General Practice Surgeries Research Articles

The effect of obesity in laparoscopic transperitoneal adrenalectomy.

Laparoscopic adrenalectomy is the gold standard for the resection of adrenal tumors. However, there are some technical difficulties, which may be due to the fact that adrenalectomy is rarely encountered in general surgery practice and has a high learning curve. In addition to these, obesity is another problem in laparoscopic adrenalectomies. In the present study, it was aimed to evaluate whether obesity affects perioperative and postop- erative complications after laparoscopic adrenalectomy. This is a retrospective comparative study carried out between December 2008 and June 2018. A total of 65 patients who un- derwent laparoscopic transperitoneal adrenalectomy were divided into two groups according to their Body Mass Index (BMI). Patients' demographic data, perioperative and postoperative results were analyzed from hospital medical records. There were 30 non-obese and 35 obese patients. There was no significant difference between obese and non-obese patients in terms of op- eration time, peroperative complications and length of hospital stay. However, there was a statistically significant difference between the two groups for postoperative complications (p <0.031). There was conversion to open surgery in four obese patients and in one patient in the non-obese group. In obese patients, technical difficulties may be encountered during surgery due to increased adipose tissue, and postoperative complica- tion rates may increase. Nevertheless, laparoscopic transperitoneal adrenalectomy can be performed safely paying attention to the management of obesity-related complications.

Effect of depression awareness and management training on the attitudes of rural primary health care workers.

To measure the effect of depression awareness and management training on the attitudes of rural primary health care workers. A repeated measures design in which participants acted as their own controls. The training program occurred in 6 locations across rural South Australia. The study enrolled primary care workers in general practitioner surgeries, Aboriginal Community Controlled Health Organisations, community health centres, public hospitals, regional health services and non-government organisations. A six-session training workshop that was informed by the National Institute for Health and Care Excellence guidelines for the treatment and care of people with depression. The 22-item Revised Depression Attitude Questionnaire comprised the main outcome measure. Participants were assessed 12weeks before the training, again on the day of commencement of the training and after the training. Seventy-two primary health workers completed the training program in depression awareness, building therapeutic relationships, working with ambivalence, and goal setting. Between the 2 pre-training assessments mean scores showed no significant difference. There were statistically significant improvements on the overall attitudes and the subscales therapeutic optimism and professional confidence between pre-training and post-training. Training rural primary health care workers in depression may improve their attitudes to working with people living with depression.

Thriving or surviving? A critical examination of funding models for fellowship council fellowships.

Since 1997, the Fellowship Council (FC) has evolved into a robust organization responsible for the advanced training of nearly half of the US residency graduates entering general surgery practice. While FC fellowships are competitive (55% match rate) and offer outstanding educational experiences, funding is arguably vulnerable. This study aimed to investigate the current funding models of FC fellowships. Under an IRB-approved protocol, an electronic survey was administered to 167 FC programs with subsequent phone interviews to collect data on total cost and funding sources. De-identified data were also obtained via 2020-2021 Foundation for Surgical Fellowships (FSF) grant applications. Means and ranges are reported. Data were obtained from 59 programs (35% response rate) via the FC survey and 116 programs via FSF applications; the average cost to train one fellow per year was $107,957 and $110,816, respectively. Most programs utilized departmental and grants funds. Additionally, 36% (FC data) to 39% (FSF data) of programs indicated billing for their fellow, generating on average $74,824 ($15,000-200,000) and $33,281 ($11,500-66,259), respectively. FC data documented that 14% of programs generated net positive revenue, whereas FSF data documented that all programs were budget-neutral. Both data sets yielded similar overall results, supporting the accuracy of our findings. Expenses varied widely, which may, in part, be due to regional cost differences. Most programs relied on multiple funding sources. A minority were able to generate a positive revenue stream. Although fewer than half of programs billed for their fellow, this source accounted for substantial revenue. Institutional support and external grant funding have continued to be important sources for the majority of programs as well. Given the value of these fellowships and inherent vulnerabilities associated with graduate medical education funding, alternative grant funding models and standardization of annual financial reporting are encouraged.

892 Emergency General Surgical Practice at a District General Hospital during COVID-19 Pandemic: Implementing Royal College of Surgeons Guidance

IntroductionCOVID-19 pandemic had a significant impact on surgical practice across NHS. RCS released guidance on altering surgical practise during the pandemic to deliver safe surgical care in March, 2020. We present an audit conducted at a DGH comparing practice of emergency general surgery (EGS) with RCS guidance at the peak of COVID-19 pandemic.MethodConsecutive patients undergoing EGS from 1st April to 15th May,2020. Data of demographics, ASA grade, comorbidities, type of surgery, hospital stay, informed COVID-19 pneumonia consent, complications and 30-day mortality were collected. Pre- and post-operative COVID-19 status was determined.ResultsForty-four (n = 44) patients, mean age 47.5 and IQR (26-69). Male (55.8%) and females (44.2%). Preoperative COVID19 status was confirmed in around 79.1% patients. All (100%) patients who underwent CT imaging preoperatively had CT chest performed. Informed consent for COVID19 pneumonia was taken in 4.7% patients. 30-day mortality risk was 7% and complications risk was 4.7%. RR of 30-day mortality in preoperative COVID19 status positive patients was RR = 0.92 (CI 0.85-1.01) and for complications was RR = 0.95 (CI 0.88-1.02).ConclusionsRCS guidance on managing and altering practice in EGS during COVID-19 pandemic is reliable, implementable, and measurable in a DGH setting. Simple improvements in consent process can achieve full compliance with RCS guidelines.

Community-based aortic stenosis detection: clinical and echocardiographic screening during influenza vaccination

BackgroundDegenerative aortic stenosis (AS), the most common valvular heart disease in the Western world, is often diagnosed late when the mortality risk becomes substantial. We determined the feasibility of AS...

‘I’m just ringing to get a repeat prescription for my contraceptive pill, doctor’: developing authentic simulated telephone consultations for medical students

ABSTRACT Within normal surgery hours telephone consultations have been previously shown to make up between 10–20% of patient contacts with General Practitioners (GPs) and to comprise a large proportion of a GP’s daily workload. Although obviously very useful, such doctor–patient interactions can be fraught with risk. The General Medical Council (GMC) requires that newly graduated doctors should be adaptable to the challenge of delivering treatment advice and management remotely. Yet, currently, there is limited specific training in telephone consultation skills in both undergraduate and postgraduate curricula. Authentic and properly supervised exposure of medical students to GP telephone consultations can be difficult to achieve in clinical placements. Therefore, we have developed emergency telephone consultations within our primary care Safe and Effective Clinical Outcomes (SECO) clinics which are simulated GP surgeries organised for our final year students. We have expanded the range of patients presenting in these clinics by including trained, simulated patients requesting an urgent telephone consultation with a GP. In doing so we aim to enhance our student’s skills and confidence in conducting telephone consultations. This teaching exchange paper aims to describe the ideas behind the construction of simulated patient telephone scripts together with the difficulties and successes encountered in introducing telephone consultations into our GP SECO clinic. We hope these ideas and processes will stimulate and enable others to help students prepare for this challenging area of clinical medicine made increasingly significant by the Covid-19 pandemic.

The effect of Covid-19 on Emergency Surgical Cases. Data From a High-Volume City.

Objective COVID -19 placed a tremendous and unforeseen burden on the health system worldwide. In addition to the general surgery practice, the approach to emergency surgery cases, and patients’ admissions to the hospitals were also seriously affected by this unexpected consequence. Herein we aim to pay attention to the notable decrease in cases requiring urgent surgical intervention in our city and to try to explain this upshot. Methods In this multicenter retrospective study, emergency general surgical interventions performed in the 3rd and 2nd stage private and public hospitals, before the pandemic (January 2020- February 2020), and acute phase of the pandemic (Mid-March 2020 - Mid-May 2020) in Sakarya province were compared. Results The distribution of patients before pandemic by gender was 53.1% in male patients, 46.9% in female patients, while 61.6% in male, and 38.4% in female patients during the pandemic respectively. The mean age of patients was 54.72±3.65 before pandemic and 38.54±2.32 during the pandemic, and there was a statistically significant difference in terms of the age distribution of patients undergoing emergency surgery (p&amp;lt;0.05). During the two months before the pandemic, a total of 290 emergency surgeries were performed, while in the acute pandemic period, 164 emergency operations were performed in the same time interval. There was a statistically significant decrease in the number of patients undergoing emergency surgery during the pandemic period compared to non-pandemic (p= 0.012). Conclusion Although the causes for the decrease in cases requiring emergency surgery may be partially defined. However, the disease groups whose alteration reasons cannot be explained at the moment may need further detailed strategic preparation in order not to encounter undesired results in the future.

Mass Testing With Contact Tracing Compared to Test and Trace for the Effective Suppression of COVID-19 in the United Kingdom: Systematic Review.

BackgroundMaking testing available to everyone and tracing contacts might be the gold standard to control COVID-19. Many countries including the United Kingdom have relied on the symptom-based test and trace strategy in bringing the COVID-19 pandemic under control. The effectiveness of a test and trace strategy based on symptoms has been questionable and has failed to meet testing and tracing needs. This is further exacerbated by it not being delivered at the point of care, leading to rising cases and deaths. Increases in COVID-19 cases and deaths in the United Kingdom despite performing the highest number of tests in Europe suggest that symptom-based testing and contact tracing might not be effective as a control strategy. An alternative strategy is making testing available to all.ObjectiveThe primary objective of this review was to compare mass testing and contact tracing with the conventional test and trace method in the suppression of SARS-CoV-2 infections. The secondary objective was to determine the proportion of asymptomatic COVID-19 cases reported during mass testing interventions.MethodsLiterature in English was searched from September through December 2020 in Google Scholar, ScienceDirect, Mendeley, and PubMed. Search terms included “mass testing,” “test and trace,” “contact tracing,” “COVID-19,” “SARS-CoV-2,” “effectiveness,” “asymptomatic,” “symptomatic,” “community screening,” “UK,” and “2020.” Search results were synthesized without meta-analysis using the direction of effect as the standardized metric and vote counting as the synthesis metric. A statistical synthesis was performed using Stata 14.2. Tabular and graphical methods were used to present findings.ResultsThe literature search yielded 286 articles from Google Scholar, 20 from ScienceDirect, 14 from Mendeley, 27 from PubMed, and 15 through manual search. A total of 35 articles were included in the review, with a sample size of nearly 1 million participants. We found a 76.9% (10/13, 95% CI 46.2%-95.0%; P=.09) majority vote in favor of the intervention under the primary objective. The overall proportion of asymptomatic cases among those who tested positive and in the tested sample populations under the secondary objective was 40.7% (1084/2661, 95% CI 38.9%-42.6%) and 0.0% (1084/9,942,878, 95% CI 0.0%-0.0%), respectively.ConclusionsThere was low-level but promising evidence that mass testing and contact tracing could be more effective in bringing the virus under control and even more effective if combined with social distancing and face coverings. The conventional test and trace method should be superseded by decentralized and regular mass rapid testing and contact tracing, championed by general practitioner surgeries and low-cost community services.

Reasons for discontinuing urate-lowering treatment in community-dwelling adults with gout: results of a primary care-based cross-sectional study.

ObjectivesThe aim was to examine the prevalence of urate-lowering treatment (ULT) in community-dwelling adults with gout and the reasons for drug discontinuation.MethodsAdults with gout living in the East Midlands, UK, were mailed a postal questionnaire by their general practice surgery. It enquired about demographic details, co-morbidities, number of gout flares in the previous 12 months, current ULT and the reasons for discontinuing ULT if applicable. The number (percentage), median [interquartile range (IQR)] and mean (s.d.) were used for descriptive purposes. The Mann–Whitney U test and χ2 test were used for univariate analyses. STATA v.16 was used for data analysis. Statistical significance was set at P < 0.05.ResultsData for 634 gout patients [89.3% men, mean (s.d.) age 64.77 (12.74) years)] were included. Of the respondents, 59.8% self-reported taking ULT currently, with the vast majority (95.6%) taking allopurinol. Participants self-reporting current ULT experienced fewer gout flares in the previous 12 months than those who did not self-report current ULT [median (IQR) 0 (0–2) and 1 (0–3), respectively, P < 0.05]. One hundred and seven participants (16.9%) self-reported ULT discontinuation previously. The most commonly cited reasons for this were side-effects (29.7%), being fed up with taking tablets (19.8%) and lack of benefit from treatment or ULT-induced gout flares (19.8%). Treatment being stopped by the general practitioner without a clear reason known to the participant (15.8%) was another common report.ConclusionThis study identified patient-, physician- and treatment-related barriers to long-term ULT. These should be addressed when initiating ULT and during regular review. Further research is required to confirm these findings in other populations.

Physician Practice Leaders' Perceptions of Medicare's Merit-Based Incentive Payment System (MIPS).

BackgroundMedicare’s Merit-based Incentive Payment System (MIPS) is a major value-based purchasing program. Little is known about how physician practice leaders view the program and its benefits and challenges.ObjectiveTo understand practice leaders’ perceptions of MIPS.Design and ParticipantsInterviews were conducted from December 12, 2019, to June 23, 2020, with leaders of 30 physician practices of various sizes and specialties across the USA. Practices were randomly selected using the Medical Group Management Association’s membership database. Practices included small primary care and general surgery practices (1–9 physicians); medium primary care and general surgery practices (10–25 physicians); and large multispecialty practices (50 or more physicians). Participants were asked about their perceptions of MIPS measures; the program’s effect on patient care; administrative burden; and rationale for participation.Main MeasuresMajor themes related to practice participation in MIPS.Key ResultsInterviews were conducted with 30 practices representing all US census regions. Six major themes emerged: (1) MIPS is understood as a continuation of previous value-based payment programs and a precursor to future programs; (2) measures are more relevant to primary care practices than other specialties; (3) leaders are conflicted on whether the program improves patient care; (4) MIPS creates a substantial administrative burden, exacerbated by annual programmatic changes; (5) incentives are small relative to the effort needed to participate; and (6) external support for participation can be helpful. Many participants indicated that their practice only participated in MIPS to avoid financial penalties; some reported that physicians cared for fewer patients due to the program’s administrative burden.ConclusionsPractice leaders reported several challenges related to MIPS, including irrelevant measures, administrative burden, frequent programmatic changes, and small incentives. They held mixed views on whether the program improves patient care. These findings may be useful to policymakers hoping to improve MIPS.Supplementary InformationThe online version contains supplementary material available at 10.1007/s11606-021-06758-w.

Pre-operative testing and personal protective equipment in the operating room during a pandemic: A survey of Ontario general surgeons

The coronavirus disease 2019 (COVID-19) pandemic has had major implications for general surgery practice. We sought to characterize general surgeons' perceptions of their surgical practice in Ontario, Canada, regarding operating room precautions to maximize safety during the pandemic. A web-administered cross-sectional survey was sent to general surgeons registered with the College of Physicians and Surgeons of Ontario on May 19, 2020. Surgeons were surveyed regarding their practices in pre-operative severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) testing, use of intra-operative personal protective equipment (PPE) given a patient's COVID-19 status, and management of common general surgical emergencies with COVID-19 patients. Responses were compared between surgeons from high- and low-prevalence public health units (PHUs) in Ontario using chi-square tests. There were 81 respondents (rate: 81/271, 30%), 48 (59%) of whom were from a PHU in the top quartile of COVID-19 prevalence. Surgeons from low-prevalence PHUs reported pre-procedural COVID-19 testing rates similar to those reported in high-prevalence PHUs for elective (36% versus 55%), urgent (36% versus 54%), and emergent (20% versus 33%) surgeries. Seventy-eight percent of surgeons with COVID-19-negative patients limited trainees in the operating room compared with 96% of surgeons with COVID-19-positive patients. Use of N95 respirators was 17% for surgeons with COVID-19-negative patients, which dramatically increased to 62% for surgeons with patients whose COVID-19 status was unknown. These findings support a need for improved understanding of local disease prevalence and risk of COVID-19 transmission to conserve PPE and return surgical trainees to pre-pandemic standards.

Editorial on the article: Young surgeons entering the workforce in the City of Buenos Aires. Need for restructuring of the general surgery training system

In the article “Young surgeons entering the workforce in the City of Buenos Aires. Need for restructuring of the general surgery training system”1 published in this issue of Revista Argentina de Cirugia, Sarsur Fernandez et al. present two independent problems that are closely related. By means of a survey, the authors tried to find out whether the recent surgeon graduate trainees continued their practice in general surgery or moved to other specialties. Based on these results, they suggested modifying the residency system to optimize the allocation of resources.

How to prepare for academic leadership: scientific training curriculum.

Thoracic surgery has evolved into an independent discipline out of general surgery practice over the past decades. The development of the field of thoracic surgery was generated from surgeons being motivated to move this field forward by constant analysis and critical appraisal and review of current practice, as well as identification of new research approaches as the pool and generator of innovation. For this purpose, scientific skills are needed that are currently not covered during the surgical training. In the present overview, we will try to summarize important factors for an academic career, although none of these recommendations are validated and also not realistic to be uniquely applied to every geographical setting. Several key factors will be described being necessary for pursuing basic science, translational, and clinical research as a surgeon scientist introducing “from bench to bedside” research ideas into clinic and “from bedside to bench” bringing important clinical problems back to the lab.

COVID-19 survivor experiencing long-term symptoms

COVID-19 survivor experiencing long-term symptoms

At a glance: The impact of COVID‐19 on emergency general surgery

AbstractAimThis study investigated the impact of COVID‐19 on emergency general surgery practice particularly on referrals, diagnosis, investigations, management pathways, outcomes, patient behaviour and consultant practice.Patients and MethodsRetrospective data collection from two cohorts: 112 patients admitted over 1 week in pre‐COVID period and 90 patients admitted over 1 week during the COVID period. A patient questionnaire and a consultant questionnaire were used to collect data on patient behaviour and consultant practice.ResultsThe COVID period saw an almost four times and seven times increase in performed X‐rays (CXRs) and CT‐thorax–abdomen–pelvis (TAPs), respectively; 6.5% increase in conservative and 6.2% reduction in surgical management; approximately 50% decline in length of stay (LoS) in conservatively managed patients; 71% of patients' decisions to attend hospital were unaffected; and 78.6% of consultant surgeons preferred to manage patients conservatively.ConclusionOverall, there were delayed hospital presentations by patients by almost twice as long, an increase in paediatric referrals, a surge in performed scans, and a reduction in hospital stay in patients managed conservatively. Patient behaviour to attend hospital was not heavily influenced by COVID, but consultant practice certainly changed towards more conservative choices. Future studies should explore the impact on paediatric referrals and long‐term effects on surgical training.

Clarifying the Role of the Modern General Surgeon: The Effect of Specialization on Inpatient Practice Patterns in General Surgery

The growing concentration of fellowship-trained and integrated residency-trained subspecialty surgeons has encroached on the breadth and volume of a so-called "true" general surgery practice, leaving the role of new general surgeons in flux. We aimed to describe the surgical practice of new general surgeons with and without subspecialty fellowship training. In this retrospective cohort study, state discharge data was linked to American Medical Association Masterfile and American Hospital Association annual survey data. New-to-practice general surgeons with and without subspecialty board-certification in colorectal surgery (CRS) or cardiothoracic surgery (CTS) were identified in 2008, and followed over 10 years. Surgeon overall inpatient case volume, colorectal resection case volume, and thoracic lobectomy case volume were compared between surgeons with and without related subspecialty training. NY and FL (2008-2017). The study population included 276 new-to-practice surgeons with mean age of 36.9 years. New-to-practice surgeons were defined as those with zero to three years of experience in 2008. Of all surgeons, 11.2% were subspecialty board-certified in CRS and 11.6% were subspecialty board-certified in CTS. Board-certified CRS surgeons performed more colorectal resections than the non-CRS general surgeons each year (p-value <0.001 for all). Overall, non-CRS general surgeons performed 60.7% of all colorectal resections. Board-certified CTS surgeons performed more thoracic lobectomies than non-CTS surgeons each year. Non-CTS surgeons performed 1.1% of all thoracic lobectomies. On average, new subspecialty surgeons perform significantly more specialty operations than non-subspecialty new general surgeons. However, as a group, new non-colorectal general surgeons perform the majority of colorectal resections. In contrast, new non-cardiothoracic general surgeons perform less than two percent of the thoracic lobectomies. This may have implications for a shift in the training paradigm going forward.

Immunogenicity of the UK group B meningococcal vaccine (4CMenB) schedule against groups B and C meningococcal strains (Sched3): outcomes of a multicentre, open-label, randomised controlled trial

The use of the multicomponent meningococcal vaccine 4CMenB in the UK schedule at 2, 4, and 12 months of age has been shown to be 59·1% effective at preventing invasive group B meningococcal disease. Here, we report the first data on the immunogenicity of this reduced-dose schedule to help to interpret this effectiveness estimate. In this multicentre, parallel-group, open-label, randomised clinical trial, infants aged up to 13 weeks due to receive their primary immunisations were recruited via child health database mailouts in Oxfordshire and via general practice surgeries in Gloucestershire and Hertfordshire. Infants were randomly assigned (1:1) with permuted block randomisation to receive a 2 + 1 (2, 4, and 12 months; group 1) or 1 + 1 (3 and 12 months; group 2) schedule of the 13-valent pneumococcal conjugate vaccine (PCV13). All infants also received 4CMenB at 2, 4, and 12 months of age, and had blood samples taken at 5 and 13 months. Participants and clinical trial staff were not masked to treatment allocation. Proportions of participants with human complement serum bactericidal antibody (hSBA) titres of at least 4 were determined for group B meningococcus (MenB) reference strains 5/99 (Neisserial Adhesin A [NadA]), NZ98/254 (porin A), and 44/76-SL (factor H binding protein [fHbp]). Geometric mean titres (GMTs) with 95% CIs were also calculated, and concomitant vaccine responses (group C meningococcus [MenC], Haemophilus influenzae b [Hib], tetanus, diphtheria, and pertussis) were compared between groups. The primary outcome was PCV13 immunogenicity, with 4CMenB immunogenicity and reactogenicity as secondary outcomes. All individuals by randomised group with a laboratory result were included in the analysis. The study is registered on the EudraCT clinical trials database, 2015-000817-32, and ClinicalTrials.gov, NCT02482636, and is complete. Between Sept 22, 2015, and Nov 1, 2017, of 376 infants screened, 213 were enrolled (106 in group 1 and 107 in group 2). 204 samples post-primary immunisation and 180 post-boost were available for analysis. The proportion of participants with hSBA of at least 4 was similar in the two study groups. For strain 5/99, all participants developed hSBA titres above 4 in both groups and at both timepoints. For strain 44/76-SL, these proportions were 95·3% (95% CI 88·5-98·7) or above post-priming (82 of 86 participants in group 1), and 92·4% (84·2-97·2) or above post-boost (73 of 79 participants in group 1). For strain NZ98/254, these proportions were 86·5% (78·0-92·6) or above post-priming (83 of 96 participants in group 2) and 88·6% (79·5-94·7) or above post-boost (70 of 79 participants in group 1). The MenC rabbit complement serum bactericidal antibody (rSBA) titre in group 1 was significantly higher than in group 2 (888·3 vs 540·4; p=0·025). There was no significant difference in geometric mean concentrations between groups 1 and 2 for diphtheria, tetanus, Hib, and pertussis post-boost. A very small number of children did not have a protective response against 44/76-SL and NZ98/254. Local and systemic reactions were similar between the two groups, apart from the 3 month timepoint when one group received an extra dose of PCV13 and recorded more systemic reactions. These data support the recent change to the licensed European schedule for 4CMenB to add an infant 2 + 1 schedule, as used in the routine UK vaccine programme with an effectiveness of 59·1%. When compared with historical data, our data do not suggest that effectiveness would be higher with a 3 + 1 schedule, however a suboptimal boost response for bactericidal antibodies against vaccine antigen fHbp suggests a need for ongoing surveillance for vaccine breakthroughs due to fHbp-matched strains. Changing from a 2 + 1 to a 1 + 1 schedule for PCV13 for the UK is unlikely to affect protection against diphtheria, tetanus, and Hib, however an unexpected reduction in bactericidal antibodies against MenC seen with the new schedule suggests that ongoing surveillance for re-emergent MenC disease is important. Bill & Melinda Gates Foundation and the National Institute for Health Research.

Inguinal hernia repair via laparoscopic transabdominal preperitoneal (TAPP) method: Our 2 years clinical results

Aim: Inguinal hernia repair is one of the most common surgeries in General Surgery practice. Although different surgical procedures have been used for the treatment of hernias, minimally invasive approaches are increasingly preferred to manage hernia repair. The aim of this study is to evaluate our 2-year laparoscopic transabdominal preperitoneal (TAPP) hernia repair outcomes. Materials and Methods: The data of patients who were diagnosed with inguinal hernia and who underwent the TAPP procedure between the dates of December 2017 and December 2019 were evaluated retrospectively.Results: Ninety-six patients were included in this study. Of these patients, 89 were male and 7 were female. The mean age was 46 (range between 22 and 76). Fifty six (58.3%) cases had right inguinal hernia, 22 (22.9%) cases had left inguinal hernia and 18 (18.7%) cases had bilateral inguinal hernia. The mean hospital stay was 1.06 (1-3) days. In the early postoperative period we observed for minor complications such as seroma, hydrocele, epididymitis, and hematoma. Three patients experienced chronic pain. Recurrence was observed in 3 patients during follow-up. No major complications were seen.Conclusion: Laparoscopic hernia repair is an efficient and attractive method because it offers better cosmetic results, earlier recovery, less pain, shortened hospital stay and early return to daily activities. However, the learning process for performing this procedure is more difficult than for the open method. Therefore, the learning curve of laparoscopic hernia surgery is longer. It has been reported that there is a difference in the rate of recurrence in surgeons trained in the laparoscopic method after specialization. We believe that this method can be applied safely by people who have received laparoscopic hernia surgery training.

The role of monocyte to lymphocyt ratio in predicting metastasis in rectal cancer

Aim: A lot of studies are being carried out to predict recurrence and metastasis in rectal cancer, which is a common type of cancer in general surgery practice. It is thought that MLR (monocyte to lymphocyte ratio) , an indice developed by division of monocyte count by lymphocyte count, may be a good marker to reflect the degree of tumor progression and predict prognosis. In our study, we investigated the role of MLR in predicting metastasis in rectal cancer.Materials and Methods: Fifty-seven patients diagnosed with rectal cancer in the Abant Izzet Baysal University general surgery clinic between 2012 and 2016 were retrospectively investigated. Albumin, CRP(C reactive protein), Platelet, Neutrophil, Lymphocyte, Monocyte values were obtained as the inflammatory markers in the blood count test of the patients before neoadjuvant treatment.Results: In this study, 25 patients who underwent neoadjuvant chemoradiotherapy and underwent full postoperative follow-up were evaluated. Eight of these 25 patients had metastasis until June 2019. There was a significant difference in monocyte and MLR values between groups with and without metastasis.Conclusion: This study is presented as a preliminary study. In our study, we showed that MLR value which measured before neoadjuvant therapy in rectum cancer patients may be useful in predicting metastasis development.

Mental health and caregiving experiences of family carers supporting people with psychosis.

Family carers supporting an individual with psychosis often experience poorer mental health, however, little is known about specific risk factors among these carers. We investigated the associations between demographic, caregiving characteristics and mental health outcomes in family carers supporting an individual with psychosis and compared carers' outcomes with general population norms. We analysed baseline data from the COPe-support randomised controlled trial of online psychoeducation and peer support for adult carers supporting an individual with psychosis between 2018 and 2020. We collected carers' demographic and health outcome data, including wellbeing using Warwick-Edinburgh Mental Wellbeing Scale (WEMWBS as primary outcome), quality of life using EQ-5D-5L and caregiving experience assessed with Experience of Caregiving Inventory. We tested associations between carers' demographic and caregiving characteristics for each outcome in turn and meta-analysed carers' WEMWBS and EQ-5D-5L with Health Survey England (HSE) general population data from 2016 and 2017, respectively. The 407 carers of people with psychosis had a mean WEMWBS score of 42.2 (s.d. 9.21) and their overall weighted pooled WEMWBS score was 7.3 (95% confidence interval (CI) -8.6 to -6.0, p < 0.01) lower than the HSE general population sample, indicating carers have poorer mental wellbeing by more than double the minimum clinically important difference of 3 points on WEMWBS. Among all caring relationships, partners had poorer wellbeing compared to parents with lower WEMWBS score (-6.8, -16.9 to 3.3, p = 0.03). Single carers had significantly poorer wellbeing (-3.6, -5.6 to -1.5, p < 0.01) and a more negative caregiving experience than those who were cohabiting. Spending more than 35 h per week caregiving increased carers' negative experience significantly (p = 0.01). Carers of people with psychosis have poorer mental health than non-carers. Partners, lone carers and those spending more than 35 h per week on caring were found to be most at risk of poor mental health. Based on the results, we advocate that the details of carers for individuals with psychosis should be added to the existing carers or severe mental illness registers at all general practitioner surgeries and for their wellbeing screened routinely. Future large-scale prospective studies are needed to develop a predictive model to determine risk factors, hence to aid early identification of carers' support needs. Such understandings are also useful to inform tailored intervention development.