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State and trait anxiety among medical staff during the first month of COVID-19 pandemic: A sample from Turkey
Objectives During the COVID-19 pandemic, excessive workload, a rapidly changing workplace environment, the danger of carrying the virus and transmitting the disease to their families, relatives and those they live with creates stress for the medical workers. In our study, we aimed to evaluate the state and trait anxiety levels of healthcare professionals who encounter patients with suspected COVID-19 infection and related factors. Method Data were collected from healthcare professionals working with patients diagnosed or suspected with COVID-19 via online self-report questionnaire between 9-19 April 2020. The state (STAI-S) and trait anxiety (STAI-T) scale was used to measure anxiety. Results A total of 291 healthcare professionals, 216 women and 75 men, participated in the study. Women-s state and trait anxiety were significantly higher than men-s. 11 participants without any lifetime psychiatric illness experienced psychiatric symptoms and consulted to a psychiatrist. The state anxiety of those who have children, nurses and those working in branches directly related to the pandemic (Infectious Diseases, Respiratory Diseases, Emergency Medicine, Internal Medicine, Radiology, Anesthesiology and Reanimation) was higher than others. The state anxiety of those who thought they were not protected with personal protective equipment and those who did not stay in their own home was higher than others. Conclusions At the forefront of the fight against COVID-19, there are medical personnel who pay a serious psychological cost. Especially in terms of anxiety, we should pay attention to women, workers with children, nurses and people working in branches that are directly related to pandemics.
Tıp Fakültesi Son Sınıf Öğrencilerin Tıpta Uzmanlık Sınavında Tercihlerini Etkileyen Faktörler ve Acil Tıp Uzmanlığı Dalı Hakkında Tutumları
Aim: It is important to investigate the factors affecting the choice of the specialty area of medical students. Determining the factors that affect this selection reveals the priorities that students take into account. It is important to investigate the prejudices about not choosing emergency medicine and some surgical branches which are in a strategic position. Solution-oriented strategies should be developed in this regard. Material and Methods: This study includes 86 of the final year students of the Faculty of Medicine. The participation rate in the survey was 80.4% and all participants- approvals were received. The questionnaire developed by the researchers was used as a data collection tool in the study. The survey consisted of 40 questions. 10 of the questions were for socio-demographic information, 30 of them included the reasons for choosing the medical school, the reasons for taking the specialty examination in medicine, the desired and unwanted specialties. 27 of these were Likert type questions. Results: 46 of the participants were female (53.3%), 40 of them were male (46.5%). Among our students, it is seen that the main reason for choosing Medical Faculty is -willingness to help people- (75.6%) and -a promising profession- (69.8%). In addition, the family influence in this preference was found to be 55.8%. Our question -Would you consider Emergency Medicine Specialist as your first choice?- Was answered negatively at a rate of 72%. The most preferred reason for those who think to choose; were the advantages of working on a seizure in emergency medicine. The biggest negative thought about emergency medicine has been its physical and psychological severity, the high number of seizures, and the fear of being exposed to violence. Dermatology and cardiology were the most desired departments among the specialty branches, while gynecology and obstetrics, General surgery, and pediatry were among the undesirable departments. Conclusion: The biggest obstacle to emergency medicine choices was the exhausting seizures and the fear of exposure to violence. The future plans of the final year students of the Faculty of Medicine do not only concern themselves but also the future of the departments that are not preferred. It is necessary to determine the factors that affect the surgical branches and emergency medicine preferences of the students. In this way, studies should be carried out for factors that are perceived negatively and important strategic expertise branches for our future should be supported. Keywords: Emergency Medicine, Medical Students, Specialization Exam
ANALYSIS OF THE RELATIONSHIP BETWEEN NURSING STUDENTS’ PERCEPTIONS OF THEIR PROFESSION AND THEIR ATTITUDES TOWARDS THEIR PROFESSION DURING THE COVID-19 PANDEMIC
ABSTRACT Introduction: It is known that nursing education, attitudes towards the profession are questioned and perceptions and attitudes of the nursing profession are evaluated. It may also have an impact on the Covid-19 pandemic. Purpose: It aimed to analysis of the relationship between nursing students- perceptions of their profession and their attitudes towards their profession during the Covid-19 pandemic. Method: The study, which was conducted as a descriptive, cross-sectional and relationship-seeking study, was applied to a total of 191 students in February 2021 through the survey form of BVU Nursing Department students. In the study, Sociodemographic Characteristics Data Form, Questionnaire Form for students- opinions about the nursing profession during the COVID-19 pandemic period and Attitude towards Nursing Profession Scale (HMYTÖ). These are HMÖ*, HMTED**, HMGD***. Statistical significance was calculated by using the p<0.05 value in the SPSS 22 program. Results: 58.1% are targeted to work in the field due to the Covid-19 pandemic process, and 41.9% are working in this field. Changing the mind at the point of designing the movement of Covid-19 is to change the dream of 11.5% of those who think and 88.5% of those who change the direction of thought. Here is one, it is significantly higher in terms of HMI (p=0.028) and HMGD (p=0.028) points compared to those who received it. Those who think that those who are in the Covid-19 pandemic process do not get the real value, HMGD average score is 042, compared to those who are thought to be entitled (p=0. HMYTÖ is significant compared to those who are self-sacrificing and self-sacrificing because of Covid 19 pandemics (p=0.042). Covid-19 pandemic Those who think that it does not have a negative effect on the nurse-s image, the HMGD is different on average compared to those who are considered in terms of score (p=0.031). Covid-19, regarding directing the gaze of the people who are directed according to the referrals, and the rotation of the changed people compared to the referrals, the HMGD scores are significantly higher than those who change the referral (p= 0.018) HMTED scores were small (p=0.018) Conclusion and suggestions: Although the students thought that nurses could not get the value they deserved even though they worked devotedly, it was revealed that their general attitudes towards their profession were positive. However, this situation has negatively affected their views on practicing the profession in the future and their outlook on the future. In addition, it has been revealed that nursing students- understanding of the importance of their profession in the Covid-19 period and realizing thesatisfying aspects of the profession affect their attitudes towards the profession positively, as well as they think that it also affects the image of the profession in a positive way. In this process, it was seen that the attitudes of the students working in any job were positive towards the profession. As a result, it is thought that for the positive development of nursing students- attitudes towards the profession, nurses should improve their working conditions and see the value they deserve in crisis situations. Keywords: Covid-19, attitude, nursing student, nursing profession
The Importance of Postpartum Kleihauer-Betke Test in Low Risk Rh-Incompatible Pregnant Population
Introduction: Prevalence of Rh disease is estimated to be 276 per 100,000 live births, which is significant considering its relationship with conditions like fetal anemia, hydrops fetalis, fetal death and recurrent fetal demises in future pregnancies. In order to prevent these, anti-D immunoglobulin should be given after inciting events, in a dose sufficient. In Turkey and some other countries, anti-D dose is given on -one shot fits for all- principle. Here, we challenge the conventional wisdom and evaluate the amount of fetomaternal hemorrhage (FMH) and adjusted the dose of anti-D accordingly. Method: In our study, Rh incompatible women who gave birth between October 2020 and March 2021 were included. FMH was determined by the Kleihauer-Betke test in the blood sample taken from the mothers after delivery. Blood smears were fixed with ethyl alcohol and incubated in citric acid buffer solution. In acid medium, HbF becomes resistant to elution, while other types are removed from erythrocytes. The smears are then taken under a microscope to examine the percentage of cells containing fetal hemoglobin. We used Oski-Naiman method to count fetal cells present, then estimated FMH using Mollison-s formula. Clinical data were available at hospital-s digital system. Results: Seventy patients got tested during study period. Twenty-five (39.6%) of cases had more than 4 mL of FMH. Among them, one (1.6%) case was found to have more than 30 mL of FMH, and was given an additional dose. This case had no obstetrical risk factor such as antepartum bleeding, preeclampsia, or manual removal of placenta. The rate of smoking was significantly higher in cases with more than 4 mL of FMH (p=0.001). There were no other variables differed significantly in women having more than 4 mL of FMH. Conclusion: FMH requiring more than 300 mcg of anti-D is significantly high in low-risk pregnant women in Turkey. Implementation of quantitative FMH testing with Kleihauer-Betke or flow cytometry test is necessary. Key words: Fetomaternal hemorrhage, Rh incompatibility
Association between human leukocyte antigen gene polymorphisms and multiple EPIYA-C repeats in gastrointestinal disorders.
Background: Polymorphisms of human leukocyte antigen (HLA) genes are suggested to increase the risk of gastric cancer (GC). Aim: To investigate the HLA allele frequencies of patients with GC relative to a control group in terms of CagA+ multiple (≥ 2) EPIYA-C repeats. Methods: The patient group comprised 94 patients [44 GC and 50 duodenal ulcer (DU) patients], and the control group comprised 86 individuals [(50 non-ulcer dyspepsia patients and 36 people with asymptomatic Helicobacter pylori (H. pylori)]. Polymerase chain reaction was performed for the amplification of the H. pylori cagA gene and typing of EPIYA motifs. HLA sequence-specific oligonucleotide (SSO) typing was performed using Lifecodes SSO typing kits (HLA-A, HLA-B HLA-C, HLA-DRB1, and HLA-DQA1-B1 kits). Results: The comparison of GC cases in terms of CagA+ multiple (≥ 2) EPIYA-C repeats showed that only the HLA-DQB1*06 allele [odds ratio (OR): 0.37, P = 0.036] was significantly lower, but significance was lost after correction (Pc = 0.1845). The HLA-DQA1*01 allele had a high ratio in GC cases with multiple EPIYA-C repeats, but this was not significant in the univariate analysis. We compared allele frequencies in the DU cases alone and in GC and DU cases together using the same criterion, and none of the HLA alleles were significantly associated with GC or DU. Also, none of the alleles were detected as independent risk factors after the multivariate analysis. On the other hand, in a multivariate logistic regression with no discriminative criterion, HLA-DQA1*01 (OR = 1.848), HLA-DQB1*06 (OR = 1.821) and HLA-A*02 (OR = 1.579) alleles were detected as independent risk factors for GC and DU. Conclusion: None of the HLA alleles were detected as independent risk factors in terms of CagA+ multiple EPIYA-C repeats. However, HLA-DQA1*01, HLA-DQB1*0601, and HLA-A*2 were independent risk factors with no criterion in the multivariate analysis. We suggest that the association of these alleles with gastric malignancies is not specifically related to cagA and multiple EPIYA C repeats.
Vaginal assisted laparoscopic sacrocervicopexy with anterior colpotomy (VALSAC): technique and mean 20 months outcomes
The main purpose of our study is to evaluate the efficacy and safety of vaginal assisted laparoscopic sacrocervicopexy with anterior colpotomy (VALSAC) for apical pelvic organ prolapse. We retrospectively reviewed the results of twenty-three women with stage III and IV prolapse treated with VALSAC between April 2017 and June 2019. With a mean follow-up of 20 months, apical pelvic organ prolapse was cured in 95.7 % of patients. There was no complication in terms of mesh exposure, persistent pain, hematoma, infection. The mean pre- and post-operative POP-Q scores were, for the Aa point, 1.61 +/- 1.82 cm and -1.96 +/- 0.87 cm (p < 0.01), for the C point, 2.87 +/- 1.6 cm and -5.26 +/- 1.86 cm (p < 0.01) for the Ap point, -1.43 +/- 0.89 cm and -2.09 +/- 0.59 cm (p < 0.01). VALSAC is a promising minimally invasive technique for pelvic floor reconstruction that appears to provide good outcomes. Content: The main purpose of our study is to evaluate the efficacy and safety of vaginal assisted laparoscopic sacrocervicopexy with anterior colpotomy (VALSAC) for apical pelvic organ prolapse.
Patient satisfaction in outpatient medical care: the case of Iraq
Background:Healthcare providers are increasingly interested in patient satisfaction as an indicator to assess the quality of health services. This study investigates the level of satisfaction among Iraqi patients attending the outpatient (OP) clinic.Methods:This was a cross-sectional study conducted from October to December 2019 among outpatient attendees in two busiestcenters in Iraq. A convenience sample of 235 (response rate of 88.0%) completed the self-administered short-form patient satisfaction questionnaire (PSQ-18). The independent variables included socio-demographic, economic, and self-perceived health status. Data were analyzed in SPSS, where descriptive analysis (mean ± standard deviation) and univariate (independent sample t-test, ANOVA test) and multivariate linear regression -Enter technique- was done at 0.05 level of significance and 95% confidence interval.Results: The mean age of respondents was 39.3 (±14.8). The sample was mostly women (55.3%), and 37.4% in the age group of 30-49 years. More than half of participants residing in the urban regions (54.5%) from families of monthly household income less than 500,000 Iraq Dinars (USD 400). However, the majority (70.6%) have the first visit to the OP clinic, and 53.6% self-perceived health as good or very good. Results of multiple linear regression showed that patients residents in rural regions (B= 5.4 ,P<0.001), married (B= 4.8,P<0.001), unemployed (B= 4.7,P<0.001) and low educated (B= 1.5,P<0.051) exhibited higher service satisfaction score compared to urban residents, single, employed and high educated participants respectively. However, patients aged fifty years and more (B= -2.1,P<0.001) and those with poor health (B=-2.5,P<0.001) exhibited lower service satisfaction scores compared to young age patients and the healthy participants, respectively.Conclusion:The high demand for the use of health resources in metropolitan cities by the rural population indicates inequality in the distribution of health services and an increase in the rural-to-urban displacement.
Recommendations for management of diabetic foot ulcers during COVID-19 outbreak.
COVID-19 pandemia began in Wuhan, China, in December 2019. A total of 1 878 489 people were infected and 119 044 people were lost because of the disease and its complications by 15 April. Severe morbidity and mortality complications are mostly seen in elderly and patients having comorbidities. Diabetic foot ulcers (DFUs) are one of severe complications of diabetes mellitus and it may require urgent surgical interventions. In this paper, we aimed to create a management algorithm to prevent the unexpected complications that may occur in the patients and health care workers during the evaluation of COVID-19 in DFU patients who require urgent surgical intervention. We advise the use of thorax computerised tomography for preoperative screening in all DFU patients with severe signs of infection and especially those requiring urgent surgery for both the detection of the possible undiagnosed COVID-19 in the patient for the need for close follow-up and protection of the surgical and anaesthesiology team.
Assessment of the Glenoid Morphology Based on Demographic Data in the Turkish Population
Purpose. In this study, our aim was to evaluate the glenoid version, height, and width measurements based on gender, side, age, height, and hand dominance in the Turkish population using computed tomography (CT) images. Methods. In our study, CT images of 140 patients (62 females and 78 males; mean age: 39.6 years) who had no shoulder complaints were evaluated retrospectively. Glenoid version (GV), AP diameter (width), and SI diameter (height) on both shoulders were measured on the CT images. Correlations between patient gender, side, age, height, and hand dominance and the GV and size were evaluated. Results. The right shoulder had a mean GV of -0.93 +/- 7.80 degrees and the left shoulder had a GV of -0.88 +/- 6.63 degrees (p>0.05). The mean AP diameter of the glenoid was 26.57 +/- 3.02 mm in the right shoulder and 26.33 +/- 3.01 mm in the left shoulder (p>0.05). The mean SI diameter of the glenoid was 31.8 +/- 3.6 mm in the right and 31.7 +/- 3.3 mm in the left shoulder (p>0.05). When men and women were evaluated in two separate groups, the GV, AP, and SI values did not exhibit a statistically significant difference between the two shoulders in both genders (p>0.05). There was a positive correlation between the ages and heights of the patients and the glenoid size (p<0.05). The mean AP diameter was approximately 28 mm and the SI diameter was 34 mm in males, whereas the mean AP diameter was 24 mm and the SI diameter was 30 mm in females (p<0.05). The GV values of the dominant shoulders were significantly more retroverted (p<0.05). There was a positive correlation between the ages and heights of the patients and the glenoid size (p<0.05). Conclusion. Hand dominance had an effect on the glenoid version, while patient gender, age, and height had an effect on the glenoid size. The glenoid width in the Turkish population was similar to that of the European and American populations, and the glenoid height was similar to that of the Asian population. Our GV values were similar to those of the Asian population and more anteverted compared to the Western population. We believe that our findings will be useful in preoperative planning and in the production of implants for our population.
Prevalence and mortality of cancer among people living with HIV and AIDS patients: a large cohort study in Turkey
Background: Cancer is responsible for elevated human immunodeficiency virus (HIV)-related mortality but there are insufficient data about cancer in HIV-positive patients in Turkey.