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  • Sartelli, Massimo; Viale, Pierluigi; Catena, Fausto; Ansaloni, Luca; Moore, Ernest; Malangoni, Mark; Moore, Frederick A.; Velmahos, George; Coimbra, Raul; Ivatury, Rao; Peitzman, Andrew; Koike, Kaoru; Leppäniemi, Ari; Biffl, Walter; Burlew, Clay Cothren; Balogh, Zsolt J.; Boffard, Ken; Bendinelli, Cino; Gupta, Sanjay; Kluger, Yoram; Agresta, Ferdinando; Di Saverio, Salomone; Wani, Imtiaz; Escalona, Alex; Ordonez, Carlos; Fraga, Gustavo P.; Pereira Junior, Gerson Alves; Bala, Miklosh; Cui, Yunfeng; Marwah, Sanjay; Sakakushev, Boris; Kong, Victor; Naidoo, Noel; Ahmed, Adamu; Abbas, Ashraf; Guercioni, Gianluca; Vettoretto, Nereo; Diaz-Nieto, Rafael; Gerych, Ihor; Trana, Cristian; Faro, Mario Paulo; Yuan, Kuo-Ching; Kok, Kenneth Yuh Yen; Mefire, Alain Chichom; Lee, Jae Gil; Hong, Suk-Kyung; Ghnnam, Wagih; Siribumrungwong, Boonying; Sato, Norio; Murata, Kiyoshi; Irahara, Takayuki; Coccolini, Federico; Segovia Lohse, Helmut A.; Verni, Alfredo; Shoko, Tomohisa (2013)
  • Catapano, Alberico L.; Graham, Ian; De Backer, Guy; Wiklund, Olov; Chapman, M. John; Drexel, Heinz; Hoes, Arno W.; Jennings, Catriona S.; Landmesser, Ulf; Pedersen, Terje R.; Reiner, Zeljko; Riccardi, Gabriele; Taskinen, Marja-Riita; Tokgozoglu, Lale; Verschuren, W. M. Monique; Vlachopoulos, Charalambos; Wood, David A.; Luis Zamorano, Jose (2016)
  • Blain, H.; Masud, T.; Dargent-Molina, P.; Martin, F. C.; Rosendahl, E.; van der Velde, N.; Bousquet, J.; Benetos, A.; Cooper, C.; Kanis, J. A.; Reginster, J. Y.; Rizzoli, R.; Cortet, B.; Barbagallo, M.; Dreinhofer, K. E.; Vellas, B.; Maggi, S.; Strandberg, T.; EUGMS Falls Fracture Interest Grp; Int Assoc Gerontology Geriatri; European Union Med Specialists EUM; Fragility Fracture Network FFN; European Soc Clinical Econ Aspects; Int Osteoporosis Fdn IOF (2016)
    Prevention of fragility fractures in older people has become a public health priority, although the most appropriate and cost-effective strategy remains unclear. In the present statement, the Interest Group on Falls and Fracture Prevention of the European Union Geriatric Medicine Society (EUGMS), in collaboration with the International Association of Gerontology and Geriatrics for the European Region (IAGG-ER), the European Union of Medical Specialists (EUMS), the International Osteoporosis Foundation - European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis, outlines its views on the main points in the current debate in relation to the primary and secondary prevention of falls, the diagnosis and treatment of bone fragility, and the place of combined falls and fracture liaison services for fracture prevention in older people.
  • Blain, H.; Masud, T.; Dargent-Molina, P.; Martin, F. C.; Rosendahl, E.; van der Velde, N.; Bousquet, J.; Benetos, A.; Cooper, C.; Kanis, J. A.; Reginster, J. Y.; Rizzoli, R.; Cortet, B.; Barbagallo, M.; Dreinhoefer, K. E.; Vellas, B.; Maggi, S.; Strandberg, T.; EUGMS Falls & Fracture Interest Gr; IAGG-ER; EUMS; FFN; European Soc Clinical & Econ Aspec; IOF (2016)
    Prevention of fragility fractures in older people has become a public health priority, although the most appropriate and cost-effective strategy remains unclear. In the present statement, the Interest Group on Falls and Fracture Prevention of the European Union Geriatric Medicine Society, in collaboration with the International Association of Gerontology and Geriatrics for the European Region, the European Union of Medical Specialists, and the International Osteoporosis Foundation-European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis, outlines its views on the main points in the current debate in relation to the primary and secondary prevention of falls, the diagnosis and treatment of bone fragility, and the place of combined falls and fracture liaison services for fracture prevention in older people.
  • Blain, H.; Masud, T.; Dargent-Molina, P.; Martin, F. C.; Rosendahl, E.; van der Velde, N.; Bousquet, J.; Benetos, A.; Cooper, C.; Kanis, J. A.; Reginster, J. Y.; Rizzoli, R.; Cortet, B.; Barbagallo, M.; Dreinhoefer, K.; Vellas, B.; Maggi, S.; Strandberg, T.; Alvarez, M. N.; Annweiler, C.; Bernard, P. -L.; Beswetherick, N.; Bischoff-Ferrari, H. A.; Bloch, F.; Boddaert, J.; Bonnefoy, M.; Bousson, V.; Bourdel-Marchasson, I.; Capisizu, A.; Che, H.; Clara, J. G.; Combe, B.; Delignieres, D.; Eklund, P.; Emmelot-Vonk, M.; Freiberger, E.; Gauvain, J. -B.; Goswami, N.; Guldemond, N.; Herrero, A. C.; Joel, M. -E.; Jonsdottir, A. B.; Kemoun, G.; Kiss, I.; Kolk, H.; Kowalski, M. L.; Krajcik, S.; Kutsal, Y. G.; Lauretani, F.; Macijauskiene, J.; Int Assoc Gerontology Geriatrics; European Union Medical Specialists; Fragility Fracture Network FFN; EUGMS Falls Fracture Interest Grp; European Soc Clinical Economic; Osteoporosis Research Information; International Osteoporosis (2016)
    Prevention of fragility fractures in older people has become a public health priority, although the most appropriate and cost-effective strategy remains unclear. In the present statement, the Interest group on falls and fracture prevention of the European union geriatric medicine society (EUGMS), in collaboration with the International association of gerontology and geriatrics for the European region (IAGG-ER), the European union of medical specialists (EUMS), the Fragility fracture network (FFN), the International osteoporosis foundation (IOF) - European society for clinical and economic aspects of osteoporosis and osteoarthritis (ECCEO), outlines its views on the main points in the current debate in relation to the primary and secondary prevention of falls, the diagnosis and treatment of bone fragility, and the place of combined falls and fracture liaison services for fracture prevention in older people. (C) 2016 Published by Elsevier Masson SAS.
  • Moustgaard, Heta; Joutsenniemi, Kaisla; Myrskyla, Mikko; Martikainen, Pekka (2014)
  • Pölkki, Anssi; Pekkarinen, Pirkka T.; Takala, Jukka; Selander, Tuomas; Reinikainen, Matti (2022)
    Background Sequential Organ Failure Assessment (SOFA) is a practical method to describe and quantify the presence and severity of organ system dysfunctions and failures. Some proposals suggest that SOFA could be employed as an endpoint in trials. To justify this, all SOFA component scores should reflect organ dysfunctions of comparable severity. We aimed to investigate whether the associations of different SOFA components with in-hospital mortality are comparable. Methods We performed a study based on nationwide register data on adult patients admitted to 26 Finnish intensive care units (ICUs) during 2012-2015. We determined the SOFA score as the maximum score in the first 24 hours after ICU admission. We defined organ failure (OF) as an organ-specific SOFA score of three or higher. We evaluated the association of different SOFA component scores with mortality. Results Our study population comprised 63,756 ICU patients. Overall hospital mortality was 10.7%. In-hospital mortality was 22.5% for patients with respiratory failure, 34.8% for those with coagulation failure, 40.1% for those with hepatic failure, 14.9% for those with cardiovascular failure, 26.9% for those with neurologic failure and 34.6% for the patients with renal failure. Among patients with comparable total SOFA scores, the risk of death was lower in patients with cardiovascular OF compared with patients with other OFs. Conclusions All SOFA components are associated with mortality, but their weights are not comparable. High scores of other organ systems mean a higher risk of death than high cardiovascular scores. The scoring of cardiovascular dysfunction needs to be updated.
  • Stubbs, Brendon; Vancampfort, Davy; Mänty, Minna; Svärd, Anna; Rahkonen, Ossi; Lahti, Jouni (2017)
    This study aimed to examine the bidirectional relationship between psychotropic medication use and changes in leisure-time physical activity (LTPA) among a population cohort study. Phase 1 data were collected by mail surveys in 2000-2002 among 40-60-year-old employees of the City of Helsinki, Finland, and phase 2 follow up survey was conducted in 2007. Based on self-report, the respondents were classified as inactive and active (.14.75 MET-hours/week) at the phases 1 and 2. Hazard ratios (HR) were calculated for subsequent (2007-10) psychotropic medication purchasing according to changes in physical activity (phases 1-2). Odds ratios (OR) for physical inactivity at phase 2 were calculated according to the amount of psychotropic medication between phases 1-2. Overall, 5361 respondents were included (mean age 50 years, 80% women). Compared with the persistently active, the persistently inactive, those decreasing and adopting LTPA had an increased risk for psychotropic medication. Only the persistently inactive remained at increased risk for psychotropic medication use, following the adjustment for prior psychotropic medication use. Compared with those having no medication, the risk for physical inactivity increased as the psychotropic medication increased. Our data suggest that physical activity has an important role in maintaining wellbeing and reducing psychotropic medication usage.
  • Bousquet, J.; Onorato, G. L.; Bachert, C.; Barbolini, M.; Bedbrook, A.; Bjermer, L.; de Sousa, J. Correia; Chavannes, N. H.; Cruz, A. A.; Keenoy, E. De Manuel; Devillier, P.; Fonseca, J.; Hun, S.; Kostka, T.; Hellings, P. W.; Illario, M.; Ivancevich, J. C.; Larenas-Linnemann, D.; Millot-Keurinck, J.; Ryan, D.; Samolinski, B.; Sheikh, A.; Yorgancioglu, A.; Agache, I.; Arnavielhe, S.; Bewick, M.; Annesi-Maesano, I.; Anto, J. M.; Bergmann, K. C.; Bindslev-Jensen, C.; Bosnic-Anticevich, S.; Bouchard, J.; Caimmi, D. P.; Camargos, P.; Canonica, G. W.; Cardona, V.; Carriazo, A. M.; Cingi, C.; Colgan, E.; Custovic, A.; Dahl, R.; Demoly, P.; De Vries, G.; Fokkens, W. J.; Fontaine, J. F.; Gemicioglu, B.; Guldemond, N.; Gutter, Z.; Haahtela, T.; Hellqvist-Dahl, B.; Jares, E.; Joos, G.; Just, J.; Khaltaev, N.; Keil, T.; Klimek, L.; Kowalski, M. L.; Kull, I.; Kuna, P.; Kvedariene, V.; Laune, D.; Louis, R.; Magnan, A.; Malva, J.; Mathieu-Dupas, E.; Melen, E.; Menditto, E.; Morais-Almeida, M.; Mosges, R.; Mullol, J.; Murray, R.; Neffen, H.; O'Hehir, R.; Palkonen, S.; Papadopoulos, N. G.; Passalacqua, G.; Pepin, J. L.; Portejoie, F.; Price, D.; Pugin, B.; Raciborski, F.; Simons, F. E. R.; Sova, M.; Spranger, O.; Stellato, C.; Bom, A. Todo; Tomazic, P. V.; Triggiani, M.; Valero, A.; Valovirta, E.; VandenPlas, O.; Valiulis, A.; Van Eerd, M.; Ventura, M. T.; Wickman, M.; Young, I.; Zuberbier, T.; Zurkuhlen, A.; Senn, A. (2017)
    A Good Practice is a practice that works well, produces good results, and is recommended as a model. MACVIA-ARIA Sentinel Network (MASK), the new Allergic Rhinitis and its Impact on Asthma (ARIA) initiative, is an example of a Good Practice focusing on the implementation of multi-sectoral care pathways using emerging technologies with real life data in rhinitis and asthma multi-morbidity. The European Union Joint Action on Chronic Diseases and Promoting Healthy Ageing across the Life Cycle (JA-CHRODIS) has developed a checklist of 28 items for the evaluation of Good Practices. SUNFRAIL (Reference Sites Network for Prevention and Care of Frailty and Chronic Conditions in community dwelling persons of EU Countries), a European Union project, assessed whether MASK is in line with the 28 items of JA-CHRODIS. A short summary was proposed for each item and 18 experts, all members of ARIA and SUNFRAIL from 12 countries, assessed the 28 items using a Survey Monkey-based questionnaire. A visual analogue scale (VAS) from 0 (strongly disagree) to 100 (strongly agree) was used. Agreement equal or over 75% was observed for 14 items (50%). MASK is following the JA-CHRODIS recommendations for the evaluation of Good Practices.
  • D'Alessio, D.; Haering, H. -U.; Charbonnel, B.; de Pablos-Velasco, P.; Candelas, C.; Dain, M. -P.; Vincent, M.; Pilorget, V.; Yki-Jarvinen, H.; EAGLE Investigators (2015)
  • Kankaanranta, Hannu; Harju, Terttu; Kilpelainen, Maritta; Mazur, Witold; Lehto, Juho T.; Katajisto, Milla; Peisa, Timo; Meinander, Tuula; Lehtimeki, Lauri (2015)
  • Vollm, Birgit A.; Clarke, Martin; Tort Herrando, Vicenc; Seppanen, Allan O.; Gosek, Pawel; Heitzman, Janusz; Bulten, Erik (2018)
    Forensic psychiatry in Europe is a specialty primarily concerned with individuals who have either offended or present a risk of doing so, and who also suffer from a psychiatric condition. These mentally disordered offenders (MDOs) are often cared for in secure psychiatric environments orprisons. In this guidance paper we first present an overview of the field of forensic psychiatry from a European perspective. We then present a review of the literature summarising the evidence on the assessment and treatment of MDOs under the following headings: The forensic psychiatrist as expert witness, risk, treatment settings for mentally disordered offenders, and what works for MDOs. We undertook a rapid review of the literature with search terms related to: forensic psychiatry, review articles, randomised controlled trials and best practice. We searched the Medline, Embase, PsycINFO, and Cochrane library databases from 2000 onwards for adult groups only. We scrutinised publications for additional relevant literature, and searched the websites of relevant professional organisations for policies, statements or guidance of interest. We present the findings of the scientific literature as well as recommendations for best practice drawing additionally from the guidance documents identified. We found that the evidence base for forensic-psychiatric practice is weak though there is some evidence to suggest that psychiatric care produces better outcomes than criminal justice detention only. Practitioners need to follow general psychiatric guidance as well as that for offenders, adapted for the complex needs of this patient group, paying particular attention to long-term detention and ethical issues. (C) 2017 Elsevier Masson SAS. All rights reserved.
  • Honkanen, Mari; Arokoski, Jari; Sipilä, Raija; Kukkonen-Harjula, Katriina; Malmivaara, Antti; Komulainen, Jorma (2019)
    Objective: Rehabilitation is often neglected in clinical practice guidelines, even when there is evidence for its effectiveness. The Current Rehabilitation development project, documented in this article, aimed to develop processes and structures to incorporate evidence and good practice on rehabilitation and functional capacity into the Finnish national Current Care Guidelines. Design: Descriptive assessment. Methods: The 3-year Current Rehabilitation development project was launched in 2012. It began with an assessment of existing rehabilitation evidence on the Current Care Guideline database and a query to Finnish rehabilitation experts. The project group developed and compiled tools for Current Care editors and guideline panels. The editorial team continued to monitor changes in rehabilitation evidence in the guidelines. Results: During the years 2012-2014, a total of 54 guidelines were published, and rehabilitation was incorporated into 31 of them. The number of rehabilitation-related evidence summaries increased from 49 to 164. During the next 3 years an additional 41 guidelines were published. Rehabilitation was incorporated to 24 of them, and the number of rehabilitation-related evidence summaries increased from 78 to 136. Conclusion: The level of evidence criteria used for rehabilitative interventions were the same as for symptomatic or curative interventions. Evidence showing the effectiveness of rehabilitation increased substantially during the project.
  • Pollesello, P.; Parissis, J.; Kivikko, M.; Harjola, V. -P. (2016)
    Background: Levosimendan is an inodilator developed for treatment of acute heart failure and other cardiac conditions where the use of an inodilator is considered appropriate. Levosimendan has been studied in different therapeutic settings including acutely decompensated chronic heart failure, advanced heart failure, right ventricular failure, cardiogenic shock, septic shock, and cardiac and non-cardiac surgery. This variety of data has been re-analysed in 25 meta-analyses from 15 different international research groups, based on different rationales to select the studies included. Methods: We here review all previously published meta-analyses on levosimendan to determine any common denominators for its effects on patient mortality. In addition, we also perform a comparative meta-analysis of the six phase II and III randomized double-blind trials which were taken into consideration by the regulatory authorities for the purpose of introducing levosimendan into the market. Results: Irrespective of clinical setting or comparator, all meta-analyses consistently show benefits for levosimendan, with lower relative risk (or odds ratio) for patient mortality. In 3/25 of the meta-analyses these beneficial trends did not reach statistical significance, while in 22/25 significance was reached. The relative risk is consistent overall, and very similar to that obtained in our own meta-analysis that considered only the 'regulatory' studies. Conclusion: The existing meta-analyses, now based on a population of over 6000 patients, provide the general message of significant benefits for levosimendan in terms of patient mortality. The weight of evidence is now clearly in favour of usefulness/efficacy of levosimendan, with data from multiple randomized trials and meta-analyses. (C) 2016 The Authors. Published by Elsevier Ireland Ltd.
  • Hulkko, A. P.; Murray, G. K.; Moilanen, J.; Haapea, M.; Rannikko, I.; Jones, P. B.; Barnett, J. H.; Huhtaniska, S.; Isohanni, M. K.; Koponen, H.; Jaaskelainen, E.; Miettunen, J. (2017)
    Background: Higher lifetime antipsychotic exposure has been associated with poorer cognition in schizophrenia. The cognitive effects of adjunctive psychiatric medications and lifetime trends of antipsychotic use remain largely unclear. We aimed to study how lifetime and current benzodiazepine and antidepressant medications, lifetime trends of antipsychotic use and antipsychotic polypharmacy are associated with cognitive performance in midlife schizophrenia. Methods: Sixty participants with DSM-IV schizophrenia from the Northern Finland Birth Cohort 1966 were examined at 43 years of age with an extensive cognitive test battery. Cumulative lifetime and current use of psychiatric medications were collected from medical records and interviews. The associations between medication and principal component analysis-based cognitive composite score were analysed using linear regression. Results: Lifetime cumulative DDD years of benzodiazepine and antidepressant medications were not significantly associated with global cognition. Being without antipsychotic medication (for minimum 11 months) before the cognitive examination was associated with better cognitive performance (P = 0.007) and higher lifetime cumulative DDD years of antipsychotics with poorer cognition (P = 0.020), when adjusted for gender, onset age and lifetime hospital treatment days. Other lifetime trends of antipsychotic use, such as a long antipsychotic-free period earlier in the treatment history, and antipsychotic polypharmacy, were not significantly associated with cognition. Conclusions: Based on these naturalistic data, low exposure to adjunctive benzodiazepine and antidepressant medications does not seem to affect cognition nor explain the possible negative effects of high dose long-term antipsychotic medication on cognition in schizophrenia. (C) 2017 Elsevier Masson SAS. All rights reserved.
  • Helin-Salmivaara, Arja; Korhonen, Maarit J.; Lehenkari, Petri; Junnila, Seppo Y. T.; Neuvonen, Pertti J.; Ruokoniemi, Päivi; Huupponen, Risto (2012)
  • Lavikainen, Lauri I.; Guyatt, Gordon H.; Lee, Yung; Couban, Rachel J.; Luomaranta, Anna L.; Sallinen, Ville J.; Kalliala, Ilkka E. J.; Karanicolas, Paul J.; Cartwright, Rufus; Aaltonen, Riikka L.; Ahopelto, Kaisa; Aro, Karoliina M.; Beilmann-Lehtonen, Ines; Blanker, Marco H.; Cardenas, Jovita L.; Craigie, Samantha; Galambosi, Päivi J.; Garcia-Perdomo, Herney A.; Ge, Fang Zhou; Gomaa, Huda A.; Huang, Linglong; Izett-Kay, Matthew L.; Joronen, Kirsi M.; Karjalainen, Päivi K.; Khamani, Nadina; Kilpeläinen, Tuomas P.; Kivelä, Antti J.; Korhonen, Tapio; Lampela, Hanna; Mattila, Anne K.; Najafabadi, Borna Tadayon; Nykänen, Taina P.; Nysten, Carolina; Oksjoki, Sanna M.; Pandanaboyana, Sanjay; Pourjamal, Negar; Ratnayake, Chathura B. B.; Raudasoja, Aleksi R.; Singh, Tino; Tahtinen, Riikka M.; Vernooij, Robin W. M.; Wang, Yuting; Xiao, Yingqi; Yao, Liang; Haukka, Jari; Tikkinen, Kari A. O. (2021)
    Background Venous thromboembolism (VTE) and bleeding are serious and potentially fatal complications of surgical procedures. Pharmacological thromboprophylaxis decreases the risk of VTE but increases the risk of major post-operative bleeding. The decision to use pharmacologic prophylaxis therefore represents a trade-off that critically depends on the incidence of VTE and bleeding in the absence of prophylaxis. These baseline risks vary widely between procedures, but their magnitude is uncertain. Systematic reviews addressing baseline risks are scarce, needed, and require innovations in methodology. Indeed, systematic summaries of these baseline risk estimates exist neither in general nor gynecologic surgery. We will fill this knowledge gap by performing a series of systematic reviews and meta-analyses of the procedure-specific and patient risk factor stratified risk estimates in general and gynecologic surgeries. Methods We will perform comprehensive literature searches for observational studies in general and gynecologic surgery reporting symptomatic VTE or bleeding estimates. Pairs of methodologically trained reviewers will independently assess the studies for eligibility, evaluate the risk of bias by using an instrument developed for this review, and extract data. We will perform meta-analyses and modeling studies to adjust the reported risk estimates for the use of thromboprophylaxis and length of follow up. We will derive the estimates of risk from the median estimates of studies rated at the lowest risk of bias. The primary outcomes are the risk estimates of symptomatic VTE and major bleeding at 4 weeks post-operatively for each procedure stratified by patient risk factors. We will apply the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to rate evidence certainty. Discussion This series of systematic reviews, modeling studies, and meta-analyses will inform clinicians and patients regarding the trade-off between VTE prevention and bleeding in general and gynecologic surgeries. Our work advances the standards in systematic reviews of surgical complications, including assessment of risk of bias, criteria for arriving at the best estimates of risk (including modeling of the timing of events and dealing with suboptimal data reporting), dealing with subgroups at higher and lower risk of bias, and use of the GRADE approach. Systematic review registration PROSPERO CRD42021234119
  • Heervä, Eetu; Carpelan, Anu; Kurki, Samu; Sundström, Jari; Huhtinen, Heikki; Rantala, Arto; Ålgars, Annika; Ristamäki, Raija; Carpen, Olli; Minn, Heikki (2018)
    Background: Most survival data in colorectal cancer (CRC) is derived from clinical trials or register-based studies. Hospital Biobanks, linked with hospital electronic records, could serve as a data-gathering method based on consecutively collected tumor samples. The aim of this Biobank study was to analyze survival of colorectal patients diagnosed and treated in a single-center university hospital over a period of 12 years, and to evaluate factors contributing to outcome.Material and methods: A total of 1777 patients with CRC treated during 2001-2012 were identified from the Auria Biobank, Turku, Finland. Longitudinal clinical information was collected from various hospital electronic records and date and cause of death obtained from Statistics Finland.Results: Cancer-specific, overall and disease-free survival was higher in patients diagnosed during 2004-2008 as compared with patients diagnosed in 2001-2003. Further improvement was not seen during years 2009-2012. Potential factors contributing to the improvement were introduction of multidisciplinary meetings, centralization of rectal cancer surgery, use of adjuvant chemotherapy and systematic preoperative radiotherapy of rectal cancer. The proportion of patients with stage I-IV CRC remained similar over the study period, but a marked decrease in non-metastatic rectal cancer with biopsy only (locally advanced disease) was observed. In stage I-III rectal cancer, Cox multivariate analysis suggested age, comorbidity, R1 resection, T staging and tumor grade as prognostic factors. In colon cancer, prognostic factors were age, comorbidity, gender and presence of lymph node metastases.Conclusions: Organizational changes in the treatment of CRC patients made since 2004 coincide with improved survival in CRC and a marked reduction in locally advanced rectal cancers. The clinical presentation of CRC has remained similar between 2001 and 2012.
  • van Essen, Thomas A.; den Boogert, Hugo F.; Cnossen, Maryse C.; CENTER-TBI Investigators Partici; Kaukonen, Maija; Kivisaari, Riku; Piippo-Karjalainen, Anna; Raj, Rahul; Tanskanen, Päivi; Palotie, Aarno; Pirinen, Matti; Ripatti, Samuli (2019)
    BackgroundNeurosurgical management of traumatic brain injury (TBI) is challenging, with only low-quality evidence. We aimed to explore differences in neurosurgical strategies for TBI across Europe.MethodsA survey was sent to 68 centers participating in the Collaborative European Neurotrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) study. The questionnaire contained 21 questions, including the decision when to operate (or not) on traumatic acute subdural hematoma (ASDH) and intracerebral hematoma (ICH), and when to perform a decompressive craniectomy (DC) in raised intracranial pressure (ICP).ResultsThe survey was completed by 68 centers (100%). On average, 10 neurosurgeons work in each trauma center. In all centers, a neurosurgeon was available within 30min. Forty percent of responders reported a thickness or volume threshold for evacuation of an ASDH. Most responders (78%) decide on a primary DC in evacuating an ASDH during the operation, when swelling is present. For ICH, 3% would perform an evacuation directly to prevent secondary deterioration and 66% only in case of clinical deterioration. Most respondents (91%) reported to consider a DC for refractory high ICP. The reported cut-off ICP for DC in refractory high ICP, however, differed: 60% uses 25mmHg, 18% 30mmHg, and 17% 20mmHg. Treatment strategies varied substantially between regions, specifically for the threshold for ASDH surgery and DC for refractory raised ICP. Also within center variation was present: 31% reported variation within the hospital for inserting an ICP monitor and 43% for evacuating mass lesions.ConclusionDespite a homogeneous organization, considerable practice variation exists of neurosurgical strategies for TBI in Europe. These results provide an incentive for comparative effectiveness research to determine elements of effective neurosurgical care.
  • Hemilä, Harri; Chalker, Elizabeth (2019)
    A number of controlled trials have previously found that in some contexts, vitamin C can have beneficial effects on blood pressure, infections, bronchoconstriction, atrial fibrillation, and acute kidney injury. However, the practical significance of these effects is not clear. The purpose of this meta-analysis was to evaluate whether vitamin C has an effect on the practical outcomes: length of stay in the intensive care unit (ICU) and duration of mechanical ventilation. We identified 18 relevant controlled trials with a total of 2004 patients, 13 of which investigated patients undergoing elective cardiac surgery. We carried out the meta-analysis using the inverse variance, fixed effect options, using the ratio of means scale. In 12 trials with 1766 patients, vitamin C reduced the length of ICU stay on average by 7.8% (95% CI: 4.2% to 11.2%; p = 0.00003). In six trials, orally administered vitamin C in doses of 1-3 g/day (weighted mean 2.0 g/day) reduced the length of ICU stay by 8.6% (p = 0.003). In three trials in which patients needed mechanical ventilation for over 24 hours, vitamin C shortened the duration of mechanical ventilation by 18.2% (95% CI 7.7% to 27%; p = 0.001). Given the insignificant cost of vitamin C, even an 8% reduction in ICU stay is worth exploring. The effects of vitamin C on ICU patients should be investigated in more detail.