Experimental Colonic Obstruction and Anastomotic Healing

Colorectal cancer is one of the most common malignant diseases world-wide. Most patients can be diagnosed, staged and treated by surgery in an elective setting. However, about one fifth of the patients will have an emergency presentation and in most cases due to malignant obstruction of the left colon. Immediate resection and anastomosis is feasible but carries a 3-fold higher risk of developing anastomotic leakage compared to elective surgery. Anastomotic healing in patients can be evaluated as clinical outcome and related to preoperative or peroperative patient factors. Experimental research renders it possible to study biochemical factors and cellular events during the course of healing. Previous research in the field of anastomotic healing has suggested a potential role for tissue-degrading enzymes on the loss of collagen in the proximity of an anastomosis leaving it vulnerable to dehiscence. The work presented in this thesis is mainly based on an established model of colonic obstruction in rat. It was found that already 24 hours after initiation of obstruction the collagen levels, analyzed as hydroxyproline, were substantially depressed proximal to the stenosis. On the other hand, the intestine had the capability to recover after relief of the obstruction since hydroxyproline levels were found to return to normal levels. The parallel in the clinical situation would be stenting of an obstruction as a bridge-to-surgery. The activity of matrix metalloproteinases is upregulated in obstructed rat colon and an anastomosis in this condition carries a high risk of leakage. The effect of a MMP inhibitor was investigated but was, contrary to expected, found to deteriorate the anastomoses. On the other hand, if an inhibitor could be delivered locally, improved healing could possibly be expected without unwanted effects, since breaking strength was increased with coated sutures in normal colon

Dispatch accuracy of physician-staffed emergency medical services in trauma care in south-east Norway: a retrospective observational study

Background Selection of incidents and accurate identification of patients that require assistance from physician-staffed emergency medical services (P-EMS) remain essential. We aimed to evaluate P-EMS availability, the underlying criteria for dispatch, and the corresponding dispatch accuracy of trauma care in south-east Norway in 2015, to identify areas for improvement. Methods Pre-hospital data from emergency medical coordination centres and P-EMS medical databases were linked with data from the Norwegian Trauma Registry (NTR). Based on a set of conditions (injury severity, interventions performed, level of consciousness, incident category), trauma incidents were defined as complex, warranting P-EMS assistance, or non-complex. Incident complexity and P-EMS involvement were the main determinants when assessing the triage accuracy. Undertriage was adjusted for P-EMS availability and response and transport times. Results Among 19,028 trauma incidents, P-EMS were involved in 2506 (13.2%). The range of overtriage was 74–80% and the range of undertriage was 20–32%. P-EMS readiness in the event of complex incidents ranged from 58 to 70%. The most frequent dispatch criterion was “Police/fire brigade request immediate response” recorded in 4321 (22.7%) of the incidents. Criteria from the groups “Accidents” and “Road traffic accidents” were recorded in 10,875 (57.2%) incidents, and criteria from the groups “Transport reservations” and “Unidentified problem” in 6025 (31,7%) incidents. Among 4916 patient pathways in the NTR, 681 (13.9%) could not be matched with pre-hospital data records. Conclusions Both P-EMS availability and dispatch accuracy remain suboptimal in trauma care in south-east Norway. Dispatch criteria are too vague to facilitate accurate P-EMS dispatch, and pre-hospital data is inconsistent and insufficient to provide basic data for scientific research. Future dispatch criteria should focus on the care aspect of P-EMS. Better tools for both dispatch and incident handling for the emergency medical coordination centres are essential. In general, coordination, standardisation, and integration of existing data systems should enhance the quality of trauma care and increase patient safety.publishedVersio

Investigation of the surface integrity of mechano-chemically finished powder metallurgy gears

Automotive gears are facing stringent requirements regarding weight and functional surfaces, especially in view of the electric powertrain. To achieve these demands, powder metallurgy gears need to be finished using grinding, and in certain cases, mechano-chemical treatments. With regards to the latter, five different triboconditioning strategies based on vibratory tub finishing and/or centrifugal barrel finishing were considered and their effects on the surface integrity and friction behavior were investigated. Triboconditioning improved the surface roughness after grinding and resulted in higher compressive residual stresses. Additionally, microscopic observations of the surface topography were carried out. The lowest friction coefficients were observed for triboconditioning with a doped material (tribofilm) on the finished surface

Surviving sepsis campaign : International guidelines for management of sepsis and septic shock in adults 2021-endorsement by the Scandinavian society of anaesthesiology and intensive care medicine

The Clinical Practice Committee of the Scandinavian Society of Anaesthesiology and Intensive Care Medicine endorses the clinical practice guideline Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021. The guideline serves as a useful bedside decision aid for clinicians managing adults with suspected and confirmed septic shock and sepsis-associated organ dysfunction.Non peer reviewe

Clinical practice guideline on the management of septic shock and sepsis-associated organ dysfunction in children : Endorsement by the Scandinavian Society of Anaesthesiology and Intensive Care Medicine

Background The Clinical Practice Committee of the Scandinavian Society of Anaesthesiology and Intensive Care Medicine endorses the clinical practice guideline Surviving Sepsis Campaign International Guidelines for the Management of Septic Shock and Sepsis-Associated Organ Dysfunction in Children. The guideline can serve as a useful decision aid for clinicians managing children with suspected and confirmed septic shock and sepsis-associated organ dysfunction.Non peer reviewe

Therapeutics and COVID-19-A living WHO guideline : Endorsement by the Scandinavian Society of Anaesthesiology and Intensive Care Medicine

The Clinical Practice Committee of the Scandinavian Society of Anaesthesiology and Intensive Care Medicine endorses the Living WHO guideline on therapeutics and COVID-19. This trustworthy continuously updated guideline serves as a highly useful decision aid for Nordic anaesthesiologists caring for patients with COVID-19.Non peer reviewe

Regional anaesthesia in patients on antithrombotic drugs - a joint ESAIC/ESRA guideline : Endorsement by the Scandinavian Society of Anaesthesiology and Intensive Care Medicine

The Clinical Practice Committee of the Scandinavian Society of Anaesthesiology and Intensive Care Medicine endorses the clinical practice guideline Regional anaesthesia in patients on antithrombotic drugs - a joint ESAIC/ESRA guideline. This clinical practice guideline serves as a useful decision aid for Nordic anaesthesiologists providing regional anaesthesia to adult patients on antithrombotic drugs.Non peer reviewe

Transfusion strategies in bleeding critically ill adults : A clinical practice guideline from the European Society of Intensive Care Medicine: Endorsement by the Scandinavian Society of Anaesthesiology and Intensive Care Medicine

The Clinical Practice Committee of the Scandinavian Society of Anaesthesiology and Intensive Care Medicine endorses the clinical practice guideline Transfusion strategies in bleeding critically ill adults: a clinical practice guideline from the European Society of Intensive Care Medicine. This trustworthy clinical practice guideline serves as a useful decision aid for Nordic anaesthesiologists caring for critically ill patients with bleeding.Non peer reviewe

Empirical Challenges in Organizational Aesthetics Research: Towards a Sensual Methodology

Despite growing scholarly interest in aesthetic dimensions of organizational life, there is a lack of literature expressly engaging with the methodological mechanics of 'doing aesthetics research'. This article addresses that gap. It begins with an overview of the conceptual idiosyncrasies of 'aesthetics' as a facet of human existence and maps out the challenges these pose for empirical research methodology. A review of methodological approaches adopted to date in empirical studies of organizational aesthetics is then presented. The remainder of the article draws on the author's experiences and suggests methods and techniques to address both conceptual and practical challenges encountered during the execution of an organizational aesthetics research project. The article calls for a firmer focus on the aesthetic experiences of organizational members in addition to those of researchers and concludes with some suggestions as to the future of such 'sensual methodologies' </jats:p