Rabia Kahveci

Syrian refugees in Turkey: numbers and emotions

764 www.thelancet.com Vol 382 August 31, 2013 Roughly 500 000 Syrians live in and outside the camps in Turkey. Basic needs such as shelter, food, health care, but also education, social activity facilities, play areas (fi gure), and employment opportunities are needed, and are provided as much as possible. According to AFAD Director General, Turkey spent US

Shared Decision-Making in Pediatric Intensive Care Units: A Qualitative Study with Physicians, Nurses and Parents

1·5 billion for Syrian refugees. Health-care services are provided through primary health-care centres, 112 medical emergency stations, and tent hospitals. Thousands of seriously injured Syrians were brought to Turkey for emergency operations or intensive care. More than 1·2 million patient consultations for Syrian refugees were registered in outpatient settings. Beyond numbers, there is also an emotional burden. Being away from home and facing uncertainty about the future affects Syrian refugees psychologically, socially, and physically. Health-care workers providing services to this vulnerable population are also aff ected. Doctors are now providing services to a large population with no medical records, who are socially and psychologically affected, and with a language barrier. Doctors face situations that are very difficult to manage. They work long hours, and manage several urgent cases. As a nurse explained to us, it is not just wounds caused by bombs or bullets that need treatment, but also spiritual wounds, fears, and pains, which need to be healed.

Quality Assessment of Clinical Practice Guidelines Developed by Professional Societies in Turkey.

ObjectivesTo understand how decisions are made in Intensive Care Unit (ICU) settings where critically-ill children require life-support decisions and what are the perceptions of health professionals and parents.MethodsIn this qualitative study, in-depth, semi-structured, face to face interviews with 8 doctors, 9 nurses and 6 parents of critically ill children were conducted. Interviews were digitally recorded and transcribed. The transcriptions were further analyzed following open coding and formation of themes.ResultsThe themes were discussed in two major titles: perceived roles and emotions during the decision-making process. All nurses and patients agreed that the decision maker should be the physician. Nurses understood patients’ emotions better and had a closer relation with the parents. Both doctors and nurses thought that parents could not have all responsibilities about treatment choices, because they do not have the required knowledge. Similarly parents were afraid to make a wrong decision, thus they wanted to leave this to the doctors.ConclusionsThe present study revealed that shared-decision making is not well understood by health care professionals in Turkey. Doctor is the major decision-making authority and this is also accepted and preferred by the patients and nurses.

Exploration Of Quality Of Life Of Diabetic Patients In State Retirement Homes In Turkey

Background Clinical practice guidelines (CPGs) are systematically developed statements to assist practitioner and patient decisions about appropriate healthcare for specific clinical circumstances. There is a limited number of studies on guidelines in Turkey. The quality of Ministry of Health guidelines have formerly been assessed whereas there is no information on the other guidelines developed in the country. Aim This study aims to assess the quality of CPGs that are developed by professional societies that work for the health sector in Turkey, and compare the findings with international guidelines. Methodology Professional societies that work for the health sector were determined by using the data obtained from the Ministry of Internal Affairs. Inclusion and exclusion criteria were defined for selecting the CPGs. Guidelines containing recommendations about disease management to the doctors, accessible online, developed within the past 5 years, citing references for recommendations, about the diseases over 1% prevalence according to the “Statistical Yearbook of Turkey 2012” were included in the study. The quality of CPGs were assessed with the AGREE II instrument, which is an internationally recognized tool for this purpose. Four independent reviewers, who did not participate in the development of the selected guidelines and were trained in CPG appraisal, used the AGREE instrument for assessment of the selected guidelines. Findings 47 professional societies were defined which provided access to CPGs in their websites; 3 of them were only open to members so these could not be reached. 8 CPGs from 7 societies were selected from a total of 401 CPGs from 44 societies. The mean scores of the domains of the guidelines which were assessed by the AGREE II tool were; Scope and purpose: 64%, stakeholder involvement: 37.9%, rigour of development: 35.3%, clarity and presentation: 77.9%, applicability: 49.0% and editorial independence: 46.0%. Conclusion This is the first study in Turkey regarding quality appraisal of guidelines developed by the local professional societies. It adds to the limited amount of information in the literature that comes from Turkey as well as other developing countries.

Evaluation of dietary habits during pregnancy

Aims: We investigated diabetes mellitus among the elderly living in state retirement homes and determined their quality of life. Methods: Our study was conducted on 134 volunteers out of 188 diagnosed with diabetes mellitus who met the inclusion criteria and lived in state retirement homes in Ankara, between February 2013 and April 2013. A survey of sociodemographic characteristics was performed. Examination results were recorded. The EuroQol 5D, a visual analogue scale, and the Audit of Diabetes Dependent Quality of Life scale were performed to assess the overall quality of life. Lastly, all volunteers underwent full physical examination. Results: The average age was 79.37 ± 7.70 years. A statistically significant difference was observed between males and females between quality of life assessment groups (if they did not have diabetes) in Audit of Diabetes Dependent Quality of Life scores (p < 0.001). A statistically significant difference was observed in EuroQol 5D and Audit of Diabetes Dependent Quality of Life scores in the types of drug used (p = 0.030, p < 0.001 respectively). Conclusions: We suggest that health professionals, especially primary healthcare professionals, should conduct regular health examinations and perform more regular follow-up of patients residing in retirement homes.

The future of elderly care in Turkey

Objective: Pregnancy is a special period of increased nutritional needs during which conscious nutritional support is required. Insufficient and imbalanced nutrition in this period of life causes serious conditions that affect both child and mother. This study aimed to evaluate the relationship between pregnancy and nutrition/nutritional habits during pregnancy. Materials and Methods: In this descriptive study, a questionnaire was conducted on a voluntary basis to pregnant women who were admitted to the Pregnancy Outpatient Clinic of Obstetrics and Gynecology Department at Ankara Numune Training and Research Hospital. Questions about general information, pregnancy-related information, thoughts and knowledge about breastfeeding, nutritional habits, and meal frequency were asked to pregnant women. Three hundred fourteen questionnaires were assessed in the study. SPSS for Windows Version 16.0 and MS-Excel 2007 were used for statistical evaluations. P<0.05 was accepted as statistical significance. Results: There was a statistically significant relationship between pre-pregnancy body mass index (BMI) and number of pregnancies; level of education and income levels; number of children and history of caesarian section as an additional problem within previous pregnancies. The change of nutritional habits during pregnancy was examined; we found that consumption of fruits (51%) and vegetables (40.8%) increased the most, while intake of tea (26.1%) and redmeat (21%) mainly decreased during pregnancy. It was found that during pregnancy 20.4% of pregnant women had never consumed fish, 13.1% abstained from red meat, and 12.4% excluded white meat from their diet. Conclusions: We believe that this study will help to raise awareness about adequate and balanced nutrition during pregnancy and to define special nutritional recommendations.

Hastane çalışanlarının sigara içme düzeylerinin belirlenmesi ve dumansız hava sahası uygulamasının değerlendirilmesi

Although elderly and end-of-life care have been neglected in Turkey, because older people did not constitute a high percentage of the population, the proportion of citizens aged >65 years is now 7.5%, with this proportion expected to increase to 10.2% by 2023, 21% by 2050 and 28% by 2075.1 These estimates put Turkey as one of the most rapidly ageing populations in the world and have stimulated research and discussions around healthy ageing, chronic …

Physicians’ attitudes toward home healthcare services in Turkey: A qualitative study

Objective: The aim of this study is to define the health knowledge, cigarette smoking behaviors, attempts and successes to quit smoking and obstacles indicated by the ones who still smoke among a Training and Research Hospital staff four years after the application of the law “Smoke Free Air Zone”. Methods: A questionnaire developed by the researchers is used for this cross sectional research. It questions the sociodemographic features and thoughts and attitudes about the “Smoke Free Air Zone” and “Smoke Free Hospital” applications. Fagerstrom Nicotine Dependence Test is also applied to the smoking attendants to define the level of dependence. Results: It was found that 29.6% of the participants still smoke. Among the still smoking ones; 29.4% did not ever attempt to quit, 28.2% attempted before starting work in the hospital, 20% attempted after starting work in the hospital and 22.4% attempted on both periods. Regarding the questions about application of “Smoke Free Hospital” it was found that 70.7% of the hospital staff support the application, 53.3% think that violators should be punished with a penalty, 48.1% think that it should be punished by the administration, 30.1% think that passive smoking is an intrusion to the personal rights and 59.1% think that quitters increased with this application. Conclusion: Reducing the smoking rates among healthcare staff is extremely important in the struggle against smoking. Establishment of applications with institutional education programs and easing access to the related services may be helpful for healthcare personnel quit smoking. J Clin Exp Invest 2015; 6 (1): 33-39

Tip 2 diyabetli hastaların aile hekimiyle iletişimi ile ilgili görüş ve deneyimleri: Kalitatif çalışma

ABSTRACT Background: Because of the growth of the older population and the prevalence of chronic diseases, home care services (HCS) have become an important aspect of healthcare worldwide. However, various difficulties and deficiencies are present in the provision of these recently implemented services in Turkey. Modifications to home healthcare services are in progress. Objective: Physicians have an active role in home healthcare services. The present study was performed to examine physicians’ attitudes toward this service in detail. Methods: Twenty-six physicians who provide home healthcare services in the city of Ankara were included in the study. We conducted in-depth, semi-structured, face-to-face interviews. The interviews were audio-recorded, transcribed, and qualitatively analysed. Results: Most physicians thought that home care could be provided to patients who are bedridden, are very old, have a chronic disease, have problems leaving the house, or do not have family support. They also expressed displeasure about the abuse of services and discordance of organization between hospitals and primary care centres. They noted that real circumstances in practice were not compatible with regulations and that cooperation and coordination between departments are necessary and important. Conclusion: The current study underlines physicians’ interest in and support of the home care system, which has various drawbacks and limitations. Legislation needs to be further changed to improve the quality of service and eliminate deficiencies in home healthcare.

CONTRIBUTIONS OF QUALITATIVE STUDIES TO OBESITY MANAGEMENT IN PRIMARY CARE

Ozet Amac. Bu niteliksel calismada, Tip 2 diyabetli hastalarin takiplerinde birinci basamagi tercih etme durumlarinin, birinci basamaktaki DM yonetimine dair goruslerinin, aile hekimleri ile aralarindaki iletisiminin ve aile hekimleri ile iletisimlerinde etkili olan faktorlerin ve nedenlerinin saptanmasi amaclandi. Yontem. Calismamiza arastirmaya katilmaya gonullu olanlardan, maksimum cesitlilik orneklemesi ile secilmis 20 Tip 2 diyabetli hasta katildi. Hastalar ile derinlemesine, yari yapilandirilmis, yuz yuze gorusmeler yapildi. Gorusmelerin tumu dijital olarak kaydedildi ve yaziya aktarildiktan sonra kalitatif olarak analiz edildi. Bulgular. DM hastalari, kapsamli, butuncul yaklasimi ve aile sagligi merkezine kolay ulasimindan dolayi takiplerinde aile hekimini secebilmektedirler. Aile hekiminde aradiklari ozellikler ise samimiyet, ulasim kolayligi, empati ve yuksek bilgi duzeyidir. Sonuc. Calismamizda, saglik hizmetleri icinde cok onemli bir yere sahip olan birinci basamak saglik sistemlerinde cekirdek yeterliliklerinin, DM gibi kronik hastaliklarin yonetiminde hastalarin aile hekimlerinden beklentileri dogrultusundaki gereken ozellikleri karsiladigi saptandi. Anahtar sozcukler: Aile hekimligi, birinci basamak saglik sistemleri, diyabet yonetimi, hasta hekim iletisimi, kalitatif arastirma Abstract Aim. This qualitative study is aimed to determine the status of type 2 diabetic patients to prefer primary care during follow-up, their views on DM management at primary care, the communication between them and family physician and the influential factors and causes of these factors in communication with family physicians. Methods. 20 Type 2 diabetic patients were selected with maximum variation sampling through the patients volunteered to participate in this research. We conducted in-depth, semi-structured, face to face interviews. Interviews were audio-recorded and transcribed, and qualitatively analyzed afterwards. Results. DM patients may select family physicians during their follow-up due to comprehensive , holistic approach and easy access to physicians and family health center. The expected features of family physicians are friendliness, ease of access, empathy and the high level of knowledge. Conclusion. In our study, we detected that the features of family physicians, in case of following up chronic diseaases such as DM, that are expected by the patients are fully met by the core competencies of family medicine at primary health care, which has a very important place in the system of health services. Keywords: Diabetes management, family medicine, patient-physician communication, primary health care systems, qualitative research