An appeal to the global health community for a tripartite innovation: an ‘‘Essential Diagnostics List,’’ ‘‘Health in All Policies,’’ and ‘‘See-Through 21st Century Science and Ethics"

Diagnostics spanning a wide range of new biotechnologies, including proteomics, metabolomics, and nanotechnology, are emerging as companion tests to innovative medicines. In this Opinion, we present the rationale for promulgating an ‘‘Essential Diagnostics List.’’ Additionally, we explain the ways in which adopting a vision for ‘‘Health in All Policies’’ could link essential diagnostics with robust and timely societal outcomes such as sustainable development, human rights, gender parity, and alleviation of poverty. We do so in three ways. First, we propose the need for a new, ‘‘see through’’ taxonomy for knowledge-based innovation as we transition from the material industries (e.g., textiles, plastic, cement, glass) dominant in the 20th century to the anticipated knowledge industry of the 21st century. If knowledge is the currency of the present century, then it is sensible to adopt an approach that thoroughly examines scientific knowledge, starting with the production aims, methods, quality, distribution, access, and the ends it purports to serve. Second, we explain that this knowledge trajectory focus on innovation is crucial and applicable across all sectors, including public, private, or public–private partnerships, as it underscores the fact that scientific knowledge is a co-product of technology, human values, and social systems. By making the value systems embedded in scientific design and knowledge co-production transparent, we all stand to benefit from sustainable and transparent science. Third, we appeal to the global health community to consider the necessary qualities of good governance for 21st century organizations that will embark on developing essential diagnostics. These have importance not only for science and knowledge based innovation, but also for the ways in which we can build open, healthy, and peaceful civil societies today and for future generations

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Mediating role of digital literacy in the effect of e-health literacy on rational drug use: The case of Bozüyük State Hospital

Bu çalışmanın temel amacı; e-sağlık okuryazarlığının akılcı ilaç kullanımı üzerine etkisinde dijital okuryazarlığın aracılık rolünü tespit etmektir. Çalışma, Bilecik Bozüyük Devlet Hastanesi'ne çoğunluğunun acil servise başvuranlardan oluştuğu, hasta/hasta yakınlarından oluşan örneklem üzerinden elde edilen veriler ile yürütülmüştür. Çalışmada kullanılan ölçüm araçları daha önce çalışılmış olan literatüre dayalı araştırmalardan elde edilmiştir. Veri toplama aracı olarak; katılımcıların sosyo-demografik bilgilerini içeren Anket Formu, dijital okuryazarlık düzeylerini, e-sağlık okuryazarlığı düzeylerini ve akılcı ilaç kullanımı düzeylerini ölçmek amacıyla 3 farklı ölçek kullanılmıştır. Araştırmada nicel araştırma yöntemi kullanılmış olup; veriler kolayda örnekleme yöntemi ile yüze yüze anket tekniği kullanılarak bizzat araştırmacı tarafından toplanmıştır. Verilerin analizinde SPSS ve AMOS istatistiksel analiz programları kullanılmıştır. Araştırma verilerinin analizlerinde; Araştırma verilerine betimsel analizler ve yol (path) analizi uygulanmıştır. Araştırmada, 405 katılımcıdan elde edilen verilerden yararlanılmıştır. Demografik özeliklerin analizinde katılımcıların; yaş, cinsiyet, eğitim düzeyi, meslek, ailenin aylık gelir durumu, düzenli ilaç kullanımı durumu, genel sağlık durumu, herhangi bir sağlık konusunda interneti kullanma durumu ve son bir yıl içerisinde sağlık hizmeti alma durumu ele alınmıştır. Belirtilen alt gruplarda, cinsiyet gruplarına, düzenli ilaç kullanım durumlarına ve ailelerinin aylık gelir durumlarına göre katılımcılara yapılan testlerde herhangi bir farklılık gözlemlenmemiştir. Diğer alt gruplarda ise bazı farklılıklar tespit edilmiştir. Fakat tüm alt grupların ortalamalarına bakıldığı zaman; dijital okuryazarlık (3,57±0,87), e-sağlık okuryazarlığı (3,54±0,79) ve akılcı ilaç kullanımı (2,69±0,36) değişkenleri için "Katılıyorum" cevabı verilmiştir. "Yol (Path) analizi'' sonuçlarında ise bağımsız değişken e-sağlık okuryazarlığının, bağımlı değişken akılcı ilaç kullanımı üzerindeki etkisi önemli çıkmıştır. Fakat aracı değişken dijital okuryazarlık bağımsız değişken e-sağlık okuryazarlığı değişkeni ile birlikte modele dâhil edildiğinde, e-sağlık okuryazarlığı değişkeninin, bağımlı değişken akılcı ilaç kullanımı değişkeni üzerindeki etkisini ve önemini ortadan kaldırarak iki değişken arasındaki ilişkiyi kendi üzerinden devam ettirmektedir. Tüm değişkenler modele dahil edildiğinde yapılan analiz sonuçlarına göre; dijital okuryazarlık değişkeninin, e-sağlık okuryazarlığı değişkeni üzerindeki etkisi pozitif yönde önemli çıkmıştır. Akılcı ilaç kullanımı değişkeninin, dijital okuryazarlık değişkenine etkisi de pozitif yönde önemli çıkmıştır. Fakat akılcı ilaç kullanımı değişkeninin, e-sağlık okuryazarlığı değişkenine etkisinin önemsiz olduğu belirlenmiştir. Sonuç olarak, e-sağlık okuryazarlığının akılcı ilaç kullanımı üzerine etkisinde dijital okuryazarlık değişkeninin ''Tam Aracılık'' rolü olduğu tespit edilmiştir.The main purpose of this study; To determine the mediating role of digital literacy in the effect of e-health literacy on rational drug use. The study was carried out with the data obtained from the sample consisting of patients/patient relatives, most of whom were admitted to the emergency department of Bilecik Bozüyük State Hospital. The measurement tools used in the study were obtained from previous literature-based studies. As a data collection tool; Questionnaire containing the socio-demographic information of the participants, and 3 different scales were used to measure their digital literacy levels, e-health literacy levels and rational drug use levels. Quantitative research method was used in the research; The data were collected by the researcher himself using the face-to-face survey technique with convenience sampling method. SPSS and AMOS statistical analysis programs were used in the analysis of the data. In the analysis of research data; Descriptive analyzes and path analysis were applied to the research data. Data from 405 participants were used in the study. In the analysis of demographic characteristics, participants; Age, gender, education level, occupation, monthly income of the family, regular drug use, general health, internet use for any health issue and receiving health services in the last year were discussed. No difference was observed in the tests performed on the participants according to gender groups, regular drug use and monthly income of their families in the subgroups mentioned. Some differences were detected in other subgroups. But when the averages of all subgroups are examined; "I agree" was given for the variables of digital literacy (3.57±0.87), e-health literacy (3.54±0.79) and rational drug use (2.69±0.36). In the "Path analysis" results, the effect of the independent variable e-health literacy on the dependent variable rational drug use was significant. However, when the mediator variable, digital literacy, is included in the model together with the independent variable, e-health literacy, it eliminates the effect and importance of the e-health literacy variable on the dependent variable, the rational drug use variable, and maintains the relationship between the two variables on its own. According to the results of the analysis made when all variables were included in the model; The effect of the digital literacy variable on the e-health literacy variable was found to be positively significant. The effect of the rational drug use variable on the digital literacy variable was also found to be positively significant. However, the effect of the rational drug use variable on the e-health literacy variable was found to be insignificant. As a result, it has been determined that the digital literacy variable has a "Full Mediation" role in the effect of e-health literacy on rational drug use

Femoral herni ameliyatlarında 19 yıllık deneyimimiz ve bassini-kischner onarımı

Amaç: Femoral herni onarımı yapılan son 19 yıldaki hastaların incelenmesi, Bassini-Kischner yöntemi uygulanan olguların literatür ışığında irdelenmesi. Gereç ve Yöntem: Nisan 1988-Mart 2007 yılları arsında ameliyat edilen femoral hernili olgular çalışmaya alındı. Başvuru şekli; acil-elektif, ortalama yaş, kadın erkek oranı, herninin sağ ve/veya solda oluşu, seçilen cerrahi onarım yöntemi dökümante edildi. Bassini-Kischner onarımı yapılan olguların uzak dönem sonuçları incelendi. Bulgular: Ameliyat edilen olgu sayısı 141 idi. Doksan yedi olgu (%69) elektif koşularda 44(%31) olgu ise acil olarak ameliyat edildi. Onarım olarak 96 olguda McVay, 31 olguda Bassini- Kischner yöntemi kullanılırken 14 olguda mesh ile onarım yapıldı. Bassini-Kischner onarımı yapılan hastaların dosya kayıtlarında ve kontrole gelenlerin muayenesinde nüks görülmedi. Sonuç: Femoral hernia daha çok acil koşullarda ameliyat gerektirir. Bassini- Kischner onarımı uygulaması kolay bir tekniktir, elektif femoral herni onarımlarında tercih edilebilir.Background and Purpose: Patients undergoing surgery for the repair of femoral hernia during the last 19 years were examined and reviewed in the light of previous studies evaluating the results of BassiniKischner repair. Methods: Patients undergoing surgery for femoral hernia between April 1988 and March 2007 were identified. The mode of admission, emergency vs. elective surgery, mean age, female to male ratio, hernia side and the preferred surgical technique were documented and long-term results of Bassini- Kischner repair were reviewed. Main Findings: A total of 141 cases were operated. Ninety-seven patients (69%) underwent elective surgery while 44 (31%) had emergency surgery. The methods used for repair were McVay method in 96 patients, BassiniKischner method in 31 patients, and mesh repair in 14. No cases of recurrence were determined either from patient records or during follow- up visits of patients who underwent Bassini- Kischner repair. Conclusions: Femoral hernias require emergency surgery more frequently and Bassini- Kischner repair is a simple technique and it may be preferred for the elective surgical treatment of femoral hernia

Evaluation of Retinal and Optic Disc Vascular Changes and Retinal Nerve Fiber Layer Thickness in Patients with Nasopharyngeal Carcinoma Following Image Guided Intensity-Modulated Radiation Therapy Using Optical Coherence Tomography Angiography

Background: Radiation-induced optic neuropathy (RION) is one of the most important late complications during head and neck radiotherapy and is recognized usually between 2-9 years after RT. Our study aims to prospectively without baseline measurement evaluate retinal and optic disc vascular changes and retinal nerve fiber layer thickness (RNFL) using optical coherence tomography angiography (OCTA) in nasopharyngeal cancer (NPC) patients previously treated with intensity-modulated radiation therapy (IMRT) and with optic nerve doses are above 45 Gy.Methods: Fourteen NPC patients and sixteen age-matched healthy control subjects were included in our study. A complete ophthalmological examination including the best-corrected visual acuity (BCVA), intraocular pressure, slit-lamp biomicroscopic, fundoscopic examination and OCTA were performed for all patients and healthy volunteers. OCTA findings of RT and control groups were compared and correlation analysis was performed to find the association between the radiation-related factors and OCTA findings. Results: Inferior hemi disc, parafovea and perifovea superficial/deep vessel densities were were statistically significantly lower in RT patients. Negative correlations were found between Dmax of optic tract and both RNFL and vessel densities. Furthermore, there were negative correlations found between the Dmean of glob and vessel densities.Conclusion: Although none of the patients in our study had marked vision loss and retinal abnormalities with the examination, OCTA findings showed that perifoveal and parafoveal vascularity were statistically significantly affected due to the RT

A Case of Severe Spontaneous Pneumomediastinum in Acquired Immunosuppressed Child with Respiratory Syncytial Virus and Human Bocavirus Co-infection

Spontaneous pneumomediastinum is an uncommon, benign, and self-limiting disease based on the presence of free air in the mediastinal cavity. It can occur after a forced Valsalva’s maneuver due to a cough, emesis or during an asthma exacerbation. We present a 4-month-old girl infant with an autoimmune hemolytic anemia and lymphopenia, who was admitted to the pediatric intensive care unit due to respiratory distress. A suspected pneumomediastinum image on chest X-ray was documented by the chest tomography. A polymerase chain reaction of the nasopharyngeal secretions was positive for a respiratory syncytial virus and human bocavirus. Additionally, she was examined for an immune deficiency due to her lymphopenia. The patient required mechanical ventilatory support for 26 days. She was treated with antibiotics, antiviral, and antifungal agents and corticosteroids. Intravenous immunoglobulin, trimethoprim sulfamethoxazole, and fluconazole prophylaxis were continued because of the ongoing lymphopenia. At the end of five weeks, the patient was discharged with a normal lymphocyte count and without any respiratory distress. In immunosuppressed patients, respiratory diseases may be severe and long. Therefore, complications including pneumomediastinum can be seen more frequently in this group of patients

Association between dopamine beta hydroxylase gene polymorphism and age at onset in male schizophrenia

Erdal, Mehmet Emin/0000-0002-6191-2930; barlas, ibrahim omer/0000-0002-2645-4487; Ankarali, Handan Camdeviren/0000-0002-3613-0523; Algul, Ayhan/0000-0002-6570-7141WOS: 000304344800009PubMed: 26953012Barlas IO, Semiz U, Erdal ME, Algul A, Ay OI, Ates MA, Camdeviren H, Basoglu C, Herken H. Association between dopamine beta hydroxylase gene polymorphism and age at onset in male schizophrenia. Objectives: The heterogeneity of schizophrenia mainly results from variations in clinical expressions of the disease, such as age at onset, gender differences in onset of illness, symptoms and response to antipsychotic treatment. Enhanced sensitisation of dopamine pathways in males, having consistently an earlier onset, might be implicated as disease modifiers for schizophrenia in males. Methods: In this study, we performed a case (n = 87)-control (n = 100) association study between the DBH5'-ins/del and DBH-444g/a polymorphisms of the DBH gene and also compared the level of psychotic symptoms between patients with different DBH genotypes/haplotypes with respect to antipsychotic therapeutic response and gender difference. Results: No significant differences between allele and genotype and haplotype frequencies at either groups (p < 0.05). When the age is considered in patient group, a significant difference was observed between patients with ID genotype and with II genotype (p = 0.018). Patients with ID genotype have been diagnosed as schizophrenics in early ages when compared to II genotype carriers. We also found a significant difference between II and ID genotype (p = 0.007) when the gender had taken into account, showing that the ID genotype carriers had an early onset to schizophrenia. Conclusions: This association was more significant in male schizophrenia patients than females. Thus, this finding may constitute a novel biological support for the prior finding that onset of schizophrenia varies with gender. The results also showed that critical genetic vulnerability may be associated with the presence or absence of the ID genotype of DBH5'-ins/del

Relation of the Fas and FasL gene polymorphisms with susceptibility to and severity of rheumatoid arthritis

Ankarali, Handan Camdeviren/0000-0002-3613-0523; barlas, ibrahim omer/0000-0002-2645-4487; Sahin, Gunsah/0000-0002-4215-6957; Erdal, Mehmet Emin/0000-0002-6191-2930WOS: 000324824500025PubMed: 23749041To investigate associations of the Fas and FasL genes polymorphisms with rheumatoid arthritis (RA). One hundred patients with RA and age-, sex- and ethnically matched 101 controls were included. Four polymorphisms of Fas (-670 A > G rs1800682, -1377 G > A rs2234767) and FasL (IVS2nt-124 A > G rs5030772, -844 T > C rs763110) genes were typed from genomic DNA. Genotype distributions and allelic frequencies were compared between patients and control subjects. After the history and clinical examination of patients with RA, in terms of pain, fatigue and general health status were evaluated by visual analogue scale. Thereafter, erythrocyte sedimentation rate, C-reactive protein, blood count and rheumatoid factor levels were measured. The Disease Activity Score-28, Health Assessment Questionnaire and modified Sharp score were used to evaluate the disease activity, functional disability and radiological damage, and their relationships with the Fas and FasL gene polymorphisms were investigated. In patients with RA, CT and TT genotypes of FasL-844, polymorphism were twofold and 4.8-fold higher, and AA genotype of FasL IVS2nt-124 polymorphism was 3.4-fold higher than the control group (respectively, p = 0.05, p = 0.002, p = 0.039). T allele of FasL-844 polymorphism was more frequent in patients than controls (respectively, 52.5 vs. 41.4 %, p = 0.027). Any association was not detected between Fas (-670 A > G, -1377 G > A) and FasL (-844 T > C, IVS2nt-124 A > G) gene polymorphisms with the disease activity scores, functional disability and radiological damage. However, the Fas-670 A > G polymorphism was associated with drug therapy (p = 0.049). The distribution of GG genotype was higher compared to GA or AA genotypes in patients using triple disease-modifying antirheumatic drug therapy (71.4, 14.3 and 14.3 %, respectively). These findings suggest that the -844 T > C and IVS2nt-124 A > G polymorphisms in the FasL gene related with apoptosis may increase genetic susceptibility to RA in a Turkish population. In addition, the Fas-670 A > G gene polymorphism may be associated with disease progression. There is a need for further studies to clarify the genetic role of apoptosis in RA

Femoral herni ameliyatlarında 19 yıllık deneyimimiz ve bassini-kischner onarımı

Amaç: Femoral herni onarımı yapılan son 19 yıldaki hastaların incelenmesi, Bassini-Kischner yöntemi uygulanan olguların literatür ışığında irdelenmesi. Gereç ve Yöntem: Nisan 1988-Mart 2007 yılları arsında ameliyat edilen femoral hernili olgular çalışmaya alındı. Başvuru şekli; acil-elektif, ortalama yaş, kadın erkek oranı, herninin sağ ve/veya solda oluşu, seçilen cerrahi onarım yöntemi dökümante edildi. Bassini-Kischner onarımı yapılan olguların uzak dönem sonuçları incelendi. Bulgular: Ameliyat edilen olgu sayısı 141 idi. Doksan yedi olgu (%69) elektif koşularda 44(%31) olgu ise acil olarak ameliyat edildi. Onarım olarak 96 olguda McVay, 31 olguda Bassini- Kischner yöntemi kullanılırken 14 olguda mesh ile onarım yapıldı. Bassini-Kischner onarımı yapılan hastaların dosya kayıtlarında ve kontrole gelenlerin muayenesinde nüks görülmedi. Sonuç: Femoral hernia daha çok acil koşullarda ameliyat gerektirir. Bassini- Kischner onarımı uygulaması kolay bir tekniktir, elektif femoral herni onarımlarında tercih edilebilir.Background and Purpose: Patients undergoing surgery for the repair of femoral hernia during the last 19 years were examined and reviewed in the light of previous studies evaluating the results of BassiniKischner repair. Methods: Patients undergoing surgery for femoral hernia between April 1988 and March 2007 were identified. The mode of admission, emergency vs. elective surgery, mean age, female to male ratio, hernia side and the preferred surgical technique were documented and long-term results of Bassini- Kischner repair were reviewed. Main Findings: A total of 141 cases were operated. Ninety-seven patients (69%) underwent elective surgery while 44 (31%) had emergency surgery. The methods used for repair were McVay method in 96 patients, BassiniKischner method in 31 patients, and mesh repair in 14. No cases of recurrence were determined either from patient records or during follow- up visits of patients who underwent Bassini- Kischner repair. Conclusions: Femoral hernias require emergency surgery more frequently and Bassini- Kischner repair is a simple technique and it may be preferred for the elective surgical treatment of femoral hernia