Turkish Hospitals Research Articles

Applicability of end of life needs assessment tool at a multicultural Turkish hospital

Improving the quality of life in terminal stage cancer patients and their families are at utmost importance. The End of Life Needs Assessment Form is adapted from Palliative Performance Scale; to assess patients' needs toward the end of their life. We studied for the first time the practicality, applicability and usefulness of this tool in a unique Turkish hospital providing services to patients from extensive number of countries in this region.

Cost-effectiveness analysis of anidulafungin vs fluconazole for the treatment of invasive candidiasis (IC) in Turkey.

Anidulafungin has been shown to be non-inferior to, and possibly more efficacious, than fluconazole in treating patients with invasive candidiasis (IC). This study aimed to determine the cost-effectiveness of anidulafungin vs fluconazole for treatment of IC in the Turkish setting. A decision analytic model was constructed to depict downstream economic consequences of using anidulafungin or fluconazole for treatment of IC in the Turkish hospitals. Transition probabilities (ie treatment success, observed or indeterminate treatment failures) were obtained from a published randomised clinical trial. Cost inputs were from the latest Turkish resources. Data not available in the literature were estimated by expert panels. Sensitivity analyses were performed to assess the robustness of the model outcome. While anidulafungin [TL 17171 (USD 4589)] incurred a higher total cost than fluconazole [TL 8233 (USD 2200) per treated patient, treatment with anidulafungin was estimated to save an additional 0.58 life-years, with an incremental cost-effectiveness ratio of TL 15410 (USD 4118) per life-years saved. Drug acquisition cost and hospitalisation were the main cost drivers for anidulafungin and fluconazole arms respectively. The model findings were robust over a wide range of input variables except for anidulafungin drug cost. Anidulafungin appears to be a cost-effective therapy in treating IC from the Turkish hospital perspective.

Status and awareness of cervical, breast, and colon cancer screening in a Turkish city.

Mortality and morbidity rates of cervical, breast, and colorectal cancers (CRC) can be decreased via effective screening strategies. Developing countries are to be expected to establish and implement their own programs. To evaluate regional awareness and status of cervical, breast, and CRC screening, a questionnaire-based study was conducted in 500 volunteers from a Turkish community hospital. Awareness rates were 57.4% for Pap smear, 61.2% for mammography, and 25.4% for CRC. Implementation rates were 19.2%, 23.9%, and 12%, respectively. Positive family history for gynecologic cancer and past cervical ablative procedure parameters were related to higher Pap smear rates. Educational level, breast self-exam, and positive Pap smear history parameters were related to higher mammography rates. Factors related to higher colorectal cancer screening rates were nulliparity and positive Pap smear history. Cancer screening rates for this Turkish city are still below the expected levels despite recently revitalized national screening program. For success, it is essential not only to educate rural populations but also to train negligent healthcare providers regularly.

The influence of authentic leadership on safety climate in nursing.

This study analysed nurses' perceptions of authentic leadership and safety climate and examined the contribution of authentic leadership to the safety climate. It has been suggested and emphasised that authentic leadership should be used as a guidance to ensure quality care and the safety of patients and health-care personnel. This predictive study was conducted with 350 nurses in three Turkish hospitals. The data were collected using the Authentic Leadership Questionnaire and the Safety Climate Survey and analysed using hierarchical regression analysis. The mean authentic leadership perception and the safety climate scores of the nurses were 2.92 and 3.50, respectively. The percentage of problematic responses was found to be less than 10% for only four safety climate items. Hierarchical regression analysis revealed that authentic leadership significantly predicted the safety climate. Procedural and political improvements are required in terms of the safety climate in institutions, where the study was conducted, and authentic leadership increases positive perceptions of safety climate. Exhibiting the characteristics of authentic leadership, or improving them and reflecting them on to personnel can enhance the safety climate. Planning information sharing meetings to raise the personnel's awareness of safety climate and systemic improvements can contribute to creating safe care climates.

Secondary Traumatic Stress and Burnout Among Muslim Nurses Caring for Chronically Ill Children in a Turkish Hospital.

This study investigated secondary traumatic stress and its relationship to burnout among nurses working at a Turkish hospital. A mixed-methods design included a cross-sectional survey administering the Professional Quality of Life instrument and Maslach Burnout Inventory to 106 nurses. Interviews with a subgroup of eight participants explored nurses' experiences and coping strategies related to caring for chronically ill pediatric patients. High risk levels of secondary traumatic stress existed among 40.6% participants, and those over the age of 40 years were at greater risk. Two main interview themes emerged that identified (a) consequences and (b) coping strategies while caring for chronically ill children. Nurses experience emotional burdens and may purposefully distance themselves from chronically ill children. Social support from nurse colleagues and spiritual beliefs assist coping. Workplaces should acknowledge stressors inherent in chronic pediatric nursing care. Environments that welcome spiritual practices and actively encourage social support could address job hazards.

Characterization and toxicity of hospital wastewaters in Turkey.

The aim of the study was to present first preliminary characterization of Turkish hospital wastewaters, their environmental risk, and a method for toxicity assessment. The hospital wastewater samples were collected from two of the largest medical faculty hospitals and a training and research hospital in Istanbul, Turkey. The samples from the selected hospitals were taken as grab samples on March 2014. Overall, 55 substances including pharmaceuticals and their metabolites, pesticides, and corrosion inhibitors were analyzed in all hospital wastewaters. Analysis of toxicity and the antibiotic resistance bacteria were investigated in addition to the chemical analysis in the wastewater of one hospital. Hazard quotients (HQs) and toxic units (TUs) were calculated as basis of the environmental risk assessment. Fourteen pharmaceuticals in hospital wastewater (HWW) were classified as "high risk" with HQ>10. HQHWW values higher than 100 were determined for five antibiotics and one analgesic, namely, ofloxacin, clarithromycin, ciprofloxacin, sulfapyridine, trimethoprim, and diclofenac. Ofloxacin with an HQHWW of 9090 was observed to be the most hazardous compound. HQ and TU values of the wastewater treatment plant (WWTP) effluent dropped significantly due to dilution in the sewer. Further elimination by biological degradation or adsorption was observed only in some cases. However, the decreased HQWWTPeffluent values do not the change environmental load significantly. Therefore, advanced treatment processes should be applied to remove the persistent compounds. In combination with the results on antibiotic resistance, we would prefer on-site treatment of hospital wastewater. Toxicological assessment was performed using cytotoxic and mutagenic screening tests. The results of the Ames assay showed that the native hospital wastewaters had strongly mutagenic activity with a ≤10-fold increase relative to negative controls. The mutagenic potentials of the samples were generally concentration and metabolic activation dependent. Multiple antibiotic resistances were demonstrated with the tested isolates to ciprofloxacin, trimethoprim, and ceftazidime. This study demonstrates that the hospital wastewaters in Istanbul exhibit strong environmental and toxicological risks, as well as high multiple drug resistance to commonly used antibiotics.

The New Internet Discourse of Healthcare in Turkish Hospitals’ Social Media Pages

In this paper, discourse analysis of health is concerned with a critical analysis of the language use and the reproduction of dominant institutional ideologies in Turkish hospitals’ Facebook pages exploring the way in which health beliefs and the dissemination of health information are coded in the new media. This paper aims to analyze the various discourses of healthcare on Turkish hospitals’ Facebook pages using “Sosyomod” new media monitoring tool. Analyzing identified health topics on these pages offers a substantial contribution to the growing field of health literacy in online health communication. How do hospitals describe their health concerns and ask for information and advice? In answering these questions, the new Internet discourse of healthcare takes an interdisciplinary approach to discourse analysis, corpus linguistics and recent work in computer-mediated communication, and shows how these fields interplay in establishing new frameworks for health communication and health literacy researches.

Virtues, Work Satisfactions and Psychological Well-Being among Nurses in Turkish Hospitals

Virtues, Work Satisfactions and Psychological Well-Being among Nurses in Turkish Hospitals

Virtues, Work Satisfactions and Psychological Well-Being among Nurses in Turkish Hospitals

Virtues, Work Satisfactions and Psychological Well-Being among Nurses in Turkish Hospitals

The Effects of Internal Marketing on Some Job Attitudes: A Study in Private Hospitals in Turkey

Organizations realize that one of their most crucial assets is the employee. This research evaluates internal marketing actions from the employers’ perspective, focusing on effects of internal marketing actions on employers perceptions of the firm. The aim of this study is to state and analyze a proposed model concerned with internal marketing (IM), organizational cynicism (OCY), organizational commitment (OC), job satisfaction (JS), and intention to leave (ITL) amongst Turkish hospital employees. Research data is obtained from those 415 employees working in private hospitals in Mugla, Turkey. The data was analyzed through the SPSS 15.0 and LISREL 8.51 statistical packages and proposed relations are analyzed through Structural Equation Modelling (SEM). The findings supported hypotheses, demonstrating that while IM has positive effects on OC and JS, it has a negative impact on OCY. Moreover, as ITL is affected negatively by OC, it is positively influenced by OCY but no relationship to JS.

Antibiotic consumption in Turkish hospitals; a multi-centre point prevalence study

This multi-centre study aimed to determine the antibiotic consumption in Turkish hospitals by point prevalence. Antibiotic consumption of 14 centres was determined using the DDD method. Among hospitalized patients, 44.8% were using antibiotics and the total antibiotic consumption was 674.5 DDD/1000 patient-days (DPD). 189.6 (28%) DPD of the antibiotic consumption was restricted while 484.9 (72%) DPD was unrestricted. Carbapenems (24%) and beta lactam/beta lactamase inhibitors (ampicillin-sulbactam or amoxicillin-clavulanate; 22%) were the most commonly used restricted and unrestricted antibiotics. Antibiotics were most commonly used in intensive care units (1307.7 DPD). Almost half of the hospitalized patients in our hospitals were using at least one antibiotic. Moreover, among these antibiotics, the most commonly used ones were carbapenems, quinolones and cephalosporins, which are known to cause collateral damage. We think that antibiotic resistance, which is seen at considerably high rates in our hospitals, is associated with this level of consumption.

TECHNICAL EFFICIENCY OF TURKISH PUBLIC HOSPITALS’ INTENSIVE CARE UNITS: MULTIPLE INPUT – OUTPUT TECHNOLOGIES AND DISTANCE FUNCTIONS

This paper presents the technical efficiencies of Turkish public hospitals’ intensive care units (ICUs) using the Stochastic Distance Functions under the multiple input-out production technologies. Two estimation models are used in the paper; input-oriented and output-oriented stochastic distance functions which both are described by the translog production technology. The efficiency analysis is made with the sample of 385MoHhospitals for the year 2014. The mean inefficiency of the sample ICUs is found to be %12 (mean efficiency score=0.88) in the input-oriented efficiency model. On the other hand, the mean output-oriented inefficiency is estimated %21. The results of the paper suggest that, in both of input and output oriented model definition, there is significant increasing returns to scale in ICUs’ service production. Teaching and branch hospital ICUs are found to be more efficient than the others.

The Technical Efficiency of Hospital Inpatient Care Services: An Application for Turkish Public Hospitals

(ProQuest: ... denotes formulae omitted.)1. IntroductionAs in all other countries, health expenditure is also progressively increasing in Turkey. As is well known, the growth of health expenditure is related with aging of the society, increasing demand for health services created by income growth, epidemiological changes and especially with the use of advanced diagnostic and treatment methods. This process inevitably led the policy makers to provide tools to control the growth of health expenditure in countries such as Turkey, where the health services are substantially financed by public resources. Within the health services production units, the largest share of government health resources is consumed by the hospitals. Therefore the analysis of hospital efficiency and productivity in hospital services became a matter of priority for both researchers and policy makers as efficiency improvements in those services yield utmost important benefits for the health system and the public entirely.In the last decade, the structure of Turkish health system has been changed evidently with the implementation of the Health Transformation Program (HTP), which was announced with the aim of achieving efficiency and effectiveness in the use of financial resources in health sector, by imposing reforms related to health care delivery, finance and human resources1. HTP was constructed on three main pillars. The first main pillar was the reforms regarding health care delivery and social security, i.e. all Social Insurance Organizations' (SII) health facilities were transferred to the Ministry of Health (MoH) which was then followed by the announcement of the General Health Insurance Program (GHIP) in 2008. The second main pillar was the establishment of family physicians in the primary health care scheme. The last one was the enactments of the Public Hospital Associations (PHA) in 2012, which are basically regional hospital unions.Establishment of the PHAs introduced a new management model for Turkish public hospitals and their managers on the basis of institutional performance. Thus, in recent years, the hospital efficiency analysis that holds key for hospital performance assessment, is located at the core of Turkey Ministry of Health policy applications. The performance assessment of Turkish public hospitals are being done in a framework of the Balanced Score Card approach. In the performance assessment of these hospitals, SFA production efficiency analysis holds a key position. As briefly explained by Atilgan (2016), in in this assessment model, the efficiency scores are being estimated in four dimensions; that is hospital's outpatient, inpatient, surgery and emergency service productions. By using the Stochastic Frontier Analysis (SFA) method.In this study, the efficiency analysis of Turkish public hospitals' inpatient care services is done by using SFA, with respect to a similar model that is used by MoH for hospital performance assessment. The main purpose of the study is to analyze the distribution of efficiency scores within the hospitals with respect to some key hospital characteristics, as well as assessing the environmental factors that affect the efficiency scores on the basis of regional differences. Accordingly, while being one of the rare examples of SFA hospital efficiency studies in Turkish case, this study also tries to contribute to the hospital efficiency literature by introducing one of the MoH's hospital efficiency assessment model in an analytical way with respect to theoretical basics.The rest of the paper is organized as follows. In the second section, a literature review on hospital efficiency studies is given. In the third section, research design and methods are introduced with the model specifications and the data used in the analysis. In the section four, the results of the estimations are given. Then the paper concludes with discussions.2. Literature ReviewSince the pioneer study of Wagstaff (1989), who examined the efficiency of Spanish hospitals, a wide literature has been conducted on efficiency estimation of hospitals with SFA. …

Impact of Laboratory Test Use Strategies in a Turkish Hospital

ObjectivesEliminating unnecessary laboratory tests is a good way to reduce costs while maintain patient safety. The aim of this study was to define and process strategies to rationalize laboratory use in Ankara Numune Training and Research Hospital (ANH) and calculate potential savings in costs.MethodsA collaborative plan was defined by hospital managers; joint meetings with ANHTA and laboratory professors were set; the joint committee invited relevant staff for input, and a laboratory efficiency committee was created. Literature was reviewed systematically to identify strategies used to improve laboratory efficiency. Strategies that would be applicable in local settings were identified for implementation, processed, and the impact on clinical use and costs assessed for 12 months.ResultsLaboratory use in ANH differed enormously among clinics. Major use was identified in internal medicine. The mean number of tests per patient was 15.8. Unnecessary testing for chloride, folic acid, free prostate specific antigen, hepatitis and HIV testing were observed. Test panel use was pinpointed as the main cause of overuse of the laboratory and the Hospital Information System test ordering page was reorganized. A significant decrease (between 12.6–85.0%) was observed for the tests that were taken to an alternative page on the computer screen. The one year study saving was equivalent to 371,183 US dollars.ConclusionHospital-based committees including laboratory professionals and clinicians can define hospital based problems and led to a standardized approach to test use that can help clinicians reduce laboratory costs through appropriate use of laboratory tests.

Looking for a ‘cure’: negotiating ‘walking’ in a Turkish rehabilitation hospital

This article explores discourses surrounding ‘walking’ in a Turkish rehabilitation hospital and their impact on in-hospital relationships, patients’ attitudes towards disability, and constructions of ‘bodily normality’. Interviews were conducted with 29 patients, 11 medical personnel, and two non-medical personnel. Three categories of discourses emerged. First, hope for walking is kept alive in doctor–patient relationships, either through a state of silence on the matter or an emphasis on time, determination, and faith in God. Second, patients are virtually assured of the retrieval of walking, mostly through interactions with fellow patients and their accompanying family members (refakatçis). Third, a possible non-walking future is highlighted, either within a framework closer to a disability rights perspective or through an emphasis on gratitude. Diverse discourses on walking emerge due to the informality of in-hospital practices. Still, the ‘normal body’ is predominantly reproduced as the ‘walking body’. Thus, patients refuse discharge before regaining the ability to walk.

Flow, Work Satisfactions and Psychological Well-Being among Nurses in Turkish Hospitals

This exploratory study examined the relationship between virtues and indicators of work satisfaction and engagement, perceptions of hospital functioning and quality of nursing care, and psychological well-being of nursing staff. Working in Turkish hospitals. A virtue is any psychological process that enables a person to benefit himself or herself and others. Two virtues were considered: optimism and proactive behaviors. This emphasis was consistent with emerging trends in both psychology and organizational studies, termed positive psychology or positive organizational scholarship respectively, to focus on strengths and excellence rather than weakness and pathology.

Flow, Work Satisfactions and Psychological Well-Being among Nurses in Turkish Hospitals

Flow, Work Satisfactions and Psychological Well-Being among Nurses in Turkish Hospitals

Sexual dimorphism in frontal bone roundness quantified by a novel 3D-based and landmark-free method

In this study we present a novel and landmark-free method for quantifying shape differences between male and female frontal bones. CT scans were recorded for 80 male and 80 female Turkish hospital patients, age 25–40. The frontal bones were first isolated from the 3D models by digital cutting along the bordering sutures, and then aligned to a CAD-based sphere. This allowed us to quantify the amount of frontal bone overlapping with the sphere (on average 43.2±6.5% for males and 33.9±6.6% for females, the difference is significant at p<0.0001), and to identify areas of shape difference and deviation from the sphere surface in male and female bones. The larger proportion of spherical frontal bone surface in males challenges the common description of the female forehead as “rounder”. Based on the overlap data, we developed discriminant functions able to correctly classify 77.5% of the frontal bone models as male/female. This demonstrates that 3D-based and landmark-free approaches to statistical shape analysis may become a viable alternative to the currently dominating landmark-based approaches for shape investigation.

Manganese superoxide dismutase, glutathione peroxidase and catalase gene polymorphisms and clinical outcomes in acute kidney injury

Introduction The aim of this study was to evaluate the potential association of single gene polymorphisms of manganese superoxide dismutase (MnSOD), glutathione peroxidase 1 (GPX1) and catalase (CAT) with clinical outcomes of acute kidney injury (AKI). Materials and methods Ninety AKI patients and 101 healthy volunteers were included in the study. Determination of MnSOD rs4880, GPX1 rs1050450 and CAT rs769217 polymorphisms was performed using real-time polymerase chain reaction amplification. The duration of hospitalization of AKI patients, dialysis and intensive care requirements, sepsis, oliguria and in-hospital mortality rates were assessed. Results The MnSOD, GPX1 and CAT genotypes and allele frequencies of AKI patients did not differ significantly from those of healthy controls. In patients with a T allele in the ninth exon of the CAT gene, intensive care requirements were greater than those of patients with the CC genotype (p = 0.04). In addition, sepsis and in-hospital mortality were observed significantly more frequently in patients with a T allele in the ninth exon of the CAT gene (p = 0.03). Logistic regression analysis determined that bearing a T allele was the primary determinant of intensive care requirements and in-hospital mortality, independent of patient age, gender, presence of diabetes and dialysis requirements (OR 6.10, 95% CI 1.34–27.81, p = 0.02 and OR 10.25, 95% CI 1.13–92.80, p = 0.04, respectively). Conclusion Among AKI patients in the Turkish population, hospital morbidity and mortality were found to be more frequent in patients bearing a T allele of the rs769217 polymorphism of the CAT gene.

Investigating the antecedents of task-technology fit: a field study in Turkish private hospitals

Turkey has faced an essential shift in healthcare services due to the establishment of healthcare information standards with a common database. We focus on assessing the progress made towards realising the operation of new health informatics with aims to present an analysis of the compatibility of the new management systems with the tasks carried out by physicians. The purpose of this study is to examine the effects of task, user and information management system IMS characteristics on users' perceived task-technology fit TTF. Adapting items from the literature, data were collected from six private hospital chains in Turkey and analysed for statistically significant relationships. The analyses indicated that task, technology, and user characteristics had effects on TTF. Technology characteristics were found to be the most effective variable in TTF at Turkish private hospitals.