Data on sales of antimicrobials using a standardised methodology have shown that there are vast differences between countries in amounts of antimicrobials sold for food-producing animals, but these ...data do not provide insight on how sales are distributed by species and age groups. The aim of this study was to compare herd level antimicrobial usage for pigs by age category, antimicrobial class and administration route for farrow-to-finish herds in four EU countries. A cross-sectional study was conducted among 227 farrow-to-finish pig herds with at least 100 sows and 500 finishing pigs in Belgium (n=47), France (n=60), Germany (n=60) and Sweden (n=60). Detailed information about the antimicrobial consumption for breeding and growing pigs was collected. Antimicrobial usage was quantified as active substance expressed as mg and then converted to treatment incidence (TI) based on Defined Daily Doses Animal per 1000 pig-days at risk. TIs varied between and within countries, herds and age groups. The Swedish herds had the lowest and the German herds the highest overall use. Most treatments were applied to weaned piglets except in the Swedish herds where treatments of suckling piglets were most frequent. Antimicrobials were most often applied through feed or water except in the Swedish herds where parenteral treatments were most frequent. Aminopenicillins was the antimicrobial class most commonly used. Use of third and fourth generation cephalosporins constituted 11% of use for the Belgian herds, which was higher compared to the other countries. There was a significant (p<0.01) association between the within‐herd antimicrobial use across different age categories. This study has shown that there were large differences in antimicrobial use for pigs between countries, herds and age groups in farrow-to-finish herds of similar size when actual consumption data were compared. Collecting detailed usage data can be used to efficiently target high users in order to reduce antimicrobial consumption.
The challenge when performing cytoreductive surgery (CRS) is to balance the benefits and risks. The aim of this study was to report short term postoperative morbidity and mortality in relation to ...surgical outcome in patients undergoing primary debulking surgery (PDS) or interval debulking (IDS) surgery in the Netherlands.
The Dutch Gynecological Oncology Audit (DGOA) was used for retrospective analysis. Patients undergoing PDS or IDS between January 1st, 2015 - December 31st, 2018 were included. Outcome was frequency of postoperative complications. Median time to adjuvant chemotherapy and severity of complications were related to outcome of CRS. Complications with Clavien-Dindo ≥3 were analyzed per region and case mix corrected. Statistical analysis was performed with R.Studio.
1027 patients with PDS and 1355 patients with IDS were included. Complications with re-invention were significantly higher in PDS compared to IDS (5.7% vs. 3.6%, p = 0.048). Complete cytoreduction was 69.7% in PDS and 62.1% IDS, p < 0.001. Time to adjuvant chemotherapy was 49 days in patients with complete CRS and a complication with re-intervention. Regional variation for severe complications showed one region outside confidence intervals.
Higher complete cytoreduction rate in the PDS group indicates that the correct patients have been selected, but is associated with a higher percentage of complication with re-intervention. As result, time to start adjuvant chemotherapy is longer in this group. Maintaining a balance in aggressiveness of surgery and outcome of the surgical procedure with respect to severe complications is underlined. Bench marked data should be discussed nationally to improve this balance.
•Complications with re-invention were significantly higher in PDS compared to IDS.•Time to start adjuvant chemotherapy is longer in patients with severe complcations.•Regional variation for severe complications is apparent in the Netherlands
Abstract Introduction Low rectal surgery remains challenging. New surgical stapler devices have been developed to counteract problems of impaired visibility and inability to get low into the pelvis. ...One of them is the Radial Reload (RR) with Tri-staple™ Technology (Covidien, New Haven, CT, USA). The aim of this study was to assess the first impressions and experiences regarding handling of this new stapler device in low anterior resection procedures in living humans. Methods A questionnaire, consisting of 27 statements concerning accessibility, maneuverability and visibility, was sent to 35 surgeons worldwide. Results A total of 85 rectal surgical procedures, both open and laparoscopic, were assessed by 31 surgeons. In 97% of the procedures the surgeons agreed that the RR stapler device facilitated access in the low pelvis. The first stapler device firing achieved complete transection in 54% of the procedures. According to the surgeons' assessments, in 91% percent of the procedures the RR stapler device enabled creation of adequate margins. Visualization of the pelvic floor was reported in 93% of the procedures. In the surgeons' opinion, the RR stapler device was considered clinically acceptable in 93% of the procedures. In 79% of the procedures the surgeon preferred the RR stapler device over the stapler device they normally used. Conclusion This study showed that the first experiences with the RR stapler device of 33 surgeons in 85 low rectal procedures are positive. It facilitates low stapling in both open and laparoscopic procedures. Good visibility, maneuverability and the possibility to create adequate distal margins were reported.
Tracking with capillaries and liquid scintillator Annis, P.; Bay, A.; Bonekämper, D. ...
Nuclear physics. B, Proceedings supplement/Nuclear physics. B, Proceedings supplements,
02/1998, Letnik:
61, Številka:
3
Journal Article
Recenzirano
Odprti dostop
The technique of glass capillaries filled with liquid scintillator allows the reconstruction of ionizing particle tracks with high spatial resolution. Detectors based on this technique consist of ...coherent arrays of capillaries having diameters of the order of 20
μm. Light signals are amplified by an optoelectronic chain composed of a series of image intensifiers: the readout is performed through a CCD.
The ongoing research in the field of liquid scintillators has led to excellent results in terms of information density (≥ 5 hits/mm) and radiation resistance (order of 1 MGy). In this paper new results about the effect of ageing and purification of liquid scintillators will be presented.
The RD46 collaboration has developed a completely new detector having a readout chain composed of only one image intensifier followed by a new device: a Megapixel Electron Bombarded CCD. First images of neutrino interactions will be shown, together with preliminary measurements of the resolution of the detector.
Previous studies have shown low adherence to surgical staging guidelines in patients with clinical early-stage ovarian carcinoma. The aim of this study was to identify guideline adherence for ...surgical staging and to show the distribution of each surgical item within the study population. In addition, we examined whether regional variation in the Netherlands exists for complete surgical staging.
Patients with ovarian cancer and surgical staging registered in the Dutch Gynecological Oncology Audit between January 1, 2015 and December 31, 2019 in the Netherlands were included. Complete surgical staging was defined according to the Dutch evidence-based guideline. Surgical items were ranked and illustrated. Variation in complete surgical staging for eight regional cancer networks was shown in funnel plots. Manual validation of registered data was performed in three gynecological oncology centers.
604 patients underwent surgical staging, 365 (60%) underwent an incomplete staging procedure, 295 (81%) were registered with early-stage disease (International Federation of Gynecology and Obstetrics I-IIA) and, of these patients, 115 (39%) received adjuvant chemotherapy. Patients with incomplete surgical staging were operated more often with minimal invasive techniques (laparoscopy or robot) compared with patients in the complete staging group (p<0.001). Sampling of cytology/ascites was the most frequently lacking factor (29%). Manual validation of data in three gynecological oncology centers identified reasons for incomplete staging, the most common being 'perioperative findings' such as dense adhesions between tumor and peritoneum, consistent with advanced stage disease (≥IIA). Regional variation for complete surgical staging showed two regions performing outside the confidence intervals (12.5% and 25.5%, mean 40%).
Guideline adherence for staging was lower than expected and validation of data gave additional insights into the reasons that were contributing to incomplete surgical staging. Moreover, this analysis showed that regional variation for surgical staging exists, which forms a starting point to improve and harmonize staging procedures for these patients nationwide.
A small Time Projection Chamber (TPC) has been read out by means of a Medipix2 readout chip as direct anode. A Micromegas foil was placed 50 /spl mu/m above the chip, and electron multiplication ...occurred in the gap. With a He/isobutane 80/20 mixture, gas multiplication factors up to tens of thousands were achieved, resulting in an efficiency for detecting single electrons of better than 90%. We recorded many frames containing 2D images with tracks from cosmic muons. Along these tracks, electron clusters were observed, as well as /spl delta/-rays. Some applications of this new device are presented.
The Dutch Gynecological Oncology Audit (DGOA) was initiated in 2014 to serve as a nationwide audit, which registers the four most prevalent gynecological malignancies. This study presents the first ...results of clinical auditing for ovarian cancer in the Netherlands.
The Dutch Gynecological Oncology Audit is facilitated by the Dutch Institute of Clinical Auditing (DICA) and run by a scientific committee. Items are collected through a web-based registration based on a set of predefined quality indicators. Results of quality indicators are shown, and benchmarked information is given back to the user. Data verification was done in 2016.
Between January 01, 2014 and December 31, 2018, 6535 patients with ovarian cancer were registered. The case ascertainment was 98.3% in 2016. The number of patients with ovarian cancer who start therapy within 28 days decreased over time from 68.7% in 2014 to 62.7% in 2018 (p < 0.001). The percentage of patients with primary cytoreductive surgery decreased over time (57.8%–39.7%, P < 0.001). However, patients with complete primary cytoreductive surgery improved over time (53.5%–69.1%, P < 0.001). Other quality indicators did not significantly change over time.
The Dutch Gynecological Oncology Audit provides valuable data on the quality of care on patients with ovarian cancer in the Netherlands. Data show variation between hospitals with regard to pre-determined quality indicators. Results of ‘best practices’ will be shared with all participants of the clinical audit with the aim of improving quality of care nationwide.
•The Dutch Gynecological Oncology Audit is a population-based data base that aims to improve quality of care.•Over the years, patients with ovarian cancer underwent more complete primary cytoreductive surgery.•Future results from the DGOA can be useful in identifying best practices and outliers.
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