Effect of vitamin D level and polypharmacy on the risk of falls in the elderly

Aim: To investigate the effects of polypharmacy and vitamin D levels on the risk of falls in the elderly. Methods: The prospective study included 201 patients (F/M: 155/46) aged 65 years and older who presented with nonspecific musculoskeletal pain. The demographic and laboratory data of the patients, as well as the results of a single leg stance test (SLST), a timed up and go (TUG) test and levels of vitamin D were recorded. Results: The percentage of patients with polypharmacy is 15.9 percent and 29.4 percent used no medications. The SLST score was the lowest and the TUG test score was significantly higher in the polypharmacy group (p<0.05). Vitamin D levels were significantly higher in patients with normal SLST times than those with abnormal SLST times (p<0.05). The risk of falls was significantly higher among patients with a previous history of a fall (p<0.05). Polypharmacy and the female gender appeared as the most significant factors affecting the risk of falls (p<0.05), while vitamin D level was found to have no effect (p>0.05). Conclusion: Medical therapies for the treatment of diseases in the elderly should have a rational basis, as this may reduce falls, particularly in the elderly population, that can have serious consequences, and may even lead to death

A Comparative Study between Human Development Index and Work Accidents in Turkey and the EU Member Countries

Today work accidents constitute a major public health problem in the world. For the last two decades, Turkey has been suffering from the death toll resulting from work accidents and occupational diseases. In this study, the analysis of human development's dimensions gives the picture of reasons why Turkey is ranked as the first in Europe in terms of the number of fatal work accidents. Authors suggest that Turkey should increase the mean years of schooling and put safety and health education/training in school curricula. This will in turn reduce accidents at work and absenteeism caused by health problems; and yield increased productivity, higher quality of work, increased workforce morale and reduced employee turnover

Formation of Six Sigma Infrastructure for the Coronary Stenting Process

The purpose of this study is to show how a tertiary care center in Turkey operating mainly in cardiology initiated Six Sigma principles to reduce the number of complications occuring during coronary stent insertion process. A Six Sigma’s Define-Measure-Analyze-Improve-Control (DMAIC) model for coronary stent insertion is suggested. Data were collected for 24-months. Twenty-two Critical-to-Quality (CTQ) factors were identified for successful coronary stent insertion. The most frequent causes of complications in the process were found to be patients with previous bypass surgery or PCI, inexperience of staff members, highly damaged vessel structure, thin and/or long vessel diameter, inappropriate selection of stent type, inappropriate selection of balloon type and poor image quality

Penetran Keratoplasti Cerrahisinde Ameliyat Sonu Komplikasyonların Altı Sigma İle Eliminasyonu

Bu çalışmanın amacı, bir Türk kamu göz ve araştırma hastanesinde, penetran keratoplasti (PKP) cerrahisinde ameliyat sonunda oluşan komplikasyon sayısının Altı Sigma vasıtasıyla nasıl azaltıldığını göstermek. Çalışmanın metodunda veriler dokuz yıl boyunca toplanmıştır. Penetran keratoplasti ameliyatı geçirmiş 55 hastada (59 gözde) oluşan ameliyat sonu komplikasyonların analizinde, Altı Sigma'nın Tanımlama-Ölçü-Analiz-Geliştirme-Kontrol (TÖAGK) iyileştirme döngüsünün temel araçları olan KGSÇM tablosu, Hata Modu ve Etki Analizi (HMEA) uygulanmıştır. On bir tip komplikasyon, kaynak ve kök sebepleri ile tespit ve rapor edilmiştir. Çalışma da göz cerrahın tecrübesi, hastanın göz anatomisi ve vericinin korneası ve cihazın performansı başarılı bir penetran keratoplasti ameliyat için Kritik Kalite faktörleri olduğu tespit edilmiştir. En sık görülen ve en yüksek zarar skorlu komplikasyonun ise göz tansiyonu olduğu saptanmıştır. Sürecin sigma seviyesinin 3,1418 olduğu ölçülmüştür. Cerrahi ekip, tüm komplikasyonlarda önemli ölçüde gerekli önlemlerin alınarak, seviyelerinin azaltılması gerektiği sonucuna varmıştır

Development of Six Sigma Infrastructure for Strabismus Surgeries

The purpose of this study is to show how a private eye care center in Turkey developed a Six Sigma infrastructure to investigate the root causes of complications occuring during strabismus surgeries. To analyze the collected data, main tools of Six Sigma’s Define-Measure-Analyze-Improve- Control (DMAIC) improvement cycle such as SIPOC table, Fishbone Diagram and, Failure, Mode and Effect Analysis were implemented. Patient’s eye anatomy, experience of the anesthesiologist, experience/attention of the strabismus surgeon was identified to be Critical-to-Quality (CTQ) factors for a successful strabismus surgery. The most frequent complications of strabismus surgeries were found to be X, Y and Z. The process sigma level was found to be 3.2025

Adoption of Six Sigma’s DMAIC to Reduce Complications in IntraLase Surgeries

Abstract: Purpose: To show how a private eye care center in Turkey initiated Six Sigma principles to reduce the number of complications encountered during and after femtosecond laser-assisted LASIK (IntraLase) surgeries. Method: Data were collected for five years. To analyse the complications among 448 surgeries, main tools of Six Sigma’s Define-Measure-Analyze-Improve-Control (DMAIC) improvement cycle such as SIPOC table, Fishbone Diagram and, Failure, Mode and Effect Analysis were implemented. Sources and root causes of seventeen types of complications were identified and reported. Results: For a successful IntraLase surgery, experience of the refractive surgeon, patient’s anatomy and calibration of laser power were determined to be the “critical few” factors whereas, patient’s psychology, sterilization and hygiene, and suction-ring’s pressure were found to be the “trivial many” factors. The most frequently occurring complication was found to be subconjunctival haemorrhage. Conclusion: The process sigma level of the process was measured to be 3.3547. The surgical team concluded that sixteen complications (out of seventeen) should be significantly reduced by taking the necessary preventive measures

Frontotemporal dementia patient with bipolar disorder

Introduction A diagnosis of frontotemporal dementia may be delayed or missed because early symptoms may develop gradually and can mimic symptoms of a variety of disorders or conditions. We aimed to write a report on a patient with frontotemporal dementia with bipolar disorder. Case report This is the case of a 63-year-old man with frontotemporal dementia whose presentation was consistent with bipolar affective disorder. With brain imaging and neurocognitive testing, frontotemporal dementia was diagnosed. Conclusion A differential diagnosis between bipolar disorder and frontotemporal dementia is difficult to establish. Frontotemporal dementia is a heterogeneous disease with a large variety of cognitive dysfunctions

Development of a Six Sigma Infrastructure for Cataract Surgery in Patients with Pseudoexfoliation Syndrome

The aim of this study is to show how an eye clinic of a Turkish public hospital initiated Six Sigma principles to reduce the number of complications encountered during and after cataract surgeries in patients with pseudoexfoliation (PEX) syndrome. Data were collected for three years. To analyse the process, main tools of Six* Sigma’s* DefineZ MeasureZAnalyzeZImproveZControl (DMAIC) improvement cycle such as SIPOC table, Fishbone Diagram and, Failure, Mode and Effect Analysis were implemented. Sources and root causes of ten types of complications were identified and reported. Experience of the refractive surgeon, patient’s anatomy, cooperation of patient during the surgery, sterilization and hygiene, attention of assistant surgeon, calibration of equipment and quality/chemical composition of intraocular material were identified to be CriticalZtoZ Quality (CTQ) factors for a successful surgery. The most frequently occurring complication was found to be posterior capsule rupture. The overall process sigma level for 3 years was measured to be 3.703. The surgical team concluded that all complications should be significantly reduced by taking the necessary preventative measures

Deployment of Six Sigma Methodology to Reduce Complications in Intravitreal Injections

The purpose of this study is to show how a private eye care center in Turkey initiated Six Sigma principles to reduce the number of complications encountered during and after intravitreal injections. Data were collected for 30-months. To analyse the complications among 229 injections administered on 106 patients, main tools of Six Sigma’s Define-Measure-Analyze-Improve-Control (DMAIC) improvement cycle such as SIPOC table, Fishbone Diagram and, Failure, Mode and Effect Analysis were implemented. Sources and root causes of seven types of complications were identified and reported. For a successful intravitreal injection, experience of the retina specialist, attention of the retina specialist and patient’s ocular pathology were determined to be the “critical few” factors whereas, sterilization and hygiene, dosage of drug/agent and chemical properties of drug/agent were found to be the “trivial many”factors. The most frequently occuring and the complication with the highest hazard score was found to be subconjunctival haemorrhage. The process sigma level of the process was measured to be 3.2657. The surgical team concluded that six of the complications (out of seven) should be significantly reduced by taking the necessary preventative measures

Diminishing Complications in Continuous Ambulatory Peritoneal Dialysis Process via Six Sigma Methodology

The aim of this paper is to investigate the complications which occurred in a dialysis polyclinic during and after CAPD process and evaluate them in terms of their root causes, severity, sigma levels and hazard scores. The data are collected from 24 patients over a 12-month period. Seventeen complications are determined. Six Sigma’s DMAIC, SIPOC table, Fishbone diagram and FMEA are employed to evaluate the overall process. Vital few CTQ factors are determined to be patient’s compliance to hygiene and presence of comorbid diseases such as diabetes, cardiovascular problems and obesity. Consequently, corrective actions are proposed for preventing the occurrence of the complications