Litigation risk, auditor conservatism and an overview of Turkey characteristic

In case of the occurrence of uncertain situations regarding the future, the investor is expected to assume that he is in a risky situation and act in a rational way. In this way, the investor will have been prudent and protected his capital. Auditor Conservatism is an approach that aims to make a more conservative audit by foreseeing a high audit risk for the financial statement disclosures of the company audited and thus protect the capital, creditors and investors. It is a likely outcome for the investor to encounter with the litigation case due to the possible presence of revenue losses that may be experienced and negatively affect the investment decisions of the third parties who will use the tables on which the auditor will express an opinion. Therefore auditors will want to set a high degree of audit for possible inconsistencies and choose the secure option against the case risk in order to protect the reputation of himself and the audit company against the possibility of audit failure by displaying a conservative approach this study, the relationship between the litigation risk and the auditor's conservative approach will be examined and these concepts will be comparatively assessed in terms of the accounting audit procedures.peer-reviewe

The interrelations of radiologic findings and mechanical ventilation in community acquired pneumonia patients admitted to the intensive care unit: a multicentre retrospective study

BACKGROUND: We evaluated patients admitted to the intensive care units with the diagnosis of community acquired pneumonia (CAP) regarding initial radiographic findings. METHODS: A multicenter retrospective study was held. Chest x ray (CXR) and computerized tomography (CT) findings and also their associations with the need of ventilator support were evaluated. RESULTS: A total of 388 patients were enrolled. Consolidation was the main finding on CXR (89%) and CT (80%) examinations. Of all, 45% had multi-lobar involvement. Bilateral involvement was found in 40% and 44% on CXR and CT respectively. Abscesses and cavitations were rarely found. The highest correlation between CT and CXR findings was observed for interstitial involvement. More than 80% of patients needed ventilator support. Noninvasive mechanical ventilation (NIV) requirement was seen to be more common in those with multi-lobar involvement on CXR as 2.4-fold and consolidation on CT as 47-fold compared with those who do not have these findings. Invasive mechanical ventilation (IMV) need increased 8-fold in patients with multi-lobar involvement on CT. CONCLUSION: CXR and CT findings correlate up to a limit in terms of interstitial involvement but not in high percentages in other findings. CAP patients who are admitted to the ICU are severe cases frequently requiring ventilator support. Initial CT and CXR findings may indicate the need for ventilator support, but the assumed ongoing real practice is important and the value of radiologic evaluation beyond clinical findings to predict the mechanical ventilation need is subject for further evaluation with large patient series

Sex difference and intra-operative tidal volume: Insights from the LAS VEGAS study

BACKGROUND: One key element of lung-protective ventilation is the use of a low tidal volume (VT). A sex difference in use of low tidal volume ventilation (LTVV) has been described in critically ill ICU patients.OBJECTIVES: The aim of this study was to determine whether a sex difference in use of LTVV also exists in operating room patients, and if present what factors drive this difference.DESIGN, PATIENTS AND SETTING: This is a posthoc analysis of LAS VEGAS, a 1-week worldwide observational study in adults requiring intra-operative ventilation during general anaesthesia for surgery in 146 hospitals in 29 countries.MAIN OUTCOME MEASURES: Women and men were compared with respect to use of LTVV, defined as VT of 8 ml kg-1 or less predicted bodyweight (PBW). A VT was deemed 'default' if the set VT was a round number. A mediation analysis assessed which factors may explain the sex difference in use of LTVV during intra-operative ventilation.RESULTS: This analysis includes 9864 patients, of whom 5425 (55%) were women. A default VT was often set, both in women and men; mode VT was 500 ml. Median [IQR] VT was higher in women than in men (8.6 [7.7 to 9.6] vs. 7.6 [6.8 to 8.4] ml kg-1 PBW, P < 0.001). Compared with men, women were twice as likely not to receive LTVV [68.8 vs. 36.0%; relative risk ratio 2.1 (95% CI 1.9 to 2.1), P < 0.001]. In the mediation analysis, patients' height and actual body weight (ABW) explained 81 and 18% of the sex difference in use of LTVV, respectively; it was not explained by the use of a default VT.CONCLUSION: In this worldwide cohort of patients receiving intra-operative ventilation during general anaesthesia for surgery, women received a higher VT than men during intra-operative ventilation. The risk for a female not to receive LTVV during surgery was double that of males. Height and ABW were the two mediators of the sex difference in use of LTVV.TRIAL REGISTRATION: The study was registered at Clinicaltrials.gov, NCT01601223

[YouTube as an informational source for brachial plexus blocks: evaluation of content and educational value].

YouTube, the most popular video-sharing website, contains a significant number of medical videos including brachial plexus nerve blocks. Despite the widespread use of this platform as a medical information source, there is no regulation for the quality or content of the videos. The goals of this study are to evaluate the content of material on YouTube relevant to performance of brachial plexus nerve blocks and its quality as a visual digital information source

YouTube as an information source of spinal anesthesia, epidural anesthesia and combined spinal and epidural anesthesia

Introduction: Social media as YouTube have become a part of daily life and many studies evaluated health-related YouTube videos. Our aim was to evaluate videos available on YouTube for the conformity to textbook information and their sufficiency as a source for patient information. Material and method: A search of the YouTube website was performed using the keywords “spinal anesthesia, epidural anesthesia, combined spinal epidural anesthesia”. Firstly, 180 videos were evaluated and the characteristics of the video were noted, and the features of the video too were noted if the video was regarding neuraxial anesthesia. Questionnaire 1 (Q1) evaluating the video quality relating to neuraxial anesthesia was designed using a textbook as reference and questionnaire 2 (Q2) was designed for evaluating patient information. Results: After exclusions, 40 videos were included in the study. There was no difference in Q1 or Q2 scores when videos were grouped into 4 quarters according to their appearance order, time since upload or views to length rate (p > 0.05). There was no statistical difference between Q1 or Q2 scores for spinal, epidural or combined videos (p > 0.05). Videos prepared by a healthcare institute have a higher score in both Questionnaires 1 and 2 (10.87 ± 4.28 vs. 5.84 ± 2.90, p = 0.044 and 3.89 ± 5.43 vs. 1.19 ± 3.35, p = 0.01 respectively). Conclusion: Videos prepared by institutes, societies, etc. were of higher educational value, but were still very lacking. Videos should be prepared in adherence to available and up-to-date guidelines taking into consideration appropriate step by step explanation of each procedure, patient safety and frequently asked questions. Resumo: Introdução: As mídias sociais como o YouTube tornaram-se uma parte do cotidiano e muitos estudos avaliaram vídeos do YouTube relacionados à saúde. Nosso objetivo foi avaliar os vídeos disponíveis no YouTube para identificar a existência de conformidade com as informações em livros didáticos e sua suficiência como fonte de informação para o paciente. Material e método: Uma pesquisa no site YouTube foi realizada usando as palavras-chave spinal anesthesia, epidural anesthesia, combined spinal-epidural anesthesia (raquianestesia, anestesia peridural, anestesia combinada raqui peridural). Em primeiro lugar, avaliamos 180 vídeos e observando suas características e se eram referentes à anestesia neuraxial. O questionário de avaliação da qualidade do vídeo (Q1) relativa à anestesia neuraxial foi criado usando um livro didático como referência e o questionário 2 (Q2) foi criado para avaliar as informações ao paciente. Resultados: Após exclusões, 40 vídeos foram incluídos no estudo. Não houve diferença nos escores de Q1 ou Q2 quando os vídeos foram agrupados em quatro categorias de acordo com a ordem de aparecimento, tempo de upload ou taxa de tempo de visualização (p > 0,05). Não houve diferença estatística entre os escores de Q1 ou Q2 para os vídeos raquianestesia, peridural ou combinada (p > 0,05). Os vídeos preparados por um instituto de saúde obtiveram escores mais elevados em ambos Q1 e Q2 (10,87 ± 4,28 vs. 5,84 ± 2,90, p = 0,044 e 3,89 ± 5,43 vs. 1,19 ± 3,35, p = 0,01, respectivamente). Conclusão: Os vídeos elaborados por institutos, sociedades etc. apresentaram um valor educativo maior, mas ainda muito incompleto. Os vídeos devem ser preparados em conformidade com as diretrizes atualizadas e disponíveis, com explicações adequadas e detalhadas sobre cada procedimento, segurança do paciente e perguntas mais frequentes. Keywords: Youtube, Anesthesia, Spinal, Epidural, Palavras-chave: YouTube, Anestesia, Raquidiana, Peridura

YouTube as an informational source for brachial plexus blocks: evaluation of content and educational value

Background and objectives: YouTube, the most popular video-sharing website, contains a significant number of medical videos including brachial plexus nerve blocks. Despite the widespread use of this platform as a medical information source, there is no regulation for the quality or content of the videos. The goals of this study are to evaluate the content of material on You Tube relevant to performance of brachial plexus nerve blocks and its quality as a visual digital information source. Methods: The YouTube search was performed using keywords associated with brachial plexus nerve blocks and the final 86 videos out of 374 were included in the watch list. The assessors scored the videos separately according to the Questionnaires. Questionnaire-1 (Q1) was prepared according to the ASRA guidelines/Miller's Anesthesia as a reference text book, and Questionnaire-2 (Q2) was formulated using a modification of the criteria in Evaluation of Video Media Guidelines. Results: 72 ultrasound-guided and 14 nerve-stimulator guided block videos were evaluated. In Q1, for ultrasound-guided videos, the least scores were for Q1-5 (1.38) regarding the complications, and the greatest scores were for Q1-13 (3.30) regarding the sono-anatomic image. In videos with nerve stimulator, the lowest and the highest scores were given for Q1-7 (1.64) regarding the equipment and Q1-12 (3.60) regarding the explanation of muscle twitches respectively. In Q2, 65.3\% of ultrasound-guided and 42.8\% of blocks with nerve-stimulator had worse than satisfactory scores. Conclusions: The majority of the videos examined for this study lack the comprehensive approach necessary to safely guide someone seeking information about brachial plexus nerve blocks. (C) 2018 Published by Elsevier Editora Ltda. on behalf of Sociedade Brasileira de Anestesiologia

Inhibition of VEGF mediated corneal neovascularization by anti-angiogenic peptide nanofibers

Atypical angiogenesis is one of the major symptoms of severe eye diseases, including corneal neo-vascularization, and the complex nature of abnormal vascularization requires targeted methods with high biocompatibility. The targeting of VEGF is the most common approach for preventing angiogenesis, and the LPPR peptide sequence is known to strongly inhibit VEGF activity by binding to the VEGF receptor neuropilin-1. Here, the LPPR epitope is presented on a peptide amphiphile nanofiber system to benefit from multivalency and increase the anti-angiogenic function of the epitope. Peptide amphiphile nanofibers are especially useful for ocular delivery applications due to their ability to remain on the site of interest for extended periods of time, facilitating the long-term presentation of bioactive sequences. Consequently, the LPPR sequence was integrated into a self-assembled peptide amphiphile network to increase its efficiency in the prevention of neovascularization. Anti-angiogenic effects of the peptide nanofibers were investigated by using both in vitro and in vivo models. LPPR-PA nanofibers inhibited endothelial cell proliferation, tube formation, and migration to a greater extent than the soluble LPPR peptide in vitro. In addition, the LPPR-PA nanofiber system led to the prevention of vascular maturation and the regression of angiogenesis in a suture-induced corneal angiogenesis model. These results show that the anti-angiogenic activity exhibited by LPPR peptide nanofibers may be utilized as a promising approach for the treatment of corneal angiogenesis. (C) 2016 Elsevier Ltd. All rights reserved