The Case of MRI Repetitions with Direct and Indirect Cost Implications: Evidence from Hacettepe University Hospitals

This study investigates the case of repeated MRIs using data from Hacettepe University Hospitals. Results indicate that almost 34% of MRI consultations have to be repeated within the same year due to suboptimal quality that hinders correct assessment and diagnosis. Suboptimal quality refers to; movement artefacts, use of wrong scan technique or sequence, inexperienced reader and/or shortened time intervals. In fact, almost 30% of those repetitions result in a change in diagnosis. Results suggest that the probability of repetition is higher among women and children

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Correction to: Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

The original version of this article unfortunately contained a mistake

Camus: varoluşçuluk ve kuşkuculuğun kesişim noktasında bir asi.

The purpose of this thesis is to examine Albert Camus’s stance in existentialism and scepticism, to discuss his philosophy by referring to his life, which, in many respects, forms a foundation for his philosophy and to exhibit that he maintains his contemporariness in the 21st century. As existentialism is treated differently by different philosophers, the main concern of the thesis is to discuss how Camus handles it. This is done by focusing on his approach to issues appearing commonly in existentialism, such as the absurd, suicide, God, rebellion, freedom, and alienation and by scrutinising the link between existentialism and skepticism. According to Camus, the absurd is the paradoxical condition caused by a contradiction or a confrontation of two unequal concepts or situations. The merit, for Camus, is to survive despite the disillusionment the absurd brings about. Consequently, he is against suicide because he regards it as surrender to the absurd. Camus claims that it is man himself who can make his own life meaningful. Thus, man may question the existence of God and revolt metaphysically against the absurdity and injustice in the world. The metaphysical rebel can then establish the unity and order that he believes is lacking in the world. Camus attaches great importance to rebellion because it brings man freedom. And freedom is indispensable because being deprived of freedom means submission to an authority and, therefore, loss of human dignity. Alienation is a major issue for Camus, too, as it is a result of man’s ‘thrownness’ on to the world and displays the human situation. The thesis analyses the above items in detail with reference to all Camus’s major works.Ph.D. - Doctoral Progra

Synthesis, phase transitions and cellular biocompatibility of nanophase alumina-hydroxyapatite composites

Nanophase alpha-alumina and hydroxyapatite (HA) composites with and without CaF(2) were prepared and sintered at 1100 degrees C for 1 h to investigate their densification, structural and biocompatibility properties. X-ray diffraction method was performed to examine the second phases in the materials. It was observed that HA slightly decomposed into tricalcium phosphate and CaO with the addition of CaF(2). The addition of CaF(2) also resulted in an increase in the density of the composites. The composites were then evaluated for their biocompatibility using cytotoxicity tests. Saos-2 cells were seeded on composite discs in order to investigate the cellular responses to materials in terms of morphology, attachment and proliferation using scanning electron microscopy and 3-(4,5-dimethylthiazol-2yl)-2,5-diphenyl-2H-tetrazolium-bromide viability assays. Cell culture studies showed that the nano-alumina and HA composite discs with or without CaF(2) additions were biocompatible. CaF(2) addition into the composites improved cell attachment and proliferation after 3 days of culture

Improvements in microstructural, mechanical, and biocompatibility properties of nano-sized hydroxyapatites doped with yttrium and fluoride

Hydroxyapatite was doped with Y3+ (2.5, 5 and 7.5 mol%) and F (2.5 mol%) ions (2.5YFHA, 5YFHA, 7.5YFHA, respectively) to compare its structural and mechanical properties and cellular response with pure-hydroxyapatite. No second phases were observed by X-ray diffraction spectra of 2.5YFHA. Doped hydroxyapatites had F- bonds in addition to OH- bonds. Hydroxyapatites sintered at 900 and 1100 degrees C were in nano-size. 7.5YFHA sintered at 1300 degrees C had the highest microhardness value. 2.5YFHA sintered at 1100 degrees C had the highest fracture toughness value. MTT viability assays showed high cell attachments on 2.5YFHA. Cell proliferation on 2.5YFHA and 5YFHA sintered at 1100 and 1300 degrees C was comparable with the control after 5-day culture. The highest ALP production and calcium deposition were observed on all hydroxyapatites sintered at 1100 degrees C. 2.5YFHA sintered at 1100 degrees C can be an alternative for hydroxyapatite in orthopedic applications. (C) 2010 Elsevier Ltd and Techna Group S.r.l. All rights reserved

Socio-economic and behavioral determinants of prescription and non-prescription medicine use: the case of Turkey

Background Demographic and socio-economic factors determine pharmaceutical health care utilization for individuals. Prescription and non-prescription medicine use are expected to have different determinants. Even though prescription and non-prescription medicine use is being well researched for developed countries, there are only a few studies for developing countries. Objectives This paper aims to analyze the socio-economic and individual characteristics that determine the use of prescription and non-prescription medicine. We examine the issue for the specific case of Turkey since Turkey's health system has undertaken significant changes in the last two decades and especially after 2003 with the "Health Transformation Programme". Methods Data from the nationally representative "Health Survey" are used in the analysis. The data set covers the 2008-2016 period with two-year intervals. Pooled multivariate logistic regression is employed to identify the underlying determinants of prescription and non-prescription medicine use. Results When compared to 2008, non-prescription medicine use decreases until 2012, however, an increasing trend appears after 2012. For prescription medicine use, a decreasing trend emerges after 2012. Findings from the marginal effects indicate that for non-prescription medicine use, the highest effect stems from the health status. For prescriptionmedicine use, the highest marginal effects arise from age, health and employment status indicating the importance of the need and predisposing factors. Conclusion Decreasing non-prescription medicine use largely depends on easier access to health care service utilization. Although having a health insurance has a positive relationship with prescription medicine use, there is still a problem for individuals living a rural area and heaving a lower income level since they are more likely to use non-prescription medicine