Mustafa Fevzi Dikici

Psychotropic drugs in pregnancy: a case-control study

Psychotropic drug exposure during pregnancy is a common problem. Among the 601 cases exposed to drugs during pregnancy, who were followed by our Toxicology Information and Follow-up Service, 124 cases had used psychotropic drugs for depression, anxiety, or psychotic disorders. As the control group, 248 women, who did not use any drugs were selected. Of the 124 cases, 80 (64.5%) had healthy babies, and 17 (13.7%) decided to terminate the pregnancy. Spontaneous abortions, intrauterine death (in the 38th week) and premature deliveries were observed in the 9 (7.3%), 1 (0.8%) and 3 (2.4%) cases, respectively, in the drug exposure group. Pregnancies of the 14 (11.3%) cases were continuing during the preparation of this manuscript. Of the 248 controls, 151 (60.9%) had healthy babies, 9 (3.6%) experienced spontaneous abortion and 3 (1.2%) decided to terminate their pregnancies, 3 (1.2%) had premature deliveries, and we observed one (0.4%) congenital abnormality, 81 (32.7%) cases were still pregnant. Odds Ratio (95% confidence interval) for spontaneous abortion was found to be 1.35 (1.27-11.82) in the cases exposed to psychotropic drugs (P=0.02). No developmental problems were observed in the babies followed for 12 months. These data may give information about the early- but not the late-term effects of psychotropic drugs used in pregnant women.

Teaching Medical Students How to Break Bad News: A Turkish Experience

Background. To assess the effect of teaching breaking bad news. Methods. The session incorporated brainstorming, presentation, discussion, small-group exercises using standardized patients. Course was evaluated through a pre-objective structured clinical examination (OSCE), first post-OSCE (post-OSCE1), second post-OSCE (post-OSCE2) (6th month), and questionnaires. Results. Pre-OSCE, post-OSCE1, post-OSCE2 scores: preparing the environment 5.83 ±0.23, 7.93 ± 0.19, 9.78 ± 0.07; understanding what patient knows and wants to learn 1.83 ± 0.33, 6.47 ± 0.27, 9.68 ± 0.11; giving information 3.25 ± 0.34, 7.43 ± 0.19, 9.67 ± 0.10; developing empathy 2.50 ± 0.32, 6.92 ± 0.28, 9.87 ± 0.06; closing the interview 2.28 ± 0.28, 6.98 ± 0.25, 9.83 ±0.07. The differences between OSCEs were significant. In the questionnaire, 54.1% of 146 students perceived more competent. Conclusions. Course seems beneficial.

Story of benzene and leukemia: epidemiologic approach of Muzaffer Aksoy.

Story of Benzene and Leukemia: Epidemiologic Approach of Muzaffer Aksoy: Fusun Yaris, et al. Karadeniz Technical University, School of Medicine, Department of Family Medicine, Turkey—In 1974, Professor Muzaffer Aksoy established a link to leukemia in humans as a result of occupational exposure to benzene. The aim of this study is to evaluate his epidemiological approach for his investigation on the effects of benzene and to bring attention to the benzene problem in Turkey. Dr. Aksoy observed that a large group of leukemic patients were shoemakers, or they worked in leather manufacturing. In the 1960s, benzene was a popular solvent in the leather industry. Dr. Aksoy conducted a field investigation in Gedikpasa‐ Istanbul, where the shoemakers worked so that he could draw his key observations from actual environmental conditions. With a gas detector, he found the concentration of benzene in these work places to be 150–210 ppm and up to 650 ppm on rare occasions. He performed an epidemiological study and health education among 28,500 shoe, slipper and handbag workers during the period from 1967 to 1974. He published these data, establishing an association between benzene and leukemia. The incidence of leukemia among the shoe workers was decreased by screening, health education, and legislative actions in Turkey, but it began to increase again because of lack of an occupational health policy and underestimation of the problem. These results suggest the importance of primary prevention of occupational cancers. Dr. Aksoys epidemiologic approach may highlight the necessity for detailed investigations of the occupational status of patients who need medical aid in order to diagnose the real underlying factor.

Women's Perceptions and Attitudes about Cervical Cancer in Turkey: Kato's Device as an Alternative to the Pap Smear

AIMS To determine the status of womens perception and attitudes about cervical cancer and their thoughts on Katos self-sampling device. MATERIALS AND METHODS This descriptive research was conducted between July- December 2012 with a study populationof married women older than 18 years. RESULTS A total of 246 women volunteered, with a mean age of 34.9±9.22 (19-52). In the last year, 52.0% had been examined by a gynecologist to address a complaint or for a periodic health check. Of the 118 who had not had a gynecological examination, 42.4% indicated negligence, 26.3% stated the reason was no complaint, 14.4% feared they might receive bad results from the examination, and 8.5% stated that were shy or embarrassed. Of all of the women, 35.0% answered that they had information about cervical cancer, and 0.7% had heard about the HPV vaccine. No one in their families had received the vaccine. Of the women, 28.5% had had a Pap smear, and 71.4% of those had normal results. Of those who had never had a Pap smear, 47.2% had never heard about the test; 18.8% explained the reason for not having a test as shyness or embarrassment with a male doctor. None of the women had heard about Katos device. Once the women were informed, 73.6% expresseed interest in use; 51.9% answered they could use it and not be embarrassed, 30.9% would use it because they did not have to see a doctor, and 17.1% would use it as it allows them to take a smear in all conditions and whenever they want. Of the women, 60.0% thought that they could not successfully use Katos device; 40.0% thought that a smear should be taken by a doctor. CONCLUSIONS Most of the women in our population had never had a Pap smear and wanted to use the Katos device.

Does early clinical practice in community settings change the perception and performance of students on preventive skills

After successful utilization of Lance Armstrong’s autobiography to teach clinical pharmacology to a small group of nursing students (Mathibe 2007), we assessed its usefulness among a larger group of medical students. The research took place over the period of two successive years (2006 and 2007), involving third-year medical students enrolled for the Bachelor of Medicine and Surgery (MBChB) degree at the University of KwaZulu-Natal (Nelson R Mandela School of Medicine, South Africa). General learning objectives as well as copies of selected chapters (4, 5 and 6) of the autobiography were given to the students at the beginning of the lectures. During the first 45 min of the lecture; willing students were requested to read certain sections of the autobiography, for the whole class, to draw attention to the names and regimens of cytotoxic drugs; side effects; investigation procedures; the role of team work in cancer management; health related quality of life and holistic health care. For the remaining 45 min the lecturer used a didactic teaching method (prepared using scientific therapeutics literature) to explain and expand on issues discussed during the autobiography-reading sessions. Self-administered originally constructed questionnaires with statements graded on 5-point Likert scale (11⁄4 strongly disagree; 21⁄4 disagree; 31⁄4 neutral; 41⁄4 agree and 51⁄4 strongly agree) and open-ended questions (qualitative measures) were used to assess students’ perceptions. Ethical permission, as well as copyright for making copies from the autobiography, was obtained from the University’s Bio-Ethics committee. Total of 259 (91% response) students completed and returned the questionnaires. Majority (90%) of participants ‘agreed’ that the exercise stimulated their interest in cancer drugs and 85% felt that the exercise was a valuable use of their time. Ninety-one percent of female and 78% of males ‘agreed’ that the ‘exercise was a valuable use’ of their time and difference (13%) was statistically significant (p < 0.008). Younger students ( 21 years old) were in favour of the use of the autobiography more (p1⁄4 0.035) than other age groups (21–25 and 26 years old). There were statistically significant (p1⁄4 0.03) results between males and females regarding their preference of the use of a popular autobiography over the ‘didactic’ teaching method; with females preferring the use of a popular autobiography over the ‘didactic’ teaching method than males. The autobiography, as a teaching method, was more appealing to younger (<21 years old) students as compared to the older ones. This discovery augurs well for implementation of this teaching method in early years of medical education.