Drugs with anticholinergic side-effects in primary care

Background: Anticholinergic drugs in elderly people have been associated with some serious side.effects. Patients in Turkey tend to attend primary care centers to have prescriptions of the drugs they chronically use. However, very little are known about how frequent that these drugs are prescribed and their side-effects in Turkish population. We aimed to investigate the usage and side.effects of drugs with anticholinergic  properties in patients over 65 years of age attending to primary care centers.Materials and Methods: Five hundred and sixty.three subjects were interviewed with a questionnaire of 16 questions inquiring their medication and possible side.effects. Timed up and go test (TUGT) and standardized mini.mental test (SMMT) were also performed.Results: Medical records of 563 individuals were screened to detect  anticholinergic medication. Twenty.eight patients were using anticholinergic medication. Mean duration of anticholinergic medication usage was 3.17 years. Mean number of falls occurred in the previous year was 1.14 « 1.17. Mean SMMT score was 27.20 « 1.13. Mean TUGT scores mean was 12.4 « 1.25. Drowsiness in 18 patients (65%), dry mouth in 15 patients (53%), dry eyes in 15 patients (53%), constipation in 11 patients (39%), blurred vision in 11 patients (%39), urinary hesitancy in eight patients (28%), confusion in six patients (21%) were reported. We found that none of the subjects were evaluated in terms of fall risk or mental status by their  doctors before the prescription of drugs with anticholinergic effects.Conclusions: A suggested approach to improve drug safety was reported as to reduce the use of anticholinergic drugs when it is possible. Psychiatrists and family physicians should select less anticholinergic drugs for  medication and have to evaluate their patientsf fall risk and their cognitive status before prescribing drugs with anticholinergic side effects.Key words: Anticholinergic side effects, cognitive status, fall risk, primary car

Unilateral Spinal Anaesthesia in Calves

ΔΕΝ ΔΙΑΤΙΘΕΤΑΙ ΕΡΙΛΗΨΗIn this study, we aimed to evaluate the effects of unilateral anaesthesia by the administration of hyperbaric bupivacaine through the lumbosacral space into the subarachnoid space in calves. A total of 10 calves with unilateral femoral fractures were included in the study. After each calf was placed in a lateral position on the side intended for surgery, 15 mg of hyperbaric bupivacaine was slowly injected into the subarachnoid space. The onset, duration and depth of anaesthesia were determined by the pinprick test (scale 1–4). In addition, heart rate, diastolic arterial blood pressure, systolic arterial blood pressure, mean arterial blood pressure, respiratory rate and body temperature of the calves were monitored and recorded from the onset to 120 min after anaesthesia. The onset of unilateral spinal anaesthesia was within 20 s and the mean duration of anaesthesia was 155.40 min. Although there were statistical differences between hemodynamic values in the study, they were within the reference values. As a result, we believe that unilateral spinal anaesthesia in calves provides adequate anaesthesia for use in orthopaedic procedures; thus, it can be used in practice

An application of quality function deployment for assessing the service quality performance of enterprises

Bu çalışmada, testere üreticisi bir işletmenin, müşterileri tarafından algılanan hizmet kalite performansını ölçmek ve kritik hizmet kalite karakteristiklerini tanımlamak amacıyla Kalite Fonksiyon Göçerimi (KFG) tekniği kullanılmıştır. Çalışma kapsamında, testere makinesini kullanan müşterilerin istek ve beklentilerinin tespit etmek ve işletmenin müşterilerine sunduğu kalite performansını ölçmek üzere bir anket çalışması yapılmıştır. Elde edilen verilere dayanarak Kalite Evi oluşturulmuştur. Çalışmanın sonuç ve değerlendirme kısmında, incelenen işletme için tespit edilen kritik hizmet kalite karakteristiklerine ve hizmet kalite performansına yer verilmiştir.  In this study, a Quality Function Deployment technique is used to define the perceived customer quality performance and determine critical service quality characteristics in a saw production enterprise. Within the framework of the study, a questionnaire is used to determine the requirements and expectations of the costumers using the saw machine and measure the quality performance of the enterprise. Based on the collected data, a House of Quality is built. At the evaluation and conclusion section of the study, the defined critical service quality characteristics and service quality performance of the considered enterprise are presented.&nbsp

The Changes in Maternal Mortality in 1000 Counties in Mid-Western China by a Government-Initiated Intervention

BACKGROUND: Since 2000, the Chinese government has implemented an intervention program to reduce maternal mortality and eliminate neonatal tetanus in accordance with the Millennium Development Goals 5. To assess the effectiveness of this intervention program, we analyzed the level, trend and reasons defining the maternal mortality ratio (MMR) in the 1,000 priority counties before and after implementation of the intervention between 1999 and 2007. METHODOLOGY/PRINCIPAL FINDINGS: The data was obtained from the National Maternal and Child Health Routine Reporting System. The intervention included providing basic and emergency obstetric equipment and supplies to local medical hospitals, and also included providing professional training to local obstetric doctors, development of obstetric emergency centers and "green channel" express referral networks, reducing or waiving the cost of hospital delivery, and conducting community health education. Based on the initiation time of the intervention and the level of poverty, 1,000 counties, containing a total population of 300 million, were categorized into three groups. MMR significantly decreased by about 50%, with an average reduction rate of 9.24%, 16.06%, and 18.61% per year in the three county groups, respectively. The hospital delivery rate significantly increased. Obstetric hemorrhage was the leading cause of maternal deaths and significantly declined, with an average decrease in the MMR of 11.25%, 18.03%, and 24.90% per year, respectively. The magnitude of the MMR, the average reduction rate of the MMR, and the occurrence of the leading causes of death were closely associated with the percentage of poverty. CONCLUSIONS/SIGNIFICANCE: The intervention program implemented by the Chinese government has significantly reduced the MMR in mid-western China, suggesting that well-targeted interventions could be an efficient strategy to reducing MMR in resource-poor areas. Reduction of the MMR not only depends on conducting proven interventions, but also relies on economic development in rural areas with a high burden of maternal death

Association of adverse perinatal outcomes of intrahepatic cholestasis of pregnancy with biochemical markers: results of aggregate and individual patient data meta-analyses

Intrahepatic cholestasis of pregnancy is associated with adverse perinatal outcomes, but the association with the concentration of specific biochemical markers is unclear. We aimed to quantify the adverse perinatal effects of intrahepatic cholestasis of pregnancy in women with increased serum bile acid concentrations and determine whether elevated bile acid concentrations were associated with the risk of stillbirth and preterm birth. We did a systematic review by searching PubMed, Web of Science, and Embase databases for studies published from database inception to June 1, 2018, reporting perinatal outcomes for women with intrahepatic cholestasis of pregnancy when serum bile acid concentrations were available. Inclusion criteria were studies defining intrahepatic cholestasis of pregnancy based upon pruritus and elevated serum bile acid concentrations, with or without raised liver aminotransferase concentrations. Eligible studies were case-control, cohort, and population-based studies, and randomised controlled trials, with at least 30 participants, and that reported bile acid concentrations and perinatal outcomes. Studies at potential higher risk of reporter bias were excluded, including case reports, studies not comprising cohorts, or successive cases seen in a unit; we also excluded studies with high risk of bias from groups selected (eg, a subgroup of babies with poor outcomes were explicitly excluded), conference abstracts, and Letters to the Editor without clear peer review. We also included unpublished data from two UK hospitals. We did a random effects meta-analysis to determine risk of adverse perinatal outcomes. Aggregate data for maternal and perinatal outcomes were extracted from case-control studies, and individual patient data (IPD) were requested from study authors for all types of study (as no control group was required for the IPD analysis) to assess associations between biochemical markers and adverse outcomes using logistic and stepwise logistic regression. This study is registered with PROSPERO, number CRD42017069134. We assessed 109 full-text articles, of which 23 studies were eligible for the aggregate data meta-analysis (5557 intrahepatic cholestasis of pregnancy cases and 165 136 controls), and 27 provided IPD (5269 intrahepatic cholestasis of pregnancy cases). Stillbirth occurred in 45 (0·83%) of 4936 intrahepatic cholestasis of pregnancy cases and 519 (0·32%) of 163 947 control pregnancies (odds ratio [OR] 1·46 [95% CI 0·73-2·89]; I2=59·8%). In singleton pregnancies, stillbirth was associated with maximum total bile acid concentration (area under the receiver operating characteristic curve [ROC AUC]) 0·83 [95% CI 0·74-0·92]), but not alanine aminotransferase (ROC AUC 0·46 [0·35-0·57]). For singleton pregnancies, the prevalence of stillbirth was three (0·13%; 95% CI 0·02-0·38) of 2310 intrahepatic cholestasis of pregnancy cases in women with serum total bile acids of less than 40 μmol/L versus four (0·28%; 0·08-0·72) of 1412 cases with total bile acids of 40-99 μmol/L (hazard ratio [HR] 2·35 [95% CI 0·52-10·50]; p=0·26), and versus 18 (3·44%; 2·05-5·37) of 524 cases for bile acids of 100 μmol/L or more (HR 30·50 [8·83-105·30]; p<0·0001). The risk of stillbirth is increased in women with intrahepatic cholestasis of pregnancy and singleton pregnancies when serum bile acids concentrations are of 100 μmol/L or more. Because most women with intrahepatic cholestasis of pregnancy have bile acids below this concentration, they can probably be reassured that the risk of stillbirth is similar to that of pregnant women in the general population, provided repeat bile acid testing is done until delivery. Tommy's, ICP Support, UK National Institute of Health Research, Wellcome Trust, and Genesis Research Trust