Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Tiroid papiller karsinomunda nodül büyüklüğü ile santral lenf nodu metastazı arasındaki ilişkinin gösterilmesi

Giriş: Papiller tiroid kanseri (PTK) tüm tiroid kanserlerinin yaklaşık % 85'ini oluşturmakta olup en önemli klinik özelliği bölgesel lenf nodlarına metastaz yapmasıdır. PTK'da hastalığın rekürrensi morbidite ve mortaliteyi artıran en önemli faktördür. Rekürrens riskini artıran en önemli etken ise lenf nodu metastazıdır. Boyunda en sık metastaz yaptığı lenf nodları ipsilateral santral lenf nodlarıdır. Klinik olarak santral bölge lenf nodu tutulumu olan hastalarda tedavi santral boyun diseksiyonudur. Servikal lenf nodu metastazı olmayan (cN0) hastalarda profilaktik Santral Lenf Nodu Diseksiyonu (pSLND) yapılması konusunda ise farklı görüşler söz konusudur. Bu çalışmanın amacı santral lenf nodu metastazı riskini artıran nedenleri bulmak ve profilaktik santral lenf nodu diseksiyonu için endikasyonları tanımlayabilmektir. Gereç ve Yöntem: Çalışmaya Gazi Üniversitesi Tıp Fakültesi Hastanesi Genel Cerrahi Anabilim Dalı'nda aynı cerrahi ekip tarafından Eylül 2009 ile Eylül 2019 tarihleri arasında PTK tanısı ile tiroidektomi ve SLND'u yapılan 255 hasta dahil edilmiştir. Hasta dosyaları retrospektif olarak incelenerek demografik özellikler, tümör subtipi, cerrahi sınır, tümörün bulunduğu lob ve lobdaki lokalizasyonu, tümörün fokalitesi, lenfovasküler invazyon, ekstrakapsüler yayılım ve santral lenf nodu metastazı parametreleri değerlendirilmiştir. Bulgular: Araştırmaya katılan bireylerin yaş ortalaması 38,4 ± 11,5 standart sapma (SS) yıl olup yaş ortancası 36,0 yıldır (min:18,0-max:69,0). Çalışma kapsamındaki 255 hastanın 61'i(%23,9) erkek, 194'ü (%76,1 ) kadındır. Çalışmamızda 45 yaş altı grupta SLNM riskinin 45 yaş üstü gruba göre anlamlı olarak yüksek olduğu bulunmuştur. Erkek cinsiyetin de risk artışı açısından anlam ifade ettiği görülmüştür. Tümör boyutu açısından irdelendiğinde tümörün en geniş çapının 9,5 mm'nin üzerinde olması halinde SLNM riskinin anlamlı biçimde yükseldiği izlenmiştir. Metastatik lenf nodu sayısının çıkarılan toplam lenf nodu sayısına oranı ile tümör boyutu arasındaki ilişki değerlendirildiğinde, boyut ile bu oran arasında düşük orta derecede anlamlı bir korelasyon olduğu da görülmüştür. Sonuç: Papiller Tiroid Karsinomu'nda santral lenf nodu metastaz açısından prediktif olabilecek faktörlerin analizi sonucunda 45 yaş altı, erkek cinsiyet, toplam tümör çapının 10,5'mm üzerinde olması ve en büyük tümör çapının 9,5 mm'nin üzerinde olması metastaz riskini anlamlı biçimde arttıran unsurlar olarak saptanmıştır. Bununla birlikte tümör boyutundaki artış bir taraftan santral lenf nodu metastazı insidansını arttırırken bir taraftan da çıkarılan lenf nodları içerisindeki metastatik lenf nodu sayısını arttırmaktadır. Bu bulgular ışığında çalışmada saptanan ölçütlerin profilaktik santral lenf nodu diseksiyonuna aday hastaları tespit etmekte yarar sağlayacağı öngörülmüştür.Introduction: Papillary Thyroid Carcinoma (PTC) makes 85% of all thyroid malignancies and its most important clinical feauture is regional lymph node metastasis. Recurrens of PTC is the most important factor in mortality and morbidity and the most important factor in increased recurrens risk is lymph node metastasis. The most frequent lymph node metastasis location is ipsilateral central lymph node group. Patients who have clinically central lymph node involvement require treatment with central neck dissection. There are different opinions on proflactic Central Lymph Node Dissection (pCLND) on patients who have no cervical lymph node metastasis (cN0). The aim of this study to evaluate the risk factors increasing central lymph node metastasis and to describe indications for proflactic central lymph node dissection. Materials and Method: Two hundred fifty five (255) patients diagnosed with PTC who undergone tyhroidectomy and CLND by the same surcigal team in Gazi University School of Medicine between September 2009 and September 2019 were included to the study. Patient records have been evaluated retrospectively for demographic features, subtype of the tumor, surgical margin status, tumor consisting thyroid lobe and tumor location within the lobe, focality of the tumor, lymphovascular invasion, extracapsular spread and central lymph node metastasis as parameters. Results: Mean age of subjects included the study was 38,4 [Standard Deviation (SD) 11,5)] and the median age was 36,0 (Min: 18,0- Max: 69,0). The study includes 61 (%23,9) males and 196 ( %76,1) females in total of 255 patients. According to our study, the risk of CLNM is significantly higher in patients under 45 years old compared to ones older 45 years old (p=0,016). Male sex appeared to be a significant factor in increased risk. Evaluation of tumor size showed significant increased risk of CLNM when the widest diameter of the tumor is above 9,5. Evaluation of relationship between ratio of the metastatic lymph nodes to the exicised total lymph nodes and tumor size shows that tumor size and that ratio have low-mild grade correlation. Conclucion: As a result of the analysis of the factors that may be predictive in terms of central lymph node metastasis in papillary thyroid carcinoma; the age of under 45, male gender, total tumor diameter above 10.5 mm and the largest tumor diameter above 9.5 mm determined to be the factors that significantly increase the risk of metastasis. However, increased tumor size, on the other hand, increases the incidence of metastatic lymph nodes as well as the number of metastatic lymph nodes among dissected lymph nodes. According to these findings, parameters determined in this study could be useful in anticipation of the candidates for proflactic lymph node dissection

Analysis of Knowledge About Male Breast Cancer Among Patients at Tertiary Medical Center

In the overall population, the incidence of breast cancer in men is lower than in women. Men's breast cancer awareness is affected both by the low incidence of breast cancer in men and by the presence of a perception that breast cancer can only be seen in women in society. This study aims to determine this awareness and guide future studies on improving social awareness. This study examined male and female patients aged 18 to 75 years who were admitted to our hospital's general surgery outpatient clinic. A questionnaire containing questions about male breast cancer was administered to the patients, and the study was conducted face-to-face voluntarily. A total of 411 patients, 270 female and 141 male, participated in the study. The results showed that 61.1% of the participants were unaware of the possibility of breast cancer in men. Evaluation of the relationship between awareness and gender revealed that women were more knowledgeable than men (p = .006). Educational status also had a significant influence on awareness (p = .001). Awareness of male breast cancer in society is low. Raising public awareness of this issue will enable men to be diagnosed earlier, at a lower stage, and thus to better respond to treatment, increasing their survival time