Pamukkale University Hospital Research Articles

Beyond the stethoscope: ageism in white coats and resident physicians' preferences for elderly patient care.

The global increase in life expectancy has significantly raised the elderly population. In Türkiye, the proportion of individuals aged 65 and over rose from 8.8% in 2018 to 10.2% in 2023. This demographic shift necessitates the planning of social and health services for the elderly. Ageism affects elderly health negatively and is prevalent in healthcare settings. This study aimed to determine the prevalence of ageism among resident physicians at Pamukkale University Hospital and identify factors influencing their preferences for providing healthcare to elderly patients. This cross-sectional study was conducted at Pamukkale University Hospital between 6 June and 16 June, 2024. A total of 448 resident physicians were selected through simple random sampling. Data were collected using a self-administered questionnaire, which included sociodemographic information, factors affecting ageism, and the Fraboni Scale of Ageism (FSA). Descriptive statistics, Chi-square tests, and logistic regression were used to evaluate factors influencing healthcare preferences. The FSA score averaged 71.89 ± 7.87, indicating a 20.1% (95% CI:16.48-24.10) prevalence of age discrimination among resident physicians. Logistic regression analysis revealed that male participants (odds ratio (OR) = 1.519, P = 0.042), those with moderate to very poor perceived knowledge of elderly health (OR = 2.418, P < 0.001), and higher FSA scores (OR = 1.046, P < 0.001) were more likely to prefer not providing healthcare services to elderly patients. Ageism among resident physicians is prevalent, impacting their willingness to provide care to elderly patients. Gender, perceived knowledge, and ageist attitudes influence their preferences for providing healthcare to elderly patients. Addressing these factors is crucial for improving healthcare services for the elderly.

INVESTIGATION OF THE RELATIONSHIP BETWEEN COGNITIVE LEVEL AND UPPER EXTREMITY FUNCTIONS IN PATIENTS WITH CHRONIC STROKE

Objective: Cognitive impairment and loss of upper limb functions are common after stroke and these two components can influence each other in anatomical and functional contexts. In this study, it was aimed to examine the relationship between cognitive level and upper extremity functions in patients with chronic stroke. Method: The study included 39 individuals diagnosed with stroke, in the chronic phase and with a mean age of 61.33±12.71 years, who were evaluated at Pamukkale University Hospital. Standardized Mini Mental Test (SMMT) and Stroop Test Basic Sciences Research Group (TBAG) Form were used to evaluate the cognitive levels of individuals. Fugl Meyer Upper Extremity Rating Scale, Frenchay Arm Test and Box-Block Test were used to evaluate upper extremity functions. Results: When the findings of the study were examined, statistically significant relationships were found between the Standardized Mini Mental Test and the Fugl Meyer Upper Extremity Rating Scale, Frenchay Arm Test and Box-Block Test (p

From the Editor-in-Chief's Desk

Journal of Child and Adolescent PsychopharmacologyVol. 33, No. 2 EditorialFree AccessFrom the Editor-in-Chief's DeskHarold S. KoplewiczHarold S. KoplewiczHarold S. Koplewicz, MD, Editor-in-ChiefChild Mind Institute, New York, New York, USA.Search for more papers by this authorPublished Online:20 Mar 2023https://doi.org/10.1089/cap.2023.29235.editorialAboutSectionsPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail To Our Readers:One of my proudest contributions as Editor-in-Chief of this journal has been working with a dedicated team to increase the global representation of research on child and adolescent psychopathology and medication treatment. This issue of the journal bears out this commitment. While Childress et al report on the important open-label safety trial of a new formulation of methylphenidate (MPH) for the treatment of attention-deficit/hyperactivity disorder (ADHD), we also have a paper from a Taiwanese group (Yu et al) on their systematic review and meta-analysis of guanfacine for ADHD treatment. Elsewhere, Büber et al provide valuable insight into prescribing trends for atypical antipsychotics in Turkish inpatient settings.Childress et al describe their trial of serdexmethylphenidate/dexmethylphenidate (SDX/d-MPH; brand name Azstarys), a mixture of d-MPH (which provides an immediate therapeutic effect) and its prodrug SDX (which is gradually converted to active d-MPH later in the day). SDX/d-MPH is approved for the treatment of patients aged 6 years or older with ADHD. The year-long open-label trial is the second phase 3 trial. The authors report that SDX/d-MPH is effective and safe. “SDX/d-MPH treatment produced a noticeable improvement in ADHD-RS-5 and CGI-S scores within 1 month of starting treatment,” they write, “and continued effectiveness was seen during the 1-year treatment period.” Although 60% of subjects reported an adverse event in the treatment phase, these percentages are “equivalent or fewer than those reported with other [MPH] treatments.”The paper from Yu et al on guanfacine, a non-stimulant second-line treatment for ADHD, is a helpful counterpart. In general, the authors report that guanfacine is effective and safe. Looking at the results of 12 randomized controlled trials comparing guanfacine to placebo, the authors were able to identify a population of 2273 participants with available safety data. In this group, 1437 (63.2%) received guanfacine, and 836 (36.8%) received a placebo. “Overall,” the authors write, “1170 (81.4%) participants in the guanfacine group experienced at least one treatment-emergent adverse event (TEAE) compared with 556 (66.5%) in the placebo group.” Low between-study heterogeneity indicates that there are certain persistent side effects of guanfacine, including dry mouth, somnolence, and sedation.Lastly, the paper from Büber et al echoes what we have learned from investigations of antipsychotic prescribing and polypharmacy in US and European settings. Their retrospective chart review included all patients treated at the Pamukkale University Hospital child and adolescent psychiatry inpatient service between 2015 and 2019. “Antipsychotic polypharmacy increased from 16.2% at admission to 30.7% at discharge,” the authors write. “Self-harm, aggression/violence, and extended hospitalization were factors associated with increased antipsychotic use. Psychotic symptoms, psychotic disorder, and extended hospitalization were factors associated with an increase in antipsychotic polypharmacy.”I hope you find the articles in this issue helpful and informative.FiguresReferencesRelatedDetails Volume 33Issue 2Mar 2023 InformationCopyright 2023, Mary Ann Liebert, Inc., publishersTo cite this article:Harold S. Koplewicz.From the Editor-in-Chief's Desk.Journal of Child and Adolescent Psychopharmacology.Mar 2023.39-39.http://doi.org/10.1089/cap.2023.29235.editorialPublished in Volume: 33 Issue 2: March 20, 2023PDF download

The reliability and validity of the Turkish version of the self-administered neck mobility assessment tool (s-rom-neck) in patients with chronic neck pain.

The self-administered neck mobility assessment tool (S-ROM-Neck) is the subjective cervical region range of motion (S-ROM) assessment scale. The study aimed to demonstrate the reliability and validity of the Turkish version of the S-ROM-Neck in patients with chronic neck pain. : A cross-sectional study was conducted with a total of 60 chronic neck pain patients in the Physical Therapy and Rehabilitation Clinic of Pamukkale University Hospital between January and August 2021. The mean age of the individuals was 34.1 ± 9.9 years. Patients were assessed with S-ROM-Neck twice to prove the test-retest reliability. In addition, Visual Analogue Scale (VAS), Neck Disability Index (NDI) and bubble inclinometer measurement were used to analyze the construct validity of S-ROM-Neck. The intraclass correlation coefficients of the S-ROM-Neck were higher than 0.80 (ICC > 80, CI: 0.90-98). The internal consistency of the S-ROM-Neck total score was within the acceptable limits (α = 0.754). Construct validity was high regarding the correlation analysis (r > 0.05, p < 0.01). Turkish S-ROM-Neck is a valid and reliable tool to assess the S-ROM of individuals with chronic neck pain.

Using Machine Learning Technique to Predict the Most Reliable Diagnostic Finding for Foreign Body Aspiration in Children: Symptoms, Chest X-ray, or Auscultation?

Foreign body aspiration (FBA) is one of the most critical and life-threatening pediatric emergency situations. Prompt diagnosis in these cases is very important as they are associated with high mortality among children. When diagnosing FBA, symptoms of the patient, auscultation findings, and chest X-ray findings are usually evaluated. In this study, we conducted a retrospective analysis of all the cases involvingsuspicion of FBA in children under the age of 18 years who were hospitalized in theDepartment of Pediatric Surgery at Denizli Pamukkale University Hospital, Turkeyfrom January 2005 to September 2020. Instead of traditional statistical methods, we used machine learning techniques such as random forest and logistic regression to determine whichfinding was diagnostically the most reliable. The variables included in the analysis that were considered to be significant were as follows: symptoms, auscultation findings, chest X-ray findings, patient gender, age, location of the foreign body, and the time of admission. For the purpose of this study, we developed four different models. Model 1 included gender, age, time of admission, location, and symptoms as variables; the correct classification rate of the model was found to be 82.3%. Model 2 included auscultation findings in addition to Model 1, and the correct classification rate of the model was 84.8%. Model 3 included chest X-ray findings in addition to Model 1, and the correct classification rate of the model was 87.4%. Model 4, on the other hand, included both auscultation findings and chest X-ray findings in addition to Model 1, and the correct classification rate of the model was 87.6%. Based on our findings, a definitive diagnosis of FBA using only symptoms, auscultation findings, or chest X-ray findings in isolation does not seem possible. Additionally, using only symptoms and chest X-ray findings is also insufficient to make a diagnosis.

Predicting the Severity of Coronary Artery Disease: Can the Leukocyte Glucose Index be Used?

To investigate the usability of leuko-glycemic index (LGI) at chronic coronary syndromes (CCS) class 1 for determining the extent and severity of coronary artery disease (CAD). An observational study. Department of Cardiology, University of Pamukkale University Hospital, Turkey, between September 2021 and January 2022. One hundred and thirty-four patients, whose myocardial perfusion scintigraphy (MPS) was requested due to CCS class 1, and on whom a coronary angiogram (CAG) was performed due to evidence of ischemia, were analysed. Blood samples were taken from the patients during their hospitalisation before CAG. LGI was calculated as mg/dl.mm3 by multiplying both values and dividing by a thousand. The patients were analysed in two groups according to the critical stenosis and non-critical stenosis detected in the coronary arteries. The LGI was recorded as 480 mg/dl.mm3 (407-603) vs. 572 mg/dl.mm3 (433-877), p=0.006, and the Gensini score (6 (3-10) vs 40 (23-60), p<0.001) was significantly higher in the critical CAD group. A significant relationship has detected the increase in LGI and the extensity and severity of CAD (Unadjusted; OR (95% CI); 1.003 (1.001 - 1.004) p=0.002, adjusted; OR (95% CI); 1.002 (1.001 - 1.004) p=0.004). A high LGI was a predictor of CAD severity among CCS class 1 patients and was found to correlate with the Gensini score. The use of this simple and inexpensive index, together with other non-invasive tests before CAG, may provide some knowledge about the severity of CAD. Coronary artery disease, Leukocyte glucose index, Myocardial perfusion scintigraphy.

Retrospective clinical evaluation of indications for termination of pregnancies due to fetal anomaly

Objective:To assess the indications for termination of pregnancy (TOP) in pregnant patients who were followed up with suspicion of fetal anomaly in a Turkish tertiary referral center.Material and Methods:This retrospective study was carried out in patients who were followed up with suspicion of fetal anomaly between May 2016 and May 2019 at the Perinatology Clinic of Obstetrics and Gynecology Department in Pamukkale University Hospital, which is a tertiary hospital in Denizli province in Turkey. Women were divided into two depending on gestational period: group 1 ≤22 weeks; and group 2 (>23 weeks of gestation).Results:Four hundred and seventeen pregnant women were evaluated and TOP was performed at a mean gestational age of 27.7±6.3 weeks. There were 308 (73.8%) women in group 1 and 109 (26.2%) in group 2. The decision to terminate pregnancy was due to fetal anomaly in 117 (28.1%). The majority of termination pregnancies in group 2 were performed because of multiple malformations and/or central nervous system defects. All chromosomal diseases were detected in group 1.Conclusion:With a good perinatal screening program, fetal anomalies can be diagnosed early. Therefore, early TOP is possible. Thus, pregnancy termination can be made before reaching the life limit.

Predictive Values of Coagulation Parameters to Monitor COVID-19 Patients.

Aims In this study, we aim to unravel the relationship between coagulation parameters together with D-dimer and the severity of coronavirus disease (COVID-19) during hospitalization as well as hospitalization in the intensive care unit (ICU). Methods This retrospective study was conducted in the Emergency Department (ED) of Pamukkale University Hospital (Denizli, Turkey) between March 1 and April 30, 2020. SARS-CoV-2 polymerase chain reaction (PCR) tests and laboratory tests, including international normalized ratio (INR), prothrombin time (PT), D-dimer, and activated thromboplastin time (APTT), were requested from 289 people presenting to the ED with symptoms of upper respiratory tract infection (URTI), such as cough, fever, and sore throat. Results While 110 patients turned out to be polymerase chain reaction (PCR) positive, 181 individuals were PCR negative. The mean D-dimer level of the patient group was 147 ng/ml DDU (min: 9, max: 2948), and their mean PT level was found as 12.8 seconds (min: 10.3, max: 34.7). Besides, the mean APTT was 31.25 seconds (min: 19, max: 46.9), and the mean INR level was calculated as 1.09 (min: 0.88, max: 2.93). 35 of the patients were not hospitalized, while 43 were admitted to the Infectious Diseases, 20 to the Chest Diseases, and 12 to the ICU. Conclusions It can be concluded from our findings that D-dimer, PT, and INR levels remained elevated in the COVID-19-diagnosed patients, but these parameters were unable to discriminate accurately between the patients with positive and negative SARS-CoV-2 results. Our findings also suggest that coagulation parameters might occupy a critical role in documenting clinical severity in patients with COVID-19 infection and requiring hospitalization.

Tip 1 Diyabet ile Yaşamak: Nitel Bir Çalışma

Objective: Type 1 diabetes is an absolute insulin-dependent autoimmune disease. It is generally seen in children and adolescents and its prevalence is increasing day by day. The management of a chronic disease during adolescence may affect the individual's biological, psychological and socialization processes. Purpose: This study was conducted to determine how Type 1 diabetes affected the lives of adolescents. Matreial and Methods: This qualitative study is of a phenomenological type. The study covered a total of 19 adolescents (14 girls and 5 boys) in 12 to 18 age group at a Pamukkale university hospital, who were followed up with the diagnosis of type 1 diabetes. In the study, the data were collected by using the semi-structured interview form and through the in-depth interview method. Interviews were recorded and ranged from a minimum of 15 minutes to a maximum of 45 minutes. The data obtained were evaluated using the content analysis method. Results: Adolescents with type 1 diabetes were affected in terms of experience, emotion and perception. Conclusion: As a result of this study, it has been found that type 1 diabetes affects adolescents' lives in many ways. In the follow-up of the disease, healthcare professionals should be aware of the factors that negatively affect the quality of life of adolescents by reducing their compliance with the disease and treatment, and should include the elimination of these factors or keeping them under control in their care.

Serum Hepcidin and Prohepcidin Levels in Nonfebrile and Febrile Neutropenia.

To compare the prohepcidin and hepcidin levels in the afebrile neutropenic period and neutropenic fever in patients with hematological malignancy. Descriptive study. Department of Hematology, Pamukkale University Hospital, Denizli, Turkey, between January 2018 and December 2019. Neutropenic patients were compared with a healthy control group. Prohepcidin and hepcidin serum levels were to be measured in neutropenic and control groups. When fever occurred in neutropenic group, serum was taken again and the same values were compared, in addition to procalcitonin and CRP values. Prohepcidin and hepcidin levels were found to be significantly higher in the neutropenic group (n = 53) than the control group [n = 44, (med:166.65 ng/ml, IQR:147.66 - 187.38 ng/ml vs. med:47.49 ng/ml, IQR:15.61 - 82.51 ng/ml; p <0.001); (med:315 ng/ml, IQR:314.92 - 315 ng/ml vs. med:26.61 ng/ml, IQR:4.69 - 66.83 ng/ml; p <0.001)]. No significant difference was found in terms of these two analyses (167.29 ± 29.31 ng/ml vs. 167.15 ± 27.61 ng/ml; p = 0.979; 296.21 ± 37.19 ng/ml vs 299.16 ± 37.68 ng/ml; p= 0.629) in the neutropenic fever period compared to the afebrile neutropenic period. In neutropenic fever patients, procalcitonin and CRP (C-reactive protein) were found significantly higher than the afebnile neutropenic group (0.7 ± 1.2 ng/ml vs. 0.25 ± 0.76 ng/ml; p = 0.034; 10.27 ± 9.93 mg/dl vs 2.61 ± 2.78 mg/dl; p <0.001). Although there was no significant difference between afebnile neutropenia and neutropenic fever in patients in terms of hepcidin and prohepcidin levels, higher levels were found in both groups compared to the control group. Key Words: Hepcidin, Prohepcidin, Neutropenia, Febrile neutropenia.

50-70 yaş arası kişilerin kolorektal kanser risk faktörleri ve erken tanısına yönelik bilgi tutum ve davranışlarının değerlendirilmesi

AMAÇ: Bu çalışmada Pamukkale üniversitesi hastanesi genel cerrahi polikliniğine başvuran 50-70 yaş arası kişilerin kolorektal kanser (KRK) belirti ve risk faktörlerine yönelik bilgilerini ve kolorektal kanser tarama testlerine yönelik bilgi, tutum ve davranışlarını değerlendirmek amaçlanmaktadır. GEREÇ ve YÖNTEM: Tanımlayıcı kesitsel tipte çalışma Ocak-Şubat 2021 tarihleri arasında genel cerrahi polikliniğine başvuran 50-70 yaş arası kişilerde yapıldı. Çalışmaya gönüllü katılan hastalara literatür taraması sonucunda oluşturulan kolorektal kanser tarama testleri, yapılma yerleri, yaptırma durumları, belirti ve risk faktörlerine yönelik sorulardan oluşan 38 maddelik anket formu yüz yüze görüşme tekniğiyle uygulandı. İstatistiksel olarak elde edilen veriler SPSS 21 programı kullanılarak analiz edildi. Verilerin değerlendirilmesinde tanımlayıcı istatistiksel yöntemler kullanıldı. Gruplar arasındaki ilişki ki-kare testi ile analiz edildi. İstatistiksel anlamlılık değeri p<0,05 olarak kabul edildi BULGULAR: Çalışmaya 104 kişi dahil edildi ve bunların yaş ortalaması 56,65±6,42 ve %70,2’si (n=71) kadındı. Katılımcılar tarafından KRK için en sık bilinen belirtiler %29,8 (n=31) ile rektal kanama, %26,9 (n=28) ile kabızlık iken, en sık bilinen risk faktörleri %36,5 (n=38) ailede kanser öyküsü ve %21,2 (n=22) ileri yaş olarak saptandı. Ayrıca katılımcıların sadece %38,5’i (n=40) kolonoskopiyi, %27,9’u (n=29) GGK testini biliyordu. Yine katılımcıların sadece %19,2’sinin (n=20) GGK testini, %8,7’sinin (n=9) kolonoskopi yaptırdığı tespit edildi. GGK testini yaptırmayanların ise %38,5’nin (n=40) GGK testi ilgili bilgisi olmadığı ve %15,4’ü (n=16) hekim tarafından önerilmediği için yaptırmadığını bulundu. SONUÇ: Bu çalışma, araştırmaya katılan kişilerde KRK ve KRK tarama yöntemleri hakkında bilgi düzeyinin ve yaptırma oranının yetersiz olduğunu göstermektedir. Bu konudaki farkındalığı artırmak için çeşitli stratejilerin geliştirilmesine ihtiyaç vardır. ANAHTAR KELİMELER: Kolorektal kanser, risk, tarama testleri, bilgi, tutum EVALUATION OF KNOWLEDGE, ATTITUDE AND BEHAVIOR FOR THE COLORECTAL CANCER RISK FACTORS and EARLY DIAGNOSIS in PERSONS BETWEEN 50-70 YEARS KNOWLEDGE, ATTİTUDE and BEHAVİOR İN COLORECTAL CANCER Abstract OBJECTIVE: Objectıve: This study aimed to evaluate the knowledge about colorectal cancer (CRC) symptoms and risk factors, attitudes and behaviors towards colorectal cancer screening tests of people aged 50-70 who reffered to Pamukkale University Hospital general surgery outpatient clinic. Materıal and methods: A descriptive cross-sectional study was conducted on people aged 50-70 years who reffered to the general surgery outpatient clinic between January and February 2021. A 38-item questionnaire consisting of questions about colorectal cancer screening tests, application locations, conditions, symptoms and risk factors, which was created as a result of the literature review, was applied to the patients who participated in the study voluntarily using the face-to-face interview technique. Data obtained were analyzed statistically using SPSS 21 software. Descriptive statistical methods were used to evaluate the data. The relations amongst groups were analyzed by chi-square tests. Statistical significance level accepted was to be p <0.05. Results: 104 people were included in the study and their mean age was 56.65±6.42 and 70.2% (n=71) of them were women. The most common symptoms for CRC by the participants were rectal bleeding with 29.8% (n=31), constipation with 26.9% (n=28), while the most common risk factors were 36.5% (n=38) a family history of cancer and 21.2% (n=22) of advanced age. In addition, only 38.5% (n=40) of the participants knew about colonoscopy, 27.9% (n=29) of them knew the fecal occult blood testing (FOBT). Again, it was found that only 19.2% (n=20) of the participants had the FOBT and 8.7% (n=9) had a colonoscopy. It was seen that 38.5% (n=40) of those, who did not have FOBT, did not have knowledge about the FOBT and 15.4% (n=16) did not have it because it was not recommended by the physician. Conclusıon: This study shows that the level of knowledge about CRC and CRC screening methods and the rate of getting it done is insufficient for the participants. Various strategies are needed to increase awareness on this issue. This study aimed to evaluate the knowledge about colorectal cancer (CRC) symptoms and risk factors, attitudes and behaviors towards colorectal cancer screening tests of people aged 50-70 who reffered to Pamukkale University Hospital general surgery outpatient clinic. KEY WORDS: Colorectal cancer, risk, screening tests, knowledge, attitude

Predictors of prenatal distress and fear of childbirth among nulliparous and parous women.

Prenatal distress and fear of childbirth negatively affect the health of the mother and the fetus. Sociodemographic and pregnancy related characteristics may influence prenatal distress and fear of childbirth. This study aimed to explore the relationship between fear of childbirth and prenatal distress levels with accompanying factors. The study was designed as a cross-sectional survey study and conducted in the outpatient clinic of Obstetrics and Gynecology Department of Pamukkale University Hospital, Denizli, Turkey, between April 2017 and January 2018. Survey data were collected from 103 third-trimester pregnant women who had admitted to the hospital for routine prenatal examination. Sociodemographic Information Form, the Revised Prenatal Distress Questionnaire (NUPDQ), and the Wijma Delivery Expectancy/Experience Questionnaire (W-DEQ) were used to collect data. Sociodemographics, obstetrics, and other variables were summarized by descriptive statistics. Mann-Whitney U-test, Chi-squared test, and Fisher's exact test were used for comparison of data between groups. The mean score of NUPDQ was 7.58 (SD 4.09) in the nulliparous group and 8.17 (SD 5.16) in the multiparous group (P = 0.68). The mean W-DEQ score was 40.46 (SD 21.80) in nulliparous women and 45.55 (SD 26.72) in multiparous women (P = 0.38). The W-DEQ and NUPDQ scores were moderately correlated with a Spearman correlation co-efficient of 0.58 (P < 0.001). The results of this study revealed that fear of childbirth and prenatal distress were moderately and positively correlated. NUPDQ and W-DEQ can be used during pregnancy to understand if pregnant women have fear or distress. This could help to give a better support to pregnant women.

Determining the factors affecting muscoloskeletal pain of the allied health personnel at Pamukkale University Hospital

GIRIS ve AMAC: Bu calisma; Pamukkale Universitesi Hastaneleri’nde calisan yardimci saglik personelinin kas-iskelet agrilarinin gorulme sikliginin ve agriyla iliskili faktorlerin arastirilmasi amaciyla planlandi.YONTEM ve GERECLER: Calismaya, akademik personel ve hekim haric 187 gonullu katildi. Olgularin demografik bilgileri bir fizyoterapist tarafindan kaydedildikten sonra kas-iskelet sistemi agrisi varligi Nordic Kas Iskelet Sistemi Anketi, agri siddeti ise Gorsel Agri Skalasi kullanilarak degerlendirildi. Elde edilen sonuclar Bagimsiz Gruplarda t Testi ve Pearson Korelasyon Analizi ile degerlendirildi.BULGULAR: Katilimcilarin yas ortalamasi 31,09±7,96 yildi. Arastirmamiza katilan saglik personelinin %62,6’si hemsire, %12,3’u tibbi sekreter, %11,2’si laborant, % 10,7’si saglik teknikeri ve % 3,2’si acil tip teknisyeniydi. Katilimcilarin calisma surelerine gore kas-iskelet agrilari karsilastirildiginda 15 yilin uzerinde calisan personelin boyun, sirt, bel ve omuz agri siddetleri 15 yildan daha az calisanlara gore daha fazla bulundu (p0,05). Katilimcilarin haftalik calisma suresinin kas-iskelet agrisi siddeti ile iliskisinin olmadigi belirlenirken (p>0,05), gunluk oturarak calisma suresinin sirt, omuz ve kalca agri siddeti ile iliskili oldugu belirlendi (p<0,05). Yasin ise boyun, sirt ve el bilegi agrisi ile iliskili oldugu tespit edildi (p<0,05). Sonuc:Elde ettigimiz sonuclar, saglik personelinin kas-iskelet agrisi prevalansinin cok ciddi duzeylere ulasabilecegini (%54) ve bu durumun mesleki travma oykusunden ziyade mesleki calisma suresinden etkilendigini ortaya koymaktadir.

Relationship between morale and motivation in teamwork environments: A research in the health sector

Hospitals in which wide variety of types of health care services are provided require the work of many professionals working together in a harmony. However, it is possible to provide the harmony by teamwork. For the quality health care, it is a must to keep the morale-motivation at high level of the hospital employees who serve 24-hour continuously. Teamwork, same in all other businesses, is considered as a factor that affects the morale and motivation of hospital employees in a positive manner.The purpose of this research is to determine the relationship between teamwork and morale-motivation levels of employees at surgery section of Pamukkale University Hospital in the province of Denizli. For this purpose, hypothesis of the research are determined by considering the theoretical discussions in the literature and research findings. Research hypothesis were tested by using the data obtained from the survey method with 58 employees of Pamukkale University Hospital in the province of Denizli. Descriptive statistical methods, correlation and regression analysis were used to analyze the data. Statistically significant relationship between some demographic characteristics of employees and the teamwork environment and morale-motivation level was found in the results. Relation between the teamwork environment and morale-motivation level was measured by correlation regression analysis, and no statistical significance was observed between two concepts. However, a statistical significance was found between the support for sub-dimension of innovation within the teamwork environment-team vision dimension and morale-motivation level.

Tetra-ataxiometric Posturography in Patients with Migrainous Vertigo

Background: Migraine is a common disorder characterized by headache attacks frequently accompanied by vestibular symptoms like dizziness, vertigo, and balance disorders. Clinical studies support a strong link between migraine and vertigo rather than between other headache types and vertigo or nonvertiginous dizziness. There is a lack of consensus regarding the pathophysiology of migrainous vertigo. Activation of central vestibular processing during migraine attacks and vasospasm-induced ischemia of the labyrinth are reported as the probable responsible mechanisms. Because vestibular examination alone does not provide enough information for diagnosis of migrainous vertigo, posturography systems which provide objective assessment of somatosensory, vestibular, and visual information would be very helpful to show concomitant involvement of the vestibular and somato-sensorial systems. There are few posturographic studies on patients with migraine but it seems that how balance is affected in patients with migraine and/or migrainous vertigo is still not clear. We want to investigate balance function in migraineurs with and without vertigo with a tetra-ataxiometric posturography system and our study is the first study in which tetra-ataxiometric static posturography was used to evaluate postural abnormalities in a well-defined population of patients with migrainous vertigo. Objective: To investigate balance functions in migraineurs with and without vertigo with a tetra-ataxiometric posturography system. Study Design: Prospective, nonrandomized, controlled study. Setting: Pamukkale University Hospital, Neurology and Physical Therapy and Rehabilitation outpatient clinics. Methods: Sixteen patients with migrainous vertigo, 16 patients with migraine without aura and no vestibular symptoms, and 16 controls were included in the study. Computerized static posturography system was performed and statistical analyses of fall, Fourier, Stability, and Weight distribution indexes were performed. The tetra-ataxiometric posturography device measures vertical pressure fluctuations on 4 independent stable platforms, each placed beneath 2 heels and toe parts of the patient; inputs from these platforms are integrated and processed by a computer digitally. Four separate plates are used and perpendicular pressures of the anterior and posterior feet are measured. Pressure of each force plate is measured and data was analyzed by the software program. Limitations: A very small, non-randomized, and controlled study with the inability to find an answer to the mechanism of involvement of the somatosensorial system and vestibular system in migrainous headaches. Results: The distribution of patients with posturographical abnormalities in the migrainous vertigo group was significantly different than the control group. Distribution of the patients with posturographical abnormalities in the high frequencies of the head-right position was significantly different in the migrainous vertigo group than in the control group and distribution of the patients with posturographical abnormalities in high frequencies of the head-right position was significantly different in the migraine group than in the controls groups. The stability index of the migrainous vertigo group was significantly higher than in the control group when tested on in the neutral-head position with open eyes. Conclusion: In this first study of tetra-ataxiometric static posturography evaluating postural abnormalities in a well-defined population of patients with migrainous vertigo, the central part of the vestibular apparatus would be responsible of postural abnormalities in patients with migraine and migrainous vertigo. Key words: Fall index, migraine, migrainous vertigo, static posturography

Unnecessary repeated total cholesterol tests in biochemistry laboratory.

IntroductionWe aimed to determine the number of repeated cholesterol (RC) tests and the ratio of unnecessary-repeated cholesterol (URC) tests among patients admitted to Pamukkale University Hospital (Denizli, Turkey) and provide solutions to avoid URC testing.Materials and methodsTotal cholesterol (T-cholesterol) tests (N = 86,817) between June 2014 and May 2015 were evaluated. The tests performed more than once per patient were determined as RC test (N = 28,811). RC test with an interval shorter than 4 weeks were determined as URC test (N = 3968) according to the shortest retest interval stated in ACC/AHA blood cholesterol guideline. RC testing included internal medicine, surgery and paediatric outpatients and inpatients. Reference change value (RCV) of total cholesterol was calculated.ResultsThe 33.1% of the T-cholesterol tests were RC tests (N = 28,811), 13.7% of them were URC tests (N = 3968). Our RCV value was 25%. The percentage change between consecutive tests was less than RCV in 86.1% (N = 3418) of URC tests. URC tests were performed more frequently in patients with desirable total cholesterol value (P < 0.001).ConclusionThere is a significant part of repeated T-cholesterol tests requested in our hospital. URC test requests can be evaluated by laboratories and the obtained data should be shared with clinicians. Laboratories can calculate RCV for the tests they performed and report this value with the test result. To prevent from URC tests, a warning plug-in can be added to hospital information software in accordance with guidelines to prevent from URC test requests.

Comparison of APACHE II, MPM and CPIS Scoring Systems with Regard to Determine of Mortality at Ventilator-Associated Pneumonia

Aims: Ventilator-associated pneumonia (VAP) due to mechanical ventilation is an important issue that increases mortality and cost of treatment. In this study, we aimed to compare the effectiveness of three scoring models for estimation of mortality and morbidity in patients with ventilator associated pneumonia. Study Design: Prospective research. Place and Duration of Study: Patients with VAP who were admitted into intensive care unit Pamukkale University Hospital prospectively included in the study between January 2012 and June 2012. Methodology: Demographical data, diagnosis on admission, departments from where admitted, APACHE II, Mortality Probability Model II0 (MPMII0) and Mortality Probability Model II24 (MPMII24) scores on admission, length of stay in intensive care and hospital, duration of mechanical Original Research Article Sirit et al.; BJMMR, 8(12): 1045-1052, 2015; Article no.BJMMR.2015.536 1046 ventilation, microbiological data for pneumonia, outcome and Clinical Pulmonary Infection Score values on day 1, 3, 5 and 7 were recorded. Results: Eighty patients (F/M: 37/43) were included study. Mortality was 67.5%. MPM II0, MPMII24 values were significantly high in patients who has died but ROC curves were not significant for any of the scoring systems. In addition, relationship between scoring models and mortality, duration of mechanical ventilation, length of stay in intensive care and hospital was not statistically significant (P=.05). Conclusion: We concluded that each of the three scoring systems for the prediction of mortality in VAP was not superior to each other.

Platelet apheresis donation: Demographic findings, processing and harvest properties

Purpose:The aim of the study is to evaluate the demographic findings of healthy volunteer donors who presented to the blood center in Pamukkale University Faculty of Medicine and the properties of obtained products from the donors. Materials and methods:Apheresis platelet donors who donated to the Pamukkale University Hospital Blood Bank between February 2013 and May 2014 were evaluated. The demographic findings, processing and harvest properties of those volunteer platelet apheresis donors determined as eligible were analyzed. Results: A total of 1717 persons were found to be eligible for plateletapheresis donations; 1680 (%97,8) male and 37 (%2,2) female. Median age was 35 (18-60) years; median height was 174 (151-193) cm, median weight was found to be 81 (56-114) kg. After plateletapheresis, product variables were analysed, single plateletapheresis suspension median volume was 285 (140-350) ml and platelet yield was found to be 3,3 (2,2-4,5) /1011. Double plateletapheresis suspension median volume was 570 (410-600) ml and platelet yield was found 6,0 (4,5-6,2) /1011. Conclusion: A sufficient amount of platelet products was obtained from the donors who donated to the Hospital Blood Bank between February 2013 and May 2014. Especially, this study seems to support plateletapheresis, where both arms are used, because of the high product and platelet yield. Pam Med J 2015;8(1):19-22

Assessment of the relation of violence and burnout among physicians working in the emergency departments in Turkey.

Violence and burnout are frequently seen among medical doctors; however, the relation is not clear. This study aimed to assess the violence and its possible effects on burnout in physicians working in emergency units. This cross-sectional study targeted all physicians working in the emergency units of Pamukkale University Hospital, County and City Hospitals, 112 Emergency Services, and Private Hospitals in Denizli. Data were obtained by means of a self-administered questionnaire that consisted of questions on the demographics of the participants, Turkish version of the Maslach Burnout Inventory, and of the perpetrators of violence. What was also documented on the questionnaire was whether participants had been subjected to or had witnessed any verbal or physical violence during the previous one month of emergency physicians' certification program. A total of one hundred and seventy-four physicians were included into the study (85% of the targeted group). Many of the participants were between 24 and 59 years of age, with a mean age of 36.8±5.8 years. Married male doctors working in the City Hospital made up the majority. There were significant associations between emotional exhaustion and total violence (p=0.012) and verbal violence (p=0.016); depersonalization and total violence (p=0.021) and verbal violence (p=0.012). The results presented here indicated that there was a strong relation between burnout and violence experienced by physicians working in emergency units. Violence in the emergency department has a substantial effect on the physicians' well-being.

HIF1A as a major vascular endothelial growth factor regulator: do its polymorphisms have an association with age-related macular degeneration?

To investigate the association between age-related macular degeneration (AMD) and the polymorphisms of HIF1A, a major vascular epithelial growth factor regulator under hypoxic conditions. The associations of AMD and polymorphisms of genes CFH, SKIV2L and MYRIP were also studied. Prospective study. Eighty-seven AMD patients and 80 healthy subjects admitted to the Department of Ophthalmology at Pamukkale University Hospital, Denizli, Turkey, were included: 45 (52%) had wet type AMD, and 42 (48%) had dry type AMD. Polymorphisms rs1061170 (CFH), rs429608 (SKIV2L), rs2679798 (MYRIP) and both rs11549465 and rs11549467 (HIF1A) were investigated in DNA isolated from peripheral blood samples of the cases and controls by dye-termination DNA sequencing. Genotype distribution of rs1061170 (CFH), rs429608 (SKIV2L), rs2679798 (MYRIP) and both rs11549465 and rs11549467 (HIF1A) in AMD cases and healthy controls; association between genotypes and AMD subtypes. Given the significant difference between the mean age of case and control groups (72.13 ± 5.77 vs. 62.80 ± 5.22, respectively) (P = .000), subsequent analyses were adjusted for age. We found that having at least one C allele for polymorphism rs1061170 increases AMD risk independent of age (OR = 2.42, 95% confidence interval [CI], 1.22-4.81). The ancestral T allele for polymorphism rs1061170 has a protective effect for AMD (OR = 0.53, 95% CI, 0.34-0.83). No statistically significant difference for distributions of other single nucleotide polymorphisms (SNPs) emerged between patients and healthy subjects. No associations appeared between HIF1A SNPs and AMD, which were studied here for the first time; however, polymorphism rs1061170 of the CFH gene is associated with AMD in our population.