Fatma Ciftci

Beliefs, attitudes, and activities of healthcare personnel about influenza and pneumococcal vaccines

ABSTRACT Objectives: Vaccination of healthcare personnel (HCP) is an effective measure for preventing the spread of influenza among at-risk patients. This study was conducted to determine influenza vaccination rates and activities among HCP working at a tertiary healthcare setting. Methods: This study included 470 HCP (85 physicians, 134 nurses, 53 healthcare assistants, 44 paramedics, 47 medical secretaries, and 107 auxillary staff members) working at the emergency, cardiology, chest diseases, and internal medicine departments with the largest volume of patients with vaccination indication of two large university hospitals with similar medical practices and work environment. Each participant completed an anonymous questionnaire form. Results: A total of 470 HCP participated in the survey. The compliance rate of the HCP to participate in the survey was 93.6%. Of these, 26.7% had been vaccinated against influenza. Vaccination in the survey year was significantly associated with having regular influenza vaccinations (OR 48.66; 95% CI:[25.09-94.369]; P<.01); having an educational level of college or higher (OR 2.07; 95% CI:[1.03-4.15]; P<.05); being a physician (OR 4.25; 95% CI:[1.28-14.07]; P< .05); and a professional experience of more than 5 years (OR 2.02; 95%CI:[1.13-5.62]; P< .05). Physicians recommended and prescribed the influenza vaccine significantly more frequently than the pneumococcal vaccine (37.6% vs 30.6%, P = .03, 25.9% vs 17.6%, P = .001, respectively). Among all HCP, the reasons for vaccination included having the opinion that the vaccine provides a partial protection against the infection (75.2%), reduces work force loss (48.8%), reduces the rates of death and severe conditions like pneumonia (43.2%), and reduces hospitalization (40.8%). The HCP had been vaccinated to protect family members (81.6%), people around (51.2%), herself/himself (47.2%), and patients (28%) fom infection. The reasons of not getting vaccinated against influenza among HCP included fear of vaccines adverse effects (31.0%), doubts about its efficacy (28.9%) and safety (22.3%), and lack of adequate knowledge about vaccination (16.2%). Conclusion: Our results indicated that influenza vaccination rates are low in our whole HCP sample, with physicians having a slightly better rate than other HCP. Getting regularly vaccinated, having an educational level of college or higher, being a physician, and having a professional experience of more than 5 years positively affects the rate of future vaccinations. Physicians significantly more commonly recommended and prescribed the influenza vaccine than the pneumococcal vaccine. The most important reasons for getting vaccinated included having the opinion that the vaccine provided partial protection and intending to protect family members from infection. In our whole HCP sample, the reasons of not getting vaccinated against influenza included fear of vaccines adverse effects and doubts about its efficacy and safety. Training meetings should be held for HCPs to underscore the importance of the influenza vaccine for protection of patients against the influenza.

Is oxygen saturation variable of simplified pulmonary embolism severity index reliable for identification of patients, suitable for outpatient treatment.

The pulmonary embolism severity index (PESI) or simplified version (sPESI) are widely validated risk scores for the identification of eligible patients for outpatient treatment. Saturation is one of these criteria. For this metric, saturation of 90% or greater is assigned zero points. However, 90% saturation does not always exclude hypoxemic respiratory failure.

Evaluation of the feasibility of average volume-assured pressure support ventilation in the treatment of acute hypercapnic respiratory failure associated with chronic obstructive pulmonary disease: A pilot study

Purpose: The purpose of the study was to assess the feasibility of average volume‐assured pressure support (AVAPS) and determine factors that affect its use in patients with chronic obstructive pulmonary disease (COPD) and acute hypercapnic respiratory failure (AHRF). Methods: Some 106 patients with COPD and AHRF received AVAPS. Patients who required invasive ventilation or died were included in the failed treatment group. Factors that affected failed treatment were determined using the Cox proportional hazard model. Analysis of variance was used to examine the variability of repeated measurements. Results: Noninvasive ventilation was successful in 81 (76.4%) patients. The successful treatment group had a significantly higher baseline Glasgow Coma Score, pH, and ratio of partial pressure of oxygen (arterial) to fraction of inspired oxygen (P < .001, P = .008, and P < .001, respectively) but significantly lower Acute Physiology and Chronic Health Evaluation (APACHE) II and Charlson comorbidity index scores (P < .001). The change in partial pressure of carbon dioxide (arterial) during the first 2 hours was significantly greater in the successful treatment group (P = .008). Multivariate Cox regression analysis showed that percentage change in partial pressure of carbon dioxide (arterial) and APACHE II scores were significantly correlated to failed treatment (P = .02 and P = .01, respectively). Conclusion: AVAPS can be used for AHRF associated with COPD. The risk of failed treatment is high for patients with higher baseline APACHE II and nonsignificant improvements in partial pressure of carbon dioxide (arterial) in the first 2 hours of treatment. HighlightsNIV with AVAPS is an effective treatment modality in patients with COPD and AHRF.AVAPS failure was correlated with the following factors: severe acidosis, disease severity (APACHE II), impairment of consciousness (GCS), presence of comorbidities (CCI), and lack of improvement of arterial blood gases in the first hours of treatment.

Association between pterygoid hamulus length and apnea hypopnea index in patients with obstructive sleep apnea: a combined three-dimensional cone beam computed tomography and polysomnographic study

OBJECTIVE The purpose of this study was to investigate the relationships among the pterygoid hamulus (PH), the maxillo-mandibular complex to the pharynx, the upper airway, and the soft palate and a possible connection to sleep apnea severity as assessed by polysomnography. STUDY DESIGN A total of 100 left and right sides of the PH were retrospectively measured by two observers from 50 cone beam computed tomography images by using three-dimensional rendering program in patients with obstructive sleep apnea (33 males and 17 females, with a mean age of 56.8 years; range 32-82 years). RESULTS The mean apnea hypopnea index was 30.2 (range 0-95). A linear regression analysis on the apnea hypopnea index with the total length of the PH adjusted for gender, body mass index, neck circumference, and age showed a statistically significant association: (-0.234(∗); P = .005). None of the other variables reached formal significance. CONCLUSION The pterygoid hamulus length is inversely associated with sleep apnea severity. Our study provides further insight into the pathophysiology of sleep apnea, with the result that PH length could be a future supplementary measurement to help clinicians to stratify and determine the best treatment options for patients with obstructive sleep apnea.

Smoking attitudes of the patients with allergic rhinitis: a comparison with asthma and chronic obstructive pulmonary disease. Are there differences when only upper airways are involved?

Introduction Despite the well documented relationship between lower airway diseases and smoking, there are limited data about smoking and allergic rhinitis (AR). In this study, we aimed to document the smoking behaviour and environmental tobacco smoke (ETS) exposure of the patients with AR in comparison with patients with asthma, chronic obstructive pulmonary diseases (COPD) and healthy controls (HC). Materials and Methods Demographics and disease characteristics were recorded from case files whereas smoking history, childhood and current exposures to ETS, as well as the smoking behaviors were investigated by a self reported questionnaire. Result A total of 937 subjects comprising patients with AR (n= 252), asthma (n= 249), COPD (n= 188) and HCs (n= 248) were enrolled in the study. The rates of active smokers were 35% (HCs), 26% (COPD), 21% (AR), and 11% (asthma). Exposure to ETS while with friends was significantly higher among HCs and AR groups (p< 0.0001). The rate of willingness to quit smoking is high in AR patients (73%) but they did not determined about date of quiting. Conclusions Our results showed that a significant number of patients with AR actively smoke and neither the patients with AR nor the people in their surroundings were sufficiently aware of the health hazards of smoking with AR. It seems necessary to inform patients with about the health effects of smoking on all respiratory tract diseases.

Modeling of Unsuccessful Repeated in Survival Analysis: Chronic Obstructive Pulmonary Disease

Objective: The purpose of this study is to determine the models expressing ideally the recurrent events data encountered in the survival analyses. In this study, the frailty model, which is used in the survival analysis to explain the heterogeneity that both modeling of recurrent events and latent risk factors cause, has been explained in detail. The heterogeneity stemming from genetics or unmeasured covariates has been modeled with adduct of unmeasured random effect to the hazard model. Material and Methods: In this study, exacerbation-free survival of chronic obstructive pulmonary disease (COPD) patients were estimated by Kaplan -Meier method. Data of recurrent exacerbations were analysed using frailty models, which are employed for repeated failures. Among frailty distributions, gamma, inverse gaussian, lognormal and positive stable distributions are considered. Fit criteria, namely Akaike information criterion (AIC) and Bayesian information criterion (BIC), as well as graphical assessment are collectively utilized in order to determine the optimal distribution model. Ultimately, the Weibull regression model was chosen to analyse the data regarding COPD patients who experienced repeated failures. Gamma distribution was selected for frailty term and the frailty model is built. Results: The frailty model for the COPD exacerbations showed that p values for mMRC variable (p<0.0001) and FEV1 variable (p<0.0001) were both significant. Latent risk factors environmental and genetic factors other than mMRC and FEV1 may effect the time to failure of COPD patients. It may be suggested that such concealed factor or factors impose 3.5 times increased risk for exacerbation in a given COPD patient. Conclusion: In conclusion, the frailty models can be used in the modeling of recurrent events in the survival analysis, and in the explanation of heterogeneity among subjects. The explanation of this heterogeneity has dynamized the interpretation made in consequence of modeling of the survival analysis.

Acute cardiac events in severe community-acquired pneumonia: A multicenter study

An increased risk of cardiovascular complications has been defined in community‐acquired pneumonia (CAP), but limited data is available for patients with severe CAP.

Do higher cut-off values for tuberculin skin test increase the specificity and diagnostic agreement with interferon gamma release assays in immunocompromised Bacillus Calmette-Guérin vaccinated patients?

PURPOSE Immunocompromised patients with latent tuberculosis infection (LTBI) are at high risk of progression to active tuberculosis. Detection and treatment of LTBI in this group of patients are very important to control active tuberculosis. Tuberculin skin test (TST) and interferon gamma release assays (IGRAs) are two methods for detection of LTBI. Diagnostic agreement between two tests are poor especially in Bacillus Calmette-Guérin (BCG) vaccinated immunocompromised patients. In this study, we tried to figure out if the use of a higher cut-off for TST increases diagnostic agreement with IGRAs and TST specificity and or not. MATERIALS/METHODS In this retrospective study, BCG vaccinated solid organ transplantation (SOT) candidates and patients scheduled for anti-tumor necrosis factor-alpha (anti- TNFα) treatment patients who underwent both TST and IGRAs between 2011 and 2017 were enrolled in the study. Diagnostic agreement between the two tests was assessed for 5, 10, 15mm cut-off values for all participants, SOT candidates and anti- TNFα treatment subgroups separately. RESULTS Fifty female and 55 male total 105 patients were included. In the anti- TNFα treatment group 92.8% of the patients were receiving at least one immunosuppressive drug. For all participants kappa (κ) values were 0.303, 0.370, 0.321 respectively for 5, 10 and 15mm cut-offs. For SOT candidates κ values were 0.488, 0.422, 0.288 respectively. For anti- TNFα treatment group κ values were 0.235, 0.332, 0.275 respectively. CONCLUSIONS In BCG vaccinated immunocompromised patients, the agreement between TST and QFT-GIT was poor regardless of cut-off value. And increasing the cut-off does not improve agreement.

Which factors effects patients belief and attitudes about influenza vaccination

Introduction Despite its proven efficacy, vaccination rates with influenza vaccine are considerably low. This study aimed to investigate the vaccination rates with influenza-vaccine and the factors affecting attitude toward vaccination. Materials and Methods A questionnaire was applied to patients presenting to outpatient clinic between October 2011-January 2012. Result Of these 1251 (671 F, 580 M) patients with a mean age of 47.7 ± 15.1, 61.9% had an indication for influenza-vaccination. The rate of vaccination was 33.4%. Among the vaccinated patients, the ratio of patients with an educational level of high-school or above (60.6%) was greater than that of patients with a lower educational level (39.4%) (p= 0.01). The vaccination rates were greater among those with chronic lung disease (43.6%), heart disease (21.2%), and diabetes (19.3%) (p< 0.001, p= 0.02, and p= 0.03, respectively). A multivariate regression analysis revealed that the independent variables associated with vaccination were considering the vaccine protective (OR, 2.13; CI, 1.85-4.24, p= 0.03), getting vaccinated to protect oneself (OR, 6.31; CI, 3.25-12.63, p< 0.001), getting vaccinated to protect ones family against influenza (OR, 5.42; CI, 3.11-9.54, p= 0.02), the vaccine being recommended by a physician (OR, 4.15; CI, 2.03-7.45, p< 0.001), being regularly-vaccinated (OR, 5.32; CI, 3.24-6.35, p< 0.001), and suffering from chronic lung disease (OR, 2.21; CI, 1.64-4.32, p< 0.001). The reasons of not getting vaccinated were considering the vaccine useless (OR, 2.46; CI, 0.77-3.98; p= 0.01),having concerns about side-effects (OR, 2.14; CI, 0.16-3.25; p= 0.02),and having inadequate knowledge (OR, 7.12; CI, 4.23-12.56; p< 0.001). Men, as compared to women, had a significantly greater rate of considering the vaccine useful (p< 0.001), getting vaccinated during campaigns held by workplaces (p= 0.002), and obtaining information through bills, brochures, or bulletins (p= 0.003). Patients vaccinated with the influenza-vaccine significantly more commonly consider the pneumococcal-vaccine useful (p= 0.02), and they had a significantly greater rateofvaccination with pneumococcal-vaccine (p< 0.001). Conclusions The vaccination rate remains low. Opinions about the vaccine that had favourable effect on vaccination rate were that the vaccine was beneficial and that it would protect ones family against the disease. The unvaccinated patients had inadequate knowledge of the vaccine. Obtaining information from a physician boosts vaccination rate. Men having a greater rate of vaccination through campaigns of workplaces as well as a greater rate of being informed can be explained by a higher employment rate in men.

Mediastinal Schwannoma with Atypical Localization Diagnosed by Endobronchial Ultrasound.

Schwannoma is a peripheral nerve sheath tumor usually originating from the posterior mediastinum. Because schwannomas can exhibit high fluorodeoxyglucose uptake on positron emission tomography, they cannot be distinguished from malignant tumors.