Among men, depression is often unrecognised and untreated. Men employed in male-dominated industries and occupations may be particularly vulnerable. However, efforts to develop tailored workplace interventions are hampered by lack of prevalence data. A systematic review of studies reporting prevalence rates for depression in male dominated workforce groups was undertaken. Studies were included if they were published between 1990 - June 2012 in English, examined adult workers in male-dominated industries or occupations (> 70% male workforce), and used clinically relevant indicators of depression. Twenty studies met these criteria. Prevalence of depression ranged from 0.0% to 28.0%. Five studies reported significantly lower prevalence rates for mental disorders among male-dominated workforce groups than comparison populations, while six reported significantly higher rates. Eight studies additionally found significantly higher levels of depression in male-dominated groups than comparable national data. Overall, the majority of studies found higher levels of depression among workers in male-dominated workforce groups. There is a need to address the mental health of workers in male-dominated groups. The workplace provides an important but often overlooked setting to develop tailored strategies for vulnerable groups.

Transversus abdominis plane (TAP) blocks can provide analgesia postoperatively for a range of surgeries. Abundant clinical trials have assessed TAP block showing positive analgesic effects. This systematic review assesses safety and effectiveness outcomes of TAP block in all clinical settings, comparing with both active (standard care) and inactive (placebo) comparators. PubMed, EMBASE, The Cochrane Library and the University of York CRD databases were searched. RCTs were screened for their eligibility and assessed for risk of bias. Meta-analyses were performed on available data. TAP block showed an equivalent safety profile to all comparators in the incidence of nausea (OR = 1.07) and vomiting (OR = 0.81). TAP block was more effective in reducing morphine consumption [MD = 13.05, 95% CI (8.33, 51.23)] and in delaying time to first analgesic request [MD = 123.49, 95% CI (48.59, 198.39)]. Postoperative pain within 24 h was reduced or at least equivalent in TAP block compared to its comparators. Therefore, TAP block is a safe and effective procedure compared to standard care, placebo and other analgesic techniques. Further research is warranted to investigate whether the TAP block technique can be improved by optimizing dose and technique-related factors.

A continuous paravertebral block is used when pain relief is required beyond the duration of a single-injection paravertebral block. Surgical procedures requiring an incision into the pleural cavity are some of the most painful procedures postoperatively and, if not managed appropriately, can lead to chronic pain. The current gold standard for post-cardiothoracic surgery pain management is epidural analgesia, which has contraindications, a failure rate of up to 12% and risk of complications such as epidural abscess and spinal haematoma. This systematic review and meta-analysis aimed to investigate the use of a continuous paravertebral block for post-cardiothoracic surgery analgesia. Randomized controlled trials evaluating the continuous paravertebral block against epidural analgesia, wound infiltration, placebo or standard care (intravenous opioids) for post-cardiothoracic surgery analgesia were considered for inclusion in the systematic review. PubMed, EMBASE, The Cochrane Library and the University of York Centre for Reviews and Dissemination databases were searched from inception to 15 September 2014. Risk of bias and generalizability were assessed using a modified Downs and Black checklist. A meta-analysis was conducted on suitable studies comparing the continuous paravertebral nerve block with epidural anaesthesia, with fixed-effects models being used to pool the effects. Twenty-three randomized controlled trials with 1120 participants were included. The continuous paravertebral block was associated with a significant improvement in incidence of nausea and vomiting (odds ratio = 0.29, 95% confidence interval = [0.16, 0.56]), hypotension (odds ratio = 0.16, 95% confidence interval = [0.06, 0.41]) and urinary retention (odds ratio = 0.22, 95% confidence interval = [0.09, 0.52]) compared with the epidural block. No statistically significant difference in pain relief was reported. The continuous paravertebral block has equivalent analgesic effects to epidural analgesia, wound infiltration and standard care, but is associated with a lower incidence of nausea and vomiting, hypotension and urinary retention than epidural analgesia.

Day surgery for groin hernia repair is safe and effective for most patients. However, evidence-based support is only one of many factors that may contribute to the uptake of day surgery in Australia. There is an opportunity for key stakeholders across the private healthcare system to deliver an equally effective but more sustainable and affordable hernia care by increasing the day surgery rates.

Background Variation in cut‐off values for what is considered a high volume (HV) hospital has made assessments of volume‐outcome relationships for pancreaticoduodenectomy (PD) challenging. Accordingly, we performed a systematic review and meta‐analysis comparing in‐hospital mortality after PD in hospitals above and below HV thresholds of various cut‐off values. Method PubMed/MEDLINE, Embase and Cochrane Library were searched to 4 January 2021 for studies comparing in‐hospital mortality after PD in hospitals above and below defined HV thresholds. After data extraction, risk of bias was assessed using the Downs and Black checklist. A random‐effects model was used for meta‐analysis, including meta‐regressions. Registration: PROSPERO, CRD42021224432. Results From 1855 records, 17 observational studies of moderate quality were included. Median HV cut‐off was 25 PDs/year (IQR: 20–32). Overall relative risk of in‐hospital mortality was 0.37 (95% CI: 0.30, 0.45), that is, 63% less in HV hospitals. All subgroup analyses found an in‐hospital survival benefit in performing PDs at HV hospitals. Meta‐regressions from included studies found no statistically significant associations between relative risk of in‐hospital mortality and region (USA vs. non‐USA; p = 0.396); or 25th percentile (p = 0.231), median (p = 0.822) or 75th percentile (p = 0.469) HV cut‐off values. Significant inverse relationships were found between PD hospital volume and other outcomes. Conclusion In‐hospital survival was significantly greater for patients undergoing PDs at HV hospitals, regardless of HV cut‐off value or region. Future research is required to investigate regions where low‐volume centres have specialized PD infrastructure and the potential impact on mortality.