Welcome to my blog on surgery and related sciences. Here I will express views on the art and science of surgery in general. Any comments and thoughts are most welcomed.

Saturday 21 December 2013

Freebies from the BJS: Emergency surgery issue launched hot from the press!!!

Now it is available for access and free download: The themed Emergency surgery issue is now published on the BJS website and can be searched up in Pubmed.

Go to this link to access the content!

Have a Merry Xmas everyone!!!



Volume 101 Issue 1 (January 2014)

Leading articles

Improving outcomes in emergency surgery 

  • Author:A. Bergenfelz, K. Søreide
  • Published: Nov 27, 2013
  • Pages: e1-e2

Barriers, regulations and solutions in emergency surgery research 

  • Author:T. J. Coats
  • Published: Nov 25, 2013
  • Pages: e3-e4

Checklists and crisis management in surgical emergencies 

  • Author:K. Ram, M. A. Boermeester
  • Published: Nov 13, 2013
  • Pages: e5-e6

Organization of emergency surgery 

  • Author:A. Leppäniemi
  • Published: Nov 13, 2013
  • Pages: e7-e8

Reviews

Global disease burden of conditions requiring emergency surgery 

  • Author:B. Stewart, P. Khanduri, C. McCord, M. Ohene‐Yeboah, S. Uranues, F. Vega Rivera, C. Mock
  • Published: Nov 25, 2013
  • Pages: e9-e22

Commentary

Global disease burden of conditions requiring emergency surgery ( Br J Surg 2014; 101: e9–e22) 

  • Author:R. T. Petroze
  • Published: Dec 12, 2013
  • Pages: e23-e23

Reviews

Contemporary management of abdominal surgical emergencies in infants and children 

  • Author:L. W. E. van Heurn, M. P. Pakarinen, T. Wester
  • Published: Nov 29, 2013
  • Pages: e24-e33

Multidisciplinary management strategies for acute non‐variceal upper gastrointestinal bleeding 

  • Author:Y. Lu, R. Loffroy, J. Y. W. Lau, A. Barkun
  • Published: Nov 26, 2013
  • Pages: e34-e50

Strategies to improve the outcome of emergency surgery for perforated peptic ulcer 

  • Author:K. Søreide, K. Thorsen, J. A. Søreide
  • Published: Nov 29, 2013
  • Pages: e51-e64

Staged multidisciplinary step‐up management for necrotizing pancreatitis 

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Saturday 30 November 2013

Abdominal emergencies in children - free paper

Please access this link to read the full text paper on "Contemporary management of acute abdominal emergencies in infants and children" just published in the BJS and free to access online.

The paper deals with update info on acute appendicitis, hernia, intestinal malrotation and/or strangulation, pyloric stenosis, intussusception and a handful of other conditions that may present to the general surgeon on call.

Illustration of malrotation, from the paper by van Heurn and colleagues in the BJS. Source: 
British Journal of Surgery 29 NOV 2013 DOI: 10.1002/bjs.9335http://onlinelibrary.wiley.com/doi/10.1002/bjs.9335/full#bjs9335-fig-0001

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Coming up: Emergency surgery issue in the BJS

A collective sieries on emergency surgery conditions will be launched in the January issue of the BJS. All papers will be free to access, either via PubMed searches or direct through the BJS website (or, most conveniently probably by downloading the BJS app for iPad, makes it easier to read on your tablet).

A leader to introduce the series has recently been launched and can be accessed here.

I will try to introduce some of the papers as they are real eased early online - I believe there are plenty material that will be of great use and interest to a worldwide readership.

Excited to have your response as we go!

Cheers,

Kjetil


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Friday 8 November 2013

Centenary Talks given at ASGBI, Glasgow and ACS, Washington 2013

Related to the BJS centenary a symposium was held at the International Surgical Congress of the Associations of Surgeons of Great Britain & Ireland in Glasgow, May 2013. You can find all the lectures to the ASGBI 2013 BJS Symposium: 100 years of BJS by going to the BJS website.
Also, a co-anniversary was held in Washington DC, marking the 100 years of both the BJS and the American College of Surgeons. The symposium can be view in entirety here.
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Saturday 26 October 2013

International collaboration in surgical research: Lancet paper

The Lancet
I very recently had the privilege to be leading a group of authors under the acronym IRIS working group (Int'l Research collaboration In Surgery) to produce a report on the current state of research collaboration across borders in surgery and suggestions as to how this can be improved for the future.
Considering the huge number of surgeries performed worldwide each year - it is estimated at 245 million operations, and not taking into account that a large part of surgeons' work consists also of non-operative management of surgical disease - the number of patients that are accrued or contributing to trials is a mere minimum, likely far below 1% of all surgeries performed.

In the paper it is being discussed the different types of strategies that can be explored to increase collaboration and involvement in research for surgeons. Obviously this is but a starting point and there is a lot more to be said and even more to be done to rectify the current state of surgical trial activity.

You can read the full paper at the Lancet or search the reference at the bottom page here.

Please do get in contact should you have any ideas or would like to get involved from your part in this.
You can send me any note (or request for the full paper) through this link.

The Lancet, Volume 382, Issue 9898, Pages 1140 - 1151, 28 September 2013, doi:10.1016/S0140-6736(13)61455-5.

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Friday 27 September 2013

Lymph nodes in colon cancer

For patients undergoing curative resections for colon cancer, the nodal status (presence or not of metastatic cells in the lymph nodes) represents the strongest prognostic factor, yet at the same time it is one of the most disputed issues as well in colorectal cancer staging. We have investigated this topic over the past several years (see references 1-6 listed below).
You can read the fulltext article on qualitative and quantitative aspects of lymph nodes in colon cancer here.
reproduced from Veen et al. Dig Surg, 2013


As a consequence of this ongoing dispute, the qualitative and quantitative aspects of lymph node evaluation are being scrutinized beyond the blunt distinction between 'node positive' (pN+) and 'node negative' (pN0) disease. 

Controversy ranges from a minimal or 'least-unit' strategy as exemplified by the 'sentinel node' (see f.ex. reference 3 below) to a maximally invasive or 'all inclusive' approach by extensive surgery. 
Ranging between these two extremes of node sampling strategies are factors of quantitative and qualitative value, which may be subject to modification. 
reproduced from Veen et al. Dig Surg, 2013.

 Qualitative issues may include aspects of lymph node harvest reflected by surgeon, pathologist and even hospital performance, which all may be subject to modification. However, patient's age, gender and genotype may be non-modifiable, yet influence node sample. 

 Quantitative issues may reflect the balance between absolute numbers and models investigating the relationships of positive to negative nodes (lymph node ratio; log odds of positive lymph nodes).

 Read the full text article (link is available above) and let me know your opinion on this!

1: Berg M, Guriby M, Nordgård O, Nedrebø BS, Ahlquist TC, Smaaland R, Oltedal S, 
Søreide JA, Kørner H, Lothe RA, Søreide K. Influence of microsatellite
instability, KRAS and BRAF mutations on lymph node harvest in stage I-III colon
cancers. Mol Med. 2013 Aug 21. doi: 10.2119/molmed.2013.00049. [Epub ahead of
print] PubMed PMID: 23979710. 

2: Veen T, Nedrebø BS, Stormark K, Søreide JA, Kørner H, Søreide K. Qualitative
and Quantitative Issues of Lymph Nodes as Prognostic Factor in Colon Cancer. Dig Surg. 2013 Apr 10;30(1):1-11.  


3: Nordgård O, Oltedal S, Aasprong OG, Søreide JA, Søreide K, Tjensvoll K, Gilje 
B, Heikkilä R, Guriby M, Lothe RA, Smaaland R, Kørner H. Prognostic relevance of 
occult metastases detected by cytokeratin 20 and mucin 2 mRNA levels in sentinel 
lymph nodes from colon cancer patients. Ann Surg Oncol. 2012 Nov;19(12):3719-26. 
doi: 10.1245/s10434-012-2454-8. Epub 2012 Jul 3. PubMed PMID: 22752373. 


4: Søreide K. Lymph node evaluation for colon cancer. JAMA. 2011 Dec
28;306(24):2669; author reply 2669. doi: 10.1001/jama.2011.1882. PubMed PMID:
22203534. 


5: Nedrebø BS, Søreide K, Nesbakken A, Eriksen MT, Søreide JA, Kørner H;
Norwegian Colorectal Cancer Group. Risk factors associated with poor lymph node
harvest after colon cancer surgery in a national cohort. Colorectal Dis. 2013
Jun;15(6):e301-8. doi: 10.1111/codi.12245. PubMed PMID: 23582027. 


6: Søreide K, Nedrebø BS, Søreide JA, Slewa A, Kørner H. Lymph node harvest in
colon cancer: influence of microsatellite instability and proximal tumor
location. World J Surg. 2009 Dec;33(12):2695-703. doi: 10.1007/s00268-009-0255-4.
PubMed PMID: 19823901.
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Tuesday 25 June 2013

BJS news: new website, new app and the newest impact factor!

IF is out today and BJS is climbing! Although not yet back at the all-time-high in 2008 (at 4.921) it is currently at 4.839.

We are now second overall! (Only after Annals - which continues to decrease considerably, from 7.49 to 6.33 = biggest drop in the category!).

Excluding the others in the "surgery" category (some of which are really not competitors, such as Am J Surg Pathol, Endoscopy and Am J Transplant):

Third place is held by JACS (steady from last year at 4.5),
Surg Obest Rel Dis has increased to 4.12
Ann Surg Oncol, steady at 4.12
Archives declined from 4.4 to 4.1
Surgery declined to 3.3….etc etc

This just to give a few details form the surgical field of the IF.

Good thing is that we are among the very few top surgical journals with an increase (and in IF, when several others see no progress or even continued decline! For what it' worth (yes, IF is not everything) I think it is a sign of the efforts put into the Journal (I hope).

Next year we'll break the 5.0 barrier!

 And... the newly refreshed web-page of the BJS is out, please click here for a view!

 Finally, and a much awaited tool for BJS readers, is the new BJS app for iPad, which is downloadable at the BJS homepage, or through this link here.


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Sunday 16 June 2013

Frontiers | Using Patient-Reported Outcome Measures for Improved Decision-Making in Patients with Gastrointestinal Cancer – the Last Clinical Frontier in Surgical Oncology? | Frontiers in Surgical Oncology

Frontiers | Using Patient-Reported Outcome Measures for Improved Decision-Making in Patients with Gastrointestinal Cancer – the Last Clinical Frontier in Surgical Oncology? | Frontiers in Surgical Oncology
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Patient-reported outcome measures (PROMs)

Patient reported data (PROMs) is the "new wine" in clinical research. It is not really new, but increased focus on the patient-reported outcomes has gained increased interest from both the point of decision-makers as well as the public itself. Doctors used to make decisions based on the risk-benefit ratio of morbidity/mortality to the gains in health intervention (and off course, still do) but now comes the added value of information obtained from the patient itself. Indeed, it might be so that patients evaluate and appreciate certain risks and benefits different than the doctor, and then this should be incorporated into the decision making process.
From Søreide & Søreide, Frontiers Oncology 2013.
We have currently published to papers dealing with PROMs. One is a perspectives article published in Frontiers in Surgical Oncology (To view the online publication, please click here: article).

Using patient-reported outcome measures for improved decision-making in patients with gastrointestinal cancer – the last clinical frontier in surgical oncology?
Kjetil Søreide1,2* and Annbjørg H. Søreide3


Front. Oncol. 3:157. doi: 10.3389/fonc.2013.00157


The other one is an article investigating PROMs in patients undergoing ERCP. In short, although a high number of patients experienced pain during the procedure, the vast majority were satisfied with the procedure and treatment. However, the findings gives reason to investigate how sedation procedures can be optimized during ERCP. The abstract can be found at (abstract).


Patient-reported outcome measures after endoscopic retrograde cholangiopancreatography: a prospective, multicentre study.Glomsaker TB, Hoff G, Kvaløy JT, Søreide K, Aabakken L, Søreide JA; On behalf of the Norwegian Gastronet ERCP group.
 2013 May 31. [Epub ahead of print]

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Saturday 8 June 2013

Trauma epidemiology in Norway

Another PhD is done and dusted... 
It was a pleasure to attend this week's dissertation in Oslo when Thomas Kristiansen defended his thesis "Epidemiology and management of traumatic injuries: a population-based study of fatal trauma and assessment of geographical challenges in the organisation of trauma care " at the Diaconess Hospital. Great job and work well done! I've had the pleasure of being co-supervisor and co-author on several of his works. The first paper we co-wrote was on trauma systems in the Nordic countries (Trauma systems and early management of severe injuries in Scandinavia: review of the current state.) 
From T Kristiansen et al  2010 May;41(5):444-52. doi: 10.1016/j.injury.2009.05.027. Epub 2009 Jun 21.
Thomas has later published a series of paper (one yet to be published, but is now in final revisions) that constitutes the material for his thesis and PhD:
1: Kristiansen T, Rehn M, Gravseth HM, Lossius HM, Kristensen P. Paediatric trauma mortality in Norway: a population-based study of injury characteristics and urban-rural differences
trauma mortality in Norway: a population-based study of injury characteristicsand urban-rural differences. Injury. 2012 Nov;43(11):1865-72. doi:
10.1016/j.injury.2011.08.011. Epub 2011 Sep 21. PubMed PMID: 21939971.
2: Kristiansen T, Ringdal KG, Skotheimsvik T, Salthammer HK, Gaarder C, Naess PA,
Lossius HM. Implementation of recommended trauma system criteria in south-eastern Norway: a cross-sectional hospital surveyNorway: a cross-sectional hospital survey. Scand J Trauma Resusc Emerg Med. 2012
Jan 26;20:5. doi: 10.1186/1757-7241-20-5. PubMed PMID: 22281020; PubMed Central
PMCID: PMC3285082.
3: Kristiansen T, Lossius HM, Søreide K, Steen PA, Gaarder C, Næss PA. Patients Referred to a Norwegian Trauma Centre: effect of transfer distance on injury patterns, use of resources and outcomesReferred to a Norwegian Trauma Centre: effect of transfer distance on injurypatterns, use of resources and outcomes. J Trauma Manag Outcomes. 2011 Jun
16;5(1):9. doi: 10.1186/1752-2897-5-9. PubMed PMID: 21679393; PubMed Central
PMCID: PMC3135518.
4: Thomas Kristiansen, Hans M Lossius, Marius Rehn, Petter
Kristensen, Hans M Gravseth, Jo Røislien and Kjetil Søreide. Epidemiology of Trauma: a population-based study of geographical risk factors for injury deaths in the working-age population of Norway. (in press soon)

Thomas K. (far left) together with the members of the evaluation committee - and after having received the final verdict! Sigh of relief!


 In addition to the work above I have previously investigated aspects of trauma epidemiology from other perspectives. One of the earliest experiences was to investigate the epidemiology of trauma deaths in our region (Stavanger area) which was published in World J Surg, 2007. In this paper, and in subsequent correspondence (Injury 2008; World J Surg 2010) and editorial work (BJS 2009), we discussed the principle of the "trimodal temporal death distribution", which I believe is a great educational model for explaining the temporal differences in relation to death causes (i.e immediate death usually occurs from non-salvagable bleeding or brain damage, most frequently outside hospital and following the accident/incident; early deaths occur from rapid bleeding that is not stopped or brain injuries not intervened on; later deaths may occur from insults to the brain, and the final mode of death is from the organ failures that follows the initial injuries). While serving a purpose as educational tool, it is simplified and obviously there is great overlap in modes and time-phrames that the researcher needs to see in relation. Also, the distribution will change somewhat from region to region, depending on the dominating mechanisms of trauma etc. If you'd like to know more details oabout this, please seek up any of the refs below or fell free to send me an email for a reprint (ksoreide@mac.com):

 
1: Søreide K. Temporal patterns of death after trauma: evaluation of circadian,
diurnal, periodical and seasonal trends in 260 fatal injuries. Scand J Surg.
2010;99(4):235-9. PubMed PMID: 21159595.

2: Søreide K. Epidemiology of trauma deaths: location, location, location! World 
J Surg. 2010 Jul;34(7):1720-1; author reply 1722-3. doi:
10.1007/s00268-010-0434-3. PubMed PMID: 20112018.

3: Meling T, Harboe K, Søreide K. Incidence of traumatic long-bone fractures
requiring in-hospital management: a prospective age- and gender-specific analysis
of 4890 fractures. Injury. 2009 Nov;40(11):1212-9. doi:
10.1016/j.injury.2009.06.003. Epub 2009 Jul 5. PubMed PMID: 19580968.

4: Søreide K. Epidemiology of major trauma. Br J Surg. 2009 Jul;96(7):697-8. doi:
10.1002/bjs.6643. PubMed PMID: 19526611.

5: Søreide K, Krüger AJ, Ellingsen CL, Tjosevik KE. Pediatric trauma deaths are
predominated by severe head injuries during spring and summer. Scand J Trauma
Resusc Emerg Med. 2009 Jan 22;17:3. doi: 10.1186/1757-7241-17-3. PubMed PMID:
19161621; PubMed Central PMCID: PMC2637226.

6: Krüger AJ, Søreide K. Trimodal temporal distribution of fatal trauma--fact or 
fiction? Injury. 2008 Aug;39(8):960-1; author reply 961-2. doi:
10.1016/j.injury.2008.01.007. Epub 2008 Jun 30. PubMed PMID: 18586249.

7: Søreide K, Krüger AJ, Vårdal AL, Ellingsen CL, Søreide E, Lossius HM.
Epidemiology and contemporary patterns of trauma deaths: changing place, similar 
pace, older face. World J Surg. 2007 Nov;31(11):2092-103. PubMed PMID: 17899256.
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Monday 6 May 2013

Success in the Stavanger Surgical Research Group

My absence from the blog recently is due to an extensive work load over the past few months, yet with a pleasure twist, as three of the candidates in our research group have defended their PhD thesis over the past several weeks. Here are the summaries and brief overview of the champs!
Terje Meling MD defended his thesis on "Implementation of a fracture and dislocation registry. Epidemiology and scoring validity of long-bone fractures" based on the publications:
Reliable classification of children's fractures according to the comprehensive classification of long bone fractures by Müller.
Meling T, Harboe K, Enoksen CH, Aarflot M, Arthursson AJ, Søreide K.
Acta Orthop. 2013 Apr;84(2):207-12. doi: 10.3109/17453674.2012.752692. Epub 2012 Dec 18.
How reliable and accurate is the AO/OTA comprehensive classification for adult long-bone fractures?
Meling T, Harboe K, Enoksen CH, Aarflot M, Arthursson AJ, Søreide K.
J Trauma Acute Care Surg. 2012 Jul;73(1):224-31. doi: 10.1097/TA.0b013e31824cf0ab.
Steppingstones to the implementation of an inhospital fracture and dislocation registry using the AO/OTA classification: compliance, completeness and commitment.
Meling T, Harboe K, Arthursson AJ, Søreide K.
Scand J Trauma Resusc Emerg Med. 2010 Oct 18;18:54. doi: 10.1186/1757-7241-18-54.
Incidence of traumatic long-bone fractures requiring in-hospital management: a prospective age- and gender-specific analysis of 4890 fractures.
Meling T, Harboe K, Søreide K.
Injury. 2009 Nov;40(11):1212-9. doi: 10.1016/j.injury.2009.06.003.

 Tom Glomsaker MD defended his work on the use of ERCP in Norway, with the thesis entitled "ERCP in Norway. Patterns of activity and undesired events " and based on the publications as follows:

Patterns and predictive factors of complications after endoscopic retrograde cholangiopancreatography.
Glomsaker T, Hoff G, Kvaløy JT, Søreide K, Aabakken L, Søreide JA; Norwegian Gastronet ERCP Group.
Br J Surg. 2013 Feb;100(3):373-80. doi: 10.1002/bjs.8992. Epub 2012 Dec 6.
Contemporary use of endoscopic retrograde cholangiopancreatography (ERCP): a Norwegian prospective, multicenter study.
Glomsaker T, Søreide K, Hoff G, Aabakken L, Søreide JA; Norwegian Gastronet ERCP group.
Scand J Gastroenterol. 2011 Sep;46(9):1144-51. doi: 10.3109/00365521.2011.594085. 
A national audit of temporal trends in endoscopic retrograde cholangiopancreatography in Norway.
Glomsaker T, Søreide K, Aabakken L, Søreide JA.
Scand J Gastroenterol. 2011 Jan;46(1):116-21. doi: 10.3109/00365521.2010.513063. Epub 2010 Aug 24. Erratum in: Scand J Gastroenterol. 2011 Jan;46(1):121.

In addition, a fourth study on patient-reported outcomes will be published sson in the Scand J Gastroenterology from this project.

And , last but not least, Bjørn Steinar Nedrebø MD, defended his thesis on "Colorectal Cancer in Norway - National Treatment Guidelines and Outcomes " of which his work is based on the publications :
Bjørn Steinar Nedrebø
Risk factors associated with poor lymph node harvest after colon cancer surgery in a national cohort.
Nedrebø B, Søreide K, Nesbakken A, Eriksen M, Søreide J, Kørner H; The Norwegian Colorectal Cancer Group.
Colorectal Dis. 2013 Apr 13. doi: 10.1111/codi.12245. [Epub ahead of print]

Excess mortality after curative surgery for colorectal cancer changes over time and differs for patients with colon versus rectal cancer.
Nedrebø BS, Søreide K, Eriksen MT, Kvaløy JT, Søreide JA, Kørner H.
Acta Oncol. 2012 Oct 29. [Epub ahead of print]


Survival effect of implementing national treatment strategies for curatively resected colonic and rectal cancer.
Nedrebø BS, Søreide K, Eriksen MT, Dørum LM, Kvaløy JT, Søreide JA, Kørner H; Norwegian Colorectal Cancer Registry.
Br J Surg. 2011 May;98(5):716-23. doi: 10.1002/bjs.7426. Epub 2011 Feb 21.

Congrats and well done!!!
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