Wos Kapalı Erişimli Yayınlar
Permanent URI for this collectionhttps://hdl.handle.net/11727/10753
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Item Evaluation of Blood Culture Practices: Use of System (Epicenter) Data(2019) Basustaoglu, Ahmet; Suzuk Yildiz, Serap; Mumcuoglu, Ipek; Karahan, Zeynep Ceren; Ogunc, Dilara; Kaleli, Ilknur; Kursun, Senol; Evren, Ebru; Ozhak, Baysal Betil; Demir, Melek; Murray, Patrick; 30683035Sepsis is a serious clinical problem and estimated to be responsible for 18 million annual deaths worldwide. Therefore, the use and the rapid processing of blood cultures are important for the transition from empiric therapy to directed therapy. The aim of this study was to assess the best blood culture practices in Turkey. We have examined the collection practices and techniques at four different hospitals, and a total of 165.443 blood culture bottles were evaluated (2013-2015). At the preanalytical phase most of the data which were important and which could support hospital quality systems/practices were not entered into the HIS and EpiCenter system. At the analytical phase loading of the bottles and removal of positive bottles primarily occurred between 6:00 and 9:00 AM but the positivity rate of the bottles showed a homogeneous distribution throughout the day. In other words, there were significant delays at processing positive blood culture bottles related to laboratory workers. The effect of education regarding best practices, transition from single bottle to two bottle cultures was successful in all hospitals. Single bottle usage decreased below 10% in all hospitals. Significantly more positive cultures were detected at multiple cultures when compared with the single bottle collection practice. In retrospective patient records, it was seen that all the laboratories reported the results of Gram staining to the clinics. However, these data were not recorded to the Epicenter. The contamination rates of Ankara Numune Hospital and Akdeniz University Faculty of Medicine Hospital are 6.2% and 5.4% respectively, contamination rates were not reported in other hospitals. The most common isolates detected in blood cultures were Escherichia coli, Klebsiella pneumoniae, Enterococcus faecium, Staphylococcus aureus, and Acinetobacter baumannii. The mean time for the detection of these organisms were less than 20 hours in the aerobic bottle and anaerobic bottles. A total of 79.6% of facultative anaerobic isolates were detected in both bottles; 9.8% were detected only in the aerobic bottles; 10.6% of the isolates were detected only in the anaerobic bottles. As a result, the educational efforts in Turkey have met with success for transition from collecting single bottle blood culture sets to two bottle blood cultures. However, further efforts are needed to increase the number of blood culture sets collected during a 24 hour's period. In addition, errors at the preanalytical, analytical and postanalytical periods (taking samples, loading bottles into the system and processing positive blood cultures) should be eliminated.Item Prognostic significance of lymphovascular space invasion in low-risk endometrial cancer(2019) Ayhan, Ali; Sahin, Hanifi; Sari, Mustafa Erkan; Yalcin, Ibrahim; Haberal, Ali; Meydanli, Mehmet Mutlu; 30665899Objective The purpose of this study was to assess the prognostic significance of lymphovascular space invasion in women with low-risk endometrial cancer. Methods A dual-institutional, retrospective department database review was performed to identify patients with 'low-risk endometrial cancer' (patients having <50% myometrial invasion with grade 1 or 2 endometrioid endometrial cancer according to their final pathology reports) at two gynecologic oncology centers in Ankara, Turkey. Demographic, clinicopathological and survival data were collected. Results We identified 912 women with low-risk endometrial cancer; 53 patients (5.8%) had lymphovascular space invasion. When compared with lymphovascular space invasion-negative patients, lymphovascular space invasion-positive patients were more likely to have post-operative grade 2 disease (p<0.001), deeper myometrial invasion (p=0.003), and larger tumor size (p=0.005). Patients with lymphovascular space invasion were more likely to receive adjuvant therapy when compared with lymphovascular space invasion-negative women (11/53 vs 12/859, respectively; p<0.001). The 5-year recurrence-free survival rate for lymphovascular space invasion-positive women was 85.5% compared with 97.0% for lymphovascular space invasion-negative women (p<0.001). The 5-year overall survival rate for lymphovascular space invasion-positive women was significantly lower than that of lymphovascular space invasion-negative women (88.2% vs 98.5%, respectively; p<0.001). Age >= 60 years (HR 3.13, 95% CI 1.13 to 8.63; p=0.02) and positive lymphovascular space invasion status (HR 6.68, 95% CI 1.60 to 27.88; p=0.009) were identified as independent prognostic factors for decreased overall survival. Conclusions Age >= 60 years and positive lymphovascular space invasion status appear to be important prognostic parameters in patients with low-risk endometrial cancer who have undergone complete surgical staging procedures including pelvic and para-aortic lymphadenectomy. Lymphovascular space invasion seems to be associated with an adverse prognosis in women with low-risk endometrial cancer; this merits further assessment on a larger scale with standardization of the lymphovascular space invasion in terms of presence/absence and quantity.Item Cytomegalovirus (CMV) Infection Induces an Angiogenic Response through Hepatic Stellate Cells (HSCs) and Leads to Early Post-Transplant Liver Fibrosis (LF) and Poor Graft Survival.(2019) Ozdemir, B.H.; Ozgun, G.; Soy, E.H. Ayvazoglu; Haberal, N.; Moray, G.; Haberal, M.; 0000-0002-0993-9917; AAC-5566-2019Item Evaluation of Blood Transfusion Applications in Newborn Intensive Care Unit; Single Center Experience(2019) Turhan, AliINTRODUCTION: The frequency of transfusion is high in infants admitted to neonatal intensive care unit (NICU). There is a higher risk of transfusion complications compared to other age groups, and there are many special considerations for transfusion in neonates. The aim of this study was to investigate the records of infants who had blood product transfusions in NICU, to investigate which patient groups were transfused, the characteristics of the blood products used and the current transfusion practices. MATERIALS and METHODS: Between November 2013 and May 2018, the records of 968 newborn infants admitted to the Istanbul Hospital NICU of Baskent University School of Medicine were retrospectively analyzed. RESULTS: Of the babies, 43.8% were female, median birth weight was 2598 (1478-3228) grams, median birth week was 36.5 (30-39) weeks and median hospitalization days were 32 (15-67.5) days. The most commonly used blood group was A Rh (+), the least used blood group AB Rh (-). 39.9% of the transfusions were fresh frozen plasma, 36.2% erythrocyte and 23.5% platelet suspension. In addition to prematurity and related diseases, diseases requiring surgery of central nervous system, congenital heart or gastrointestinal system diseases were the most common transfused group. According to term babies, the rate of use of thrombocyte suspension was higher in preterm infants, however the rate of use of other products was similar. CONCLUSIONS: Knowledge of the selection, preparation of blood products to be used in transfusion and the specific methods for reducing the risks of transfusion will reduce the potential risks and increase the safety of transfusion.Item POSTOPERATIVE ANTICOAGULANT AND ANTIAGGREGANT STRATEGY FOR THE PATIENTS WITH ATRIAL FIBRILLATION FOLLOWING CAROTID ENDARTERECTOMY-SINGLE CENTER EXPERIENCE(2019) Oztas, Didem Melis; Ugurlucan, Murat; Akay, Hakki Tankut; Erdinc, Ibrahim; Aydin, Kubilay; Alpagut, UfukObjective: Literature does not contain a standard procedure about anticoagulant therapy aimed at patients with atrial fibrillation and carotid artery stenosis following carotid endarterectomy. In this paper, we present our therapy modality at these patients in our clinic. Material and Method: The study includes 424 patients and 498 carotid endarterectomy operations performed by two surgeons with the same technique between June 2010 and December 2017. Fourty-five patients had chronic or paroxysmal atrial fibrillation. Therefore, the patients were receiving Coumadin and aspirin. The median age was 63.4 +/- 7.9. There were 27 female and 18 male patients. Thirty seven patients were hypertensive and 17 patients were diabetic. Nine patients underwent bilateral carotid endarterectomy operations. Thirty three patients were symptomatic. Eleven patients had coronary artery disease and 5 patients had cardiac valvular pathologies. Results: The whole carotid endarterectomy operations were performed under locoregional anesthesia. Early mortality occured in one patient because of hypertensive intracranial bleeding. The median follow up period was 68.4 +/- 19.2 months. One patient was lost due to aging and co-morbid factors and one patient was lost due to malignancy in late follow up period. Three patients required revisions for hematoma at incision region but an active bleeding focus could not be detected. There was no re-stenosis in any patient during follow-up. Conclusion: The large and multi-centered studies are needed for the anticoagulant therapy protocol for the patients with atrial fibrillation following carotid endarterectomy. We prefer combination of warfarin, providing INR value between 2-3, and 100 mg aspirin per day at our patients as therapy modality.Item Antifungal Stewardship(2019) Kurt-Azap, OzlemInvasive fungal infections are commonly detected because of increasing number of immunocompromised patients. Emerging antifungal resistance in addition to high mortality and costs are the triggers for the implementation of antifungal stewardship (AFS) programmes. The aim of stewardship programmes is the quality improvement in health care and better outcomes for the patients rather than the costs. Optimizing the use of antifungal drugs to achieve the best outcomes while minimizing adverse events and the emergence of resistance are the accompanying goals. AFS is less established than antibacterial stewardship because of a narrower and more complex evidence base along with only a few number of available drugs. Rapid diagnostic tools and therapeutic drug monitoring are the key components of the AFS programmes. Available data show that AFS programmes are feasible, sustainable and well accepted and favor the implementation of AFS programmes in routine care.Item Terrorism Strategy or Strategies of Terrorism?(2019) Gungor, UgurTerrorism is both a strategy in itself and also has several strategies. While terrorism can be seen as a strategy which is used by countries and terrorist organizations, terrorist organizations also use several strategies. There are five principal strategic logics of costly signaling at work in terrorist campaigns: attrition, intimidation, provocation, spoiling, and outbidding. Effective counterstrategies cannot be designed without first understanding the strategic logic that drives terrorist violence. This paper will analyze the relations among goal, strategy and tactic and investigate whether terrorism is a strategy or not. In the concluding section, paper will discuss the strategies of terrorism and conditions favorable to each strategies.Item Determination of anthropometric measurements in obstructive sleep apnea syndrome in Turkish population(2019) Savas Bozbas, Serife; 32050866Introduction: In this study, we aimed to determine the values of anthropometric measurements and rates used in the evaluation of obstructive sleep apnea syndrome (OSAS) in our country. Materials and Methods: Twenty accredited sleep centers in thirteen provinces participated in this multicenter prospective study. OSAS symptoms and polysomnographic examination and apnea-hypopnea index (AHI) >= 5 cases OSAS study group; patients with AHI <5 and STOP-Bang <2 were included as control group. Demographic characteristics (age, sex, body mass index-BMI) and anthropometric measurements (neck, waist and hip circumference, waist/hip ratio) of the subjects were recorded. Results: The study included 2684 patients (81.3% OSAS) with a mean age of 50.50 +/- 0.21 years from 20 centers. The cases were taken from six geographical regions of the country (Mediterranean, Eastern Anatolia, Aegean, Central Anatolia, Black Sea and Marmara Region). Demographic characteristics and anthropometric measurements; age, neck, waist, hip circumference and waist/hip ratios and BMI characteristics when compared with the control group; when compared according to regions, age, neck, waist, hip circumference and waist/hip ratios were found to be statistically different (p<0.001, p<0.001, p<0.05, respectively). When compared by sex, age, neck and hip circumference, waist/hip ratio, height, weight and BMI characteristics were statistically different (p<0.001, respectively). Neck circumference and waist/hip ratio were respectively 42.58 +/- 0.10 cm, 0.99 +/- 0.002, 39.24 +/- 0.16 cm, 0.93 +/- 0.004 were found in women. Conclusion: The neck circumference was lower than the standard value in men, but higher in women. The waist/hip ratio was above the ideal measurements in both men and women. In this context, the determination of the country values will allow the identification of patients with the possibility of OSAS and referral to sleep centers for polysomnography.Item Effects of Radial Extracorporeal Shock Wave Therapy on Pain, Grip Strength, and Functionality in Patients with Lateral Epicondylitis: A Randomized Controlled Study(2016) Yuruk, Zeliha Ozlem; Kirdi, Nuray; Simsek, NihalObjective: In this study, the effects of radial extracorporeal shock wave therapy (RESWT) on pain, grip strength, and functionality were investigated in patients with lateral epicondylitis. Methods: The study included 30 patients who were divided into two groups: RESWT and exercise and placebo RESWT and exercise. In the RESWT and exercise group, RESWT was applied at 2000 pulses, once a week, for a total of three sessions, and in the placebo RESWT and exercise group, RESWT was applied at 20 pulses, once a week, for a total of three sessions. Patients in all groups underwent stretching and eccentric strengthening exercises. Patients were evaluated before and after undergoing the treatment and at 6 and 12 weeks after undergoing the treatment using a visual analog scale (VAS) for pain intensity during palpation and gripping, dynamometer for grip strength, and patient-rated tennis elbow evaluation (PRTEE) for functionality. Results: There were statistically significant differences between groups with respect to all parameters, except VAS during palpation (p<0.05). With time, there were more significant changes in VAS during palpation and gripping, grip strength, and PRTEE in the RESWT and exercise group compared with those in the placebo RESWT and exercise group (p<0.05). Conclusion: We concluded that using RESWT combined with other conservative treatments, mostly exercise, could be more effective.Item After a Workshop on the Novel Antivirals for Treatment of Hepatitis C Virus Infection (4-6 December 2015, Istanbul)(2016) Tekin, Suda; Aygen, Bilgehan; Aydin, Mehtap; Simsek, Funda