The participation of the people in health decisions may be structured in various levels. One of these is participation in decisions for the treatment. "Advanced directives" is one of the examples for ...the participation in decisions for the treatment.
We wanted to determine the decisions on advanced life support at the end-stage of life in case of a life-threatening illness for the people themselves and their first degree relatives and the factors effecting these decisions.
The cross-sectional study was conducted with volunteers among patients and patient relatives who applied to all polyclinics of the Ankara Numune Training and Research Hospital except the emergency, oncology and psychiatry polyclinics between 15.12.2012 and 15.03.2013.
A questionnaire, the Hospital Anxiety Depression (HAD) scale, and Templer's Death Anxiety Scale (TDA) were applied to all individuals. SPSS for Win. Ver. 17.0 and MS-Excel 2010 Starter software bundles were used for all statistical analysis and calculations.
The participants want both themselves and their first degree relatives included in end-stage decision-making process. Therefore, the patients and their families should be informed adequately during decision making process and quality communication must be provided.
Participants who have given their end-stage decisions previously want to be treated according to these decisions. This desire can just be possible by advanced directives.When moral and material loads of end-stage process are taken into consideration, countries, in which advanced directives are practiced, should be examined well and participants' desire should be evaluated in terms of practicability.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Clinical practice guidelines (CPGs) are systematically developed statements to assist practitioner and patient decisions about appropriate healthcare for specific clinical circumstances. There is a ...limited number of studies on guidelines in Turkey. The quality of Ministry of Health guidelines have formerly been assessed whereas there is no information on the other guidelines developed in the country.
This study aims to assess the quality of CPGs that are developed by professional societies that work for the health sector in Turkey, and compare the findings with international guidelines.
Professional societies that work for the health sector were determined by using the data obtained from the Ministry of Internal Affairs. Inclusion and exclusion criteria were defined for selecting the CPGs. Guidelines containing recommendations about disease management to the doctors, accessible online, developed within the past 5 years, citing references for recommendations, about the diseases over 1% prevalence according to the "Statistical Yearbook of Turkey 2012" were included in the study. The quality of CPGs were assessed with the AGREE II instrument, which is an internationally recognized tool for this purpose. Four independent reviewers, who did not participate in the development of the selected guidelines and were trained in CPG appraisal, used the AGREE instrument for assessment of the selected guidelines.
47 professional societies were defined which provided access to CPGs in their websites; 3 of them were only open to members so these could not be reached. 8 CPGs from 7 societies were selected from a total of 401 CPGs from 44 societies. The mean scores of the domains of the guidelines which were assessed by the AGREE II tool were;
64%, stakeholder involvement: 37.9%, rigour of development: 35.3%, clarity and presentation: 77.9%, applicability: 49.0% and editorial independence: 46.0%.
This is the first study in Turkey regarding quality appraisal of guidelines developed by the local professional societies. It adds to the limited amount of information in the literature that comes from Turkey as well as other developing countries.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Despite 82 million populations, Turkey is one of the countries with the lowest mortality rates in the world as a result of successful crisis management and public compliance. Turkey’s public health ...response to the COVID-19 pandemic has been rapid and continually evolving as described here. In this short communication we offer insight into the preparedness and response by Turkey of this continued global health threat posed by COVID-19. Turkey implemented multiple containment strategies prior to the first reported case within its borders- to reduce the burden and deadly risk of the virus. In the absence of a specific vaccine, governments, health care professionals and communities in general are continually working together to reduce exposure, infection, clinical severity and community transmission of COVID-19.
Introduction:Cigarette smoking is one of the most important preventable risk factors for atherosclerotic diseases. This study aims to assess the smoking behaviour after acute coronary syndrome (ACS) ...and aims to delineate the factors affecting smoking status after discharge.Methods:The Fagerström Test for Nicotine Dependence score, the sociodemographic status of patients, types of ACS and applied treatment methods were recorded. The Gensini scoring system was used to evaluate the extent and severity of coronary artery disease. Patients were reached via phone calls in the first, third and sixth month after discharge to assess their smoking status, their reasons for relapse and any recurrences of their diseases.Results:Forty-five percent of patients were treated for ST-elevated myocardial infarction, and 43.2% (n=48) had high or very high levels of dependence. Patients who had early symptoms had a higher rate of quitting smoking (p=0.009). Only 78.4% had thought of quitting smoking after discharge. Seventy-four (66.6%) patients underwent catheter-based interventions. The rates of relapse were 20.8% (n=15), 42.6% (n=32) and 53.9% (n=41) at the end of the first, third and sixth month after discharge, respectively. Gensini scores seemed to be higher among patients who had quit smoking (p<0.05). Patients who have received medical treatment had a higher rate of smoking than before the end of six months (p<0.05). Only 28.8% (n=32) of patients stated that they had received information about smoking cessation from their family physician and 3.6% (n=4) of patients have applied to a smoking cessation unit.Conclusion:Smoking cessation rates of patients who have suffered an ACS were low and rates of cigarette consumption in the following periods tended to increase. Family physicians should take a more active role in this topic in Turkey.
Objective: We aimed to investigate cardiovascular disease (CVD) risk and risk factors and evaluate the relationship among disease activity, inflammation markers, and uric acid levels in patients with ...rheumatoid arthritis (RA) and spondyloarthritis (SpA). Materials and Methods: In this study, 98 patients with RA, 41 patients with SpA, and 95 controls were included. Participants' demographic features, levels of body mass index (BMI), blood pressure (BP), waist circumference, glucose, cholesterol, uric acid, disease activity, and metabolic syndrome (MetS) prevalence were recorded. The 10-year CVD risk and heart age were calculated by using the Framingham risk score. Results: The mean BMI, systolic BP, diastolic BP, and waist circumference were higher in RA patients. There was no difference among patients with RA, those with SpA, and controls in terms of MetS prevalence (43.9%, 41.5%, and 35.8%, respectively, p=0.510) and 10-year CVD risk (12.7+ or -10.2, 9.2+ or -8.7, and 11.4+ or -10.8, respectively, p=0.174). Higher uric acid levels were indicated in patients with MetS in both RA and SpA groups. Uric acid levels were associated with the Framingham score in RA patients. Conclusion: In patients with RA and SpA, CVD risk was determined to be similar to that of the general population. On the other hand, the uric acid level was found to be correlated with the risk of MetS, and uric acid is associated with CVD risk, especially in patients with RA. Keywords: Metabolic syndrome, rheumatoid arthritis, spondyloarthritis, uric acid
Objective: In this study, we searcheddemographic analysis of complications of patients who took warfarin treatment andadmitted to our hospital with high INR levels and factors affecting mortality.
...Material and Method: All patients who were admitted to our hospital for any reason, who had at least 4 INR and received warfarin treatment were included in the study. The studies were analyzed retrospectively. The hospitalization epicrisis of 187 patients was evaluated. Questions were asked about duration of warfarin use, follow-up frequency, primary health care status, changes in the floor made by the clinic, and the use of warfarin data.
Results: The study population consisted of 87 women and 100 men. The mean age of the patients was 64.1 ± 17.6 years. The most common hospitalization complaints in the whole population were bleeding (22.4%), dyspnea (18.2%), confusion (17.1%) and nausea / vomiting (9.6%). INR level was above 10 in 34.2% of the patients. The highest indication of warfarin use was AF. Hypertension was the highest comorbidity. The predictors of mortality were chest pain (HR = 3.808; p = 0.012) and hemathesis (HR = 3.688; p = 0.033), respectively. The number of patients admitted to primary care for warfarin was 23 (12.3%). Patients were followed up in cardiology, home health care, cardiovascular surgery and neurology (16%, 6.4%, 5.9%, 4.3%, respectively). The rate of people who received warfarin training was 36.8%.
Conclusion: Although warfarin is a drug that should be monitored frequently, the follow-up frequency of patients is very low.
Amaç: Bu çalışma ile warfarin tedavisi alıp hastanemize yüksek INR değerleri ile başvuran hastaların demografik analizlerini yapmayı, mortaliteye etki eden nedenleri saptamayı ve birinci basamaktan yararlanma durumlarını belirlemeyi amaçladık.
Gereç ve Yöntem: Herhangi bir nedenle warfarin tedavisi alan, INR değeri 4'ün üzerinde olan ve komplikasyon yaşayan 187 hasta çalışmamıza dahil edildi. Hastaların hastane epikrizlerinden hastane başvuru nedeni, hangi kliniğe başvurduğu, INR değerleri, komorbid hastalık varlığı, kan transfüzyonu ihtiyacı, tedavi sonrası sağlık durumu, warfarin endikasyonu, warfarin başlayan klinik retrospektif olarak değerlendirildi. Taburculuk durumu, warfarin kullanma süresi, takip sıklığı, birinci basamağa başvuru durumu, doz değişikliklerini hangi kliniğin yaptığı, eğitim durumu telefondan öğrenildi.
Bulgular: En sık hastaneye başvuru sebepleri kanama (%22,4), dispne (%18,2), ve kusma/bulantı (%9,6) olarak belirlendi. Hastaların %34,2'sinin INR değeri 10'un üzerindeydi. En sık warfarin başlama endikasyonu AF idi. Mortaliteye etki eden prediktörler göğüs ağrısı (p:0,012) ve hematemaz (p:0,033) olarak değerlendirildi. Birinci basamağa doz değişimi için başvuran hasta oranı %12,3idi. Hastaların takipleri en sık olarak kardiyoloji, evde sağlık hizmetleri, kardiyovasküler cerrahi ve nöroloji tarafından yapılmaktaydı (sırasıyla; 16%,6.4%,5.9%,4.3%). Warfarin eğitimi %36,8idi.
Sonuç: Warfarin sık takip gerektiren ve komplikasyonları mortal olan bir ilaç olduğu için hasta eğitimi çok önemlidir ve hastaların en kolay ulaşabilecekleri sağlık hizmeti olan birinci basamak sağlık hizmetlerini kullanmaları yönünde teşvik edilmesi gerekmektedir.
According to AFAD Director General, Turkey spent US$1·5 billion for Syrian refugees.2 Health-care services are provided through primary health-care centres, 112 medical emergency stations, and tent ...hospitals.
Aim
This study aimed to determine the approaches of family physicians in Turkey towards the fasting of diabetic patients and whether they used international treatment guidelines when making ...recommendations. In addition, this study also aimed to increase the awareness of family physicians about this issue before Ramadan, which is a month of fasting.
Material and method
The study herein comprised cross‐sectional, observational research. Before Ramadan 2018, a structured questionnaire form, which was unique to this study, was prepared based on the guidelines of the International Diabetes Federation (IDF) and the American Diabetes Association (ADA), through platforms where family physicians gather via social media and mail groups, and sent to family physicians in Turkey via a link using an electronic questionnaire preparation and application programme. Moreover, the total knowledge level, attitude, and approach scores were calculated from the questions prepared from the relevant guidelines.
Results
Participating in the survey were 262 family physicians. Only 22% of the family physicians stated that they were aware of the international guidelines for Ramadan and diabetes management, and only 10% said that they had read them. The mean knowledge level, attitude, and approach scores were determined to be lower than expected, and a significant difference was found between the scores and academic titles.
Conclusion
The lack of international guidelines on the subject, and of knowledge and experience about Diabetes Mellitus (DM) patient management during the month of fasting, stood out as the biggest problems. This study revealed that the awareness and competence of family physicians in disease management should be increased, in addition to that of fasting before, during, and after Ramadan in patients with DM, which has increasing prevalence in Turkey.
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