Typhoon" to The People of the Abyss. The Jack London who emerges in the pages of Author Under Sail is a writer whose partnership with publishers, most notably his productive alliance with George Brett of Macmillan, was one of the most formative in American literary history. London pioneered many author models during the heyday of realism and naturalism, blurring the boundaries of these popular genres by focusing on absorption and theatricality and the representation of the seen and unseen. London created an impassioned, sincere, and extremely personal realism unlike that of other American writers of the time. Author Under Sail is a literary tour de force that reveals the full range of London as writer, creative citizen, and entrepreneur at the same time it sheds light on the maverick side of machine-age literature.Intro -- Title Page -- Copyright Page -- Dedication -- Contents -- Acknowledgments -- Introduction -- 1. Spirit Truth -- 2. From Absorption to Theatricality and Back Again -- 3. "I Will Build a New Present" -- 4. Sons as Authors -- 5. Fathers as Publishers -- 6. The Daughter as Author -- 7. Lovers as Authors -- 8. At Sea with the Family -- 9. Yellow News, Yellow Stories -- 10. The Return Home -- Notes -- Bibliography -- Index -- About Jay WilliamsIn Author Under Sail, Jay Williams offers the first complete literary biography of Jack London as a professional writer engaged in the labor of writing. It examines the authorial imagination in London's work, the use of imagination in both his fiction and nonfiction, and the ways he defined imagination in the creative process in his business dealings with his publishers, editors, and agents. In this first volume of a two-volume biography, Williams traverses the years 1893 to 1902, from London's "Story of a Typhoon" to The People of the Abyss. The Jack London who emerges in the pages of Author Under Sail is a writer whose partnership with publishers, most notably his productive alliance with George Brett of Macmillan, was one of the most formative in American literary history. London pioneered many author models during the heyday of realism and naturalism, blurring the boundaries of these popular genres by focusing on absorption and theatricality and the representation of the seen and unseen. London created an impassioned, sincere, and extremely personal realism unlike that of other American writers of the time. Author Under Sail is a literary tour de force that reveals the full range of London as writer, creative citizen, and entrepreneur at the same time it sheds light on the maverick side of machine-age literature.Description based on publisher supplied metadata and other sources.Electronic reproduction. Ann Arbor, Michigan : ProQuest Ebook Central, YYYY. Available via World Wide Web. Access may be limited to ProQuest Ebook Central affiliated libraries
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