Quality of life from a randomized trial of laparoscopic or open liver resection for colorectal liver metastases.

BACKGROUND: Most treatments for cancer cause a decline in patients' health-related quality of life (HRQoL). Limiting this decline is a universal goal for healthcare providers. Using minimally invasive instead of open surgical techniques might be one way to achieve this. The aim of this study was to compare postoperative HRQoL after open and laparoscopic liver resection. METHODS: This was a predefined substudy of an RCT comparing open with laparoscopic liver resection. Patients with colorectal liver metastases were assigned randomly to open or laparoscopic parenchyma-sparing liver resection. HRQoL was assessed with the Short Form 36 questionnaire at baseline, and 1 and 4 months after surgery. RESULTS: A total of 280 patients were randomized, of whom 273 underwent surgery (129 laparoscopic, 144 open); 682 questionnaires (83.3 per cent) were available for analysis. One month after surgery, patients in the laparoscopic surgery group reported reduced scores in two HRQoL domains (physical functioning and role physical), whereas those in the open surgery group reported reduced scores in five domains (physical functioning, role physical, bodily pain, vitality and social functioning). Four months after surgery, HRQoL scores in the laparoscopic group had returned to preoperative levels, whereas patients in the open group reported reduced scores for two domains (role physical and general health). The between-group difference was statistically significant in favour of laparoscopy for four domains after 1 month (role physical, bodily pain, vitality and social functioning) and for one domain after 4 months (role physical). CONCLUSION: Patients assigned to laparoscopic liver surgery reported better postoperative HRQoL than those assigned to open liver surgery. For role limitations caused by physical health problems, patients in the laparoscopic group reported better scores up to 4 months after surgery. Registration number: NCT01516710 ( http://www.clinicaltrials.gov).

ANTECEDENTES: La mayoría de los tratamientos para el cáncer causan una disminución de la calidad de vida relacionada con la salud (health-related quality of life, HRQoL) de los pacientes. Limitar este declive es un objetivo universal para los proveedores de atención médica. El uso de técnicas quirúrgicas mínimamente invasivas en lugar de abiertas podría ser una forma de lograrlo. El objetivo de este estudio fue comparar la HRQoL postoperatoria después de la resección hepática abierta y laparoscópica. MÉTODOS: Se trata de un subestudio predefinido de un ensayo aleatorizado y controlado que comparó la resección hepática abierta con la laparoscópica. Los pacientes con metástasis hepáticas colorrectales se asignaron aleatoriamente al grupo de resección hepática con preservación de parénquima por vía abierta o por vía laparoscópica. La HRQoL se evaluó con el cuestionario abreviado SF-36 en el momento basal y al cabo de 1 y 4 meses después de la cirugía. RESULTADOS: Un total de 280 pacientes fueron aleatorizados, de los cuales 273 se sometieron a cirugía (129 = laparoscópica, 144 = abierta) y hubo 682 cuestionarios (83%) disponibles para el análisis. Un mes después de la cirugía, los pacientes del grupo de cirugía laparoscópica presentaron puntuaciones reducidas en dos items de HRQoL (función física y rol físico), mientras que los pacientes del grupo de cirugía abierta presentaron puntuaciones reducidas en cinco items (función física, rol físico, dolor corporal, vitalidad y función social). Cuatro meses después de la cirugía, el grupo de cirugía laparoscópica había vuelto a los niveles preoperatorios de la HRQoL, mientras que los pacientes del grupo de cirugía abierta presentaron puntuaciones reducidas para dos items (función física y salud general). La diferencia entre los grupos fue estadísticamente significativa a favor de la laparoscopia para cuatro items después de un mes de la cirugía (rol físico, dolor corporal, vitalidad y función social) y para un ítem (rol físico) después de cuatro meses. CONCLUSIÓN: Los pacientes asignados a cirugía hepática laparoscópica presentaron mejor HRQoL postoperatoria que los pacientes asignados a cirugía hepática abierta. Para las limitaciones de roles causadas por problemas físicos de salud, los pacientes de cirugía laparoscópica presentaron mejores puntuaciones a los cuatro meses tras la intervención quirúrgica.

Trends in Abdominal Aortic and Iliac Aneurysm Repairs in Norway from 2001 to 2013.

OBJECTIVE/BACKGROUND: The objective was to examine trends in abdominal aortic and iliac aneurysm repairs in Norway from 2001 to 2013, and study regional variations and organizational developments in this type of vascular surgery. METHODS: This was a retrospective study on aortic and iliac aneurysm repairs using data from the Norwegian Patient Register. The vascular centers were categorized by yearly volume of repairs into small (<18), medium (18-49) and large (≥50). Incidence rates were assessed per 100,000 ≥ 60 years. The percentage of endovascular aneurysm repairs (EVAR) was calculated among the conducted repairs at the three categories of centers and the South-Eastern, Western, Central, and Northern Norway Regional Health Authority (NRHA). RESULTS: The national incidence rates of intact repairs per 100,000 ≥ 60 years increased from 57.4 to 65.7 (p < .01). Ruptured repairs decreased from 19.7 to 9.2 (p < .01). The rate of EVAR increased from 6.0 to 29.9 (p < .01) in intact and from 0.4 to 2.5 (p < .01) in ruptured repairs. The vascular centers were reduced from 25 to 16. The rate of EVAR was 27.1% (p < .01) higher at large centers and 7.9% (p < .03) higher at medium centers compared with small centers, and from 11.1% to 15.7% higher (p < .01) at the Central, Western, and Northern NRHA compared with the South-Eastern NRHA, which had the most centers (also in the large category). The national increase in intact EVAR from 10.6% to 43.3% was less compared with many other Western countries. CONCLUSION: During the study period the rates of intact repairs increased while the ruptured repairs decreased. EVAR was associated with centers performing high volumes of abdominal aortic and iliac aneurysm repairs and regional authorities organized with few centers.

Growth/no growth models for Zygosaccharomyces rouxii associated with acidic, sweet intermediate moisture food products.

The most notorious spoilage organism of sweet intermediate moisture foods (IMFs) is Zygosaccharomyces rouxii, which can grow at low water activity, low pH and in the presence of organic acids. Together with an increased consumer demand for preservative free and healthier food products with less sugar and fat and a traditionally long self-life of sweet IMFs, the presence of Z. rouxii in the raw materials for IMFs has made assessment of the microbiological stability a significant hurdle in product development. Therefore, knowledge on growth/no growth boundaries of Z. rouxii in sweet IMFs is important to ensure microbiological stability and aid product development. Several models have been developed for fat based, sweet IMFs. However, fruit/sugar based IMFs, such as fruit based chocolate fillings and jams, have lower pH and aw than what is accounted for in previously developed models. In the present study growth/no growth models for acidified sweet IMFs were developed with the variables aw (0.65-0.80), pH (2.5-4.0), ethanol (0-14.5% (w/w) in water phase) and time (0-90 days). Two different strains of Z. rouxii previously found to show pronounced resistance to the investigated variables were included in model development, to account for strain differences. For both strains data sets with and without the presence of sorbic acid (250 ppm on product basis) were built. Incorporation of time as an exploratory variable in the models gave the possibility to predict the growth/no growth boundaries at each time between 0 and 90 days without decreasing the predictive power of the models. The influence of ethanol and aw on the growth/no growth boundary of Z. rouxii was most pronounced in the first 30 days and 60 days of incubation, respectively. The effect of pH was almost negligible in the range of 2.5-4.0. The presence of low levels of sorbic acid (250 ppm) eliminated growth of both strains at all conditions tested. The two strains tested have previously been shown to have similar tolerance towards the single stress factors included in the study, but when the stress factors were combined the two strains showed difference in their ability to grow illustrating the importance of including more strains when developing growth/no growth models. The developed models can be useful tools for development of new acidic sweet IMFs.

Elderly people in a large Danish city.

The Aalborg Model of elderly care contains the following new concepts: It is a comprehensive system, including housing, activities, a food service, practical assistance, nursing care, physical rehabilitation and counselling. High priority is given to the earlier detection of illness and of special needs in an attempt to enrich the quality of life of the elderly and to reduce the cost of treatment. Suitable, independent housing for the elderly has been integrated into ordinary residential areas. The elderly choose their own housing and the assistance they require based on the principle that they will be given help to help themselves, no matter where they live. The former division between visiting nurses and nursing homes has been eliminated, and the elderly are no longer classified according to "diagnosis." One exception to this is the geronto-psychiatric patients who are cared for in special nursing homes. The various kinds of assistance give many options to choose from, regardless of where you live. The services offered are flexible and are provided according to need. They can range from the once a week delivery of frozen, ready-to-serve dishes to extensive care both day and night. Decisions regarding the content and extent of the services are made by members of the permanent staff and the group leaders in cooperation with the elderly users. The various kinds of assistance can be adjusted to suit changing priorities and are provided in accordance with the special character of a local district. One group leader in each district is responsible for coordinating the services. The users have great influence.

Perforations in surgeons' gloves.

The frequency of unused surgeons' gloves with perforations was investigated by using a watertightness test. Lot-to-lot variations and inter-lot variation were found. It is the responsibility of the manufacturer to ensure that the quality of the lot is in accordance with the stated Acceptable Quality Level.