Analysis of Boston department store advertising linage in Boston newspapers since 1928

Thesis (M.B.A.)--Boston University, 1947. This item was digitized by the Internet Archive

Colorectal cancer : aspects of multidisciplinary treatment, metastatic disease and sexual function

More than 6000 people in Sweden are diagnosed with colorectal cancer annually. One out of five patients already has metastases at diagnosis. However, the occurrences of metastases at specific locations, e.g. peritoneal carcinomatosis and ovarian metastases, are not well known. The development of surgical and oncological treatment strategies for primary tumours and metastatic disease has led to a need to discuss colorectal cancer patients in a multidisciplinary team (MDT). Although oncologic cure and overall survival are the main goals of treatment, quality of life and functional results are becoming increasingly important with the prolonged survival. While male sexual dysfunction after rectal cancer treatment has been well described, considerably less data have been published about the impact on women. In addition to surgical trauma, female androgen insufficiency could be a contributing factor to sexual dysfunction. Radiotherapy for rectal cancer may increase the risk of reduced ovarian androgen production, but there is scant information on this in the literature. Papers I-III are large population-based cohort studies reporting on the effects of the development and implementation of MDT-conferences in patients with metastatic disease (Paper I) and the epidemiology of peritoneal carcinomatosis and ovarian metastases in colorectal cancer patients (Papers II–III). MDT assessment and metastasis surgery were more common in rectal cancer patients than in colon cancer patients, and the proportion increased over time. Peritoneal carcinomatosis was common, and risk factors were colon cancer, advanced tumour and nodal stage, fewer than 12 examined lymph nodes, emergency surgery, and a non-radical resection of the primary tumour. Ovarian metastases were uncommon, especially in rectal cancer patients. Paper IV assesses feasibility and internal and external validity in a prospective, observational cohort study on sexual function and androgen levels in women with rectal cancer. The methods were workable and the patients’ compliance was good. Comparison of clinical data from the study cohort with that of women who were eligible for inclusion but not included revealed a selection bias. Having a partner and sexual activity was more common among women who answered all questions in the questionnaires about sexual function compared with those who did not. A power calculation based on data from the first included patients showed that a larger sample size than initially planned for was needed. In conclusion, an increasing proportion of patients with metastatic colorectal cancer were discussed by the MDT. Predictors for and the occurrence of peritoneal carcinomatosis and ovarian metastases were defined, which may help to decide on individual treatment and follow-up regimens. The analysis of baseline data from the study on sexual function and androgen levels in women with rectal cancer indicates feasible methods but a selection bias. Inclusion of new patients in the study continues

Slöjdundervisning och digitala verktyg

Denna licentiatuppsats syftar till att undersöka vad digitala verktyg erbjuder lärare och elever i årskurs nio i slöjdundervisning. Licentiatuppsatsen består av två empiriska studier, som benämns lärarstudien och elevstudien. I lärarstudien producerades det empiriska materialet genom intervjuer med slöjdlärare, och i elevstudien producerades empiriskt material genom klassrumsobservation, fältanteckningar och ljudmemo-inspelningar i grundskolans slöjdundervisning. Resultaten från lärarstudien och elevstudien är sammanflätade genom en deduktiv sociomateriell analys baserad på deras resultat. Licentiatuppsatsen bygger på ett sociomateriellt perspektiv, då fokus i denna licentiatuppsats är riktat mot vad digitala verktyg erbjuder slöjdlärare och elever i slöjdundervisning. Sociomateriellt perspektiv har valts för att belysa vad som händer i intra-aktionen mellan eleverna i undervisningssituationen och de digitala verktyg de använder å ena sidan, och de uppfattningar av digitala verktyg som uttrycks under intervjuer med slöjdlärare å andra sidan. Sociomateriellt perspektivet bidrar genom att rikta uppmärksamheten mot materielens inverkan på hur utforskande processer ger mening åt slöjdutbildning, den meningsskapande som sker i intra-aktionen mellan material, eleven och verktygen, snarare än att fokusera på människan. Resultaten visar att slöjdundervisning och digitala verktyg erbjuder både möjligheter och utmaningar, och vad dessa verktyg erbjuder beror på olika förutsättningar. Digitala verktyg kan stödja och förbättra undervisningen på många sätt, men deras betydelse för slöjdundervisningen beror på hur och när de används. De slutsatser som dragits från lärarstudien, elevstudien och den sammanflätade studien är: 1) digitala verktyg erbjuder slöjdlärare och elever förutsättningar utifrån olika behov, 2) slöjdlärare och elever skapar förutsättningar utifrån de digitala verktygens erbjudande, 3) digitala verktyg öppnar upp för nya förutsättningar för slöjdlärare och elever i slöjdundervisning, 4) digitala verktyg erbjuder slöjdlärare och elever förutsättningar som skapar en dynamisk sociomateriell miljö och 5) digitala verktyg erbjuder elever förutsättningar i slöjdprocessen

Adjuvant hyperthermic intraperitoneal chemotherapy (HIPEC) in patients with colon cancer at high risk of peritoneal carcinomatosis; the COLOPEC randomized multicentre trial

Background: The peritoneum is the second most common site of recurrence in colorectal cancer. Early detection of peritoneal carcinomatosis (PC) by imaging is difficult. Patients eventually presenting with clinically apparent PC have a poor prognosis. Median survival is only about five months if untreated and the benefit of palliative systemic chemotherapy is limited. Only a quarter of patients are eligible for curative treatment, consisting of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CR/HIPEC). However, the effectiveness depends highly on the extent of disease and the treatment is associated with a considerable complication rate. These clinical problems underline the need for effective adjuvant therapy in high-risk patients to minimize the risk of outgrowth of peritoneal micro metastases. Adjuvant hyperthermic intraperitoneal chemotherapy (HIPEC) seems to be suitable for this purpose. Without the need for cytoreductive surgery, adjuvant HIPEC can be performed with a low complication rate and short hospital stay. Methods/Design: The aim of this study is to determine the effectiveness of adjuvant HIPEC in preventing the development of PC in patients with colon cancer at high risk of peritoneal recurrence. This study will be performed in the nine Dutch HIPEC centres, starting in April 2015. Eligible for inclusion are patients who underwent curative resection for T4 or intra-abdominally perforated cM0 stage colon cancer. After resection of the primary tumour, 176 patients will be randomized to adjuvant HIPEC followed by routine adjuvant systemic chemotherapy in the experimental arm, or to systemic chemotherapy only in the control arm. Adjuvant HIPEC will be performed simultaneously or shortly after the primary resection. Oxaliplatin will be used as chemotherapeutic agent, for 30 min at 42-43 degrees C. Just before HIPEC, 5-fluorouracil and leucovorin will be administered intravenously. Primary endpoint is peritoneal disease-free survival at 18 months. Diagnostic laparoscopy will be performed routinely after 18 months postoperatively in both arms of the study in patients without evidence of disease based on routine follow-up using CT imaging and CEA. Discussion: Adjuvant HIPEC is assumed to reduce the expected 25 % absolute risk of PC in patients with T4 or perforated colon cancer to a risk of 10 %. This reduction is likely to translate into a prolonged overall survival

Referral pathways and outcome of patients with colorectal peritoneal metastasis (CRPM)

Introduction Traditionally patients with colorectal peritoneal metastases (CRPM) were offered palliative chemotherapy and best supportive care. With the introduction of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC), patients in the UK have been referred to nationally approved centres. This study describes the pattern of referral and outcomes of patients managed through one UK centre. Methods and Methods: A prospective register recorded referrals, demographics, prior treatment pathways, and specialist multidisciplinary team (MDT) decisions (2002-2015). Peritoneal cancer index (PCI) was recorded intra-operatively; complete cytoreduction was deemed when a CC0/1 was achieved. Complications were classified using NCI CTCAE. v.4. Median overall survivals (OS) were described for those treated by CRS/HIPEC and in derived estimates for patients with isolated peritoneal metastases treated by chemotherapy alone in the ARCAD trials consortium. Results Two-hundred-eighty-six patients with CRPM were referred. Despite increasing numbers of referrals annually, the proportion of patients selected for CRS/HIPEC decreased from 64.5%, to 40%, and to 37.1% for 2002–09, 2010–12, and 2013–15, respectively (p < 0.017). CRS/HIPEC was undertaken in 117 patients with a median PCI of 7 and CC0/1 achieved in 86.3%. NCI CTCAE grade 3/4 complication rates were 9.4%; 30-day mortality was 0.85%. Median OS following CRS/HIPEC was 46.0 months: that for patients not receiving CRS/HIPEC was 13.2 months. Conclusion The evolution of the national peritoneal treatment centre over 14 years has been associated with increased referral numbers, refinement of selection for major surgery, matched with achievements of low complication rates and survival advantages in selected patients compared with traditional non-surgical treatments

Association of mechanical bowel preparation with oral antibiotics and anastomotic leak following left sided colorectal resection:an international, multi-centre, prospective audit

Introduction: The optimal bowel preparation strategy to minimise the risk of anastomotic leak is yet to be determined. This study aimed to determine whether oral antibiotics combined with mechanical bowel preparation (MBP+Abx) was associated with a reduced risk of anastomotic leak when compared to mechanical bowel preparation alone (MBP) or no bowel preparation (NBP). Methods: A pre-planned analysis of the European Society of Coloproctology (ESCP) 2017 Left Sided Colorectal Resection audit was performed. Patients undergoing elective left sided colonic or rectal resection with primary anastomosis between 1 January 2017 and 15 March 2017 by any operative approach were included. The primary outcome measure was anastomotic leak. Results: Of 3676 patients across 343 centres in 47 countries, 618 (16.8%) received MBP+ABx, 1945 MBP (52.9%) and 1099 patients NBP (29.9%). Patients undergoing MBP+ABx had the lowest overall rate of anastomotic leak (6.1%, 9.2%, 8.7% respectively) in unadjusted analysis. After case-mix adjustment using a mixed-effects multivariable regression model, MBP+Abx was associated with a lower risk of anastomotic leak (OR 0.52, 0.30–0.92, P&nbsp;=&nbsp;0.02) but MBP was not (OR 0.92, 0.63–1.36, P&nbsp;=&nbsp;0.69) compared to NBP. Conclusion: This non-randomised study adds ‘real-world’, contemporaneous, and prospective evidence of the beneficial effects of combined mechanical bowel preparation and oral antibiotics in the prevention of anastomotic leak following left sided colorectal resection across diverse settings. We have also demonstrated limited uptake of this strategy in current international colorectal practice

Colorectal-vaginal fistula after rectal cancer resection: international comparative cohort study of characteristics and treatment

A colorectal-vaginal fistula (CRVF) can occur as a complication of rectal cancer surgery. They can cause discomfort, repeated infection, need for treatment/further surgery, and a permanent stoma (an opening in the abdomen to collect bowel contents). This study looked at how often CRVF happened after surgery complicated by a leak where bowels ends have been joined together, how they were treated, and how likely patients were to live without a stoma 1 year after surgery. Researchers collected data on women from around the world who had rectal cancer surgery between 2014 and 2018 and developed a bowel leak (called anastomotic leakage). They compared those with and without a CRVF. A total of 88 out of 694 patients (12.7%) developed a CRVF. These patients more often had major surgery involving removal of nearby organs, including part of the vagina. They were more likely to have ongoing problems and needed more surgeries to manage them. Most had a temporary stoma, but only 29.5% could live without it after 1 year, compared with 48.7% of women without CRVF. CRVF is a serious complication that makes recovery harder. These patients are less likely to live without a stoma and usually need more surgery. However, if the leak is small, the chances of recovery without a permanent stoma are better