Comparison of Linear versus Circular Stapling Techniques in Laparoscopic Gastric Bypass Surgery — A Pilot Study

Background:There is major variability in how the gastrojejunostomy (GJ) is created when laparoscopic gastric bypass (LRYGB) is performed. This is a prospective, non-randomised pilot comparison of two different techniques during our learning curve period performed by two different surgeons with similar surgical experience.Methods:From March 2006 until May 2008, 71 consecutive patients, 28 men and 43 woman, mean age 44 (range 24 to 62 years) who were operated for morbid obesity by laparoscopic bypass surgery have been included. Mean preoperative Body Mass Index (BMI) (range) was 47 (34–63). The patients were divided into two groups on the basis of the stapler used. Group 1 comprised 30 patients who underwent surgery using a 25 mm circular stapler to create the GJ. Group 2 comprised 41 patients who underwent surgery using a 45 mm, blue cartridge linear stapler. Operative time, intra-operative complications, hospital stay, major and minor complications were detected.Results:Intra-operative complications occurred in 4 patients (13.3%) in Group 1, in 5 patients (12.2%) in Group 2. Re-operations occurred 3 times (10.0%) in Group 1, and 4 times (9.8%) in Group 2 due to anastomotic complications, bleeding and/or bowel obstruction. Major complications occurred in four patients in Group 1 (13.3%) and in seven patients in Group 2 (17.1%). There was a significant difference in the overall morbidity rate (major and minor complications), which was 56.7% in Group 1 and 34.1% in Group 2 (p = 0.05). Mean operative time in Group 1 was 135 minutes, and in Group 2 122 minutes. Mean hospital stay was significantly shorter in Group 2 (3.9 days) than in Group 1 (5.7 days, p = 0.04).Conclusions:Learning to handle the technique when performing the gastrojejunostomy during laparoscopic gastric bypass surgery may be faster and easier by using the linear stapler. This may be important knowledge for centres considering starting LRYGB practice, although the surgeon factor needs to be taken in account.The results should be interpreted with caution because the confounding effect of one surgeon performing one type of operation while the other surgeon (is performing) the second type of operation could not be taken into account in this prospective non-randomized analysis.</div

The Price and Market Share Evolution of the Original Biologics and Their Biosimilars in Finland

Background Biological drugs are generally expensive and produce a continuously growing share of drug costs. Yet they are essential in the treatment of many chronic diseases. Biosimilars, clinically equivalent to biological originator products, are expected to restrain drug costs in the biological market. Objective This study aimed to examine the impact of the biosimilar market entry on the prices of the reference products in outpatient care in Finland, investigate the impact of biosimilar market entries on price competition among biological medicinal products, and examine how the prices and market shares of outpatient biosimilars have developed in Finland during 2009-2020. Methods This retrospective register study applied data from IQVIA covering national community pharmacy wholesale data between 1 January, 2009, and 31 August, 2020, for somatropin, epoetin, filgrastim, follitropin, insulin glargine, insulin lispro, etanercept, pegfilgrastim, adalimumab, teriparatide, and enoxaparin biosimilars and their reference products, in addition to two relevant insulin products. We determined the monthly wholesale amounts in defined daily doses and wholesale weighted average prices (excluding value-added tax) per defined daily dose for each product. We analyzed the evolution of the price and market shares. We performed a linear segmented regression analysis to examine the impact of the market entry of biosimilars on the prices of reference products. Results The prices of the reference products mainly decreased after the biosimilar entered the market. If the reference product price was not reduced, it was no longer reimbursable after evaluation under the Health Insurance Act, leading to marginal market shares. The changes in the prices of biosimilars were not as remarkable as the changes in the prices of reference products after the biosimilar market entry. For most active substances, biosimilar prices were stable or decreased. The utilization of biosimilars varied widely between different active substances at the end of the observation period. Conclusions Changes in pricing policy and the public reimbursement scheme related to the market entry of biosimilars were the main reasons for the decrease in the prices of reference products. Therefore, biosimilars did not generate genuine price competition between biological products. In many of the drug groups examined, the market shares of biosimilars have growth potential in the future.Peer reviewe

Arvottaminen rakennusperinnön hoidossa

Tiivistelmä. Diplomityössä tutkitaan arvottamista rakennusperinnön hoidossa. Rakennusperinnön hoito on prosessi, jonka tavoitteena on kohteen arvojen säilyttäminen. Arvot ja arvottaminen ovat sidoksissa aikaan ja kulttuuriin. Suomen rakennusperinnön hoito on jatkumoa eurooppalaiselle rakennusperinnön vaalimiselle. Muutokset restaurointiperiaatteissa ja suhtautumisessa rakennuskannan säilyttämiseen ovat heijastumia siitä, miten rakennusperintöä on arvotettu. Rakennusperinnön hoidon varhaisia esimerkkejä löytyy varhaiskeskiajan Roomasta. Antiikin monumenttien korjaaminen liitti korjaajan antiikin sivistykseen. Renessanssin aikaan rakennusperinnön absoluuttisesta taidearvosta tuli antiikin ihailun myötä tietoisesti suojeltava arvo. Länsimaisen restaurointi- ja suojelukäsityksen synty on yhteydessä 1700-luvulla kehittyneeseen historiatietoisuuteen. Valistuksen aikana rakennusperintöä tarkasteltiin todisteena kulttuurien kehityskuluista. Romantiikan aikaan heräsi kiinnostus keskiaikaisen rakennusperinnön vaalimiseen, minkä myötä kehittyi erilaisia restaurointisuuntauksia. 1900-luvulla rakennusperinnön hoitoa suunniteltiin kansainvälisten sopimusten avulla sotien tuhojen seurauksena. Toisaalta modernistisilla kehitysteorioilla perusteltiin rakennusperinnön purkamista uuden tieltä. Suomessa rakennusperinnön hoidon kehitys seurailee Ruotsin kehitystä. Nykyään velvoite rakennusperinnön arvojen vaalimisesta on kirjattu Suomen lainsäädäntöön monella tasolla. Rakennusperintöä suojellaan pääasiassa kaavoituksella sekä suojelulaeilla ja -asetuksilla. Rakennusperinnön hoidon prosessia ja arvottamisen roolia tarkastellaan työssä kehitetyn prosessikaavion avulla. Prosessi koostuu neljästä vaiheesta: 1. Tahto: tavoitteiden ja lähtötietojen määrittely 2. Tutkimus: kohteen historian ja nykytilan tutkimus ja analysointi 3. Arvottaminen: arvottamiskriteerien määrittely ja kohteen arvottaminen 4. Toimenpiteet: toimenpiteiden määrittely, toteutus ja arviointi Prosessikaaviota soveltumista erityyppisiin hankkeisiin tutkitaan seuraavien tapausten kuvaamisen ja arvioinnin avulla: — Oulun ruutukaavakeskustan modernin rakennuskannan inventointi 2015–2016 — Kajaanin rauniolinna — asiakasturvallisuus ja käytettävyys 2016 — Louhisaaren kartanon kaakkoisen sivurakennuksen vesikattorakenteiden restaurointisuunnitelma 2017–2018.Value assessment in the preservation of built heritage. Abstract. The diploma thesis addresses the assessment of values in the preservation of built heritage. The preservation of built heritage is a process. The main objective of the process has to be the preservation of the values related to the object. Values are relative, changeable and bound to each time and culture. Changes in restoration principles reflect changes in the perception of built heritage and its values. Some of the earliest examples of preservation of built heritage can be found in Rome in the Early Middle Ages. Ancient monuments were preserved in order to associate the preserver to the Antiquities. During Renaissance, the concept of art value became the key factor behind monument preservation. The modern, western approach to the preservation of built heritage evolved along with the modern society in the eighteenth century. In the Age of Enlightenment built heritage was seen as evidence of the natural developement of cultures. During the nineteenth century different restoration and conservation movements emerged particularly from the need and will to preserve Gothic built heritage. The preservation of built heritage in the twentieth century was defined by international agreements, since much of the European built heritage had been destroyed during wars. In addition, modernistic ideology of inevitable progress was used to justify the demolition of historic buildings. The historical development of preservation of the built heritage in Finland is parallel to that of Sweden. The current Finnish legislation obligates to preserve the values of built heritage on many levels. In Finland, buildings can be protected by means of urban planning and laws. The preservation of built heritage and the role of value assessment in it are examined with a process flowchart. The process consists of four phases: 1. Will: defining the objective of the process 2. Research: a history research and documentation of the object, analysing the data 3. Value assessment: defining the criteria for assessment, assessing the values of the object 4. Measures: defining, implementing and assessing measures The process flowchart was used to describe and evaluate the following case studies: — Inventory of the modern architecture in the centre of Oulu 2015–2016 — Kajaani castle ruins — user safety and funktionality 2016 — Restoration plan for the roof structures of the south-eastern side building of Louhisaari manor 2017–201

Medication safety risks to be managed in national implementation of automatic substitution of biological medicines : a qualitative study

Peer reviewe