The conventional approach for identifying ground glass opacities (GGO) in medical imaging is to use a convolutional neural network (CNN), a subset of artificial intelligence, which provides promising ...performance in COVID‐19 detection. However, CNN is still limited in capturing structured relationships of GGO as the texture and shape of the GGO can be confused with other structures in the image. In this paper, a novel framework called DeepChestNet is proposed that leverages structured relationships by jointly performing segmentation and classification on the lung, pulmonary lobe, and GGO, leading to enhanced detection of COVID‐19 with findings. The performance of DeepChestNet in terms of dice similarity coefficient is 99.35%, 99.73%, and 97.89% for the lung, pulmonary lobe, and GGO segmentation, respectively. The experimental investigations on DeepChestNet‐Lung, DeepChestNet‐Lobe and DeepChestNet‐COVID datasets, and comparison with several state‐of‐the‐art approaches reveal the great potential of DeepChestNet for diagnosis of COVID‐19 disease.
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.
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.
Objective: Several factors in our life process may directly contribute to frailty or are associated with diseases that can lead to frailty. In this study, we aimed to determine the factors and life ...events that contribute to frailty and affect gait speed using several tests. Materials and Methods: This cross-sectional study included patients aged 65 and above. The Tilburg Frailty Indicator (TFI), the timed up and go (TUG) test, and the gait speed (GS) test were used. Independent determinants for different types of frailty and TUG and GS scores were examined using multivariate logistic and linear regression models. Results: There were 263 individuals included in this study. The mean age of the individuals was 72.53+ or -5.83 years old, and 46% of the individuals (n=121) were frailty. The total frailty score of the participants was 4.59+ or -3.10, the mean TUG score was 10.28+ or -3.11 s, and the GS score was 0.80+ or -0.30 m/s. Female sex (adjusted odds ratio aOR=5.3), middle and bad health perception (aOR=6.8, aOR=58.3), poor living environment satisfaction (aOR=14.3), and TUG test score (aOR=1.6) were significantly associated with an increase in risk for frailty. Conclusion: In this study, as we have found that factors such as sex, health perception, and gait speed affect frailty and factors such as age, polypharmacy, and frailty affect gait speed; the quality of life of the elderly can be improved with suitable intervention for these factors. Keywords: Frailty, gait speed, elderly, quality of life, walking
HEALTH TECHNOLOGY ASSESSMENT IN TURKEY Kahveci, Rabia; Koç, Esra Meltem; Küçük, Emine Özer
International journal of technology assessment in health care,
01/2017, Letnik:
33, Številka:
3
Journal Article
Recenzirano
The healthcare transformation program in Turkey has shown its success with improvements in important health indicators, increased access to healthcare services and expansion of coverage to all ...citizens. Turkey has been relatively able to bear the burdens associated with this due to rapid economic growth. The need for health technology assessment (HTA) was believed as a result of the expansion of coverage, pressure of new technologies, and increased expenditures. This study outlines the background and current formalization of HTA and shares the current use of HTA in decision making, while summarizing the transformation of the Turkish healthcare system for developing a high-quality, equal, and accessible care system.
We reviewed and analyzed policy changes in the Turkish healthcare system, universal health coverage, healthcare expenditures, and pricing and reimbursement policies to identify the changes leading to HTA. We reviewed existing HTA functions in Turkey and outlined their activities. Finally, we outlined a set of major challenges for HTA in Turkey over the next decade.
HTA was formalized in Turkey in 2012-2013 with three national HTA structures and one hospital-based HTA unit. These functions currently run independent from each other. There are three major challenges in this country for HTA in the next decade: clarification of the assessment scope and methods, building a strong supporting system for HTA, and defining the role of HTA in the future vision of Turkish healthcare policy.
HTA, despite challenges, has a good opportunity to develop further with clear action plans and strong political will.
Aim:Frailty has become an important health issue in recent years. The aim of this study was to investigate the relationship between frailty and medicine use and polypharmacy in people over 65 years ...of age.Methods:Patients aged 65 years and over, who were admitted to family medicine outpatient clinics, were included in the study. The Tilburg frailty indicator, timed up and go test and gait speed test were used. Multivariate linear and logistic regression model were conducted.Results:Individuals, who used five or more medicines (polypharmacy) daily, constituted 49.1% of all participants. 55.6% of patients on polypharmacy were frail. Gender (β=-0.560, 95% Cl=-0.943-0.177) and the number of chronic diseases (β=1.496, 95% Cl=1.376-1.616) were found to have an effect on the total number of medicines. According to the results of logistic regression analysis on polypharmacy; female gender (aOR=3.4, 95% Cl=1.412-8.639), living alone (single/divorced/widowed) (aOR=2.8, 95% Cl=1.133-7.201) and number of chronic diseases (aOR=6.8, 95% Cl=4.218-11.075) were significantly associated with increased risk of polypharmacy.Conclusion:A significant increase in frailty score and reduction in walking speeds were detected in patients aged 65 years and over on polypharmacy. It should be kept in mind that polypharmacy is significantly related with frailty in elderly patients.
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