50 research outputs found
ASO Author Reflections: Increasing National Performance on Complete Tumor Resection in Patients with Gastric Cancer by Awareness of Risk Factors and Network Organization for Gastric Cancer Surgery
Quality Measurement in Oesophagogastric Cancer Surgery
Quality of oesophagogastric cancer surgery is measured with quality indicators.
The reliability, validity and value of these indicators is tested in this thesis
ASO Author Reflections: Increasing National Performance on Complete Tumor Resection in Patients with Gastric Cancer by Awareness of Risk Factors and Network Organization for Gastric Cancer Surgery
Mid-infrared diagnostics of starburst galaxies: clumpy, dense structures in star-forming regions in the Antennae (NGC 4038/4039)
Recently, mid-infrared instruments have become available on several large
ground-based telescopes, resulting in data sets with unprecedented spatial
resolution at these long wavelengths. In this paper we examine
'ground-based-only' diagnostics, which can be used in the study of star-forming
regions in starburst galaxies. By combining output from the stellar population
synthesis code Starburst 99 with the photoionization code Mappings, we model
stellar clusters and their surrounding interstellar medium, focusing on the
evolution of emission lines in the N- and Q-band atmospheric windows (8-13 and
16.5-24.5 micron respectively) and those in the near-infrared. We address the
detailed sensitivity of various emission line diagnostics to stellar population
age, metallicity, nebular density, and ionization parameter. Using our model
results, we analyze observations of two stellar clusters in the overlap region
of the Antennae galaxies obtained with VLT Imager and Spectrometer for mid
Infrared (VISIR). We find evidence for clumpy, high density, ionized gas. The
two clusters are young (younger than 2.5 and 3 Myr respectively), the
surrounding interstellar matter is dense (10^4 cm^-3 or larger) and can be
characterized by a high ionization parameter (logU > -1.53). Detailed analysis
of the mid-infrared spectral features shows that a (near-)homogeneous medium
cannot account for the observations, and that complex structure on scales below
the resolution limit, containing several young stellar clusters embedded in
clumpy gas, is more likely.Comment: 24 pages, 16 figures (3 in color), accepted for publication in Ap
Reporting National Outcomes After Esophagectomy and Gastrectomy According to the Esophageal Complications Consensus Group (ECCG)
OBJECTIVE: This nation-wide population-based study aimed to report postoperative morbidity and mortality after esophagectomy and gastrectomy in the Netherlands according to the definitions of the Esophagectomy Complications Consensus Group (ECCG). BACKGROUND: To standardize international outcome reporting in esophageal surgery, the ECCG developed a standardized outcomes set. METHODS: For this national cohort study, all patients undergoing esophagectomy or gastrectomy for cancer between 2016 and 2017 were selected from the Dutch Upper gastrointestinal Cancer Audit. In a random sample of hospitals, data completeness and accuracy were validated by reabstraction of the data. The investigated o
Postoperative intensive care unit stay after minimally invasive esophagectomy shows large hospital variation:Results from the Dutch Upper Gastrointestinal Cancer Audit
Item does not contain fulltextINTRODUCTION: The value of routine intensive care unit (ICU) admission after minimally invasive esophagectomy (MIE) has been questioned. This study aimed to investigate Dutch hospital variation regarding length of direct postoperative ICU stay, and the impact of this hospital variation on short-term surgical outcomes. MATERIALS AND METHODS: Patients registered in the Dutch Upper Gastrointestinal Cancer Audit (DUCA) undergoing curative MIE were included. Length of direct postoperative ICU stay was dichotomized around the national median into short ICU stay ( ≤ 1 day) and long ICU stay ( > 1 day). A case-mix corrected funnel plot based on multivariable logistic regression analyses investigated hospital variation. The impact of this hospital variation on short-term surgical outcomes was investigated using multilevel multivariable logistic regression analyses. RESULTS: Between 2017 and 2019, 2110 patients from 16 hospitals were included. Median length of postoperative ICU stay was 1 day [hospital variation: 0-4]. The percentage of short ICU stay ranged from 0 to 91% among hospitals. Corrected for case-mix, 7 hospitals had statistically significantly higher short ICU stay rates and 6 hospitals had lower rates. ICU readmission, in-hospital/30-day mortality, failure to rescue, postoperative pneumonia, cardiac complications and anastomotic leakage were not associated with hospital variation in length of ICU stay. Total length of hospital stay was significantly shorter in hospitals with relatively short ICU stay. CONCLUSION: This study showed significant hospital variation in postoperative length of ICU stay after MIE. Short ICU stay was associated with shorter overall hospital admission and did not negatively impact short-term surgical outcomes. More selected use of ICU resources could result in a national significant cost reduction