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This prospective nation-wide study was performed to evaluate the effect of hospital category and subspeciality training on surgical treatment of ovarian cancer. Data were obtained from a questionnaire filled in by the operating unit, and from the surgical and histopathology reports. The survey included 307 patients. Half of them were operated in the university hospitals where gynaecologic oncologists performed 72% of the operations. This was the case in only 4% and 19% in the central and district hospitals, respectively. In university hospitals, pelvic lymphadenectomy was performed in 88%, and para-aortic lymphadenectomy in 73%, of the patients with stage I disease. The corresponding figures ranged from 11% to 21% in central and district hospitals. For stage III patients operated by gynaecologic oncologists, the estimated odds ratio for no macroscopic tumour was 3.0 times higher (95% CI 1.2-7.5) than for those operated by general gynaecologists. These results favour centralisation of surgical treatment of ovarian cancer. [ABSTRACT FROM AUTHOR]

Objective: Correct assessment of patient urgency is critical to ensuring patient safety in emergency departments (EDs). Although significant time and effort have been devoted to developing triage systems, less attention has been paid to the development of quality control. The aim of this study is to introduce and test observation technique, which enables identifying of patient groups at risk of erroneous assessment in triage. The introduced technique is aimed to be less laborious to use than existing triage quality control methods., Design: The study developed an observation technique for identifying patients with possible erroneous assessments in triage. Data sample for the observation technique is carried out with survey form filled in by nurse., Setting: Hospital ED with ~74 000 patient visits annually., Participants: Consecutive adult patients in an ED for baseline study period of 14 days (1774 patients) in 2010 and control study period of 4 days (541 patients) in 2012., Intervention: Triage observation technique for continuous improvement of triage performance., Main Outcome Measures: Primary measures of triage improvement were triage accuracy and nurses' ability to predict patient admissions., Results: With the observation technique the ED staff was able to identify patient groups at risk for erroneous triage. Under-triage related mostly to patients with chest pain, shortness of breath, collapse, stomach pain and infections. Instead injures and muscular skeletal symptoms were seldom undertriaged even though they are common., Conclusions: EDs can control triage quality with simple observation technique. The usability of observation technique and triage quality improvement process were good., (© The Author 2017. Published by Oxford University Press in association with the International Society for Quality in Health Care. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com)

Unlabelled: Paired associative stimulation (PAS) is a non-invasive stimulation method developed to induce bidirectional changes in the excitability of the cortical projections to the target muscles. However, very few studies have shown an association between changes in motor evoked potentials (MEP) after PAS and behavioral changes in healthy subjects. In the present study we hypothesized that the functional relevance of PAS can be seen during fatiguing exercise, since there is always a central contribution to the development of fatigue. Transcranial magnetic stimulation was applied over the motor cortex to measure changes in the MEPs of the soleus muscle before and after PAS. Furthermore, fatigue resistance was tested during 15s sustained maximal isometric contractions before and after PAS. On average, fatigue resistance did not change after PAS, however the change in excitability correlated significantly with the change in fatigue resistance., Discussion: Functionality of PAS intervention was not demonstrated in this study. However, the observed relationship between excitability and fatigue resistance suggests that PAS might have affected central fatigue during short maximal contractions., (Copyright © 2015 Elsevier Ireland Ltd and the Japan Neuroscience Society. All rights reserved.)

Purpose: Extensive evidence exists that regular physical exercise offers neuroplastic benefits to the brain. In this study, exercise-specific effects on motor cortex plasticity were compared between 15 skilled and 15 endurance trained athletes and 8 controls., Methods: Plasticity was tested with a paired associative stimulation (PAS) protocol. PAS is a non-invasive stimulation method developed to induce bidirectional changes in the excitability of the cortical projections to the target muscles. Motor cortex excitability was assessed by motor-evoked potentials (MEPs) in the task-relevant soleus muscle, elicited with transcranial magnetic stimulation, before and following PAS. To test for changes at the spinal level, soleus short latency stretch reflexes (SLSR) were elicited before and after PAS., Results: PAS induced a significant (76 ± 83 %) increase in MEP amplitude in the skill group, without significant changes in the endurance (-7 ± 35 %) or control groups (21 ± 30 %). Baseline MEP/post MEP ratio was significantly different between the skill and endurance groups. SLSR remained unchanged after the PAS intervention., Conclusion: The possible reason for differential motor cortex plasticity in skill and endurance groups is likely related to the different training-induced adaptations. The findings of the current study suggest that long-term skill training by skill group induced preferable adaptations in the task-related areas of the motor cortex because increased plasticity is known to enhance motor learning.

Changes in the excitability of the cortical projections to muscles in the upper and lower limbs can be induced in the intact human by paired associative stimulation (PAS). An interstimulus interval (ISI) of 25 ms between peripheral nerve and transcranial magnetic stimuli has been found to be effective when targeting hand muscles. The optimal ISI to induce plasticity changes in the cortical projections to lower limbs is still not well established. The purpose of this study was twofold: first, to investigate the effect of PAS with four different ISIs based on the individual latency of the sensory evoked potential (SEP plus 6, 12, 18 and 24 ms) and second, to evaluate the repeatability of the established optimal ISI. Transcranial magnetic stimulation was used to measure changes in the motor evoked potentials (MEPs) of the soleus (SOL) muscle before and after the PAS interventions. Significant increases in the amplitude of SOL MEPs (88 %) were attained with an ISI of SEP latency plus 18 ms (P32 + 18 ms). The PAS effect was long-lasting, input-specific and supraspinal in origin. The intraclass correlation coefficient to test the repeatability of the PAS intervention with the optimal ISI was 0.85. The results show that the excitability of cortical projections to the soleus muscle can be repeatedly increased after PAS with an optimal ISI of SEP plus 18 ms.

Objective: Our recent prospective, nation-wide study indicated better surgical outcome in ovarian cancer patients operated at university hospitals compared to other hospitals. Here we report how this is reflected in 5-year cancer-specific survival (CSS)., Methods: Detailed 5-year follow-up data were obtained on 275 patients by using a special questionnaire, and the data were verified from the Finnish Cancer Registry data. The hospitals were categorized to university and other hospitals and by the number of operations performed in 1999 (<10, 10-20, or >20 operations). Data were analyzed using the Cox's proportional hazards regression analysis., Results: The study population covered 90% of the epithelial ovarian cancer patients operated in 1999, in Finland. Eighty-two percent of the patients received platinum-based chemotherapy. The percentage of patients treated with a platinum-taxane combination was higher in university hospitals (63% vs. 49%, P=0.037). The 5-year CSS was 56% and the median disease-free survival (DFS) was 33 months. In multivariate analysis prognostic factors for CSS were stage (P=0.0027), residual tumor (P=0.0001), and primary chemotherapy (P<0.0001). Hospital operative volume was associated with residual tumor (P=0.027). When hospital operative volume increased with ten patients per year, the odds ratio for no residual disease was 1.203 (95% CI 1.022-1.417)., Conclusion: FIGO stage, residual tumor, and primary chemotherapy are significant prognostic factors for ovarian cancer. Hospital volume is associated with residual tumor. The results favor performance of ovarian cancer surgery in hospitals with higher operative volumes.

In acid conditions, as in acid mine drainage waters, iron oxide particles are positively charged, attracting negatively charged organic particles present in surrounding natural waters. Schwertmannite (Fe8O8(OH)6SO4) and goethite (alpha-FeOOH) are the most typical iron oxide minerals found in mine effluents. We studied schwertmannite formation in the presence of humic acid. Further, surface charge and adsorption of humic acid on synthetic schwertmannite and goethite surfaces in pH 2-9 and in humic acid concentrations of 0.1-100 mg/L C were examined. Schwertmannite did precipitate despite the presence of humic acid, although it contained more sulphate and had higher specific surface area than ordinary schwertmannite. Specific surface area weighted results showed that schwertmannite and goethite had similar humic acid adsorption capacities. Sulphate was released from schwertmannite surfaces with increasing pH, resulting in an increase in specific surface area. Presence of sulphate in solution decreased the surface charge of schwertmannite and goethite similarly, causing coagulation. In acid conditions (pH 2-3.5), according to the zeta potential, schwertmannite is expected to coagulate even in the presence of high concentrations of humic acid (< or = 100 mg/L C). However, at high humic acid concentrations (10-100 mg/L C) with moderate acid conditions (pH>3.5), both schwertmannite and goethite surfaces are strongly negatively charged (zeta potential < -30 mV) thus posing a risk for colloid stabilization and colloidal transport.

Background: Surgical treatment and staging of ovarian borderline tumors have been reported to be often suboptimal and differ considerably. We evaluated the extent of surgical treatment of these tumors in different hospital categories., Material and Methods: A prospective survey performed in 1999 included 65 patients operated on for borderline ovarian tumors and covered 78% of such patients reported to the Finnish Cancer Registry. Detailed information of demographic data and surgical treatment was reported by the responsible physicians using a special questionnaire after confirmation of histopathology., Results: Fifty-eight patients (89%) had stage I tumor, only two patients (3%) had stage II disease and five patients (8%) had stage III disease with peritoneal implants. The majority of the patients underwent bilateral salpingo-oophorectomy (66%) and hysterectomy (58%). Unilateral salpingo-oophorectomy was performed for 21 (32%) and omentectomy for 22 (34%) patients. Ten out of the 16 women under 40 years of age had fertility-sparing surgery. Peritoneal biopsies were taken in 16 (25%) women and lymphadenectomy was performed for 9 (14%) patients with clinical suspicion of invasive ovarian carcinoma. Frozen section was taken in half of the patients and the histology remained the same in 72% of the final pathology reports. No clear differences of the extent of surgical treatment were detected between different hospital categories. Overall cumulative 5-year relative survival rate was 96%., Conclusions: Bilateral salpingo-oophorectomy and hysterectomy was performed for the majority of patients with borderline ovarian tumor. More attention should be paid to adequate staging of borderline tumors in all hospital categories.

To assess the effect of different hospital types or surgical volume on the survival of ovarian cancer patients, a nationwide and population-based analysis was carried out in Finland. The study included all 3,851 ovarian cancer patients operated from 1983-94. The patients were classified according to the hospital of the first surgery. The hospitals were categorized by type (university, central or other hospital) and, separately, into quartiles by the number of operated patients (surgical volume). The patients operated at university hospitals had better survival than those operated in central hospitals, the 5-year relative survival rates (RSR) being 45% (95% CI = 42-48%) and 37% (34-40%), respectively. RSR in the 'other hospital' category was 45% (42-48%). The RSR for the patients operated in the highest volume hospitals was 47% (43-50%), and by decreasing volume (quartile) the RSR was 40% (36-43%), 40% (36-43%) and 42% (38-45%), respectively. After controlling for potential confounding by stage and age using regression models, the results remained practically the same. The results indicate that further centralizing of operative treatment of ovarian cancer may still improve survival rates on a population level in Finland., (Copyright 2002 Wiley-Liss, Inc.)