Browsing by Subject "tertiary health care"

Now showing 1 - 10 of 10
  • No Thumbnail Available
    Item
    Economic impact of primary headaches in Turkey: A university hospital based study: Part II
    (2006) Karli N.; Zarifoǧlu M.; Ertaş M.; Saip S.; Öztürk V.; Biçakçi Ş.; Boz C.; Selçuki D.; Oǧuzhanoǧlu A.; Neyal M.; Siva A.; Irkeç C.; Kaleaǧasi H.; Kansu T.; Sarica Y.; Taşdemir N.; Uzuner N.
    This study was planned to investigate the economic impact of headache on Turkish headache sufferers attending a tertiary care outpatient headache clinic. A total of 937 headache patients were included in this study and questioned using a questionnaire for the profile of patients and headache, quality of life of patients and economic impact of headache. The median total direct cost was found to be 88.0 USD and the median total cost was 160.7 USD. The drug treatment cost was the highest item followed by the specialist outpatient care cost. The average lost and inefficient work/school days was 1.5 (0-45) and 8.4 (0-100) days for one year. It was shown that loss of productivity was higher for migraine without aura group when compared with the episodic and chronic tension-type headache groups. The results of this nationwide university hospital based study showed that headache, especially migraine, has considerable economic impact on patients. © Springer-Verlag Italia 2006.
  • No Thumbnail Available
    Item
    Evaluation of species distribution and risk factors of candidemia: A multicenter case-control study
    (2010) Yapar N.; Pullukcu H.; Avkan-Oguz V.; Sayin-Kutlu S.; Ertugrul B.; Sacar S.; Cetin B.; Kaya O.
    This study was planned to determine the risk factors of candidemia, and the most common Candida species causing bloodstream infections. A case-control study which included adult patients was conducted over a 1-year period at tertiary-care educational hospitals in Turkey. A total of 83 candidemia episodes were identified during the study period. Candida albicans was the most common species recovered (45.8%) followed by Candida tropicalis (24.1%) Candida parapsilosis (14.5%) and Candida glabrata which was isolated from only four (4.8%) patients. Presence of a urethral catheter (odds ratio [OR] 2.38; 95% confidence interval [CI] 1.095.19; P 0.02), previous use of antibiotics (OR 2.61; 95% CI 1.056.46; P 0.03), RBC transfusions (OR 2.14; 95% CI 1.163.94; P 0.01) and parenteral nutrition (OR 4.44; 95% CI 2.438.11; P < 0.01) were found as independent risk factors for candidemia. TPN (Total Parenteral Nutrition) was an independent risk factor for both C. albicans and non-Candida albicans Candida species (P < 0.001). Most of the risk factors were invasive procedures and former medications. We conclude that a great number of candidemia cases are preventable by means of reduction of unnecessary invasive procedures and the use of antimicrobials. © 2011 ISHAM.
  • No Thumbnail Available
    Item
    The cost of care of rheumatoid arthritis and ankylosing spondylitis patients in tertiary care rheumatology units in Turkey
    (2012) Malhan S.; Pay S.; Ataman S.; Dalkilic E.; Dinc A.; Erken E.; Ertenli I.; Ertugrul E.; Gogus F.; Hamuryudan V.; Inanc M.; Karaaslan Y.; Karadag O.; Karakoc Y.; Keskin G.; Kisacik B.; Kiraz S.; Oksel F.; Oksuz E.; Pirildar T.; Sari I.; Soy M.; Senturk T.; Taylan A.
    Objectives: To determine the direct and indirect costs due to rheumatoid arthritis (RA) and ankylosing spondylitis (AS) patients in Turkey. Methods: An expert panel was convened to estimate the direct and indirect costs of care of patients with RA and AS in Turkey. The panel was composed of 22 experts chosen from all national tertiary care rheumatology units (n=53). To calculate direct costs, the medical management of RA and AS patients was estimated using "cost-of-illness" methodology. To measure indirect costs, the number of days of sick leave, the extent of disability, and the levels of early retirement and early death were also evaluated. Lost productivity costs were calculated using the "human capital approach", based on the minimum wage. Results: The total annual direct costs were 2,917.03 Euros per RA patient and 3,565.9 Euros for each AS patient. The direct costs were thus substantial, but the indirect costs were much higher because of extensive morbidity and mortality rates. The total annual indirect costs were 7,058.99 Euros per RA patient and 6,989.81 for each AS patient. Thus, the total cost for each RA patient was 9,976.01 Euros and that for an AS patient 10,555.72 Euros, in Turkey. Conclusion: From the societal perspective, both RA and AS have become burden in Turkey. The cost of lost productivity is higher than the medical cost. Another important conclusion is that indirect costs constitute 70% and 66% of total costs in patients with RA and AS, respectively. © Clinical and Experimental Rheumatology 2012.
  • No Thumbnail Available
    Item
    Drug allergy in tertiary care in Turkey: Results of a national survey. The ADAPT study: Adult drug allergy perception in Turkey
    (Elsevier Doyma, 2014) Çelik G.E.; Karakaya G.; Öztürk A.B.; Gelincik A.; Abadoğlu T.; Sin A.; Damadoğlu E.; Yilmaz T.I.; Demirtürk M.; Dursun B.; Özdemir S.K.; Çelikel S.; Değirmenci P.; Bozkurt B.; Göksel T.; Erkekol F.; Aydin T.; Kavut A.B.; Kirmaz C.; Kalpaklioğlu F.; Büyüköztürk S.; Kalyoncu F.
    Background: No data are available on the incidence of drug hypersensitivity (DH) reactions in outpatient settings of tertiary allergy/immunology clinics. Our aims were to document the frequency of outpatient hospital admissions due to DH reactions to allergy/immunology clinics in adults and the management of these reactions in real life. We also investigated whether drug allergy affected social and medical behaviours of the patients. Methods: This multi-centre study was performed for one year with the participation of 11 out of 16 tertiary allergy/clinical immunology clinics in Turkey. The study group consisted of the patients with DH reactions. Results of a questionnaire including drug reactions and management were recorded. Results: Among 54,863 patients, 1000 patients with DH were enrolled with a median of 2.1% of all admissions. In real life conditions, the majority of approaches were performed for finding safe alternatives (65.5%; 1102 out of 1683) with 11.7% positivity. Diagnostic procedures were positive in 27% (154/581) of the patients. The majority of the patients had higher VAS scores for anxiety. A total of 250 subjects (25%) reported that they delayed some medical procedures because of DH. Conclusion: Our results documented the frequency of admissions due to DH reactions to allergy/clinical immunology clinics for the first time. Although physicians mostly preferred to perform drug tests in order to find safe alternatives, considering the fact that DH was confirmed in 27% of the patients, use of diagnostic tests should be encouraged, if no contraindication exists in order to avoid mislabelling patients as DH. © 2013 SEICAP.
  • No Thumbnail Available
    Item
    Etiology of hypopituitarism in tertiary care institutions in Turkish population: Analysis of 773 patients from pituitary study group database
    (Humana Press Inc., 2014) Tanriverdi F.; Dokmetas H.S.; Kebapci N.; Kilicli F.; Atmaca H.; Yarman S.; Ertorer M.E.; Erturk E.; Bayram F.; Tugrul A.; Culha C.; Cakir M.; Mert M.; Aydin H.; Taskale M.; Ersoz N.; Canturk Z.; Anaforoglu I.; Ozkaya M.; Oruk G.; Hekimsoy Z.; Kelestimur F.; Erbas T.
    Hypopituitarism in adult life is commonly acquired and the main causes are known as pituitary tumors and/or their treatments. Since there are new insights into the etiology of hypopituitarism and presence of differences in various populations, more studies regarding causes of hypopituitarism are needed to be done in different ethnic groups with sufficient number of patients. Therefore, we performed a multi-center database study in Turkish population investigating the etiology of hypopituitarism in 773 patients in tertiary care institutions. The study was designed and coordinated by the Pituitary Study Group of SEMT (The Society of Endocrinology and Metabolism of Turkey). Nineteen tertiary reference centers (14 university hospitals and 5 training hospitals) from the different regions of Turkey participated in the study. It is a cross-sectional database study, and the data were recorded for 18 months. We mainly classified the causes of hypopituitarism as pituitary tumors (due to direct effects of the pituitary tumors and/or their treatments), extra-pituitary tumors and non-tumoral causes. Mean age of 773 patients (49.8 % male, 50.2 % female) was 43.9 ± 16.1 years (range 16-84 years). The most common etiology of pituitary dysfunction was due to non-tumoral causes (49.2 %) among all patients. However, when we analyze the causes according to gender, the most common etiology in males was pituitary tumors, but the most common etiology in females was non-tumoral causes. According to the subgroup analysis of the causes of hypopituitarism in all patients, the most common four causes of hypopituitarism which have frequencies over 10 % were as follows: non-secretory pituitary adenomas, Sheehan's syndrome, lactotroph adenomas and idiopathic. With regard to the type of hormonal deficiencies; FSH/LH deficiency was the most common hormonal deficit (84.9 % of the patients). In 33.8 % of the patients, 4 anterior pituitary hormone deficiencies (FSH/LH, ACTH, TSH, and GH) were present. Among all patients, the most frequent cause of hypopituitarism was non-secretory pituitary adenomas. However, in female patients, present study clearly demonstrates that Sheehan's syndrome is still one of the most important causes of hypopituitarism in Turkish population. Further, population-based prospective studies need to be done to understand the prevalence and incidence of the causes of hypopituitarism in different countries. © 2013 Springer Science+Business Media.
  • No Thumbnail Available
    Item
    Necrotising fasciitis: Clinical evaluation and treatment results of 18 patients; [Nekrotizan Fasiit: 18 Hastanın Klinik Durumlarının ve Tedavi Sonuçlarının Değerlendirilmesi]
    (Galenos, 2019) Öztürk A.M.; Süer O.; Erdem H.A.; Yildirim Şimşir I.; Şenol Akar Ş.; Özkayin N.; Işikgöz Taşbakan M.; Akyol D.
    Introduction: Necrotizing fasciitis (NF) is a complicated and rapidly spreading soft tissue infection that affects the superficial fascia, skin, and subcutaneous tissue. In this study, we evaluated patients who were diagnosed with NF and treated in two tertiary-care educational university hospitals. Materials and Methods: Patients diagnosed with NF in three centers (Ege University Department of Orthopedics and Traumatology and Department of Infectious Diseases and Clinical Microbiology and Celal Bayar University Department of Infectious Diseases and Clinical Microbiology) between November 2016 and December 2018 were retrospectively analyzed. The patients’ demographic characteristics, significant risk factors for infection, sites of infection, models of surgical treatment, department(s) that performed the surgery, causative infectious agents, empirical and agent-specific treatment regimens and their duration, length of hospital stay, need for intensive care, and one month survival were evaluated. Results: Eighteen patients (10 females, mean age 53.7 [19-86 years]) who were diagnosed with NF were included in the study. Diabetes mellitus, trauma/surgery history, and decubitus wound were the most common predisposing factors. The most common anatomic site was lower extremity (n=10, 55.5%). All patients underwent surgical debridement. The most commonly isolated microorganisms were Escherichia coli (n=4), Klebsiella pneumoniae, Proteus mirabilis, and Acinetobacter baumannii (each n=3). Empirical treatment was initiated with meropenem in eight patients (32%) and tigecycline in four patients (12.5%), and the antibiotic was changed in five patients based on culture results. The mean duration of antibiotic therapy was 35.5 (9-68) days. The average hospital stay was 55 (11-186) days. Six patients (33.3%) required intensive care during followup. The mortality rate was 16.6%. Conclusion: NF is a fulminant disease, and early diagnosis and effective multidisciplinary treatment are crucial for reducing mortality rates. When the diagnosis is suspected, early surgical debridement should be performed and empirical antibiotherapy should be started immediately. ©Copyright 2019 by the Infectious Diseases and Clinical Microbiology Specialty Society of Turkey.
  • No Thumbnail Available
    Item
    Cryptosporidium spp. During chemotherapy: A cross-sectional study of 94 patients with malignant solid tumor
    (King Faisal Specialist Hospital and Research Centre, 2021) Karabey M.; Can H.; Öner T.Ö.; Döşkaya M.; Alak S.E.; Döşkaya A.D.; Karakavuk M.; Köseoğlu A.E.; Ün C.; Gürüz A.Y.; Alacacıoğlu A.; Pektaş B.; Gül A.; Kaya S.; Gökmen A.A.
    BACKGROUND: Cryptosporidium spp. is a protozoan parasite that infects many vertebrate animals, including humans. Since Cryptosporidium spp. can cause chronic life-threatening diarrhea and severe malabsorption in immunocompromised patients, we investigated the prevalence of this parasite among patients undergoing chemotherapy for malignant solid tumors. OBJECTIVE: Investigate the prevalence of Cryptosporidium spp. in stool samples. DESIGN: Cross-sectional. SETTING: Tertiary care. PATIENTS AND METHODS: Stool samples were collected from adult patients with malignant solid tumors receiving chemotherapy and diarrhea. Cryptosporidium spp. prevalence was determined using Ziehl-Neelsen staining, ELISA, and real-time PCR targeting of the COWP gene. MAIN OUTCOME MEASURE: The prevalence of Cryptosporidium spp. in patients undergoing chemotherapy for malignant solid tumors. SAMPLE SIZE: 94 RESULTS: The prevalence was 2.1% (2/94), 5.3% (5/94), and 5.3% (5/94) as detected by Ziehl-Neelsen staining, real-time PCR and ELISA, respectively. The prevalence reached 8.5% (8/94) using all results obtained from the three methods. Among eight positive stool samples, four were positive by at least two different methods (Ziehl-Neelsen staining-ELISA or ELISA-real-time PCR) whereas the remaining four were positive by either ELISA or real-time PCR. CONCLUSION: These findings show the risk of cryptosporidiosis in cancer patients and the necessity to use at least two diagnostic methods during the diagnosis of cryptosporidiosis to reach more accurate and trustworthy results. LIMITATIONS: Further studies with a larger sample size are recommended. Copyright: Copyright © 2021, Annals of Saudi Medicine, Saudi Arabia. This is an open access article under the Creative Commons Attribution-NonCommercialNoDerivatives 4.0 International License (CC BY-NC-ND). The details of which can be accessed at http://creativecommons. org/licenses/bync-nd/4.0/
  • No Thumbnail Available
    Item
    Rate of Overlap between ICD-11 Gaming Disorder and DSM-5 Internet Gaming Disorder along with Turkish Reliability of the Gaming Disorder Scale for Adolescents (GADIS-A)
    (S. Karger AG, 2023) Tuncturk M.; Karacetin G.; Ermis C.; Ciray R.O.; Can M.; Yesilkaya C.; Atay A.; Alkas G.E.; Kasap D.; Guney O.; Alarslan S.; Cakir B.; Halac E.; Tonyall A.; Elmas F.N.; Turan S.
    Introduction: The main aims of the current study were (i) to explore the overlap between Internet gaming disorder (IGD) and gaming disorder (GD) diagnoses, (ii) to identify clinical characteristics in clinical settings, and (iii) to measure psychometric properties of the Gaming Disorder Scale for Adolescents (GADIS-A). Methods: 222 adolescents who were followed up within a tertiary-care mental health hospital, were included (IGD/GD group [n = 111], clinical comparison group [n = 90], healthy controls [n = 21]). The tools used were the GADIS-A, Internet Gaming Disorder Scale-Short-Form, The Difficulties in Emotion Regulation Scale (DERS-36), Children's Global Assessment Scale, and a semistructured interview for DSM-5 diagnoses. Results: The overlap rate of IGD and GD is 73%. Comorbid ADHD diagnoses were more commonly found in the IGD group compared to the clinical comparison group. Patients who met GD and IGD diagnoses revealed higher scores in DERS-36. Turkish GADIS-A Item-Total score correlation coefficients were between 0.627 and 0.860. In the sample, there was a high level of correlation between the number of DSM-5 and ICD-11 diagnostic criteria met and GADIS-A scale scores. The Cronbach's alphas if item deleted ranged between 0.942 and 0.954. In addition, treatment refusal was more frequent in the IGD group than in the clinical comparison group. Conclusion: The GADIS-A had good to excellent psychometric properties in Turkish adolescents. Despite having a stricter diagnostic criterion, GD overlapped with IGD in a clinical population. © 2023 S. Karger AG. All rights reserved.
  • No Thumbnail Available
    Item
    Key recommendations for primary care from the 2022 Global Initiative for Asthma (GINA) update
    (Nature Research, 2023) Levy M.L.; Bacharier L.B.; Bateman E.; Boulet L.-P.; Brightling C.; Buhl R.; Brusselle G.; Cruz A.A.; Drazen J.M.; Duijts L.; Fleming L.; Inoue H.; Ko F.W.S.; Krishnan J.A.; Mortimer K.; Pitrez P.M.; Sheikh A.; Yorgancıoğlu A.; Reddel H.K.
    The Global Initiative for Asthma (GINA) was established in 1993 by the World Health Organization and the US National Heart Lung and Blood Institute to improve asthma awareness, prevention and management worldwide. GINA develops and publishes evidence-based, annually updated resources for clinicians. GINA guidance is adopted by national asthma guidelines in many countries, adapted to fit local healthcare systems, practices, and resource availability. GINA is independent of industry, funded by the sale and licensing of its materials. This review summarizes key practical guidance for primary care from the 2022 GINA strategy report. It provides guidance on confirming the diagnosis of asthma using spirometry or peak expiratory flow. GINA recommends that all adults, adolescents and most children with asthma should receive inhaled corticosteroid (ICS)-containing therapy to reduce the risk of severe exacerbations, either taken regularly, or (for adults and adolescents with “mild” asthma) as combination ICS–formoterol taken as needed for symptom relief. For patients with moderate–severe asthma, the preferred regimen is maintenance-and-reliever therapy (MART) with ICS–formoterol. Asthma treatment is not “one size fits all”; GINA recommends individualized assessment, adjustment, and review of treatment. As many patients with difficult-to-treat or severe asthma are not referred early for specialist review, we provide updated guidance for primary care on diagnosis, further investigation, optimization and treatment of severe asthma across secondary and tertiary care. While the GINA strategy has global relevance, we recognize that there are special considerations for its adoption in low- and middle-income countries, particularly the current poor access to inhaled medications. © 2023, The Author(s).
  • No Thumbnail Available
    Item
    Being a health care professional in the ICU serving patients with covid-19: A qualitative study
    (Elsevier Inc., 2023) Ozan E.; Durgu N.
    Background: The COVID-19 pandemic has placed a great deal of strain on healthcare providers across the world. There has been no research into the experiences of health care providers in Turkey caring for hospitalized patients with COVID-19 in the ICU. Objectives: To explain the experiences of health care providers who provide services to patients with Covid-19 in an intensive care unit. Methods: This study used a phenomenological approach to recruit 15 participants (10 nurses and 5 physicians). The data was gathered through semi-structured in-depth interviews conducted face-to-face. Results: The four primary themes that came up in the results were COVID-19: the unidentified enemy, front-line struggle, psychological struggle, and invasion of social life. Conclusion: During the epidemic, health care providers encountered several psychological, physical, social, and professional difficulties. All health care personnel must receive information and skills training on what to do in crisis and risk circumstances such as infectious disease, decision-making, anxiety management, and problem-solving during pandemics. © 2022 Elsevier Inc.