Environmental characteristics of older people attending physical medicine and rehabilitation outpatient clinics

Objective: A residential environment refers to the physical and social characteristics in a neighbourhood. The physical characteristics include interior housing qualities, exterior neighbourhood characteristics, and the accessibility of essential facilities and services outside the neighbourhood. Older adults especially may be vulnerable to the negative impacts of the residential environment. The aim of this study is to elucidate the problems ageing people face in their neighbourhoods, buildings and public areas. Methods: The study group consisted of a total of 1,001 people over the age of 65 who were admitted to physical medicine and rehabilitation clinics in Turkey and consented to participate. A questionnaire covering demographic, social and environmental information was used. Results: Of the study group, 58.6% was living in an apartment building, but only 23.6% of these buildings had an elevator, and the stairs were inconvenient in 46.7% of the buildings. Only 49% of the elderly people went for a walk regularly. The most frequent complaint about the hospitals, community health centres and other public areas was the inappropriate restroom conditions. Eighty-six percent of the study group were not members of an organization, a foundation or a group, and 73.6% did not have personal hobbies. Conclusions: The layouts of buildings and surroundings are inappropriate for older people, and the opportunities for them to participate in social activities are limited. Health and social programmes and governmental and local policies for older people are needed, and public awareness about this issue should be raised

Konya il merkezinde hizmet veren iki hastanenin tiroidektomi endikasyonlarının değerlendirilmesi

Amaç: Konya İl Merkezindeki iki farklı hastanenin Tiroidektomi uygulamalarını, endikasyonları bakımından karşılaştırmayı amaçladık. Yöntem: Ocak 2007 ile Aralık 2008 tarihleri arasında Konya’da farklı iki A ve B hastaneleri hastanede tiroidektomi ameliyatı geçiren hastaların dosyaları retrospektif olarak incelendi. Hastaların yaş, cins, tiroit fonksiyon testleri TFT , tiroit ultrasonografi USG bulguları, yapıldıysa tiroit ince iğne aspirasyon biyopsileri İİAB raporları ve tiroit ameliyat raporları bulunanlar çalışmaya alındı. İki hastanenin tiroidektomi ameliyatı yapılan hastaları ameliyat endikasyonları ve malignite tespiti bakımından birbiriyle karşılaştırıldı. Bulgular: İki yıllık süre içinde A hastanesinde 60, B hastanesinde 223 hastaya tiroidektomi ameliyatı yapılmıştı. Hastaların yaş ortalaması sırasıyla 53 , 49 idi. İki guruptaki vakalar cins, yaş ve dominant nodül çapları bakımından benzerdi. A hastanesinde tiroidektomi kararında klinik, USG ve İİAB ile belirlenen malignite riski öne çıkarken, B hastanesinde ise palpable nodül varlığı, USG’ de nodülün 1 cm den büyük olması ve USG ile malignite şüphesi tespit edilmiş olması yeterli idi. A hastanesinde basit nodüler guatrlı 53 hastanın 19 unda % 35.8 İİAB yapılmıştı. B hastanesinde hiç bir hastaya İİAB yapılmamıştı. A hastanesinde genel malignite oranı % 25, B hastanesinde ise % 13 idi p=0.028 . Sonuç: Nodüler guatrlarda, klinik, US ve İİAB’ nin birlikte kullanımı ile malignite riski daha iyi belirlenebilir. Ameliyat veya takip kararı buna göre verilmelidi

Pooled analysis of WHO Surgical Safety Checklist use and mortality after emergency laparotomy

Background The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89.6 per cent) compared with that in countries with a middle (753 of 1242, 60.6 per cent; odds ratio (OR) 0.17, 95 per cent c.i. 0.14 to 0.21, P <0001) or low (363 of 860, 422 per cent; OR 008, 007 to 010, P <0.001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high-HDI countries (risk difference -94 (95 per cent c.i. -11.9 to -6.9) per cent; P <0001), but the relationship was reversed in low-HDI countries (+121 (+7.0 to +173) per cent; P <0001). In multivariable models, checklist use was associated with a lower 30-day perioperative mortality (OR 0.60, 0.50 to 073; P <0.001). The greatest absolute benefit was seen for emergency surgery in low- and middle-HDI countries. Conclusion Checklist use in emergency laparotomy was associated with a significantly lower perioperative mortality rate. Checklist use in low-HDI countries was half that in high-HDI countries.Peer reviewe

Global variation in anastomosis and end colostomy formation following left-sided colorectal resection

Background End colostomy rates following colorectal resection vary across institutions in high-income settings, being influenced by patient, disease, surgeon and system factors. This study aimed to assess global variation in end colostomy rates after left-sided colorectal resection. Methods This study comprised an analysis of GlobalSurg-1 and -2 international, prospective, observational cohort studies (2014, 2016), including consecutive adult patients undergoing elective or emergency left-sided colorectal resection within discrete 2-week windows. Countries were grouped into high-, middle- and low-income tertiles according to the United Nations Human Development Index (HDI). Factors associated with colostomy formation versus primary anastomosis were explored using a multilevel, multivariable logistic regression model. Results In total, 1635 patients from 242 hospitals in 57 countries undergoing left-sided colorectal resection were included: 113 (6·9 per cent) from low-HDI, 254 (15·5 per cent) from middle-HDI and 1268 (77·6 per cent) from high-HDI countries. There was a higher proportion of patients with perforated disease (57·5, 40·9 and 35·4 per cent; P < 0·001) and subsequent use of end colostomy (52·2, 24·8 and 18·9 per cent; P < 0·001) in low- compared with middle- and high-HDI settings. The association with colostomy use in low-HDI settings persisted (odds ratio (OR) 3·20, 95 per cent c.i. 1·35 to 7·57; P = 0·008) after risk adjustment for malignant disease (OR 2·34, 1·65 to 3·32; P < 0·001), emergency surgery (OR 4·08, 2·73 to 6·10; P < 0·001), time to operation at least 48 h (OR 1·99, 1·28 to 3·09; P = 0·002) and disease perforation (OR 4·00, 2·81 to 5·69; P < 0·001). Conclusion Global differences existed in the proportion of patients receiving end stomas after left-sided colorectal resection based on income, which went beyond case mix alone

TURK OSTEOPOROZ DERGISI-TURKISH JOURNAL OF OSTEOPOROSIS

Objective: In this study, it was aimed to evaluate the relationship between vitamin D level and pain severity, localization and duration in patients with non-specific musculoskeletal pain. Materials and Methods: Patients who applied to physical medicine and rehabilitation outpatient clinics due to non-specific muscle pain in 19 centers in Turkey were retrospectively screened. Three thousand four hundred fourpatients were included in the study, whose pain level was determined by visual analog scale (VAS) and the painful region, duration of pain and vitamin D level were reached. D group was found to be D deficient (group 1) when 25 (OH) D level was 20 ng/mL or less and group D 2 (vitamin D deficiency) was higher than 30 ng/mL (group 3). The groups were compared in terms of pain duration, localization and severity. In addition, the correlations of pain localization, severity and duration with vitamin D levels were examined. Results: D vitamin deficiency was detected in 2202 (70.9%) of 3 thousand four hundred and four registered patients, and it was found that vitamin D deficiency in 516 (16.6%) and normal vitamin D in 386 (12.4%). The groups were similar in terms of age, body mass index, income level, duration of complaint, education level, family type and working status (p>0.05). There was no statistically significant difference between groups in terms of VAS, pain localization and duration scores (p>0.05). Conclusion: Our study shows that vitamin D deficiency in patients with nonspecific musculoskeletal pain is not associated with the severity and duration of pain

Breast Cancer During Pregnancy: Case Report

During pregnancy breast cancer is rarely seen. In this case, when the patient was being operated for the right breast cancer which was diagnosed in the first exam, a left breast cancer was also detected in the operation. When the patient analysed retrospectively, lesion in the left breast could not detected because of the lactation period. Consequently,pregnancy patients must be re-examined after the lactation period to avoid any possible mistakes. [Cukurova Med J 2013; 38(3.000): 492-494

A qualitative analysis on the experiences of mothers of children in burn ICU: "She burned on the outside, me inside..."

Mothers closely follow the complex process due to the burning of their children. Caring for and supporting the child can pose various challenges for mothers. With the phenomenological method, this study was conducted to investigate mothers' experiences staying with their children in the pediatric burn intensive care unit. Twelve mothers participated in the study. The semi-structured face-to-face interviews obtained data. After each interview, the research team transcribed the interviews verbatim. Interpretive Phenomenological Analysis was used to analyze the data. The experiences of the mothers were classified in four contexts as a result of the interpretative phenomenological analysis; "first reactions to burn trauma" related to the awareness that the child has been burned, "being a mother in the burn intensive care unit" related to caring for the child as a companion in the burn intensive care unit, "coping" related to how they cope with the problems throughout the whole process, and "requirements" regarding the subjects it needs in the process. It was determined that mothers went through a physically and emotionally challenging process from the beginning of the burn trauma and throughout the intensive care unit. During this challenging process, it was observed that mothers could not use effective coping methods and did not receive the necessary professional support. In line with these results, it is recommended that psychological support programs be applied to the mothers and that care focused on the needs of the mothers should be provided

Randomized prospective comparison of long-term results of onlay and sublay mesh repair techniques for incisional hernia

Objective: Incisional hernia is a significant problem after laparotomy, and there is still no consensus on an idealtreatment method. The aim of this study was to compare the results of onlay and sublay mesh repair techniques.Material and Methods: In this randomized prospective trial, 100 patients were divided into two groups: onlay andsublay groups. Recurrences were evaluated by performing a physical examination.Results: The median follow-up was 37.1 (26.6 to 46.5) months. In the onlay group, the mean operation time wassignificantly shorter. However, in terms of postoperative pain and wound complications, the sublay group had significantlybetter results. The recurrence rates were found to be similar in both groups (6% in the onlay group and2% in the sublay group).Conclusion: In the treatment of incisional hernia, sublay mesh repair is superior to onlay mesh repair in terms ofpostoperative pain and wound complications. Both techniques have similar recurrence rates

Radionuclide concentrations in soil and lifetime cancer risk due to gamma radioactivity in Kirklareli, Turkey

The objective of this study is to ovaluate and map soil radionuclides' activity concentrations and environmental outdoor gamma dose rates (terrestrial and cosmic) in Kirklareli, Turkey. The excess lifetime cancer risks are also calculated. Outdoor gamma dose rates were determined in 230 sampling stations and soil samples were taken from 177 locations. The coordinates of the readings were determined by the Global Positioning System (GPS). The outdoor gamma dose rates were determined by Eberline smart portable device (ESP-2) and measurements were taken in air for two minutes at I m from the ground, The average outdoor gamma close rate was 118 +/- 34 nGy h(-1). Annual effective gamma dose of Kirklareli was 144 mu Sv and the excess lifetime cancer risk of 5.0 x 10(-4). Soil samples were analyzed by gamma spectroscopy. The average Ra-226, U-238, Th-232, Cs-137, and K-40 activities were 37 +/- 18 Bq kg(-1), 28 +/- 13 Bq kg(-1), 40 +/- 18 Bq kg-1, 8 5 Bq kg(-1) and 667 +/- 281 Bq kg(-1), respectively. The average soil radionuclides' concentrations of Kirklareli were within the worldwide range although some extreme values had been determined. Annual effective gamma doses and the excess lifetime risks of cancer were higher than the world's average. (c) 2009 Elsevier Ltd. All rights reserved

Zinc oxide, lidocaine, hot water, and lateral internal sphincterotomy for fissure-in-ano: Randomized controlled study

Aim: Aim of this study is to compare the effect of zinc oxide pomade, lidocaine pomade, hot water sitting bath and lateral internal sphincterotomy for treatment of chronic anal fissure in terms of healing and complications.Material and Methods: One hundred and forty five patients who were diagnosed with chronic anal fissure between May 2011 and September 2012 at our clinic were enrolled for this prospective randomized trial. All cases were randomized into four groups. Group 1: The patients would apply 15% of zinc oxide pomade twice a day after the 10 minutes of hot water sitting bath. Group 2: The patients would apply 5% of lidocaine pomade twice a day after the 10 minutes of hot water sitting bath. Group 3: The patients would make only 10 minutes of hot water sitting bath twice a day.Group 4: Lateral internal sphincterotomy was performed to the patients.Healing rates, recurrences,changes in symptoms after the treatment and complications were recorded.Results: There were not any difference within the groups in terms of age and gender. The healing in the Sphincterotomy group significantly much more when compared to the other groups at both the third and the sixth weeks(p0,001).The other groups were similar with the each other(p0,05).Conclusion: LIS is superior to zinc oxide, lidocaine or hot water applications. There was no difference between the non-operative treatments