Hospitalisti kirurgisella vuodeosastolla : hyötyä saavutettavissa?

TiivistelmäHospitalisti on sairaalassa työskentelevä yhdyslääkäri, jolla on laaja näkemys potilaiden akuuttien ja pitkä­aikaisten ongelmien hoidosta.Hospitalistien määrä on lisääntynyt voimakkaasti mallin synnyinmaassa Yhdysvalloissa.Malli tähtää hoidon laadun parantamiseen ja jatkuvuuden turvaamiseen.Suomessa mallia on pilotoitu Oulun yliopistollisessa sairaalassa. Alalle aikoville on tarjolla lisäkoulutusohjelma.AbstractA hospitalist is a clinician in hospital medicine who specializes in managing a patient’s acute hospital care. This discipline grew in the USA out of the increasing complexity of patients requiring hospital care and the need for dedicated clinicians to oversee their management. During the last two decades the number of hospitalists in the USA has reached 50 000.The two largest review articles show that both hospital stay and costs diminished with no decline in the quality of care when the hospitalist concept was used.We conducted a pilot study concerning the use of hospitalists on a surgical ward. The results are promising and the hospitalist role also seems to fit into the Finnish health care system.The Faculty of Medicine at the University of Oulu is offering an advanced hospitalist training programme, which has not previously been available either in Finland or in any other European country. It lasts two years and prepares a new path to coordinating comprehensive healthcare of patients with more complex care needs.Tiivistelmä Hospitalisti on sairaalassa työskentelevä yhdyslääkäri, jolla on laaja näkemys potilaiden akuuttien ja pitkä­aikaisten ongelmien hoidosta. Hospitalistien määrä on lisääntynyt voimakkaasti mallin synnyinmaassa Yhdysvalloissa. Malli tähtää hoidon laadun parantamiseen ja jatkuvuuden turvaamiseen. Suomessa mallia on pilotoitu Oulun yliopistollisessa sairaalassa. Alalle aikoville on tarjolla lisäkoulutusohjelma.Abstract A hospitalist is a clinician in hospital medicine who specializes in managing a patient’s acute hospital care. This discipline grew in the USA out of the increasing complexity of patients requiring hospital care and the need for dedicated clinicians to oversee their management. During the last two decades the number of hospitalists in the USA has reached 50 000. The two largest review articles show that both hospital stay and costs diminished with no decline in the quality of care when the hospitalist concept was used. We conducted a pilot study concerning the use of hospitalists on a surgical ward. The results are promising and the hospitalist role also seems to fit into the Finnish health care system. The Faculty of Medicine at the University of Oulu is offering an advanced hospitalist training programme, which has not previously been available either in Finland or in any other European country. It lasts two years and prepares a new path to coordinating comprehensive healthcare of patients with more complex care needs

Prospective randomized controlled trial comparing the efficacy and safety of Roux-en-Y gastric bypass and one-anastomosis gastric bypass (the RYSA trial): trial protocol and interim analysis

INTRODUCTION: There is a lack of prospective studies comparing Roux-en-Y gastric bypass (RYGB) and one-anastomosis gastric bypass (OAGB). Also, the effects of bariatric surgery and weight loss need a deeper understanding through metabolic studies. We describe the trial protocol and interim analysis of a prospective randomized controlled study comparing RYGB and OAGB: the RYSA trial. MATERIALS AND METHODS: In total, 120 bariatric patients will be randomized between RYGB and OAGB in two academic centers. All patients will be followed up for 10 years with analysis and measurements of weight, comorbidities, blood tests, body composition and questionnaires. Extensive metabolic analyses (mixed meal tests, energy expenditure, biopsies of muscle and subcutaneous fat, urine, saliva and fecal samples) will be carried out in the Obesity Research Unit, University of Helsinki, for all patients treated at the Helsinki University Hospital (80 patients) at baseline, 6 months and 12 months. Bile reflux will be studied for the OAGB group at the Helsinki University Hospital at 6 months with gastroscopy and scintigraphy. RESULTS: At an interim analysis at 3 months (half-way) through recruitment (30 RYGB and 30 OAGB patients) there have been no deaths and no intensive care unit admittances. One patient in both groups required additional gastroscopy, with anastomosis dilatation in the RYGB group but with no additional intervention in the OAGB group. CONCLUSION: The trial can be safely carried out. Recruitment is estimated to be complete by the end of 2019. TRIAL REGISTRATION: Clinical Trials Identifier NCT02882685. Registered on August 30th 2016.Peer reviewe

Microbiota and Extracellular Vesicles in Anti-PD-1/PD-L1 Therapy

Cancer is a deadly disease worldwide. In light of the requisite of convincing therapeutic methods for cancer, immune checkpoint inhibition methods such as anti-PD-1/PD-L1 therapy appear promising. Human microbiota have been exhibited to regulate susceptibility to cancer as well as the response to anti-PD-1/PD-L1 therapy. However, the probable contribution of bacterial extracellular vesicles (bEVs) in cancer pathophysiology and treatment has not been investigated much. bEVs illustrate the ability to cross physiological barriers, assemble around the tumor cells, and likely modify the tumor microenvironment (EVs). This systematic review emphasizes the correlation between cancer-associated extracellular vesicles, particularly bEVs and the efficacy of anti-PD-1/PD-L1 therapy. The clinical and pharmacological prospective of bEVs in revamping the contemporary treatments for cancer has been further discussed

Lihavuuskirurginen potilas päivystyksessä - mitä päivystäjän pitää osata epäillä?

Teema : lihavuuskirurgia. English summar

Thirty years of esophageal cancer surgery in Oulu University Hospital

AbstractBackground:Esophagectomy is the mainstay of surgical treatment of esophageal cancer, but involves high operative risk. The aim of this study was to review the evolution surgical treatment of esophageal cancer in Northern Finland, with introduction of minimally invasive techniques.Methods:All elective esophagectomies performed in Oulu University Hospital between years 1987 and 2020 were included. Treatment strategies were compared to current guidelines including staging and use of neoadjuvant therapy, and benchmark values including postoperative morbidity, hospital stay, readmissions and 90-day mortality. Long-term survival was compared to previous national studies.Results:Between years 1987 and 2020 a total of 341 underwent an esophagectomy. Transhiatal resection was performed to 167 (49.3%), Ivor Lewis to 129 (38.1%) and McKeown to 42 (12.4%) patients. MIE was performed to 49 (14.5%) patients. During the past four years 83.7% of locally advanced diseases received neoadjuvant treatment. Since 1987, gradual improvements have occurred especially in incidence of pleural effusion requiring additional drainage procedure (highest in 2011–2013 and in last four years 14.0%), recurrent nerve injuries (highest in 2008–2010 29.4% and lowest in 2017–2020 1.8%) and in 1-year survival rate (1987–1998 68.4% vs. 2017–2020 82.1%). No major changes in comorbidity, complication rate, anastomosis leaks, hospital stay or postoperative mortality were seen.Conclusions:Esophageal cancer surgery has gone through major changes over three decades. Current guideline-based treatment has resulted with progressive improvement in mid- and long-term survival. However, despite modern protocol, no major improvement has occurred for example in major complications, anastomosis leak rates or hospital stay.Abstract Background:Esophagectomy is the mainstay of surgical treatment of esophageal cancer, but involves high operative risk. The aim of this study was to review the evolution surgical treatment of esophageal cancer in Northern Finland, with introduction of minimally invasive techniques. Methods:All elective esophagectomies performed in Oulu University Hospital between years 1987 and 2020 were included. Treatment strategies were compared to current guidelines including staging and use of neoadjuvant therapy, and benchmark values including postoperative morbidity, hospital stay, readmissions and 90-day mortality. Long-term survival was compared to previous national studies. Results:Between years 1987 and 2020 a total of 341 underwent an esophagectomy. Transhiatal resection was performed to 167 (49.3%), Ivor Lewis to 129 (38.1%) and McKeown to 42 (12.4%) patients. MIE was performed to 49 (14.5%) patients. During the past four years 83.7% of locally advanced diseases received neoadjuvant treatment. Since 1987, gradual improvements have occurred especially in incidence of pleural effusion requiring additional drainage procedure (highest in 2011–2013 and in last four years 14.0%), recurrent nerve injuries (highest in 2008–2010 29.4% and lowest in 2017–2020 1.8%) and in 1-year survival rate (1987–1998 68.4% vs. 2017–2020 82.1%). No major changes in comorbidity, complication rate, anastomosis leaks, hospital stay or postoperative mortality were seen. Conclusions:Esophageal cancer surgery has gone through major changes over three decades. Current guideline-based treatment has resulted with progressive improvement in mid- and long-term survival. However, despite modern protocol, no major improvement has occurred for example in major complications, anastomosis leak rates or hospital stay