Sultan Alan

A case study from the perspective of medical ethics: refusal of treatment in an ambulance

This paper will examine a sample case encountered by ambulance staff in the context of the basic principles of medical ethics. An accident takes place on an intercity highway. Ambulance staff pick up the injured driver and medical intervention is initiated. The driver suffers from a severe stomach ache, which is also affecting his back. Evaluating the patient, the ambulance doctor suspects that he might be experiencing internal bleeding. For this reason, venous access, in the doctors opinion, should be achieved and the patient should be quickly started on an intravenous serum. The patient, however, who has so far kept his silence, objects to the administration of the serum. The day this is taking place is within the month of Ramadan and the patient is fasting. The patient states that he is fasting and that his fast will be broken and his religious practice disrupted in the event that the serum is administered. The ambulance doctor informs him that his condition is life-threatening and that the serum must be administered immediately. The patient now takes a more vehement stand. ‘If I am to die, I want to die while I am fasting. Today is Friday and I have always wanted to die on such a holy day,’ he says. The ambulance physician has little time to decide. How should the patient be treated? Which type of behaviour will create the least erosion of his values?

An evaluation of knowledge of pharmacovigilance among nurses and midwives in Turkey.

This study aimed to evaluate the awareness of nurse/midwives regarding pharmacovigilance as well as their knowledge and experience in identifying and reporting adverse reactions of drugs. Nurse/midwives (n = 329), working in four state hospitals, were provided a questionnaire with a view of identifying their knowledge and skills pertaining to pharmacovigilance. Around 45% of the participants claimed to have knowledge of pharmacovigilance but only 23.3% of them could define it correctly. Although 24.3% of the participants acknowledged that adverse reactions should be reported to a centre, only 1.2% of them named this centre (Turkey Pharmacovigilance Centre-TUFAM). The present study indicates that nurse/midwives have insufficient knowledge of pharmacovigilance practices. Hence, it is essential to include pharmacovigilance training in their undergraduate and graduate education programs, and to promote reporting of adverse reactions.

Health-promoting lifestyle behaviours in pregnant women in Turkey.

This study aims to describe the health-promoting lifestyle behaviours of pregnant women. The study was carried out with pregnant women who applied to the polyclinics in different maternity and children hospitals located in Adana, Turkey, between 1 March and 30 May 2009. The data collection tools used in the study were (i) a questionnaire that was used to collect sociodemographic data from the participants and (ii) the Health Promoting Lifestyle Profile II (HPLP II). The results obtained from the study showed that total HPLP II scores were moderate; the highest scores were obtained on the spiritual growth dimension and the lowest scores on the physical activity dimension. Pregnant women with older age, those with a higher educational level, those with a better socioeconomic status and those living in a nuclear family were found to be more likely to have health-promoting lifestyles. Health promotion and healthy lifestyle need to be an integral part of health services provided for pregnant women. Midwives and nurses have prominent roles in encouraging pregnant women to engage in health-promoting behaviours.

Attitudes of prehospital emergency care professionals toward refusal of treatment: A regional survey in Turkey

Introduction: Prehospital emergency medicine is a specific field of emergency medicine. The basic approach of prehospital emergency medicine is to provide patients with medical intervention at the scene of the incident. This special environment causes health professionals to encounter various problems. One of the most important problems in this field is ethics, in particular questions involving refusal of treatment and the processes associated with it. Objective: The objective of this study is to identify emergency health professionals’ views regarding refusal of treatment. Methods: This study was conducted with 356 health professionals who were on active duty in prehospital emergency health services. The data were collected through a form which included 10 statements. The participants were asked to indicate their level of agreement with the statements given by rating them between 0 and 10. Ethical considerations: Before conducting the research, permission was received from the local ethics committee. Participants were given written information about the purpose of the study. Participants were assured that their participation was voluntary. Results: The healthcare professionals with fewer years of experience in the profession and female participants adopted an attitude of giving priority to providing care. Young participants, in general, respected patient autonomy. However, paradoxically, when it comes to emergency medical cases, they expressed an opinion closer to paternalism. Conclusions: This study has found that prehospital emergency health professionals generally respect the patient’s right to refuse treatment; however, they do not prioritize this right when there is a life-threatening situation or when the person does not have decision-making capacity. In these cases, prehospital emergency health professionals tended to adopt a more paternalistic approach.

Sexual function and quality-of-life-related problems during the menopausal period:

This study aims to evaluate the relationship between the sexual functions and quality of life and the problems during menopausal period. This descriptive, cross-sectional study included a total of 317 women. The mean total Female Sexual Function Index score was 18.8 ± 8.7, while the mean total Sexual Quality of Life Questionnaire-Female score was 72.7 ± 13.7. Sexual dysfunction was found in 82 percent. There was a positive significant correlation between the total Female Sexual Function Index scores and total Sexual Quality of Life Questionnaire-Female scores (p < 0.05). Our study results suggest that women do not often experience serious menopausal symptoms, but have sexual dysfunction with a moderate sexual quality of life.

The effect of ice pressure applied on large intestinal 4 on the labor pain and labor process

PURPOSE This study was designed as an experimental controlled study, aiming to identify the effect of ice massage with short duration (40 min) and long duration (80 min) applied on Large Intestinal 4 (LI4) acupressure point on labor process and perception of labor pain. METHODS The participants, who met the research criteria according to the results of power analysis, were 72 healthy pregnant women divided into experiment and control group. RESULTS Results show that ice massage applied on the LI4 region was effective in the 80th minute. Moreover, in terms of the effect of ice massage on labor duration, the application was found to reduce the labor duration of the women in the experimental group approximately 1 h on average. CONCLUSION It was found that the ice massage applied by midwives on the LI4 point during the active phase of delivery could reduce pain and shorten the delivery duration.

The effect of music on pain and anxiety of women during labour on first time pregnancy: A study from Turkey

OBJECTIVE This study aims at analyzing the effect of music on pain and anxiety felt by women in labor during their first pregnancy. METHOD When the pregnant women in the experimental group progressed into the active phase of the labor, they were made to listen to music in Acemasiran mode with earplugs for 3 h (20 min of listening with 10-min breaks). FINDINGS It was observed that after the first-hour women indicated that their pain was statistically less in the experimental group. Trait anxiety scores of the women in labor were similar for experimental and control groups. Following the practice, state anxiety average scores became lower in favor of the experimental group and the correlation was statistically significant. CONCLUSION In order to facilitate womens coping with labor pain and improve their wellbeing with the activity during the labor, musicotherapy, a non-pharmacological method, is an effective, simple and economical method.

A comparison of contribution of informed consent forms with long or short texts with regard to obtaining knowledge by volunteers: A pilot study -

Objective. The objective is to determine which of the two texts giving information about the same issue and one of which id short and one of which is long is more effective in enlightening readers having no pre-knowledge of medical science and whether there is coherence between the scores obtained from the texts. Methods. The sampling of the research planned as experimental is constituted by 66 volunteer female students who are 1st year students at the faculty of agriculture. The group was randomly divided into two and the first group was given the short text and the other one the long text. Then the question from was applied in order to find out how much of the information in the form they learnt. Each true answer given to the questions was scored as 1, and each wrong answer was secored as 0; therefore a total grade was obtained. For data analysis, Mann Whitney-U and t Tests analysis methods have been used. Score averages have been compared using Chi-square statistics and calculated using Odds ratio (OR). Consistency between the average scores of the answers given to short and long forms were evaluated through kapa statistics. Results. 100% of the answers obtained using the long form was above the average, 20% of the answers obtained using the short form was above the average and 80% was below the average. Kappa between the answers in the long and short from was found as 81%. The results obtained from the long form were determined to be seven times better than the short one (OR:7,0). The non-random alignment between responses to the long and short form was found to be 81% (Cohen Kappa: 0.814). When the score average scores obtained from the answers given according to the demographic qualities of the participants, no meaningful relation was found. Conclusions. The long version of the context of informed was found more effective than the short one.