Orçun Çiftci

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.

Subcutaneous emphysema, pneumo-orbita and pneumomediastinum following a facial trauma caused by a high-pressure car washer

Pneumomediastinum is air leakage to mediastinal space from various potential sites, including lung, esophagus, trachea, and neck. It is a rare condition that develops either spontaneously with increased intraalveolar or intrabronchial pressure, or due to trauma. Although cases where face or neck trauma with subcutaneous emphysema that extended to mediastinal cavity via anatomical connections in face and neck have been reported, orbital traumas leading to pneumomediastinum are very rare occurrences that have seldom been reported. This paper documents a 17-year-old male who presented with diffuse subcutaneous emphysema involving paraorbital facial areas, which extended to neck and mediastinal cavity.

Biventricular Pacemaker Implantation in an Elderly Patient with Situs Inversus Dextrocardia

Dextrocardia is a rare anomaly having an incidence of 0.83/10.000 (1). Approximately one-third of dextrocardia cases have situs inversus dextrocardia (SID), where cardiac chambersare located in the mirror image of their usual locations. Although other congenital defects may accompany this anomaly, many patients have normally functioning hearts, and when they age, they face common cardiac disorders, namely coronary heart diease and heart failure and require pacemaker implantation. The number of papers reporting biventricular pacemaker implantation in these patients is limited (2). We report a woman with SID who underwent biventricular cardiac pacemaker implantation for advanced heart failure.

Comparison of application of 2013 ACC/AHA guideline and 2011 European Society of Cardiology guideline for the management of dyslipidemias for primary prevention in a Turkish cohort

Objective: Atherosclerotic cardiovascular disease is a major global cause of death. The common approach in primary prevention of cardiovascular disease is to identify patients at high risk for cardiovascular disease. This article analyzes and compares the application of 2013 American College of Cardiology/American Heart Association (ACC/AHA) guideline and the 2011 European Society of Cardiology (ESC) guideline for the management of dyslipidemias for primary prevention in Turkish population. Methods: The study included 833 patients (482 women and 351 men). Risk scores were calculated according to both guidelines and indications for statin treatment were determined according to sex and age group. Variables are presented as mean±SD or median with interquartile range for continuous data and as proportions for categorical data. Variables were analyzed by unpaired t-test, Mann-Whitney U test, chi-square or Fischer’s exact test as appropriate. Results: The ACC/AHA would suggest statin treatment in 415 patients out of 833 (49.5%), while ESC would recommend statin for 193 patients out of 833 (23.1%) (p<0.001). Statins would be recommended for 40.4% of women and 62.6% of men for primary prevention by the ACC/AHA, while this figure was 12% for women and 38.4% for men according to the ESC guideline (p<0.001 for both). Conclusion: When compared to the ESC guideline, the ACC/AHA guideline suggests augmented statin treatment for primary prevention in Turkish population.

Demographics, Management Strategies, and Problems in ST-Elevation Myocardial Infarction from the Standpoint of Emergency Medicine Specialists: A Survey-Based Study from Seven Geographical Regions of Turkey

Background This study aimed to explore the ST segment elevation myocardial infarction (STEMI) management practices of emergency medicine specialists working in various healthcare institutions of seven different geographical regions of Turkey, and to examine the characteristics of STEMI presentation and patient admissions in these regions. Methods We included 225 emergency medicine specialists working in all geographical regions of Turkey. We e-mailed them a 20-item questionnaire comprising questions related to their STEMI management practices and characteristics of STEMI presentation and patient admissions. Results The regions were not significantly different with respect to primary percutaneous coronary intervention (PCI) resources (p = 0.286). Sixty six point two percent (66.2%) of emergency specialists stated that patients presented to emergency within 2 hours of symptom onset. Forty three point six percent (43.6%) of them contacted cardiology department within 10 minutes and 47.1% within 30 minutes. In addition, 68.3% of the participants improved themselves through various educational activities. The Southeastern Anatolian region had the longest time from symptom onset to emergency department admission and the least favorable hospital admission properties, not originating from physicians or 112 emergency healthcare services. Conclusion Seventy point seven percent (70.7%) of the emergency specialists working in all geographical regions of Turkey comply with the latest guidelines and current knowledge about STEMI care; they also try to improve themselves, and receive adequate support from 112 emergency healthcare services and cardiologists. While inter-regional gaps between the number of primary PCI capable centers and quality of STEMI care progressively narrow, there are still issues to address, such as delayed patient presentation after symptoms onset and difficulties in patient admission.

Notes on patient compensation system suggestion.

We have read with great interest the letter to the editor entitled “An alternative malpractice system suggestion for Turkey: Patient compensation system” by Olcay et al. (1) that was published in Anatolian J Cardiol 2015; 15: 775-6. It is our opinion that the patient compensation system (PCS) that was proposed to prevent healthcare staff burnout, defensive medical practices, and increased healthcare expenditures at first appears convenient in general terms. According to our previous study in which judicial issues experienced by emergency physicians were examined, we determined that 57.8% of emergency physicians were complained to patient communication units and 14.2% of them were sued for medical malpractice. Furthermore, we observed that clinical decisions of 41.5% of emergency physicians were affected by previously experienced judicial and administrative inquiries (2). With respect to these studies, we believe that some legal points need to be considered while designing PCS, which is deemed beneficial to conduct healthcare services. First, PCS cannot alter the physicians’ responsibilities within the context of penal law and disciplinary law. It would be useful to mention that such a compensation system cannot concern the physicians’ penal and administrative/disciplinary responsibilities but can concern their civil (pecuniary) responsibilities. Moreover, regarding the scope of PCS, it would be appropriate to clarify the compensation matter of “moral damages” alongside “material damages”, arising from malpractice. Besides, it appears that the PCS board would comprise healthcare professionals and is projected to function as part of PCS has been designed as a relatively autonomous “administrative” board. The organization, powers, and activities of such a board should be regulated by the “law” in accordance with the Principle of Legality of the Administration that is provided by Article 123 of the Constitution. Legislative regulations concerning the compensation board must comply with the constitutional principles and rules. In this context, because the board authorized to pay compensation would not be regarded as a “judicial organ” and its decisions as “judicial decisions”; it would not be legally possible for this board to be organized and authorized in a manner that it would replace “courts”/“judicial review”, even for merely a specific field. This system can be expected to form a facultative alternative rather than a compulsory substitution to a judicial review. What needs to be currently stressed is that judicial review cannot be excluded against the board’s decisions. Hence, according to Article 125 of the Constitution stating that “Recourse to judicial review shall be available against all actions and acts of administration.”, it will be clearly unconstitutional to enact that decisions of a compensation board, considered to be “administrative”, would be definitive and cannot be sued. Moreover, composing additional regulations should be considered for the time limit to bring actions, such as providing that application to the board shall stop the time limit. Furthermore, Article 129 of the Constitution, which states “Compensation suits concerning damages arising from faults committed by public servants and other public officials while exercising their duties shall be filed only against the administration in accordance with the procedure and conditions prescribed by law, as long as the compensation is recoursed to them.” should be considered while making legislative regulations with respect to the pecuniary liability of physicians who have a “public official” status. As it can be observed, an array of legislative regulations and amendments are required to realize PCS. However, in that case, it is clear that such a system would be completely different from the one proposed and would deviate from its original goals when the abovementioned points are to be considered. Moreover, this subject has some other dimensions that may lead to some professional and legal issues that require careful attention. In conclusion, PCS may initially make sense by providing hope of minimizing actions for compensation resulting from malpractice; however, the authors of this study regard it as a proposal that is not so easy to implement in the short term because the “conciliation procedure”, with which PCS has some similarities and that had been promulgated in 2011 (3) concerning the compensation for damages arising from the health practices, was abrogated in 2014 (4).