Is Concomitant Cholecystectomy Necessary for Asymptomatic Cholelithiasis During Laparoscopic Sleeve Gastrectomy?

Background There is not any consensus on concomitant cholecystectomy for asymptomatic gallbladder stones during laparoscopic sleeve gastrectomy (LSG). The aim of this study was to evaluate the surveillance results of the LSG patients who have asymptomatic gallbladder stones and did not undergo cholecystectomy. Methods Patients who underwent laparoscopic sleeve gastrectomy with preoperatively detected gallbladder stones and completed at least 6 months follow-up were included in the study. Concomitant cholecystectomy was performed for symptomatic patients while it was not performed for asymptomatic subjects. At the end of the follow-up time, symptoms and signs related to gallbladder disease were recorded. Clinical and demographic characteristics were compared between symptomatic and asymptomatic patients. Results Between February 2012 and October 2016, 312 laparoscopic sleeve gastrectomies were performed. Among the patients, 24 were regarded as asymptomatic cholelithiasis, and cholecystectomy was not performed. The mean follow-up period was 27 (6-58) months. The mean preoperative BMI was 50.0 +/- 7.6 kg/m(2), and at the end of the follow-up time, it decreased to 35.6 +/- 8.8 kg/m(2). Five (20.8%) patients experienced biliary colic. Acute cholecystitis or obstructive jaundice was not observed in any of the patients. Characteristics of patients who developed symptomatic gallbladder disease (n = 5) were not significantly different from those of patients who remained asymptomatic (n = 19). Conclusions The risk of becoming symptomatic for asymptomatic cholelithiasis is very close to the healthy population after sleeve gastrectomy. Although further studies with a high number of cases are needed, we suggest only observation for asymptomatic gallbladder stones in patients who will undergo sleeve gastrectomy

Impact of The Method of Diagnosis on The Stage of Breast Carcinoma

Objective: Screening mammography is recommended to women at a certain age to achieve an early diagnosis. The purpose of this study is to find out how breast carcinoma was diagnosed and the impact of the method of diagnosis on the stage of the tumor. Materials and Methods: In this study, 903 operated breast cancer patients, between 2010-2016, in a large volume Marmara University Istanbul Pendik Education and Research Hospital were analyzed retrospectively. Patients presenting with clinical symptoms and those diagnosed with screening were investigated separately. The percentage of the patients diagnosed with symptoms and the impact of the method of diagnosis on the stage of the tumor was the primary outcome of the study. Results: 738 patients fulfilling inclusion criteria with complete clinical records were analyzed. 126 patients (17%) were in the age range of 19-39 years, while 32% (236 patients) were 40-50 and 51% (376 patients) were older than 50 years. 485 patients (65.7%) were diagnosed with a mass in the breast, while 241 (32.6%) patients were diagnosed with screening with mammography. Twelve patients (1.7%) presented with nipple discharge. Median tumor sizes measured in the resected specimen were 22 mm, 21 mm, and 21 mm in patients diagnosed with a mass, screening, and nipple discharge respectively. The difference among the groups were not significant (p=0.460). Axillary lymph nodes were positive in 210 (43.3%) of patients presenting with a mass in the breast while 85 patients (35.3%) diagnosed with screening had metastatic lymph nodes in the axilla. Three patients presenting with nipple discharge had positive axillary lymph nodes (p=0.137). Conclusion: This study demonstrated that breast cancer screening programs in Turkey needs improvement and at the same time shows that screening with mammography after 40 years of age should be done annually despite Ministry of Health recommendations

Gastrointestinal sistem cerrahisi uygulanacak hastaların preoperatif dönemde subjetif global değerlendirme (SGA) yöntemi ile beslenme durumlarının değerlendirilmesi ve uygulanan beslenme desteğinin yararının incelenmesi

1.ÖZETAraştırma, gastrointestinal sistem (GIS) cerrahisi uygulanacak hastaların preoperatif dönemde subjektif global değerlendirme (SGA) yöntemi ile beslenme durumlarının değerlendirilmesi ve uygulanan beslenme desteğinin yararının incelenmesi amacıyla prospektif ve tanımlayıcı araştırma olarak yapıldı. Araştırmanın evrenini bir üniversite hastanesi ile Sağlık Bakanlığı’na bağlı iki eğitim ve araştırma hastanesinin genel cerrahi kliniklerinde GIS ameliyatı için yatan hastalar oluşturdu. Örnekleme, hastaların aydınlatılmış onamları alınarak gönüllülük esasına göre % 40 tabakalı örnekleme yöntemi (yaş) ile hasta alınmış ve örneklem sayısı 100 olarak belirlenmiştir. Veriler araştırmacı tarafından hazırlanan “Bireysel Özellikler Formu”, Hasta İzlem Formu ile çeşitli hastanelerde halen kullanılmakta olan Subjektif Global Değerlendirme Formu(SGA) aracılığı ile yüz yüze görüşme ve izlem yoluyla elde edildi. Verilerin değerlendirilmesinde oran, ortalama(x), standart sapma (SD), x2, t testi ve Mann Whitney U testi kulanıldı.Araştırmanın verilerine göre, uygulama yapılan hastanelerde cerrahi işlem öncesi ve sonrası gastrointestinal sistem cerrahisi uygulanacak hastalarda yatış anında malnütrisyon oranları, kanser tiplerine göre malnütrisyon düzeyleri ve uygulanan beslenme açısından istatistiksel olarak anlamlı fark (p<0.05) olduğu belirlendi.Araştırmada elde edilen bulgular gastrointestinal ameliyatı geçirecek olan hastalarda preoperatif dönemde subjektif global değerlendirme (SGA) ile beslenmenin değerlendirilmesinin preoperatif dönemde beslenmesi gereken hastaların seçilmesi, ve bu şekilde postoperatif dönemde gelişebilecek komplikasyonların önlenmesinde, iyileşme sürecinin kısalması ve mortalite ve morbiditenin azalmasında etkili olduğu görülmüştür. Anahtar Kelimeler: Preoperatif beslenme, postoperatif beslenme, malnütrisyon.SUMMARYTHE PREOPERATIVE EVALUATION OF NUTRITIONAL STATUS AND SUPPORT WITH SUBJECTIVE GLOBAL ASSESSMENT (SGA) METHOD IN PATIENTS UNDERGOING TO GASTROINTESTINAL SYSTEM SURGERYThis study is designed as a prospective evaluation of nutritional status and the benefits of a nutritional support regimen depending on subjective global assessment (SGA) in preoperative patients under gastrointestinal system surgery.The population of the study was the patients who has underwent to a planned gastrointestinal system surgery in general surgery departments of a University Hospital and two Research and Training Hospitals. We planned this study by taking informed consents from the patients with 40% sheeted sampling method (age) and determined a sample size of 100.Data were collected during face-o-face interviews and follows ups by using “Personel Characteristics Form” and “Patient Follow-up Forms” developed by the researcher and Subjectif Global Assessment (SGA) Form which is currently used in various hospitals were performed. Rate, percentages(x), standart deviation (SD), x2, t-test and Mann Whitney-U tests were used during evaluation of the data. A statistical significance (p<0.05) was found after the evaluation of the data in patients undergoing gastrointestinal system surgery in preoperative and postoperative time period, between malnutrition conditions at the time of hospital administration, level of malnutrition in different types of cancer and the type of nutritional support in different study hospitals.As a result of this study, in patients undergoing gastrointestinal system surgery, the evaluation of patients with subjective global assessment (SGA) is concluded to be an effective method for selection of the patients who needs nutritional support preoperatively and prevention of complications postoperatively, shortening the healing time and reducing the morbidity and mortality

Gastrointestinal sistem cerrahisi uygulanacak hastaların preoperatif dönemde subjetif global değerlendirme (SGA) yöntemi ile beslenme durumlarının değerlendirilmesi ve uygulanan beslenme desteğinin yararının incelenmesi

1. Araştırma, gastrointestinal sistem (GIS) cerrahisi uygulanacak hastaların preoperatif dönemde subjektif global değerlendirme (SGA) yöntemi ile beslenme durumlarının değerlendirilmesi ve uygulanan beslenme desteğinin yararının incelenmesi amacıyla prospektif ve tanımlayıcı araştırma olarak yapıldı. Araştırmanın evrenini bir üniversite hastanesi ile Sağlık Bakanlığı’na bağlı iki eğitim ve araştırma hastanesinin genel cerrahi kliniklerinde GIS ameliyatı için yatan hastalar oluşturdu. Örnekleme, hastaların aydınlatılmış onamları alınarak gönüllülük esasına göre % 40 tabakalı örnekleme yöntemi (yaş) ile hasta alınmış ve örneklem sayısı 100 olarak belirlenmiştir. Veriler araştırmacı tarafından hazırlanan “Bireysel Özellikler Formu”, Hasta İzlem Formu ile çeşitli hastanelerde halen kullanılmakta olan Subjektif Global Değerlendirme Formu(SGA) aracılığı ile yüz yüze görüşme ve izlem yoluyla elde edildi. Verilerin değerlendirilmesinde oran, ortalama(x), standart sapma (SD), x2, t testi ve Mann Whitney U testi kulanıldı. Araştırmanın verilerine göre, uygulama yapılan hastanelerde cerrahi işlem öncesi ve sonrası gastrointestinal sistem cerrahisi uygulanacak hastalarda yatış anında malnütrisyon oranları, kanser tiplerine göre malnütrisyon düzeyleri ve uygulanan beslenme açısından istatistiksel olarak anlamlı fark (p<0.05) olduğu belirlendi. Araştırmada elde edilen bulgular gastrointestinal ameliyatı geçirecek olan hastalarda preoperatif dönemde subjektif global değerlendirme (SGA) ile beslenmenin değerlendirilmesinin preoperatif dönemde beslenmesi gereken hastaların seçilmesi, ve bu şekilde postoperatif dönemde gelişebilecek komplikasyonların önlenmesinde, iyileşme sürecinin kısalması ve mortalite ve morbiditenin azalmasında etkili olduğu görülmüştür. Anahtar Kelimeler: Preoperatif beslenme, postoperatif beslenme, malnütrisyon. SUMMARY THE PREOPERATIVE EVALUATION OF NUTRITIONAL STATUS AND SUPPORT WITH SUBJECTIVE GLOBAL ASSESSMENT (SGA) METHOD IN PATIENTS UNDERGOING TO GASTROINTESTINAL SYSTEM SURGERY This study is designed as a prospective evaluation of nutritional status and the benefits of a nutritional support regimen depending on subjective global assessment (SGA) in preoperative patients under gastrointestinal system surgery. The population of the study was the patients who has underwent to a planned gastrointestinal system surgery in general surgery departments of a University Hospital and two Research and Training Hospitals. We planned this study by taking informed consents from the patients with 40% sheeted sampling method (age) and determined a sample size of 100. Data were collected during face-o-face interviews and follows ups by using “Personel Characteristics Form” and “Patient Follow-up Forms” developed by the researcher and Subjectif Global Assessment (SGA) Form which is currently used in various hospitals were performed. Rate, percentages(x), standart deviation (SD), x2, t-test and Mann Whitney-U tests were used during evaluation of the data. A statistical significance (p<0.05) was found after the evaluation of the data in patients undergoing gastrointestinal system surgery in preoperative and postoperative time period, between malnutrition conditions at the time of hospital administration, level of malnutrition in different types of cancer and the type of nutritional support in different study hospitals. As a result of this study, in patients undergoing gastrointestinal system surgery, the evaluation of patients with subjective global assessment (SGA) is concluded to be an effective method for selection of the patients who needs nutritional support preoperatively and prevention of complications postoperatively, shortening the healing time and reducing the morbidity and mortality

How Do Operating Room Nurses Cope with Work-Related Tension and Stress?

Amaç: Ameliyathane hemşirelerinin iş ortamına bağlı gerginlik ve stresle baş etme durumlarınınincelenmesi amacıyla tanımlayıcı bir araştırma olarak yapılmıştır. Gereç ve Yöntemler:Çalışma, Ocak-Nisan 2014 tarihleri arasında, İstanbul İli Anadolu yakasında bulunan,ameliyat masası ve ameliyathane hemşiresi sayısı en yüksek dört olan kamu hastanesi ile dörtözel hastanede yürütülmüş olup, araştırmanın verileri Kişisel Özellikler Bilgi formu (KÖBF),Stresle Başa Çıkma Tarzları Ölçeği formu (SBTÖ), İşe Bağlı Gerginlik Ölçeği Formu (İBGÖ) kullanılaraktoplanmıştır. Çalışmanın örneklemini, çalışmaya katılmayı kabul eden 210 ameliyathanehemşiresi oluşturmuştur. Veri analizinde, IBM SPSS Statistics v24 programı kullanılarakyüzdelik dağılım, Pearson korelasyon analizi ve Independent Sample t-testleri kullanılmış vesonuçlar %95 güven aralığında, anlamlılık değeri p<0,05 düzeyinde değerlendirilmiştir. Bulgular:Hemşirelerde işe bağlı gerginlik ve stresle baş etme tarzları alt faktörleri olan kendine güvenliyaklaşım (r=-423), iyimser yaklaşım (r=-213) ve sosyal destek arama yaklaşımı (r=-,154)arasında anlamlı ve negatif bir ilişki bulunur iken; çaresiz yaklaşım (r=,366) ve boyun eğici yaklaşım(r=,209) arasında anlamlı pozitif ilişki saptanmıştır. İşe bağlı gerginlik artarken; kendinegüvenli yaklaşım, iyimser yaklaşım ve sosyal destek arama yaklaşımının azalmakta olduğu belirlenmiştir.Çalışma biçimleri ile işe bağlı gerginlik ve stresle baş etme arasında anlamlı bir ilişkibulunmuş olup, vardiya usulü çalışan hemşirelerin daha gergin oldukları ve “çaresiz yaklaşım”puanlarının daha yüksek olduğu saptanmıştır. Sonuç: Ameliyathane hemşirelerinin çalıştıklarıortamda daha kaliteli hizmet verebilmeleri için, çalışma koşullarının düzenlenmesi ve hizmet içieğitim programları ile stresle baş etme yollarının öğretilmesi ve psikolojik rehberlik hizmetlerininverilmesi önerilebilmektedir.Objective: This descriptive study aimed to investigate the effect of coping with workrelated strain and the ways of coping with stress among the operating room nurses. Material and Methods: The study was conducted between January 2014-April 2014 in four training-research hospitals and four hospitals have the largest number of operating rooms and operating room nurses in İstanbul Anatolia. Data was collected using Personal Attributes Questionnaire (PAQ), WorkRelated Strain Inventory (WRSI) and Ways of Coping Questionnaire (WCQ). The sample included 210 operating room nurses who accepted participating. Data were analyzed using the IBM SPSS Statistics for Windows v24. Findings evaluated according to a confidence interval of 95% and a significance level of p<0.05 and presented as frequency and percentage values with Pearson’s correlations analysis and Independent Sample t-test. Results: It was noted that there was a significant and negative correlation between self-confidence approach (r=-423), optimistic approach (r=-213) and seeking social support approach (r=-.154) and a significant and positive correlation between escapeavoidance approach (r=.366) and submissive approach (r=.209). As the nurses’ work-related tension increases, self-confidence approach and optimistic approach decreases whereas submissive approach and seeking social support approach decreases. There was a significant relationship between working styles and work-related tension and coping with stress. Nurses working in shift mode were found to be more nervous and "helpless approach" scores were higher. Conclusion: It is advisable to arrange working conditions and teach in-service training programs, ways to cope with stress, and provide psychological guidance services in order to make operating room nurses provide a qualified service in their work environment

Physician-nurse attitudes toward collaboration in Istanbul's public hospitals

The need for greater collaboration between nurses and physicians in clinical practice is essential to improve patient care and worker satisfaction. This study used t-tests and logistic regression to test four research hypotheses concerning attitudes toward physician-nurse collaboration in Istanbul, Turkey. The study found that nurses express more positive attitudes toward collaboration than physicians. Noteworthy was the finding that male physicians expressed more positive attitudes toward collaboration than female physicians. Residents and those employed in secondary institutions were also more likely to express more positive attitudes toward collaboration than permanent physicians and those employed in tertiary hospitals. (c) 2004 Elsevier Ltd. All rights reserved

How Do Operating Room Nurses Cope with Work-Related Tension and Stress?

Amaç: Ameliyathane hemşirelerinin iş ortamına bağlı gerginlik ve stresle baş etme durumlarınınincelenmesi amacıyla tanımlayıcı bir araştırma olarak yapılmıştır. Gereç ve Yöntemler:Çalışma, Ocak-Nisan 2014 tarihleri arasında, İstanbul İli Anadolu yakasında bulunan,ameliyat masası ve ameliyathane hemşiresi sayısı en yüksek dört olan kamu hastanesi ile dörtözel hastanede yürütülmüş olup, araştırmanın verileri Kişisel Özellikler Bilgi formu (KÖBF),Stresle Başa Çıkma Tarzları Ölçeği formu (SBTÖ), İşe Bağlı Gerginlik Ölçeği Formu (İBGÖ) kullanılaraktoplanmıştır. Çalışmanın örneklemini, çalışmaya katılmayı kabul eden 210 ameliyathanehemşiresi oluşturmuştur. Veri analizinde, IBM SPSS Statistics v24 programı kullanılarakyüzdelik dağılım, Pearson korelasyon analizi ve Independent Sample t-testleri kullanılmış vesonuçlar %95 güven aralığında, anlamlılık değeri p0,05 düzeyinde değerlendirilmiştir. Bulgular:Hemşirelerde işe bağlı gerginlik ve stresle baş etme tarzları alt faktörleri olan kendine güvenliyaklaşım (r-423), iyimser yaklaşım (r-213) ve sosyal destek arama yaklaşımı (r-,154)arasında anlamlı ve negatif bir ilişki bulunur iken; çaresiz yaklaşım (r,366) ve boyun eğici yaklaşım(r,209) arasında anlamlı pozitif ilişki saptanmıştır. İşe bağlı gerginlik artarken; kendinegüvenli yaklaşım, iyimser yaklaşım ve sosyal destek arama yaklaşımının azalmakta olduğu belirlenmiştir.Çalışma biçimleri ile işe bağlı gerginlik ve stresle baş etme arasında anlamlı bir ilişkibulunmuş olup, vardiya usulü çalışan hemşirelerin daha gergin oldukları ve “çaresiz yaklaşım”puanlarının daha yüksek olduğu saptanmıştır. Sonuç: Ameliyathane hemşirelerinin çalıştıklarıortamda daha kaliteli hizmet verebilmeleri için, çalışma koşullarının düzenlenmesi ve hizmet içieğitim programları ile stresle baş etme yollarının öğretilmesi ve psikolojik rehberlik hizmetlerininverilmesi önerilebilmektedir.Objective: This descriptive study aimed to investigate the effect of coping with workrelatedstrain and the ways of coping with stress among the operating room nurses. Material andMethods: The study was conducted between January 2014-April 2014 in four training-researchhospitals and four hospitals have the largest number of operating rooms and operating room nursesin İstanbul Anatolia. Data was collected using Personal Attributes Questionnaire (PAQ), WorkRelatedStrain Inventory (WRSI) and Ways of Coping Questionnaire (WCQ). The sample included210 operating room nurses who accepted participating. Data were analyzed using the IBM SPSSStatistics for Windows v24. Findings evaluated according to a confidence interval of 95% and a significancelevel of p0.05 and presented as frequency and percentage values with Pearson’s correlationsanalysis and Independent Sample t-test. Results: It was noted that there was a significant andnegative correlation between self-confidence approach (r-423), optimistic approach (r-213) andseeking social support approach (r-.154) and a significant and positive correlation between escapeavoidanceapproach (r.366) and submissive approach (r.209). As the nurses’ work-related tensionincreases, self-confidence approach and optimistic approach decreases whereas submissiveapproach and seeking social support approach decreases. There was a significant relationship betweenworking styles and work-related tension and coping with stress. Nurses working in shiftmode were found to be more nervous and "helpless approach" scores were higher. Conclusion: It isadvisable to arrange working conditions and teach in-service training programs, ways to cope withstress, and provide psychological guidance services in order to make operating room nurses providea qualified service in their work environment

Simultaneous resection for colorectal cancer with synchronous liver metastases is a safe procedure: Outcomes at a single center in Turkey

The optimal surgical strategy for treating colorectal cancer with synchronous liver metastases is subject to debate. The current study sought to evaluate the outcomes of simultaneous colorectal cancer and liver metastases resection in a single center. Prospectively collected data on all patients with synchronous colorectal liver metastases who underwent simultaneous resection with curative intent were analyzed retrospectively. Patient outcomes were compared depending on the primary tumor location and type of liver resection (major or minor). Between January 2005 and August 2016, 108 patients underwent simultaneous resection of primary colorectal cancer and liver metastases. The tumor was localized to the right side of the colon in 24 patients (22%), to the left side in 40 (37%), and to the rectum in 44 (41%). Perioperative mortality occurred in 3 patients (3%). Postoperative complications were noted in 32 patients (30%), and most of these complications (75%) were grade 1 to 3 according to the Clavien-Dindo classification. Neither perioperative mortality nor the rate of postoperative complications after simultaneous resection differed among patients with cancer of the right side of the colon, those with cancer of the left side of the colon, and those with rectal cancer (4%, 2.5%, and 2%, respectively, p = 0.89) and (17%, 33%, and 34%, respectively; p = 0.29)]. The 5-year overall survival of the entire sample was 54% and the 3-year overall survival was 67 %. In conclusion, simultaneous resection for primary colorectal cancer and liver metastases is a safe procedure and can be performed without excess morbidity in carefully selected patients regardless of the location of the primary tumor and type of hepatectomy