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.
Premenstrual syndrome (PMS), dysmenorrhea, and abnormal uterine bleeding are frequent gynecological problems in adolescent girls. Studies show that sleep disorders and menstrual cycle irregularities ...are common conditions and indicate that they may occur together. Studies on the relationship between sleep quality and menstruation are mostly available for late adolescents (17 years and older) and young adult age groups. Our study aims to evaluate this relationship in adolescents aged 12-18.STUDY OBJECTIVEPremenstrual syndrome (PMS), dysmenorrhea, and abnormal uterine bleeding are frequent gynecological problems in adolescent girls. Studies show that sleep disorders and menstrual cycle irregularities are common conditions and indicate that they may occur together. Studies on the relationship between sleep quality and menstruation are mostly available for late adolescents (17 years and older) and young adult age groups. Our study aims to evaluate this relationship in adolescents aged 12-18.A survey study was structured and consisted of 4 sections. The first section includes anthropometric measurements and medical history of the participants; the second section includes 'menstruation and menstruation symptoms history'; the third section includes 'The Sleep Quality Scale and Sleep Variable Questionnaire' (SQS-SVQ); and the fourth section includes the 'Premenstrual Syndrome Assessment Scale' (PMSAS). Our survey was applied to those who visited the adolescent medicine outpatient clinic.METHODSA survey study was structured and consisted of 4 sections. The first section includes anthropometric measurements and medical history of the participants; the second section includes 'menstruation and menstruation symptoms history'; the third section includes 'The Sleep Quality Scale and Sleep Variable Questionnaire' (SQS-SVQ); and the fourth section includes the 'Premenstrual Syndrome Assessment Scale' (PMSAS). Our survey was applied to those who visited the adolescent medicine outpatient clinic.The Sleep Quality Scale (SQS) score was significantly lower in those with high PMSAS scores (p<0.001). The participants who had dysmenorrhea and experienced other symptoms during menstruation had significantly lower SQS scores and sleep efficiency (p<0.001). There was no significant difference between heavy menstrual bleeding (HMB), defined as lasting more than 7 days, requiring more than 5-6 pads/tampons per day, and sleep efficiency/quality (p>0.05).RESULTSThe Sleep Quality Scale (SQS) score was significantly lower in those with high PMSAS scores (p<0.001). The participants who had dysmenorrhea and experienced other symptoms during menstruation had significantly lower SQS scores and sleep efficiency (p<0.001). There was no significant difference between heavy menstrual bleeding (HMB), defined as lasting more than 7 days, requiring more than 5-6 pads/tampons per day, and sleep efficiency/quality (p>0.05).According to our study, dysmenorrhea and the presence of PMS may negatively affect the sleep quality of adolescents. Health professionals dealing with young people should take into account the effects of menstrual problems on sleep quality and offer appropriate support/treatment options.CONCLUSIONAccording to our study, dysmenorrhea and the presence of PMS may negatively affect the sleep quality of adolescents. Health professionals dealing with young people should take into account the effects of menstrual problems on sleep quality and offer appropriate support/treatment options.
Radiation therapy can result in injury to the lung parenchyma and central airways; the latter is less well documented in the literature. Here, we describe a 65-year-old Caucasian male, who developed ...focal endobronchial nodules and right main bronchial stenosis suggesting tumour recurrence, 32 months following curative intent concurrent chemoradiation therapy for Stage 3B squamous cell carcinoma of the lung. Computed tomography and positron emission tomography results are detailed. Flexible bronchoscopy with bronchial biopsies revealed squamous metaplasia rather than malignant tumour recurrence, with ongoing observation planned.
Radiation therapy can result in injury to the lung parenchyma and central airways; the latter is less well documented in the literature. Here, we describe a 65-year-old Caucasian male, who developed ...focal endobronchial nodules and right main bronchial stenosis suggesting tumour recurrence, 32 months following curative intent concurrent chemoradiation therapy for Stage 3B squamous cell carcinoma of the lung. Computed tomography and positron emission tomography results are detailed. Flexible bronchoscopy with bronchial biopsies revealed squamous metaplasia rather than malignant tumour recurrence, with ongoing observation planned.
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.
INTRODUCTION: Healthy child follow-up is mostly carried out by family physicians working in primary care and their parents.The aim of our study is to draw attention to the responsibilities of ...families in healthy child follow-up, to raise awareness and to determine their relationship with health literacy situations. METHODS: The study was planned as an observational and cross-sectional survey.It was carried out on parents with children between the ages of 0-5 years followed up in a family health center in Ankara.648 families were invited to study.We developed a structured questionnaire and used Turkey Health Literacy Scale(TSOY-32) in order to measure the parents' health literacy.After obtaining the necessary permissions, the questionnaire was filled through the face-to-face questionnaire application method. RESULTS: 269 families agreed to participate in the study.The median score of total TSOY-32 was calculated as 32.3 and it was included in the 'limited-problematic' health literacy group.It was determined that the TSOY-32 scores were significantly higher in high education and good income levels and among working parents.It was determined that the parents who 'regularly make their children's follow-ups by themselves' have higher health literacy total and component scores than the parents who 'follow-up by their doctor's calling'. DISCUSSION AND CONCLUSION: Health literacy knowledge level scores of the families were lower than expected.Health literacy is an important factor in raising awareness of health-related responsibilities for building a healthy society.This study has made awareness among families in terms of what to do about child follow-up,and contributed to the literature on a more careful,healthy and conscious follow-up on the identified issues.
The purpose of this study was to investigate the opinions of health professionals (HPs) who provide family planning counselling (FPC) within the scope of primary health care services since they are ...perceived as role models by the society. The number of HPs providing family planning counselling in primary health services in Turkey was 43,000 and 40,000 of these individuals were invited to participate in this observational, cross-sectional study via e-mail and social media. There were 740 responders and all were included in the study. Physicians providing FPC within the scope of primary health care services consisted of 45.1% of the responders and the remaining were nurses. Among all HPs, 59.7% had insufficient awareness regarding Turkey’s population growth. Most of the HPs (52.4%) believed that the ideal number of children was 2 or less. The abortion rate was 9.1% in all pregnancies of HPs. The rate of caesarean section was 56% in all live births. According to responses, 75.6% of all pregnancies experienced by HPs were planned. According to 42.1% of the HPs, abortion must be performed if there is a life-threatening situation for the mother or if the fetus has some abnormalities. The most common method of birth control used by married HPs between the ages of 18 and 49 was male condoms (39.9%), while the pull-out method ranked first in the general population (25.5%). It was found that HPs, who had different opinions and practices about family planning than the general population, had insufficient awareness regarding population growth. Increased awareness of demography and FPC among HPs will likely contribute to the quality of service and the general wellbeing of the population.
Rationale, aims, objectives
Clinical Practice Guidelines are mostly developed by 3 methods; namely, de novo, adoption, and adaptation. Nonpublished studies and authors experience shows that most ...guidelines in Turkey are either by adoption or by adaptation. There is no available local tool for adaptation, so the process is not standardized and most of the time not explicitly defined. The objective of this study is to search for international guideline adaptation tools and test their feasibility in Turkish context, to serve a final goal of developing a unique local strategic tool for guideline adaptation.
Methods
The methodological design of this study includes selection of an international tool for Clinical Practice Guideline adaptation, piloting this tool with selected Turkish guidelines, identifying the feasibility of this tool and exploring the needs for adaptation of the tool, drawing recommendations for adaptation of the strategies, and validation of the process by local experts.
Results
The study from planning phase to finalizing the guidance, including pilot studies and panel but excluding translation of ADAPTE, lasted 18 months. Nine researchers were involved in the adaptation process and 15 more experts were involved in the validation panel. Following the suggestions of the research team on modifications and validation through the expert panel; 2 steps of the ADAPTE toolkit were rejected, 2 steps were accepted by modification, 7 steps were accepted by additional recommendations. In addition, 2 tools were suggested to be added to the toolkit.
Conclusion
This is the first study on adaptation of guidelines in Turkey. Pilot adaptation of 2 guidelines with ADAPTE revealed that ADAPTE is a useful and feasible tool in Turkish setting, but might require certain changes in recommendations and revision of tools.
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