General Practice Surgeries Research Articles

Probiotics for preventing and treating infant regurgitation: A systematic review and meta-analysis.

Infant regurgitation is common during infancy and can cause substantial parental distress. Regurgitation can lead to parental perception that their infant is in pain. Parents often present in general practitioner surgeries, community baby clinics and accident and emergency departments which can lead to financial burden on parents and the health care system. Probiotics are increasingly reported to have therapeutic effects for preventing and treating infant regurgitation. The objective of this systematic review and meta‐analysis was to evaluate the efficacy of probiotic supplementation for the prevention and treatment of infant regurgitation. Literature searches were conducted using MEDLINE, CINAHL, and the Cochrane Central Register of Controlled trials. Only randomised controlled trials (RCTs) were included. A meta‐analysis was performed using the Cochrane Collaboration methodology where possible. Six RCTs examined the prevention or treatment with probiotics on infant regurgitation. A meta‐analysis of three studies showed a statistically significant reduction in regurgitation episodes for the probiotic group compared to the placebo group (mean difference [MD]: −1.79 episodes/day: 95% confidence interval [CI]: −3.30 to −0.27, N = 560), but there was high heterogeneity (96%). Meta‐analysis of two studies found a statistically significant increased number of stools per day in the probiotic group compared to the placebo group at 1 month of age (MD: 1.36, 95% CI: 0.99 to 1.73, N = 488), with moderate heterogeneity (69%). Meta‐analysis of two studies showed no statistical difference in body weight between the two groups (MD: −91.88 g, 95% CI: 258.40–74.63: I 2 = 23%, N = 112) with minimal heterogeneity 23%. Probiotic therapy appears promising for infant regurgitation with some evidence of benefit, but most studies are small and there was relatively high heterogeneity. The use of probiotics could potentially be a noninvasive, safe, cost effective, and preventative positive health strategy for both women and their babies. Further robust, well controlled RCTs examining the effect of probiotics for infant regurgitation are warranted.

General surgery practice in Aceh rural hospital during the COVID-19 pandemic: a descriptive cross-sectional study

Background: COVID-19 pandemic is one of the biggest issues that we have faced and has had a significant impact on healthcare practice worldwide. Increasing COVID-19 cases requires the surgical department to reorganize all the patient treatment to prevent infection. This study aims to find out the pattern of general surgery care during the COVID-19 pandemic compared to the non COVID-19 period and to know better to prepare for surgical patients' treatment in the future.Method: This is a descriptive cross-sectional study. We studied the important points of a complete range of the patient at the department of surgery outpatient, inpatient, and operation theatre of Datu Beru Hospital from 1 March 2020 to 31 December 2020 for the COVID period and 1 March 2019 to 31 December 2019 for the non-COVID period.Result: There were 2822 outpatient visits during the non-COVID period and 1949 patients during the COVID period. The total decrease in outpatient visits was 30.93% during the pandemic. Female outpatient visits are 51.25% during COVID period. There is 36.49 % reduction in total operation during pandemic. Total elective cases were 78,68% decrease over the pandemic period from 591 to 126 cases. There were 45% reduction inpatient admissions during pandemic.Conclusion: There is a reduction in number of general surgery cases during COVID-19. Some elective surgeries can still be performed with triage according to the guideline. All actions are following protocol and Personal Protection Equipment so that the safety of surgeons, staff, and patients is maintained.

General surgery practice in Aceh rural hospital during the COVID-19 pandemic: a descriptive cross-sectional study

Background: COVID-19 pandemic is one of the biggest issues that we have faced and has had a significant impact on healthcare practice worldwide. Increasing COVID-19 cases requires the surgical department to reorganize all the patient treatment to prevent infection. This study aims to find out the pattern of general surgery care during the COVID-19 pandemic compared to the non COVID-19 period and to know better to prepare for surgical patients' treatment in the future.Method: This is a descriptive cross-sectional study. We studied the important points of a complete range of the patient at the department of surgery outpatient, inpatient, and operation theatre of Datu Beru Hospital from 1 March 2020 to 31 December 2020 for the COVID period and 1 March 2019 to 31 December 2019 for the non-COVID period.Result: There were 2822 outpatient visits during the non-COVID period and 1949 patients during the COVID period. The total decrease in outpatient visits was 30.93% during the pandemic. Female outpatient visits are 51.25% during COVID period. There is 36.49 % reduction in total operation during pandemic. Total elective cases were 78,68% decrease over the pandemic period from 591 to 126 cases. There were 45% reduction inpatient admissions during pandemic.Conclusion: There is a reduction in number of general surgery cases during COVID-19. Some elective surgeries can still be performed with triage according to the guideline. All actions are following protocol and Personal Protection Equipment so that the safety of surgeons, staff, and patients is maintained.

Type, source, adequacy and outcome of consultations requested from the department of general surgery: a retrospective cohort study

Objectives: To evaluate consultations requested from the department of general surgery in terms of type, source and adequacy and outcome regarding general surgery practice. Methods: A total of 4706 consultations requested from the department of general surgery during the 2019 calendar year were included in this retrospective study. Data on patient demographics, type of consultation (urgent, routine), the requesting clinic, time of request, response time to consultation request (min), diagnosis and management of consulted patients by general surgery clinic and survivorship status were recorded. Results: Consultations were urgent (69.0%) and made outside office hours (66.0%) in most of cases and more commonly requested by the emergency department (67.5%). The surgical pathology was confirmed only in 1338 (28.4%) consultations, while more commonly for urgent vs. routine requests (37.4 vs. 8.5%, p = 0.001), for consultations requested by emergency department (ranged 30.9 to 40.0%) vs. other clinics (ranged 0.0% to 19.1%, p = 0.001) and for diseases of colon-rectum-anus (100.0%, p = 0.001) than other disorders. The likelihood of urgent consultations (72.0% vs. 37.3%, p = 0.001) and post-consultation inpatient management (90.5% vs. 24.7%, p = 0.001) and were more likely among survivors vs. non-survivors. Conclusions: In conclusion, our findings revealed that most of the consultations were urgent, outside the office hours and outpatient consultations requested by the emergency department, while surgical pathology was confirmed only in one third of consultations. Our findings indicate improved consultation practice particularly for routine requests by non-emergency clinics to prevent the incompatible or unnecessary consultation requests and related healthcare resource utilization.

Patients' Perceptions of Residents Involved in Their Care in a Community General Surgery Practice.

Resident involvement in patient care in the general surgery setting is most often encountered in an academic setting. Many community hospitals have residents involved in patient care as well. There are no studies that gauge patients' perceptions in the involvement of residents in their general surgery care in the community setting. Patients were given a Northeast Georgia Health System Graduate Medical Education Department Institutional review Board approved 26-question questionnaire during their office visit gauging their wiliness to allow a resident be involved in their care, and their understanding of what a resident is. A total of 196 patients completed the survey with answers that could be analyzed. Overall, 67.3% would allow residents be involved in their care. The main reasons for this were to educate future surgeons, they enjoy a teaching environment, and that they have had residents involved in their care and it was a good experience. Of the 27 % that did not want a resident involved in their care, the main reason was they only wanted their doctor involved in their care. Of the respondents, 58 % were comfortable having a resident involved in their surgery or procedure. Only 14% noted that they would prefer not to have a resident involved in their procedure or surgery. Patents appear receptive to general surgery residents' involvement in their care in the community setting. This is reassuring as community practices may be more receptive to including residents in their practices, based upon these findings.

Analysis of the third WHO Global Safety Challenge ‘Medication Without Harm’ patient-facing materials: exploratory descriptive study

ObjectivesTo evaluate patients’ views on the content and use of the ‘Five Moments for Medication Safety’ materials developed as part of the WHO’s ‘Medication Without Harm’ Global Patient Safety Challenge....

A SURGICAL AUDIT OF GENERAL SURGERY CASES IN A TERTIARY CARE HOSPITAL AND THE IMPACT OF COVID-19 ON THE SAME

BACKGROUND: After the COVID-19 pandemic was declared on March 11, 2020 by the World Health Organization (WHO), routine clinical and surgical practices were affected, including General Surgery services. We aimed to compare how our General Surgery department was affected during this time period of Covid, we have included various parameters, we have also statistically shown how the elective and emergency services were before the Covid outbreak and during the COVID-19 pandemic in our institution. MATERIAL AND METHODS: We retro spectively compared General Surgery practices, including elective, emergency and septic surgeries in a surgical unit of Sir JJ Group of Hospitals over a span of 3 years (April 2018 - March 2021), including the era before and during Covid. RESULTS: The frequency of all the surgeries performed during the pandemic was lower as compared to previous two years before the pandemic in our study, also there was a signicant drop in the number of laparoscopic surgeries. CONCLUSION: The General Surgery practices in our institution have been drastically affected by the COVID-19 pandemic. This setback needs a denite strategy to be formulated to decrease the morbidity and mortality from the neglected elective surgical cases, the real risk-benet ratio must be met before operating such cases.

Integrating a simple and brief home-based exercise programme within a UK stop smoking service: a mixed method feasibility study

BackgroundSmoking remains a leading cause of morbidity and mortality. Exercise improves physical health and reduces cigarette cravings and nicotine withdrawal symptoms, but has required attendance at multiple sessions using specialised equipment that limits delivery in a service. The purpose of this study was to test the feasibility of delivering a simple and brief home-based exercise intervention with existing smoking cessation support in a stop-smoking service. MethodsWe used a mixed-methods approach in a UK stop-smoking service operating from general practitioner surgeries and libraries near the most deprived areas in Surrey. Smokers recruited through the service gave written consent and received a 12-week exercise programme that included 5 min of home-based jumping activities and an activity diary with educational instructions 1 week before their quit date. Feasibility was assessed by recruitment, retention, adherence to the exercise programme, and follow-up and completion of assessments. Semi-structured interviews with trial participants (n=16), people who declined to take part (n=21), and smoking cessation advisors (n=10) assessed views and attitudes to participation and delivery of the intervention. Interviews were audio-recorded, transcribed verbatim, and analysed using thematic analysis (NVivo, version 12.0). Findings30 eligible trial participants consented, with 14 (47%) lost to follow-up, 16 participants (eight females, eight males; mean age 48 years [SD 11]) completed a mean of 47 (SD 18) of 74 prescribed exercise sessions over the 12-week period, resulting in 63% adherence. The exercise programme was received positively by most who engaged with it; fitting into their daily routine was an important outcome for completion. Of the participants who declined to take part (15 females, six males; mean age 48 years [SD 12]), many were positively disposed to the idea of participation, especially if the programme could be offered later in their treatment. All smoking cessation advisors (six females, four males; mean age 48 years [SD 20]) were supportive of the exercise programme, but several favoured the delivery by someone independent of the service. InterpretationA simple and brief exercise intervention may be feasible for smokers receiving smoking cessation treatment in a UK stop-smoking service. However, substantial attrition and non-compliance, along with some delivery components, need to be addressed before to a definitive trial. FundingMedical Research Council Public Health Intervention Development Scheme (MR/P017142/1).

Mixed Methods Process Evaluation of a National Peer-Led Training Program to Increase Brief Advice on Physical Activity Given By Health Care Professionals.

Health care professionals are well-positioned to encourage physical activity. The Clinical Champions Physical Activity Training Program (CCTP) aimed to increase population-level physical activity across England. This study aimed to (1)evaluate CCTP uptake and utilization; (2)explore CCTP fidelity, barriers, facilitators, and satisfaction; and (3)provide recommendations for program improvement. Physical Activity Clinical Champions were recruited and trained to deliver training to other health care professionals about physical activity. The Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework was used to conduct a process evaluation using data collected from CCTP training sessions delivered (often at hospitals and General Practitioner surgeries) between February and December 2018. About 509 training sessions were delivered, with 89% of sessions delivered by doctor/physician and nurse Clinical Champions; 8917 health care professionals attended a training session. Sessions lasted on average 1hour 28minutes and core slide sets were used in 65% of sessions. Barriers related to arranging the sessions and time available to deliver sessions. The process evaluation demonstrated a national peer-led training program can reach all geographical regions of England; however, barriers need to be addressed. Recommendations include providing more administrative support to the Clinical Champions, improving communication and advertising to raise awareness of the CCTP, and standardizing training session duration and content.

Impact of the first surge of the coronavirus disease pandemic on general thoracic surgery practices in Kanagawa: a questionnaire survey by the Kanagawa General Thoracic Surgical Study Group.

ObjectivesThe first surge in severe acute respiratory syndrome coronavirus 2 infection had a significant impact on health care institutions. Understanding how the pandemic affected general thoracic surgery would provide valuable data for establishing a health care protocol for upcoming surges.MethodsA questionnaire survey on coronavirus disease-related patient statistics and health care was conducted between February 2020 and June 2020 across 14 facilities affiliated with the Kanagawa General Thoracic Surgery Study Group.ResultsThe average number of newly referred patients from February to June 2020 was 65% of that during the same period in 2019. Six facilities placed restrictions on medical care services, among which four restricted surgeries. At all institutions and those placed on surgical restriction, the total number of surgeries under general anesthesia was 92% and 78%, the total number of primary lung cancers was 94% and 86%, and the total number of surgeries for pneumothorax was 71% and 77% of that in the preceding year, respectively. Infection control and insufficient resources of the medical material were the most influential factors impacting the medical institutions’ decision to restrict the services provided.ConclusionsRestrictions on surgery had a significant impact on the care provided by general thoracic surgery departments. To avoid patient inconvenience, establishing a collaborative system that refers patients to operational medical institutions in case of medical treatment restrictions may be useful.Supplementary InformationThe online version contains supplementary material available at 10.1007/s11748-021-01724-z.

EP.WE.20At a glance: the impact of COVID-19 on Emergency General Surgery

Abstract Aim This study investigated the impact of COVID-19 on emergency general surgery practice, in a district general hospital in the United Kingdom, particularly on referrals, diagnosis, investigations, management pathways, outcomes, patient behaviour and consultant practice. Methods Retrospective data collection from two cohorts: 112 patients admitted over one week in pre-COVID period and 90 patients admitted over one week during the COVID period. We used patient questionnaire and a consultant questionnaire to collect data on patient behaviour and consultant practice. Results Almost four times and seven times increase in performed X-rays (CXRs)and CT-thorax-abdomen-pelvis (TAPs) respectively. The COVID period saw 6.5% increase in conservative and 6.2% reduction in surgical management, and about 50% decline in length of stay (LoS) in conservatively managed patients. 71% of patients’ decisions to attend hospital were not affected and 78.6% of consultant surgeons preferred to manage patients conservatively during the COVID period. Conclusion Overall, there were delayed patients’ presentations to hospital at almost twice, increase in paediatric referrals, a surge in performed scans, and a reduction in hospital stay in patients who were 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. This study's manuscript has been accepted for publication in the Surgical Practice Journal.

APPLICATION OF THE MODIFIED PECS BLOCKADE DURING RECONSTRUCTIVE AND AESTHETIC SURGERY ON THE MAMMARY GLANDS

Existing methods of anesthesia, drugs used in the field of breast plastic surgery have a number of features compared to anesthesia in the practice of general surgery. In particular, techniques of regional blockades, such as interfascial blocks PECS 1 and PECS 2 are taken into account. Their effectiveness in comparison with standard methods of anesthesia for different types of interventions on the breast is subject to further discussion.
 Thus, the article presents the results of efficiency in the implementation of the author's development - a modified PECS-block during reconstructive and aesthetic surgery on the mammary glands.
 Material and methods. During 2018-2020, 58 women (average age 36,8 ± 10,8 years) were included in the prospective study, who underwent low-flow inhalation anesthesia with sevoflurane during surgery, and in the postoperative period were divided into two subgroups: 1) subgroup 1, in whom regional anesthesia according to the author's method used; 2) subgroup 2 with nalbuphine analgesia. At the first visit, clinical and laboratory, instrumental ultrasound examination, completed informed consent cards of patients, as well as long-term observation cards were filled in.
 The method of postoperative analgesia developed by the author's method is, in essence, a combination of PECS 1 and PECS 2 blockades. The anesthetic solution was administered so as to effectively block the intercostal nerves that run along the posterior surface of the chest and extend outward into the parasternal region.
 For statistical analysis of the obtained results we used a package of general statistic data “Statistica for Windows” version 6.0 (Stat Soft inc., USA). At p<0, 05, the difference was considered statistically significant.
 Results. It was found that the use of modified PECS-block was characterized by a shortening of the verticalization time by 58,8%, compared with the introduction of nalbuphine and 2,16 times in the absence of postoperative anesthesia. The absolute efficiency (AE,%) of the modified PECS-block relative to the verticalization time was 68,0% higher compared to the use of nalbuphine, with a probable relative efficiency (RR, p<0,05) and the odds ratio (OR, p<0,05). 3 hours after the intervention of AE modified PECS-block relative to the intensity of pain less than 1 point was 89,0%, with a clinical efficiency of 60,0% relative to the use of nalbuphine, probable RR (p<0,05) and OR (p<0,05). The majority of patients who underwent modified PECS-block rated their physical and motor activity by more than 2 points (86,0%), while using nalbuphine the part was only 43.0% (p<0,05). The reversal, moderate regression relationship between pain self-esteem and physical activity (r=-0.46, p<0.05) persisted for 3 hours after the intervention.
 Against the background of the modified PECS block, there was no cases of postoperative nausea, in contrast to nalbuphine (AE – 18,0%, RR – 0,02 [0,003-0,97], p<0,05; HS – 0,02 [0,004-0,87], p<0,05). Regarding the parameters of cardio hemodynamics, it was found that against the background of nalbuphine there was an increase in heart rate to 29,3% after 1 hour, by 48,6 and 39,7% after 3 and 8 hours, compared with the modified PECS-block. The tendency to high (greater than 140 mm Hg) and high normal (greater than 130 mm Hg) blood pressure on the background of nalbuphine, in contrast to the modified PECS-block, where the CAT values during the 1st day stayed in the range of optimal pressure (110-130 mm Hg).

Investigating the impact of distance on the use of primary care extended hours.

IntroductionPoor access to general practice services has been attributed to increasing pressure on the health system more widely and low satisfaction among patients. Recent initiatives in England have sought to expand access by the provision of appointments in the evening and at weekends. Services are provided using a hub model. NHS national targets mandate extended opening hours as a mechanism for increasing access to primary care, based on the assumption that unmet need is caused by a lack of appointments at the right time. However, research has shown that other factors affect access to healthcare and it may not simply be appointment availability that limits an individual’s ability to access general practice services.ObjectivesTo determine whether distance and deprivation impact on the uptake of extended hours GP services that use a hub practice model.MethodsWe linked a dataset (N = 25,408) concerning extended access appointments covering 158 general practice surgeries in four Clinical Commissioning Groups (CCGs) to the General Practice Patient Survey (GPPS) survey, deprivation statistics and primary care registration data. We used negative binomial regression to estimate associations between distance and deprivation on the uptake of extended hours GP services in the Greater Manchester City Region. Distance was defined as a straight line between the extended hours provider location and the patient’s home practice, the English Indices of Multiple Deprivation were used to determine area deprivation based upon the home practice, and familiarity was defined as whether the patient’s home practice provided an extended hours service.ResultsThe number of uses of the extended hours service at a GP practice level was associated with distance. After allowing for distance, the number of uses of the service for hub practices was higher than for non-hub practices. Deprivation was not associated with rates of use.ConclusionThe results indicate geographic inequity in the extended hours service. There may be many patients with unmet need for whom the extension of hours via a hub and spoke model does not address barriers to access. Findings may help to inform the choice of hub practices when designing an extended access service. Providers should consider initiatives to improve access for those patients located in practices furthest away from hub practices. This is particularly of importance in the context of closing health inequality gaps.

An Examination of General Surgery Residency Programs with a Rural Track

There is a steady decline in the general surgery workforce in rural areas of the United States. In response, some surgery residency programs have developed rural tracks to encourage rural practice and adequately prepare trainees for this setting. To compare the practice type and location of graduates from general surgery residency programs with and without a dedicated rural track between 2011-2020. General surgery residency programs with and without a rural track were identified using the American Medical Association Residency and Fellowship Electronic Interactive Database and the Rural Surgery Program list from the American College of Surgeons. Graduates of these programs who entered general surgery practice between 2011-2020 were subsequently identified from individual residency program websites and tracked to their current practice setting using a Google search of first and last name and residency affiliation. Practice location was identified by zip code or county name and coded by Rural-Urban Continuum Codes (RUCC, Economic Research Service, USDA). We identified 2,582 general surgery residency graduates from 2011 to 2020 across 66 residency programs. Of these graduates from programs without a rural track, 23.6% entered general surgery practice without additional fellowship training, compared to 34.0% from residency programs with a rural track (p = 0.019). Community or University-based program designation was not associated with decision to enter general surgery practice over fellowship training (p = 0.420). Proportion of graduates entering rural practice as defined by RUCC groups 7-9 was not associated with having a rural program track or with community or university-based program status. Residency programs with a rural track produce a higher proportion of graduates entering general surgery compared to fellowship, though they are no more likely than programs without a rural track to produce graduates who ultimately practice in rural areas.

Posttraumatic Vascular Anomalies in Hand Surgery-A Case-based Approach.

Summary:The field of vascular anomalies (VA) has been subject to changes during the last few decades. The current classification of the International Society for the Study of Vascular Anomalies (ISSVA) offers a simple diagnostic structure. Hand surgeons commonly appear to have limited exposure to VA. Already recognized for more than 120 years, pyogenic granuloma (PG) is by far the most commonly described VA by different disciplines with accordingly diverse treatment strategies and theories behind it. Arteriovenous fistula (AVF), venous aneurysms (VAN), and venous malformations (VM) are, however, rare in hand surgery. With a compilation of four illustrative cases of posttraumatic entities such as AVF, VAN, VM, and PG, we would like to highlight possible daily exposure to VA in the general hand surgery practice. We discuss diagnostic and therapeutic options as well as the current literature with focus on posttraumatic VA.

Long-term monitoring in primary care for chronic kidney disease and chronic heart failure: a multi-method research programme

Long-term monitoring in primary care for chronic kidney disease and chronic heart failure: a multi-method research programme

Brief intervention of low carbohydrate dietary advice: clinic results and a review of the literature.

The purpose of the review is to assess the efficacy of a brief intervention of low carbohydrate dietary advice for weight loss in patients with a raised body mass index (BMI) (>25 kg/m2) during routine patient appointments in primary care. Brief interventions in primary care have been shown to be a valuable tool in supporting patients to make lifestyle changes. Low carbohydrate diets have been successful in helping patients lose weight.The authors carried out a retrospective observational study based on the electronic records from a single general practitioner surgery with 7,500 patients in Essex, UK. Low carbohydrate dietary advice was given opportunistically to patients with a raised BMI, over an 18 month period, with advice and weights recorded. In total, 774 patients were given low carbohydrate dietary advice. Overall, 1103 kg of weight was lost by 339 patients, there was a median weight loss of 2.5 kg (interquartile range 0.0-6.0 kg) and a mean weight loss of 3.3 kg. There is no published literature available assessing the efficacy of brief interventions of low carbohydrate dietary advice. Our clinic results indicate that this may be an effective weight loss tool in primary care.

Distribution of AB0 and Rh blood groups in cancer patients; is A Rh (+) blood group a risk factor in colorectal cancer development?

Objective: Genetic factors have been the subject of many studies in cancer etiology. One of the most striking of these is the relationship between blood groups and cancer. Therefore, in our study, we examined the relationship between blood groups of stomach, colorectal, breast, thyroid and pancreatic cancers, which are common in general surgery practice, with single-center data. Method: We retrospectively analyzed cancer cases who applied to our University Hospital between 2005-2021. This analysis was done using a hospital database. 7899 cancer patients were included in the study. Cancer types, blood types, ages and gender of the patients were recorded. Results were analyzed statistically. Results: 55.2% of the patients included in the study were male and 42.8% were female. Of the patients, 553 (7%) were stomach, 767 (9.7%) colorectal, 779 (9.9%) breast, 625 (55.15%) thyroid, 209 (2.6% ) pancreatic cancer. 87.4% of the patients were Rh (+), 12.6% of them were Rh (-). 38% of patients A Rh (+), 5.2% A Rh (-), 13.8% B Rh (+), 2.2% B Rh (-), 7.7% AB Rh (+), 1.3% AB Rh (-), 28% 0 Rh (+), 3.8% 0 Rh (-). With the blood group distribution of all cancers; When the blood group distribution of gastric, colorectal, breast, thyroid and pancreatic cancers were compared, no statistically significant difference was found. However, it was found that the A Rh (+) blood group was higher in colorectal cancers compared to other cancers. Conclusions: In our study, no relationship was found between all cancers and blood type. In addition, no relationship was found between blood type and stomach, colorectal, breast, thyroid and pancreatic cancers, which are common in general surgery practice. Although it is generally accepted that especially A blood group is a risk factor for gastric cancer, there was no significant difference in our patient series. When AB0 and Rh blood groups were evaluated together, the A Rh (+) blood group was seen more in colorectal cancers.

A qualitative study of the views of healthcare professionals on providing vaccines information to patients

Background Healthcare professionals (HCPs) such as pharmacists, general practitioners and practice nurses are a trusted source of vaccines information for patients in primary care. Global regulators have highlighted the key role of HCPs in fostering confidence in COVID-19 vaccines. Objective This study aims to gain insight into the views and experiences of HCPs on providing vaccines information to patients. Setting Primary care general practice surgeries and community pharmacies in Ireland. Methods Qualitative, semi-structured interviews were conducted with 14 HCPs (five General practitioners [GPs], four practice nurses and five community pharmacists) identified through purposive and convenience sampling. The interviews were analysed by inductive thematic analysis. Main outcome measure Participants’ views and experiences of providing vaccines information to patients. Results Five key themes were identified: roles and responsibilities, perception of risk, perception of the public, building a relationship, and emotion. HCPs were motivated by duty and care for their patients. They respected patient autonomy and were driven by their concern for public health. HCPs were influenced by their perception of risk and their perceptions of the public. HCPs practiced patient-centred care by providing tailored vaccines information. They favoured an approach of providing patients with information and support to make their own decision. The topic was emotive; HCPs empathised with patients but were also frustrated by their perceived inability to change some patients’ views. Conclusion The provision of vaccines information by HCPs to patients is multifactorial with participants mindful of patient autonomy and the HCP role to support vaccinations as a public health priority. Participants suggested that education and support on vaccines communication would enable them to support the vaccines uptake in their practice.

Towards an Open Medical School without Checkerboards during the COVID-19 Pandemic: How to Flexibly Self-Manage General Surgery Practices in Hospitals?

Background: Can we create a technological solution to flexibly self-manage undergraduate General Surgery practices within hospitals? Before the pandemic, the management of clerkships was starting to depend less on checkerboards. This study aims to explore undergraduates’ perceptions of doing rotations in teaching hospitals using different teaching styles and elicit their views regarding the options of managing practices to design a mobile app that substitutes for checkerboards. Methods: In this sequential exploratory mixed methods study, 38 semi-structured interviews at a teaching hospital were conducted. The data was used to survey 124 students doing their rotations in four teaching hospitals during the first wave of COVID-19. Results: 21 themes highlighted concerns related to the practices, the teacher involvement in the students’ education, and the students’ adaptation to clinical culture. The students reported positive perceptions concerning self-managing and organizing practices via a mobile application. However, problems emerged regarding transparency, the lack of feedback, and the need for new tools. Regarding the teaching styles, the facilitator and personal models were perceived as optimal, but the personal style had no effect on using or not using a tool. Conclusions: A mobile-learning application designed like an educational opportunities’ manager tool can probably promote self-directed learning, flexible teaching, and bidirectional assessments. However, teachers who employ a personal teaching style may not need either checkerboards or a tool. This solution supports teaching at hospitals in pandemic times without checkerboards.