Health transformation project and defensive medicine practice among neurosurgeons in Turkey.

The term "Defensive" medicine was coined in the early 1970's and has been an important topic of scientific investigation and professional debate ever since.The aim of this study was to investigate the characteristics of defensive medicine, its reasons, and the extent to which it is practiced in the Turkish health care system. This is the first national survey to study the practice of defensive medicine among neurosurgeons in Turkey.The present cross-sectional study on defensive medicine assessed neurosurgeons registered at the Turkish Neurosurgical Society, who are actively working in various centers and hospitals within the Turkish health care system. A 40-question survey was adapted from existing measures described in the literature and was completed by a total of 404 neurosurgeons, representing 36.7% of the neurosurgeons registered at the Turkish Neurosurgical Society.Seventy-two percent of the participants in the current study reported practicing defensive medicine. This practice was mainly reported among inexperienced neurosurgeons (74.4%). Most were younger than 40 years of age (75.2%), working in state hospitals/universities (72.7%), and living in the Marmara region (38%). Respondents reported engaging in defensive medicine by avoiding high-risk surgery (62.6%), ordering additional imaging studies (60.9%) and laboratory tests (33.7%), and referring patients to consultants (31.2%). Most participants consider every patient as a potential threat in terms of a medical lawsuit (68.3%) and do not believe the courts can distinguish malpractice from complications (89.6%).Concerns and perceptions about medical liability lead neurosurgeons to practice defensive medicine. By avoiding high-risk surgery, ordering unnecessary diagnostic tests, and referring the patients to consultants, neurosurgeons try to minimize the risk of malpractice and protect themselves from legal risks, resulting in higher healthcare expenditure and longer treatment periods

Machine learning prediction of Gleason grade group upgrade between in-bore biopsy and radical prostatectomy pathology

Abstract This study aimed to enhance the accuracy of Gleason grade group (GG) upgrade prediction in prostate cancer (PCa) patients who underwent MRI-guided in-bore biopsy (MRGB) and radical prostatectomy (RP) through a combined analysis of prebiopsy and MRGB clinical data. A retrospective analysis of 95 patients with prostate cancer diagnosed by MRGB was conducted where all patients had undergone RP. Among the patients, 64.2% had consistent GG results between in-bore biopsies and RP, whereas 28.4% had upgraded and 7.4% had downgraded results. GG1 biopsy results, lower biopsy core count, and fewer positive cores were correlated with upgrades in the entire patient group. In patients with $$\hbox {GG}>1$$ GG > 1 , larger tumor sizes and fewer biopsy cores were associated with upgrades. By integrating MRGB data with prebiopsy clinical data, machine learning (ML) models achieved 85.6% accuracy in predicting upgrades, surpassing the 64.2% baseline from MRGB alone. ML analysis also highlighted the value of the minimum apparent diffusion coefficient ( $$\hbox {ADC}_{\text{min}}$$ ADC min ) for $$\hbox {GG}>1$$ GG > 1 patients. Incorporation of MRGB results with tumor size, $$\hbox {ADC}_{\text{min}}$$ ADC min value, number of biopsy cores, positive core count, and Gleason grade can be useful to predict GG upgrade at final pathology and guide patient selection for active surveillance

Distribution of the participants based on the malpractice premiums.

<p>Distribution of the participants based on the malpractice premiums.</p

Distribution of the respondents according to their area of interest.

<p>Distribution of the respondents according to their area of interest.</p

Distribution of the respondents according to number of operation per year.

<p>Distribution of the respondents according to number of operation per year.</p

Defensive medicine practices among the respondents.

<p>Defensive medicine practices among the respondents.</p

Perceptions of the neurosurgeons who participated this survey.

<p>Perceptions of the neurosurgeons who participated this survey.</p

Identification of an AFLP marker linked with yellow rust resistance in wheat (Triticum aestivum L.)

An important application of molecular markers in plant systems involves improvement in the efficiency of conventional plant breeding by carrying out indirect selection through molecular markers linked to the traits of interest. AFLP analysis was used to identify molecular markers associated with yellow rust resistance in wheat (Triticum aestivum L.) in this study. DNA isolated from the selected yellow rust tolerant and susceptible F 2 individuals derived from a cross between Izgi2001 (resistant) and ES14 (susceptible) at seedling and adult stage was used for bulked segregant analysis combined with AFLP. From the screening of 34 PstI/MseI AFLP primer combinations, the AFLP marker P-GAC/M-ACG (133 bp) was identified and presented in the resistant parent and resistant F 2 individuals but not in the susceptible ones. Future research will obtain more adjacent sequences associated with the polymorphic M-ACG/P-GAC (133bp) marker by the PCR walking method to design SCAR markers for wheat breeding programs