PubMed Açık Erişimli Yayınlar
Permanent URI for this collectionhttps://hdl.handle.net/11727/10763
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Item Nurses' attitudes toward, perceptions of, and experiences with conscientious objection(2022) Karabulut, Seyhan Demir; Gul, Senay; Keles, Sukru; Baykara, Zehra Gocmen; Yalim, Neyyire Yasemin; 0000-0001-5473-573X; 35575202; AAB-3163-2021Background Conscientious objection is a person's refusal to fulfill a legal duty due to their ethical values, religious beliefs, or ideological affiliations. In nursing, it refers to a nurse's refusal to perform an action or participate in a particular situation based on their conscience. Conscientious objection has become a highly contested topic in recent years. Research objectives This study had four objectives: (1) eliciting information on how Turkish nurses perceive conscientious objection, (2) revealing whether their moral beliefs affect the care they provide, (3) determining their experiences with conscientious objection, and (4) identifying existing or potential issues of conscientious objection. Research design This qualitative study collected data through semi-structured interviews. The data were analyzed using thematic content analysis. Participants The sample consisted of 21 nurses. Ethical considerations The study was approved by an ethics committee. Confidentiality and anonymity were guaranteed. Participation was voluntary. Findings The analysis revealed four themes: (1) universal values of nursing (professional values), (2) experiences with conscientious objection (refusing to provide care/not providing care), (3) possible effects of conscientious objection (positive and negative), and (4) scope of conscientious objection (grounded and groundless). Conclusion Participants did not want to provide care due to (1) patient characteristics or (2) their own religious and moral beliefs. Participants stated that conscientious objection should be limited in the case of moral dilemmas and accepted only if the healthcare team agreed on it. Further research is warranted to define conscientious objection and determine its possible effects, feasibility, and scope in Turkey.Item Atypical Glandular Cells in Papanicolaou Test: Which is More Important in The Detection of Malignancy, Architectural or Nuclear Features?(2021) Yucel Polat, Aysegul; Tepeoglu, Merih; 0000-0002-3590-9375; 0000-0002-9894-8005; 33606313; AAP-3975-2021; AAK-5222-2021Objective Atypical glandular cells (AGCs) in Pap (Papanicolaou) smears are uncommon but may represent various benign and malignant lesions. The aim of this study was to evaluate the AGC incidence in Pap smears, analyse the relationship between AGC and malignancy, and reveal the importance of architectural and nuclear features observed cytologically in malignancies. Methods Patients diagnosed with AGC on the basis of cervicovaginal cytology between May 2011 and July 2018 were included in this study. All slides were retrospectively reviewed and subclassified according to the Bethesda 2001 classification system. The cytomorphological features observed in the smears were recorded. Cytohistological correlations were evaluated, and the significant clinicopathological findings for malignancy were determined. Results Of 87 536 Pap smears, 195 (0.22%) had AGC results and 156 had tissue follow-up. Among the 156 smears with AGC, 80 (51.3%) were diagnosed as AGC-NOS (atypical glandular cells, not otherwise specified) and 76 (48.7%) as AGC-FN (atypical glandular cells, favour neoplastic). Follow-up biopsies revealed benign pathologies in 49 cases (31.4%) and malignant pathologies in 107 (68.6%). The rate of malignancy observed in AGC-FN cases (89.5%) was higher than the rate of malignancy in AGC-NOS cases (48.8%). Among the cytomorphological features, nuclear irregularity, presence of macronucleoli, feathering, loss of polarity, papillary pattern, and three-dimensional formation were found to be significant indicators of malignancy. Conclusion As AGC in Pap smear was associated with a clinically significant diagnosis in 68.6% of the cases in our study, we suggest that all patients with AGC should undergo further clinical assessment.Item Early Maxillary Expansion with the Ni-Ti Memory Leaf Expander-A Compliance-Free Fixed Slow Maxillary Expansion Screw: A Report of 2 Cases(2021) Ulug, Bahar; Ozcirpici, Ayca Arman; 35110164Transversal problems such as crowding and crossbite are one of the most common problems dealt with in early orthodontic treatments. Early correction of these problems may ease or even eliminate the future need for treatment. This paper presents the management of 2 cases with transverse discrepancy using the Ni-Ti Memory Leaf Expander-a new compliance-free slow maxillary expansion appliance. The total treatment time for both cases was 9 months. In both cases, the inter-canine, inter-premolar, and inter-molar distances, as well as the arch length, have all increased.Item Feasibility of Hyperthermic Intraperitoneal Chemotherapy (HIPEC) in Ovarian Cancer During COVID-19 Pandemic(2021) Ayhan, Ali; Yilmaz Baran, Safak; Vatansever, Dogan; Dogan Durdag, Gulsen; Celik, Husnu; Taskiran, Cagatay; Akilli, Huseyin; 0000-0001-5874-7324; 0000-0002-5240-8441; 33858953; AAX-3230-2020Objective This study aims to evaluate the effect of the COVID-19 pandemic and related restrictions on patients who underwent cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC) for ovarian cancer. Methods We retrospectively evaluated ovarian cancer patients who underwent HIPEC following complete cytoreductive surgery performed during the outbreak of the COVID-19 pandemic in three different centers specializing in gynecological oncology. All patients who underwent cytoreduction plus HIPEC for a primary, interval, and recurrent surgery were evaluated. Primary outcomes was postoperative 30-day morbidity and mortality. The secondary outcome was infection of patient and/or related staff with COVID-19 during the perioperative or early postoperative period. Results We performed a total of 35 HIPEC procedures during the pandemic: 15 (42.9%) patients underwent primary/interval surgery, while 20 (57.1%) patients had recurrent disease. Grade 3-4 complications occurred in one patient (2.9%) (chronic renal failure), while mortality did not occur in any patient. Neither the patients nor related staff were infected with the coronavirus during the perioperative or early postoperative period. One patient, who was diagnosed with COVID-19 pneumonia on postoperative day 80 died from the infection. Another patient died on postoperative day 85 due to progressive ovarian cancer, a disorder in vital functions, and organ failure. Conclusion HIPEC during the COVID-19 pandemic seems a safe and feasible procedure, with acceptable morbidity and mortality rates. Careful selection of patients is important and precautions should be taken before the procedure.Item Economic Burden Of Lung Cancer In Turkey: A Cost Of Illness Study From Payer Perspective(2021) Cicin, Irfan; Oksuz, Ergun; Karadurmus, Nuri Nuri; Malhan, Simten; Gumus, Mahmut; Yilmaz, Ulku; Cansever, Levent; Cinarka, Halit; Cetinkaya, Erdogan; Kiyik, Murat; Ozet, Ahmet; 0000-0002-5723-5965; 34173876; K-8238-2012Background This study was designed to estimate economic burden of lung cancer in Turkey from payer perspective based on expert panel opinion on practice patterns in clinical practice. Methods In this cost of illness study, direct medical cost was calculated based on cost items related to outpatient visits, laboratory and radiological tests, hospitalizations/interventions, drug treatment, adverse events and metastasis. Indirect cost was calculated based on lost productivity due to early retirement, morbidity and premature death resulting from the illness, the value of lost productivity due to time spent by family caregivers and cost of formal caregivers. Results Cost analysis revealed the total per patient annual direct medical cost for small cell lung cancer to be euro8772), for non-small-cell lung cancer to be euro10,167. Total annual direct medical cost was euro497.9 million, total annual indirect medical cost was euro1.1 billion and total economic burden of lung cancer was euro1.6 billion. Hospitalization/interventions (41%) and indirect costs (68.6%) were the major cost drivers for total direct costs and the overall economic burden of lung cancer, respectively. Conclusions Our findings indicate per patient direct medical costs of small cell lung cancer and non-small-cell lung cancer to be substantial and comparable, indicating the substantial economic burden of lung cancer in terms of both direct and indirect costs. Our findings indicate that hospitalization/interventions cost item and indirect costs were the major cost drivers for total direct costs and the overall economic burden of lung cancer, respectively. Our findings emphasize the potential role of improved cancer prevention and early diagnosis strategies, by enabling cost savings related to drug treatment and metastasis management cost items, in sustainability of cancer treatments.Item Medial olivary complex reflex in term newborns with hyperbilirubinemia(2021) Culhaoglu, Belde; Erbek, Selim S.; İnce, Deniz Anuk; Ecevit, Ayse Nur; Erbek, Seyra; 0000-0002-8453-6069; 34116320; AAJ-2445-2021Objective: This study aimed to compare the integrity of the efferent auditory pathways of newborns that had high hyperbilirubinemia levels and required treatment due to these and healthy newborns. Methods: Term-born (37 weeks or later) infants that were brought to the Newborn Polyclinic of the Baskent University Hospital were included in the study. The study included a total of 84 infants including healthy newborns (n = 42) and those that had jaundice and were receiving phototherapy (n = 42). After conducting a general otorhinolaryngology examination on all newborns included in the study, Transient Otoacoustic Emission (TEOAE) test was carried out in the absence and presence of contralateral noise. The obtained contralateral suppression values were compared between the two groups. Results: In the TEOAE test, the responses obtained at 1 kHz in the newborns receiving phototherapy were found to be lower. The difference between the groups was significant (p = 0.038). The rates of suppression presence at 2 kHz, 2.8 kHz and total OAE were found significantly higher (p < 0.05) in the group not receiving phototherapy. Among the phototherapy-receiving infants, the hyperbilirubinemia levels of the infants in whom suppression was obtained in the contralateral suppression test did not show a statistically significant difference in comparison to those in whom suppression was not obtained (p > 0.05). Conclusion: Based on the obtained data, hyperbilirubinemia may have a disruptive effect on the efferent auditory system in newborns. Consequently, we are of the opinion that, in addition to hearing screening in risky newborn infants, a MOC suppression test would be useful.Item Prediction of treatment response in patients with locally advanced cervical cancer using midtreatment PET/MRI during concurrent chemoradiotherapy. In regard to Vojtisek et al.(2021) Onal, Cem; Yavas, Guler; Yavas, Cagdas; 0000-0002-2742-9021; 34341837; D-5195-2014Item The annual recurrence risk model for tailored surveillance strategy in patients with cervical cancer(2021) Kim, Sarah H.; 34666213Purpose: Current guidelines for surveillance strategy in cervical cancer are rigid, recommending the same strategy for all survivors. The aim of this study was to develop a robust model allowing for individualised surveillance based on a patient's risk profile. Methods: Data of 4343 early-stage patients with cervical cancer treated between 2007 and 2016 were obtained from the international SCCAN (Surveillance in Cervical Cancer) consortium. The Cox proportional hazards model predicting disease-free survival (DFS) was developed and internally validated. The risk score, derived from regression coefficients of the model, stratified the cohort into significantly distinctive risk groups. On its basis, the annual recurrence risk model (ARRM) was calculated. Results: Five variables were included in the prognostic model: maximal pathologic tumour diameter; tumour histotype; grade; number of positive pelvic lymph nodes; and lymphovascular space invasion. Five risk groups significantly differing in prognosis were identified with a five-year DFS of 97.5%, 94.7%, 85.2% and 63.3% in increasing risk groups, whereas a two-year DFS in the highest risk group equalled 15.4%. Based on the ARRM, the annual recurrence risk in the lowest risk group was below 1% since the beginning of follow-up and declined below 1% at years three, four and >5 in the medium-risk groups. In the whole cohort, 26% of recurrences appeared at the first year of the follow-up, 48% by year two and 78% by year five. Conclusion: The ARRM represents a potent tool for tailoring the surveillance strategy in early-stage patients with cervical cancer based on the patient's risk status and respective annual recurrence risk. It can easily be used in routine clinical settings internationally. (c) 2021 Elsevier Ltd. All rights reserved.Item A rare presentation of stafne bone cyst(2020) Bayrak, N. B.; 30769109Stafne bone cysts (SBC) are defined as pseudocysts of the jaw in the literature. These lesions are typically localized at lingual cortical surface of the mandible and generally included normal salivary gland tissue; but they do not contain an epithelial lining. They may contain fat, muscle, connective tissue, lymphatic tissue, nerve bundles, blood vessels or air. In the literature, unlike posterior variant of SBC, anterior type of SBC (aSBC) is almost seven times less common (0.009%-0.3%). Usually, SCBs are identified at dental examination randomly. Since these lesions are mostly asymptomatic, some additional imagining modalities such as magnetic resonance imaging (MRI), computed tomography (CT) or sialography may be useful to confirm the diagnosis for atypical lesions. The aim of this report is to present a new case of aSBC and focuses on differential diagnosis along with alternative diagnostic imaging resources and review current literature. (C) 2019 Elsevier Masson SAS. All rights reserved.Item Design, synthesis and in vitro apoptotic mechanism of novel pyrrolopyrimidine derivatives(2019) Kilic-Kurt, Zuhal; Bakar-Ates, Filiz; Aka, Yeliz; Kutuk, Ozgur; 0000-0001-9854-7220; 30458413; AAH-1671-2019In this work we described the synthesis and evaluation of cytotoxic and apoptotic activity of novel pyrrolopyrimidine derivatives against A549, PC3 and MCF-7 cells. Among the synthesized compounds, 6b, 8a, 9a and 7a, 8b displayed the significant cytotoxic activities against A549 and PC3 cells with IC50 value of 0.35, 1.48, 1.56 and 1.04, 1.89 mu M, respectively. It was found that A549 cells were more sensitive to synthesized compounds than PC3 and MCF-7 cells. In order to evaluate the mechanism of cytotoxic activity in A549, compounds 6b, 8a and 9a were selected for further studies. Annexin V binding assay and western blot analysis results revealed that 6b, 8a and 9a induced apoptosis in A549 cells by intrinsic apoptotic pathway through the activation proapoptotic proteins such as Bim, Bax, Bak, Puma and deactivation of anti-apoptotic proteins including Bcl-2, Mcl-1 and Bcl-XL accompanied by the activation of caspase-3, caspase-9 and cleavage of PARP. Also, compounds 6b, 8a and 9a triggered apoptosis in HCT116 wt cells via activation of caspase-3 and caspase-9, but not in HCT116 Bax/Bak KO cells, indicating resistance to 6b, 8a and 9a treatment.