Destination management: Right or wrong measures

Planning studies are important for the competitiveness of destinations and their actions with the principles of sustainability. Kuşadası and Didim, which have been among the most important mass tourism destinations in Turkey since 1960, have also long experienced common problems such as lack of coordination, environmental and infrastructural problems, and a lack of an integrated destination approach. Although a series of initiatives have been attempted to solve these problems—with a series of initiatives and good intentions—these initiatives have ultimately failed to achieve their outcomes. The current study aims to present the problems faced with destination management in both destinations. Specifically, it explains the whole process of destination management, including an attempt to guide and play a mediating role for stakeholders through a participatory approach. Therefore, revealing salient problems experienced in both destinations and preparing action plans for the solution of these problems are possible. The research is based on qualitative data from key stakeholders and opinion leaders. The process of data collection took almost two years, including one kick-off meeting, four workshops, and five mini-meetings. In addition, seven in-depth interviews were carried out to follow up on the outcomes. Although common problems such as lack of cooperation, coordination, budget, qualified workforce, infrastructure, and promotion have been identified, establishing a coordination platform and preparing action plans seems to remain remote. Therefore, despite all efforts, attempts at management planning may be regarded as an example of destination management failure

Tourismes, patrimoines, identités, territoires

L’approche des tourismes présentée dans cet ouvrage qui recueille les communications des participants au colloque Tourismes Patrimoines Identités et Territoires, organisé par l’Université de Perpignan Via Domitia, fait une large place aux facteurs humains souvent négligés au profit d’un raisonnement réduit à l’économie. Les territoires y sont pensés comme des espaces dotés d’identités que les patrimoines illustrent et les coprésences liées aux tourismes permettent en remettant souvent en cause le mythe d’autochtonie ou le « noble mensonge » de Socrate c’est à dire la croyance des « dirigeants eux-mêmes et (des) militaires, ensuite (du) reste de la cité, qu’ils avaient été modelés sous la terre et qu’une fois que leur fabrication avait été terminée, la terre, qui est leur mère, les avait mis au monde ; et qu’à présent ils doivent délibérer au sujet du pays où ils sont, et le défendre contre quiconque l’attaque, comme si c’était là leur mère et leur nourrice, et penser aux citoyens comme à des frères nés comme eux de la terre ». Ils apparaissent comme un compromis entre un aspect affectif et un aspect rationnel : tout à la fois espaces fonctionnels, et lieux de pouvoir. L’ouvrage s’adresse aux étudiants des différentes filières de formation aux métiers du tourisme et à l’ensemble des acteurs du secteur touristique soucieux de développement durable, respectueux des identités et des patrimoines

Treatment delays and in-hospital outcomes in acute myocardial infarction during the COVID-19 pandemic: A nationwide study

© 2020 by Turkish Society of Cardiology.Objective: Delayed admission of myocardial infarction (MI) patients is an important prognostic factor. In the present nationwide registry (TURKMI-2), we evaluated the treatment delays and outcomes of patients with acute MI during the Covid-19 pandemic and compaired with a recent pre-pandemic registry (TURKMI-1). Methods: The pandemic and pre-pandemic studies were conducted prospectively as 15-day snapshot registries in the same 48 centers. The inclusion criteria for both registries were aged ≥18 years and a final diagnosis of acute MI (AMI) with positive troponin levels. The only difference between the 2 registries was that the pre-pandemic (TURKMI-1) registry (n=1872) included only patients presenting within the first 48 hours after symptom-onset. TURKMI-2 enrolled all consecutive patients (n=1113) presenting with AMI during the pandemic period. Results: A comparison of the patients with acute MI presenting within the 48-hour of symptom-onset in the pre-pandemic and pandemic registries revealed an overall 47.1% decrease in acute MI admissions during the pandemic. Median time from symptom-onset to hospital-arrival increased from 150 min to 185 min in patients with ST elevation MI (STEMI) and 295 min to 419 min in patients presenting with non-STEMI (NSTEMI) (p-values <0.001). Door-to-balloon time was similar in the two periods (37 vs. 40 min, p=0.448). In the pandemic period, percutaneous coronary intervention (PCI) decreased, especially in the NSTEMI group (60.3% vs. 47.4% in NSTEMI, p<0.001; 94.8% vs. 91.1% in STEMI, p=0.013) but the decrease was not significant in STEMI patients admitted within 12 hours of symptom-onset (94.9% vs. 92.1%; p=0.075). In-hospital major adverse cardiac events (MACE) were significantly increased during the pandemic period [4.8% vs. 8.9%; p<0.001; age- and sex-adjusted Odds ratio (95% CI) 1.96 (1.20-3.22) for NSTEMI, p=0.007; and 2.08 (1.38-3.13) for STEMI, p<0.001]. Conclusion: The present comparison of 2 nationwide registries showed a significant delay in treatment of patients presenting with acute MI during the COVID-19 pandemic. Although PCI was performed in a timely fashion, an increase in treatment delay might be responsible for the increased risk of MACE. Public education and establishing COVID-free hospitals are necessary to overcome patients' fear of using healthcare services and mitigate the potential complications of AMI during the pandemic