Hakan Yaman

Control of Allergic Rhinitis and Asthma Test (CARAT): dissemination and applications in primary care

Asthma frequently occurs in association with allergic rhinitis and a combined management approach has been suggested. The Control of Allergic Rhinitis and Asthma Test (CARAT) is the first questionnaire to assess control of both diseases concurrently. However, to have an impact on healthcare it needs to be disseminated and adopted. In this paper we discuss the dissemination of CARAT in different countries and its possible applications in primary care. At present, the adaptation of CARAT for use in different languages and cultures is being led by volunteer researchers and clinicians in 15 countries. Website and smartphone applications have been developed, and a free open model of distribution was adopted to contribute to the dissemination of CARAT. Examples of dissemination activities include distribution of leaflets and posters, educational sessions on the use of the questionnaire in the follow-up of patients, development of clinical studies, collaborations with professional organisations and health authorities, and the inclusion of CARAT in clinical guidelines. The adoption of innovations is an important challenge in healthcare today, and research on the degree of success of dissemination strategies using suitable methods and metrics is much needed. We propose that CARAT can be used in a range of settings and circumstances in primary care for clinical, research and audit purposes, within the overall aim of increasing awareness of the level of disease control and strengthening the partnership between patients and doctors in the management of asthma and rhinitis.

The diabetic brain and cognition

The prevalence of both Alzheimer’s disease (AD) and vascular dementia (VaD) is increasing with the aging of the population. Studies from the last several years have shown that people with diabetes have an increased risk for dementia and cognitive impairment. Therefore, the authors of this consensus review tried to elaborate on the role of diabetes, especially diabetes type 2 (T2DM) in both AD and VaD. Based on the clinical and experimental work of scientists from 18 countries participating in the International Congress on Vascular Disorders and on literature search using PUBMED, it can be concluded that T2DM is a risk factor for both, AD and VaD, based on a pathology of glucose utilization. This pathology is the consequence of a disturbance of insulin-related mechanisms leading to brain insulin resistance. Although the underlying pathological mechanisms for AD and VaD are different in many aspects, the contribution of T2DM and insulin resistant brain state (IRBS) to cerebrovascular disturbances in both disorders cannot be neglected. Therefore, early diagnosis of metabolic parameters including those relevant for T2DM is required. Moreover, it is possible that therapeutic options utilized today for diabetes treatment may also have an effect on the risk for dementia. T2DM/IRBS contribute to pathological processes in AD and VaD.

PhD theses in Turkish sports sciences: A study covering the years 1988-2002

AimsUndergraduate education in physical education is widely common in Turkey. Postgraduate training is provided mostly by institutes of health sciences, educational science and social sciences. The aim of this study was to evaluate the characteristics of PhD theses in sports sciences.MethodsThe database of the Turkish Council of Higher Education has been searched the years 1988–2002 for PhD theses with different combinations of keywords like “Sport(s)”, “All Dissertations” and “Physical Education”. Theses were classified according to the institute, year, university, the title of the mentors and the field of sports sciences. The inter-and intra-validity of ratings were high (Kendall Tau_b=0.84 and 1.00, p <0.01).ResultsMost of theses were prepared in Institutes for Health Sciences (n=196, 86.3%), second mostly in Institutes of Social Sciences (n=25, 11.0%). Theses originated mostly from Marmara (n=90, 39.6%), Gazi (n=59, 25.9%) and Dokuz Eylül Universities (n=25, 11.0%). Ninety two theses (46.9%) were prepared in Training and Movement Sciences, 40 (20.4%) in Sports Management, 29 (14.7%) Psycho-Social Fields of Sports Sciences, 23 (11.7%) Sports Health Sciences and 13 (6.6%) in Sports Pedagogy.ConclusionMost theses were prepared in Institutes of Health Sciences, but the subjects covered the field of training and movement sciences. The unique and multi-disciplinary nature of sports sciences seems to warrant the foundation of an Institute of Sports.

The development of research capacity in Europe through research workshops—the EGPRN perspective

The academic development of the domain of General Practice and family medicine (FM) has made notable progress recently, but one should never rest on one’s laurels. Continuing progress requires a strong research base for the discipline, which is still weak both in terms of evidence, with relatively few publications from primary care, and in the limited number of research institutes around the world. Ironically, even though the evidence for primary care in health care systems is rather strong and international political support has been repeatedly promised, the spirit of Alma Ata seems not to have been realized and governments seem to be more supportive of investment in secondary and tertiary care. The key to development as an independent specialist discipline is the development of an independent research base to define the characteristics of the domain, to support clinical work and to inform educational and professional development. Primary care researchers have to go beyond the agenda of public health and secondary care and carry out research into the content and delivery of primary care and into diagnosis in primary care. What does research in general practice/FM entail? The researcher may be a clinician with a special interest, a student who is preparing a dissertation for a University degree or a researcher from a field outside medicine. A research question is developed, and with some advice, an appropriate methodology is selected (such as a questionnaire to fellow clinicians, a study of patient records or an intervention to improve practice). The novice researcher will benefit enormously from expert advice at this stage since errors in research question development or methodology for data collection may make the project untenable at a later stage. Successful completion of the project may result in obtaining a degree, improving practice at a local or regional setting in a specific domain or national or international publication of a paper and the start of a new academic career in parallel or instead of a purely clinical one. Successful publication will make access to research grants and/or career posts, and further publication, more likely.

What Kind of Curriculum Can Better Address Community Needs? Problems Arisen by Hypothetical-Deductive Reasoning

The aim of this study was to identify problems arisen by conventional curricula, the guidelines for development of an appropriate educational model for 21st century, and the advantages and disadvantages of the last two curricular models. The medical education literature published from 1995 through 2002 of four reputable journals in medical education were searched (Academic Medicine, Teaching and Learning in Medicine, Medical Education, and Medical Teacher). First the possibly best articles were identified. During the second screening process 76 of 180 articles were found to be highly relevant to our questions. A review of the chosen articles revealed a concept map which starts from currently applied hypothetical-deductive reasoning (HDR)-based curricula in many medical schools all around the world. Results revelaed that continuing cyclical process might be time consuming, enhance burden of faculty and might be stressful for students involved. Current issues in health care system are possibly attributable to current HDR-based curricular models including PBL. Advantages of reiterative PBL theory can not be denied, but it appears that its limited application should be mainly seen in some academic classes to develop some generic transferable skills simultaneously with other teaching methods. Therefore vast application of HDR in clinical settings is not recommended according to our study. However the relationships demonstrated between factors and outcomes mentioned in the concept map can be used to run some new studies to test some hypotheses.

Equity in healthcare: status, barriers, and challenges

(1) Waris Qidwai Department of Family medicine, Aga Khan University E-mail: waris.qidwai@aku.edu (2) Tabinda Ashfaq Department of Family Medicine Aga Khan University E-mail: tabinda.ashfaq@aku.edu (3) Tawfik A M Khoja Director General, Executive Board, Health Ministers’ Council for Cooperation Council States Email: sgh@sgh.org.sa (4) Ketki Merchant Consultant, Mumbai, India E-mail: ketkimerchant@hotmail.com

Family practice in Turkey: views of family practice residents.

Abstract Turkeys family practice training program is aimed at providing further training to clinically proficient family physicians who serve the community. A survey conducted in 2001 revealed that there was a need for providing additional training and more time in a specially dedicated family practice placement for family practitioners. Recent changes in the Turkish health care system have also impacted the training environment of family practice residents. Clearly, training needs to change with time. The aims of this study are to investigate the attitudes of resident family practice physicians regarding their training in the health care system in order to gather their views on the hospital learning environment, and to estimate their burnout levels. For this research, the design included a 1-phase cross-sectional study. This study was undertaken in 2008 in departments of family medicine at universities (n = 21) and training and research hospitals of the Ministry of Health (n = 11). Approximately 250 family practice residents in Turkey were approached. In total, 174 residents participated (70% response rate). The survey instruments included a questionnaire with 25 queries and 2 scales: The Postgraduate Hospital Educational Environment Measure and the Maslach Burnout Questionnaire–Human Services Survey. The average age of the participants was 32.2 years (standard deviation, 4.5 years; range, 24–57 years). The gender distribution was 57.6% women and 42.4% men. Marital status was 34.7% single, 62.9% married, and 2.4% divorced/widowed. In our results, residents affirmed that university hospitals were the best facilities for residency training. Their future plans confirmed that most would like to work in family health centers. This sample showed average levels of emotional exhaustion, depersonalization, and lack of personal accomplishment. Perceptions of professional autonomy, quality of training, and social support were below average. It may be concluded that certain milestones in the development of family practice in Turkey have been fulfilled. The new regulation for postgraduate training has increased the share of family practice training to 50% (18 months). Establishment of educational family health centers has been planned. Introduction of the formative and summative assessment processes in family practice training is anticipated. It is expected that an assessment such as the Membership of the Royal College of General Practitioners (International) (mRCGP[INT]) examination would be helpful for Turkish residents in reaching these goals.

Institutional Authority and Traces of Intergenerational Conflict

While societys level of education increases in a modernization process, the knowledge monopoly is taken over by the young. Increasing demand on knowledge attained through organized education leads to increasing power by the young. In the modernizing society of Turkey, this kind of struggle will occur between intellectual groups. Results of this study reveal a conflict between the elder generations granted institutional authority and the young population having the capability of seizing this authority. Obtained results demonstrate that there exist remarkable negative aspects in the attitudes of the university youth towards the institutional authority of the elderly. The importance of the study lies in the fact that it is the first study introducing the concept of “intergenerational conflict” to the sociological society of Turkey and, thus, paving the way to further research.

Development and validation of the short version of the diabetes obstacles questionnaire (DOQ-30) in six European countries.

Abstract Background: Patients with type 2 diabetes reveal different obstacles in living with the disease. The EGPRN initiated a qualitative research EUROBSTACLE to create a broadly conceptualized diabetes-related quality of life (DR-QoL) instrument. It led to the development of the diabetes obstacle questionnaire (DOQ), a five-point Likert-scaled measure, consisting of 78 items in eight scales. Objectives: To develop and validate a short, easy-to-use version of the DOQ. Methods: A cross-sectional study with the DOQ was carried out. Participants answered the DOQ and GPs added some clinical data from their medical records. Data of 853 patients from Belgium, France, Estonia, Serbia, Slovenia, and Turkey were included in the analysis. The selection of items for the short version of the DOQ was achieved with exploratory factor analysis (EFA). Construct validity was proved with EFA and Pearson correlations between the DOQ and the new DOQ-30. Internal reliability was established with Cronbach’s alpha. Results: DOQ-30 resulted in 30 items in nine subscales. It explained 49.8% of items’ variance. It shows a considerable good internal reliability and construct validity. Conclusion: The DOQ-30 is a five-point Likert-scaled broadly conceptualized measure of DR-QoL. It addresses a variety of obstacles, such as social, psychological, cognitive and behavioural. The DOQ-30 is ready for implementation in general practice and research in Europe as a valuable instrument to assess DR-QoL.

MRCGP(International) development day

The 6th MRCG(Int) Development Days were held this year between 22 and 24 May, hosted by the Royal College of General Practitioners at Princes Gate in London. Invited participants from sister colleges and associations came from as far as Japan, India, Sri Lanka, Pakistan, Afghanistan, Oman, Brunei, the United Arab Emirates, Kuwait, Saudi Arabia, Nigeria, Kosovo, Malta, and Turkey, reflecting the wide and diverse interest in this RCGP project. The seminar was preceded by hands-on pre-conference workshops on 21 May, facilitating capacity building through test-writing exercises, with the practical outcome of producing material for the MRCGP(Int) test banks. Topics included multiple-choice question writing for applied knowledge assessment, and scenario writing and rehearsal for clinical skills assessment and OSCE. The sessions were facilitated by Dr Mei …