Turkish Hospitals Research Articles

Methodological concerns in usability evaluation of software prototypes

Karahoca et al. [1] addressed an important topic in their paperconcerning the use of usability evaluation methods to choose anappropriate software prototype for tablet personal computers.They applied a combination of usability evaluation methods toevaluate the usability of two software prototypes with differentgraphical user interfaces (GUIs); iconic and non-iconic. These GUIswere designed to replace the paper-based forms at an emergencydepartment of a Turkish hospital. The whole healthcare staff ofthe department, consisting of 6 physicians and 32 nurses, partici-patedas evaluatorsin the study.The findingsof the comprehensiveevaluation showed that the iconic GUI prototype had better usabil-ity thanthe non-iconicGUI prototype.This studycontributesto thebody of knowledge concerning the usability of GUIs. Such studiesare important from a practical perspective because in the compet-itive market of clinical software they help health care organiza-tions in selecting systems that best suits their users’ needs.Moreover, the results of these studies provide practical input tosoftware developers concerning the design of software that is easyto use and that fits the workflow of healthcare providers.Although Karahoca and his colleagues applied a comprehensivemethod and obtained interesting findings, we would like to drawattention to some methodological issues concerning the way theusability evaluation methods were employed in this study.The authors mention that Hom [2] identifies three types ofusability evaluation methods, which include testing, inspectionand inquiry and state that they applied heuristic evaluation andcognitive walkthrough (CW), both expert inspection methods, toevaluate the usability of the two prototypes.1. Recruitment of evaluators for heuristic evaluationThe authors recruited potential users of the prototypes as heu-ristic evaluators. Based on a computer literacy test, half of theseusers were classified as novice users. In a study identifying the fac-tors affecting heuristic expertise and levels of expertise permissi-ble to conduct a heuristic evaluation, according to Kirmani [3]three factors (usability experience, experience with the heuristicevaluation, and heuristic training) significantly affect the outcomesof heuristic evaluation. This study showed that domain expertisedoes not have a large impact on the outcomes. Nielsen [4] likewiseshowed that the performance of novice heuristic evaluators, hav-ing general computer knowledge but no special usability expertise,was fairly poor compared to the performance of evaluators withusability expertise. Novice evaluators must first become knowl-edgeable of and proficient in applying heuristics [5]. Therefore,the validity of the heuristic evaluation results of Karahoca et al.using ‘‘usability novices” of which half was computer illiteratecan be disputed.2. Recruitment of evaluators for cognitive walkthroughCW is a usability inspection method that evaluates the easewith which a typical new user can successfully learn to performa task using a given interface design. As also stressed by Hom, inCW either usability specialists or software developers shouldexamine the behavior of the interface [6]. In the study performedby the authors CW was again carried out by end users and notby usability experts. In usability inspection methods such as CW,experts evaluate a user interface without involving users. This isin contrast to usability testing where evaluators let users workwith the system while recording the user sessions for later analysisof usability problems.The approach that the authors followed to assess the learnabil-ity of the prototypes by real users is not in agreement with the CWmethod. In CW, inspectors should know the interface before apply-ing the method and then speculate about the ease with which anovice user can learn how to use the system taking user back-ground knowledge such as computer literacy into account.3. Usability problemsThis usability evaluation study lacks the detection of usabilityproblems,whichisthemaingoalofeveryusabilityevaluationstudy[4,7].Thislackcanaffecttheresultsofthestudyinseveralways.(A)Comparing the effectiveness of the prototypes based on scenariocompletion rates and completion time, without a careful reviewand analysis of the main usability problems that potentially canaffectuserinteractionandtaskoutcomes,doesnotseemvalid.Users,for example, could have completed a scenario in a shorter time byskipping some none mandatory steps hindering them during the

Phenotypic and molecular characterization of SHV, TEM, CTX-M and extended-spectrum -lactamase produced by Escherichia coli, Acinobacter baumannii and Klebsiella isolates in a Turkish hospital

A total of 94 clinical isolates were collected from Gazi University Hospital, Turkey.Presence of ESBL positivity was detected using the double disk synergy test (DDST). ESBL isolates were further typed for the blaTEM, blaSHV, blaCTX-M andblaOXA using designed primers. ESBLs were found in 65 (69.14%) isolates using DDST. Plasmid DNAs of potentially ESBL positive strains were isolated. About 7.69% of the ESBL positive isolates did not harbour plasmid DNA. According to the PCR technique, only 2 additional isolates were found to be ESBL producers.blaTEM was the commonest genotype (73.43%), followed by blaSHV (21.87%) and blaCTX-M (17.18%), either alone or in combination. ESBL positive strains ofKlebsiella pneumoniae, Escherichia coli, Acinetobacter baumannii andPseudomonas aeruginosa are increasingly found in hospital isolates. Because these strains become resistant to available antibiotics and they can pass the gene to other clinical strains, the quick detection of these strains in clinical laboratories is very important. Key words: ESBL, double disk synergy test, plasmid, PCR.

Burnout, work satisfactions and psychological well-being among nurses in Turkish hospitals

This exploratory study examined the relationship between self-reports of burnout and indicators of work satisfaction and engagement, perceptions of hospital functioning and quality of nursing care, and psychological well-being of nursing staff. Data were collected from 224 staff nurses using anonymously completed questionnaires, a 37 percent response rate. Three indicators of burnout were considered: emotional exhaustion, cynicism, and lack of personal efficacy. Hierarchical regression analyses, controlling for both personal demographic and work situation characteristics, indicated that burnout accounted for significant increments in explained variance on most outcome measures. Explanations for the association of burnout with various outcomes are offered along with potentially practical implications.

Health network mergers and hospital re-planning

This paper presents an integer programming formulation for the hospital re-planning problem which arises after hospital network mergers. The model finds the best re-allocation of resources among hospitals, the assignment of patients to hospitals and the service portfolio to minimize the system costs subject to quality and capacity constraints. An application in the Turkish hospital networks case is illustrated to show the implications of consolidation of health insurance funds on resource allocations and flow of patients in the system.

Validity and reliability of Turkish version of "Hospital Survey on Patient Safety Culture" and perception of patient safety in public hospitals in Turkey

BackgroundThe Hospital Survey on Patient Safety Culture (HSOPS) is used to assess safety culture in many countries. Accordingly, the questionnaire has been translated into Turkish for the study of patient safety culture in Turkish hospitals. The aim of this study is threefold: to determine the validity and reliability of the translated form of HSOPS, to evaluate physicians' and nurses' perceptions of patient safety in Turkish public hospitals, and to compare finding with U.S. hospital settings.MethodsPhysicians and nurses working in all public hospitals in Konya, a large city in Turkey, were asked to complete a self-administrated patient safety culture survey (n = 309). Data collection was carried out using the Turkish version of HSOPS, developed by Agency for Healthcare Research and Quality (AHRQ). Data were summarized as percentages, means, and SD values. Factor analysis, correlation coefficient, Cronbach's alpha, ANOVA, and t tests were employed in statistical analyses. Items on patient safety were categorized into 10 factors. Factor loadings and internal consistencies of dimension items were high.ResultsMost of the scores related to dimensions, and the overall patient safety score (44%) were lower than the benchmark score. "Teamwork within hospital units" received the highest score (70%), and the lowest score belonged to the "frequency of events reported" (15%). The study revealed that more than three quarters of the physicians and nurses were not reporting errors.ConclusionThe Turkish version of HSOPS was found to be valid and reliable in determining patient safety culture. This tool will be helpful in tracking improvements and in heightening awareness on patient safety culture in Turkey.

Low prevalence of 16S methylases among extended-spectrum- -lactamase-producing Enterobacteriaceae from a Turkish hospital

Low prevalence of 16S methylases among extended-spectrum- -lactamase-producing Enterobacteriaceae from a Turkish hospital

Epidemiology of nosocomial candidaemia in a university hospital: a 12-year study

The incidence of nosocomial candidaemia was evaluated in a retrospective study in a Turkish tertiary-care hospital. Over a 12-year period (1996-2007), a total of 743 episodes of candidaemia occurred in 743 patients, accounting for an average incidence of 1.9 episodes/1000 admissions and 2.9 episodes/10 000 patient-days per year. The annual incidence was almost constant during the study period except for 1996 when it was significantly higher in comparison with other years (P<0.05). The most common species isolated was Candida albicans (45%), followed by C. parapsilosis (26%), C. tropicalis (7%), C. krusei (7%), and C. glabrata (3.5%). A significant increase in C. albicans isolates causing candidaemia linked to a decrease in C. parapsilosis isolates in adult patients and C. krusei isolates in children was found between the two 6-year study periods. This trend reflects improved infection control at Uludağ University Hospital. Ninety percent of isolates were susceptible to fluconazole (8 microg/ml) and resistance was found only in C. glabrata and C. parapsilosis isolates. Regular local surveillance of Candida spp. is important in order to develop empirical treatment protocols to reduce the incidence and mortality of candidaemia.

Analysis of the Relation between Change Perception and Demographic Factors (A Research in Turkish Hospital Sector)

Analysis of the Relation between Change Perception and Demographic Factors (A Research in Turkish Hospital Sector)

Tetanus in an intensive care unit of a Turkish hospital: Patient analysis of a 6-year period

To retrospectively evaluate the clinical features of patients admitted to the medical intensive care unit (ICU) of our hospital between January 2001 and May 2007 due to tetanus. Materials and methods: Patient vaccination history, incubation period, nosocomial infections, noninfectious conditions, mortality, and length of stay in the ICU and hospital were documented. Results: Fifteen tetanus patients were admitted during the 6-year period. Mean age of the patients (9 male, 6 female) was 60 ± 13 years. Median length of stay was 42 days (range: 30-77 days) for survivors and 7 days (range: 1-59 days) for non-survivors. Mortality was consequent to severe tetanus in 5 patients, sepsis in 2 patients, and myocardial infarction in 1 patient. One patient died due to complications of acute renal failure, and another died due to acute pancreatitis and renal failure. The mortality rate was 66%. Seven patients had nosocomial infections (16 episodes). Ventilator-associated pneumonia was the most common infection, followed by primary bacteremia and urinary tract infection. Conclusion: Although it is preventable with vaccination, tetanus remains a problem, especially for the elderly population. Despite intensive support, the mortality rate in our tetanus patients was high.

Designing a Capability-Focused Strategic Management Model for a Turkish Public Hospital: Learning from Failure

This study aims to depict a failed strategic change initiative in a Turkish public hospital by means of an action research and it strives to explain critical factors underpinning the failure, thereby proposing how such factors should be tackled with for similar initiatives elsewhere. The study calls attention to the recent challenges ongoing in the environment of hospitals, which urge them to take on a more strategic focus. In this vein, we discredit accreditation based systems, which emphasize monitoring resources and propose a capability-focused strategic management model for hospitals. A hybrid action research protocol, which combines both traditional and participatory action research methodologies in its design, is employed to formulate and implement the model in a public hospital. The phases of the project and obstacles faced during these phases are discussed. The findings suggest that although the model offers significant potential for competitive success and better resource efficiency, path-dependent characteristics of the public sector governance in Turkey have impeded the adoption of the model in our case. Both macro-systemic characteristics related mainly to the Turkish national culture and management of public institutions and situation-specific characteristics, such as top management’s decision making orientation, professional norms and patronage relationships have blocked the way for the aspired transformation despite positive attitudes of and support from higher order public authorities and internal professional groups.

A study of Turkish critical care nurses’ perspectives regarding family‐witnessed resuscitation

. This paper reports a study to determine the experiences and attitudes of Turkish critical care nurses concerning family presence during cardiopulmonary resuscitation. The debate surrounding family-member presence in resuscitation areas has been evolving since the 1980s. The practice of performing resuscitation of adults in the presence of family members is controversial and has stimulated discussion and debate worldwide. A descriptive survey. The survey was carried out in 2007 with 135 critical care nurses from two university hospitals in Izmir. A structured questionnaire was used, which incorporated a series of attitude statements that were rated using a three-point Likert scale. The attitudes of the nurses were explored in three areas: decision making, processes and outcomes of resuscitation. Of the nurses, only 22.2% experienced a situation where family members were present during cardiopulmonary resuscitation. Most of these nurses (n = 20) had one or more negative experiences. The majority disagreed that family members should always be offered the opportunity to be with the patient during cardiopulmonary resuscitation. The most common concerns for not favouring family-witnessed resuscitation were reported as performance anxiety, fear of causing psychological trauma to family members and increased risk of litigation. Many Turkish critical care nurses have no knowledge of family-witnessed resuscitation and do not support the practice. We suggest that Turkish critical care nurses should be informed by the international literature on the concept of family-witnessed resuscitation and the culturally appropriate policies concerning this subject should be changed in Turkish hospitals. Most critical care nurses in Turkey are not supportive of family-witnessed resuscitation. All critical care nurses should be informed by the international literature on the concept of family-witnessed resuscitation.

Therapies for Pediatric Seborrheic Dermatitis

CME Educational Objectives 1. Describe the typical presentation of seborrheic dermatitis in infants and children. 2. Restate the proposed etiology of seborrheic dermatitis. 3. Recognize the different medications available for the treatment of seborrheic dermatitis and when it is best to use them.

Inappropriate antimicrobial use in Turkish pediatric hospitals: A multicenter point prevalence survey

Although well-defined principles of rational antimicrobial use are available, inappropriate prescribing patterns are reported worldwide. Accurate information on the usage of antimicrobials, including factors associated with and influencing their use, is valuable for improving the quality of prescription practices. In this cross-sectional point prevalence survey, data on patients hospitalized in 12 different children's hospitals were collected on a single day. Appropriateness of prescription was compared between the types of antimicrobials prescribed, indications, wards, and presence of/consultation with an infectious disease physician (IDP). A total 711 of 1302 (54.6%) patients evaluated were receiving one or more antimicrobial drugs. The antimicrobial prescription rate was highest in pediatric intensive care (75.7%) and lowest in the surgery wards (37.0%). Of the 711 patients receiving antimicrobials, 332 patients (46.7%) were found to be receiving at least one inappropriately prescribed drug. Inappropriate use was most frequent in surgery wards (80.2%), while it was less common in oncology wards (31.8%; p<0.001). Respiratory tract infection was the most common indication for antimicrobial use (29.4%). Inappropriate use was more common in deep-seated infections (54.7%) and respiratory infections (56.5%). Fluoroquinolones were used inappropriately more than any other drugs (81.8%, p=0.021). Consultation with an IDP appears to increase appropriate antimicrobial use (p=0.008). Inappropriate antimicrobial use remains a common problem in Turkish pediatric hospitals. Consultation with an IDP and prescribing antimicrobial drugs according to microbiological test results could decrease the inappropriate use of antimicrobials.

Low back pain: prevalence and associated risk factors among hospital staff

This paper is a report of a study conducted to describe the prevalence and risk factors for lower back pain amongst a variety of Turkish hospital workers including nurses, physicians, physical therapists, technicians, secretaries and hospital aides. Hospital workers experience more low back pain than many other groups, the incidence varies among countries. Work activities involving bending, twisting, frequent heavy lifting, awkward static posture and psychological stress are regarded as causal factors for many back injuries. A 44-item questionnaire was completed by 1600 employees in six hospitals associated with one Turkish university using a cross-sectional survey design. Data were collected over nine months from December 2005 to August 2006 and analysed using Chi square and multivariate logistic regression techniques. Most respondents (65.8%) had experienced low back pain, with 61.3% reporting an occurrence within the last 12 months. The highest prevalence was reported by nurses (77.1%) and the lowest amongst secretaries (54.1%) and hospital aides (53.5%). In the majority of cases (78.3%), low back pain began after respondents started working in the hospital, 33.3% of respondents seeking medical care for 'moderate' low back pain while 53.8% (n = 143) had been diagnosed with a herniated lumbar disc. Age, female gender, smoking, occupation, perceived work stress and heavy lifting were statistically significant risk-factors when multivariate logistic regression techniques were conducted (P < 0.05). Preventive measures should be taken to reduce the risk of lower back pain, such as arranging proper rest periods, educational programmes to teach the proper use of body mechanics and smoking cessation programmes.

Cigarette smoking and pregnancy: Results of a survey at a Turkish women's hospital in 1,020 patients

SummaryWe aimed to investigate the level of knowledge about the effects of cigarette smoking and status before and during pregnancy. The study was performed on 1,020 pregnant women who attended the clinic for a routine visit. The questionnaire consisting of questions about sociodemographic data, smoking habits and knowledge about harmful effects of smoking on fetus (miscarriage, intrauterine growth retardation, pre-term birth, fetal mortality-morbidity, postpartum infant death, pre-term premature rupture of membranes, lung disease, attention deficit) was administered. Data were analysed by SPSS 10.0 using χ2-test and binary regression analysis. Mean age was 26.3 years. Smoking rates before and after pregnancy were 34.7% and 14%, respectively. Passive smoking was seen in 69.2%. The number of cigarettes smoked before pregnancy had a significant impact on continuation of smoking during pregnancy [OR (95% CI) 29.94 (12.88–69.64)]. For passive smoking at home for a young age [OR (95% CI) = 1.33 (1.01–1.76)] had a positive impact and university education [OR (95% CI) = 0.40 (0.24–0.67)] had a negative impact. Most pregnant women (97.5%) knew smoking was harmful. Awareness of intrauterine fetal death as a harmful effect was the single most important factor associated with quitting active and passive smoking. Despite some level of knowledge of pregnant women regarding adverse effects of smoking, there is a strong need for education on quitting smoking during pregnancy. Prevention of passive smoking should have the highest priority.

Cross-resistance and associated resistance in Escherichia coli isolates from nosocomial urinary tract infections between 2004–2006 in a Turkish Hospital

Abstract In this study, antimicrobial resistance profiles were determined for 748 isolates of Escherichia coli from patients with acute nosocomial urinary tract infections (UTIs) at a Turkish Training Hospital. Thirteen antibiotics were included. Resistance to ampicillin alone (45.1%) and ciprofloxacin alone (20.6%) were the most commonly identified ‘single resistances’. Multiple resistance was found in 49.7% of the strains. The most common multiple antibiotic resistance profiles included ampicillin-sulbactam/amoxycilline-clavulonate (4.0%) and ampicillin-sulbactam/trimethoprim-sulfamethoxazole/amoxycilline-clavulonate (2.8%). From 2004 to 2006, ampicillin, trimethoprim-sulfamethoxazole and ciprofloxacin resistant strains increased to 76% from 57%, 53% from 43% and 55% from 41%, respectively. The percentage of extended-spectrum β-lactamase (ESBL) producing strains was 7.8% and imipenem resistance was seen in 5.2% of ESBL positive strains. We conclude that clinically important E.coli strains have now emerged with broader multidrug resistance. Periodical evaluation of laboratory results and clinical surveillance are crucially important for optimal antibiotic management of UTIs and infection control policies.

Predictive factors for occupational bloodborne exposure in Turkish hospitals

This study was conducted to evaluate the epidemiology of percutaneous injury and/or mucosa exposure (PME) with blood or other body fluids that poses serious risks for health care workers (HCWs). An analytic, cross-sectional, countrywide survey study was conducted to describe the extent of and predictive factors for PME among HCWs in hospital settings in Turkey, with total of 5258 HCW participants from 30 hospitals in 19 cities throughout the country. The respondent group included 41.3% nurses, 29.0% doctors, 9.3% laboratory workers, and 20.3% paramedics. The survey found that 50.1% of the participants reported at least 1 occupational PME in the previous year. Doctors (2.57/person/year) and nurses (2.56/person/year) had the highest PME incidents. In the multivariate analysis, working at a surgical site (P = .000), being a doctor (P = .000), being a nurse (P=.000), young age (P = .025), and living in a poor region (P = .005) were significant factors for high occupational exposure. The presence of a health office for HCWs at the hospital (P = .000) and working at a university hospital (P = .003) were significant predictors of less occupational exposure. Overall, the mean number of PME incidents was 2.16/person/year. Along with the other well-known predictive factors, regional economic status and a health office for HCWs are preventive factors for PME exposure of HCWs.

Relationships between coping strategies, individual characteristics and job satisfaction in a sample of hospital nurses: Cross-sectional questionnaire survey

Objectives This study aims to describe and compare the job satisfaction, coping strategies, personal and organizational characteristics among nurses working in a hospital in Turkey. Methods In this cross-sectional survey design study, 186 nurses from Cumhuriyet University Hospital completed Personal Data Form, Minnesota Satisfaction Questionnaire and Ways of Coping Inventory. Response rate was 74.4%. Results In this study, it was found that job satisfaction score of nurses showed moderate (mean: 3.46 ± 0.56) was found. While nurses mostly used to employ self-confident and optimistic approaches that had already being considered as positive coping strategies with stress, yielding and helpless approaches were employed less than that. While a statistically significant positive relation ( p < 0.05) was found between job satisfaction and dimensions of Ways of Coping Inventory “self-confident approach” and “optimistic approach”, negative relation ( p < 0.01) was found between job satisfaction and dimensions of the “helpless approach”. Organizational and individual nurse characteristics were not found to be associated with job satisfaction. But, job satisfaction of the nurses who is bounded by a contract was found higher than that of permanent staff nurses ( p < 0.05). Conclusions The job satisfaction of Turkish hospital nurses was at a moderate and that of the nurses who succeeded to coping with the stress was heightened. Higher levels of job satisfaction were associated with positive coping strategies. This study contributes to a growing body of evidence demonstrating the importance of coping strategies to nurses’ job satisfaction.

Prevalence of Raynaud’s phenomenon in healthy Turkish medical students and hospital personnel

In this study, we investigated the frequency of Raynaud's phenomenon (RP) in medical students and hospital personnel and determined associated factors. Students and hospital personnel of our medical faculty (1,414 subjects; 838 females, 576 males, mean age, 27.2+/-6.6) were questioned for symptoms associated with RP, and the presence of smoking and headache. 530 subjects (37.5%) defined color changes on cold exposure. 51 subjects (3.6%) had biphasic or triphasic color changes (definite RP). The prevalence of definite RP in females (4.8%) was significantly higher than in males (1.9%) (P=0.005). The frequency of smoking subjects (45.1 vs. 28.8%) was significantly higher in patients with RP (P=0.009). There was numbness and/or paresthesia in 174 subjects (12.3%) who defined uniphasic color change on cold exposure (possible RP). Female sex and being a smoker were factors associated with RP in our study.

Comparison of trauma mortality between two hospitals in Turkey to one trauma center in the US

The development of comprehensive international trauma case registries could be used to perform outcomes analysis and comparisons between countries with the goal of improving trauma care worldwide. A retrospective study (April 2004 to April 2005) of injured patients from a Pennsylvania state trauma center (PSTC) were case matched according to age, sex, and injury severity score with two Turkish hospitals. Patients' demographics (age, sex), prehospital information (mechanism of injury, mode of transportation), injury severity (injury severity score and Glasgow coma score), and outcomes (intensive care unit length of stay, hospital length of stay, mortality) were collected. P value of less than 0.05, odds ratio (OR), chi2 test, two-sample t-test, mean+/-SD. Medical records from 506 Turkish trauma patients were abstracted and compared with 506 injured patients in the PSTC registry. Patients in Turkey presented more commonly with a Glasgow coma score of less than or equal to 8 (13.09 vs. 4.26%, P<0.01, OR 3.38) had increased mortality (8.30 vs. 0.79%, P<0.01, OR 11.36) and required mechanical ventilation more than 1 day more often (16.44 vs. 8.75%, P<0.01, OR 2.05). Motor vehicle crashes were the leading cause of injury in both groups. Assaults and falls were more frequent in the PSTC. Pedestrian injuries were more common and had higher mortality rates in Turkey (P<0.05). This study demonstrates significantly worse outcomes in trauma care and higher mortality rates in Turkey versus PSTC. Developing a trauma registry to monitor improvements in patient care and to target injury prevention strategies should be a high priority for the Turkish healthcare system.