Bir kamu hastanesinde yemekhane hizmet sürecinin iyileştirilmesi

Neredeyse tüm hastanelerin bilinen problemlerinden birisi, farklı düzeylerde de olsa, yemeklerin hastalara soğuk ulaşmasıdır. Problemin çözümü süreç iyileştirme kapsamında ele alınabilmektedir. Bu çalışmada, bir kamu hastanesinde daha önceden yapılmış bir anket sonucu ortaya çıkan bu sorun, süreç iyileştirme analizi yapılarak çözülmeye çalışılmakta, iyileştirme önerileri ortaya konmaktadır. Araştırmada, tanımlayıcı ve açıklayıcı bilgileri elde etmek için tarama modeli kullanılmıştır. DMAIC metodolojisi takip edilerek etki-neden analizleri yapılmış, yemek dağıtım süreleri gözlemlenmiştir. Yemek dağıtım sürelerini olumsuz etkileyen darboğazlar üzerinde durularak yemekhane servislerinin daha kısa sürede gerçekleştirilebilmesi için Hizmet Kalite Standartları da gözetilerek öneriler ortaya konmuştur.One of the common problems that exists at different levels in almost all of the hospitals, is serving the meals to patients cold. The problem could be solved by process improvement approach. In this study, the problem, which emerged as an outcome of a previously conducted survey, is to be solved in a public hospital and improvement suggestions are put forward. In the research, a scanning model is used in order to attain descriptive and explanatory information. Following the DEMAIC methodology, cause and effect analyses were conducted; times for meal serving were observed. Focusing on the bottlenecks that affect negatively the meal serving times, improvement suggestions were made to realize the serving time shorter by taking into account the Quality Service Standards

Prominent features of platelet count, plateletcrit, mean platelet volume and platelet distribution width in pulmonary tuberculosis

BACKGROUND: We aimed to investigate the relation of platelet count (PLT) and plateletcrit (PCT), mean platelet volume (MPV) and platelet distribution width (PDW) with other acute phase reactants and radiological extent in pulmonary tuberculosis (PTB). METHODS: One hundred patients with PTB (Group 1), 50 patients with community-acquired pneumonia (Group 2) and 28 healthy control individuals (Group 3) were included in this analytic study. RESULTS: WBC (White Blood Cell), ESR (Eritrocyte Sedimentation Rate), CRP (C-Reactive Protein), PLT and PCT values were both in Group 1 and Group 2 than in Group 3. PDW values were significantly higher in Group 1 than Group 3. WBC, ESR and CRP values were lower, while PLT and PCT values were higher in the Group 1 compared to Group 2 (p < 0.001). PLT was positively correlated with CRP and ESR values in the tuberculosis group (p < 0.001), while it was not correlated with CRP and ESR in the pneumonia group (p > 0.05). ESR, CRP, PLT and PCT values were found higher in radiological advanced stage (Stage 3) patients with PTB, while hemoglobin (Hb) was found lower (p < 0.05). Higher WBC, ESR, CRP and PCT values as well as radiological advanced stage were more common in PTB patients with thrombocytosis compared to the patients with normal platelet count, whereas Hb was found lower in these patients. CONCLUSIONS: This study indicates that reactive thrombocytosis and higher PCT and PDW develop frequently in PTB and there is a relation between thrombocytosis and acute phase reactants, that is the inflammatory response. In addition, tuberculosis with radiological advanced stage is seen more frequently in the patients with thrombocytosis and higher PCT, drawing attention to the possible role of platelets in the cell-based immune process of tuberculosis

Presence of biogenic amines in fish and fish products

Biyojen aminler hayvan, bitki ve mikroorganizmaların normal metabolizmasında rol alan düşük molekül ağırlıklı organik bazlardır. Genellikle serbest aminoasitlerin mikrobiyal enzimlerle dekarboksilasyonu sonucu oluşmaktadır. Bu bileşikler, insan ve hayvanlarda toksik etkiye sahip olabilmektedirler. Biyojen aminler, olgunlaştırma veya fermantasyon işlemleri ile üretilen çeşitli gıdalarda ve içeceklerde bulunmaktadır. Biyojen amin içeren gıdalar arasında balık ve balık ürünleri, et ürünleri, yumurta, peynir çeşitleri, fermente sebzeler ve soya fasulyesi ürünleri, bira ve şarap yer almaktadır. Biyojenik aminler kimyasal olarak alifatik (putresin, kadaverin, spermin, spermidin), aromatik (tiramin, feniletilamin) ve heterosiklik (histamin, triptamin) yapıda olabilirler. Balık kasında en sık bulunan aminler histamin, kadaverin ve putresindir. Bu derlemede, biyojenik aminlerin önemi ve bunların balık ve balık ürünlerinde oluşumu üzerinde durulmuştur.Biogenic amines are low molecular organic bases in normal metabolisms of animal, vegetable and microorganisms. These amines are formed by decarboxylation of free amino acids with microbial enzymes. These compounds can have toxic efffects in human and animal. Biogenic amines, produced by ripening or fermentation processes are in various foods and beverages. Biogenic amines such as fish, fish products, meat products, eggs, cheese, fermented vegetables, soy bean products, beer and wine are available. The chemical structure of bioljenik amines aliphatic (putrescine, cadaverine, spermine, spermidine), aromatic (tyramine, phenylethylamine) and heterocyclic (histamine, tryptamin) are vary. Most commonly amines are histamine, cadaverine and putresin in fish muscle. In this review, significance on the biogenic amines and the formation this amines of in fish and fish products were examined

Complementary and Alternative Medicine in Children with Type 1 Diabetes Mellitus

Objective: Complementary and alternative medicine (CAM) is increasingly utilized in adults and children for treatment of various conditions. Studies on CAM in diabetes have mainly focused on the adult population and its application in children has not been well established. The aim of this study was to examine the prevalence and characteristics of CAM use in Turkish children with type 1 diabetes mellitus (T1DM)

EFFECT OF CREATIVE DRAMA METHOD ON GEOMETRY TEACHING

Geometry holds an important place in the developmental process of mathematical thinking. When geometry is the subject in mathematics lessons, it is seen by students as an unlikeable and hard to understand. It is not easy to get students who come to school with this prejudice to like the lesson and explain it. Our aim in this research is to eliminate this prejudice using right teaching methods and make mathematics a lesson attended voluntarily and with pleasure by the students. With this aim in mind, the effect of creative drama method on students’ success for the 6th grade mathematics lesson, area of triangles subject has been researched. This study has been applied on 100 students enrolled in two different state secondary schools in Aegean Region in 2017-2018 teaching term. In this study, classes are divided into two groups as control group and experimental group and a success test designed by researchers on area of triangles subject is applied to students as pretest and final test. This test consists of 7 multiple choice and 3 open ended questions. Data obtained from the test is analyzed by statistical method. After the analysis, a meaningful difference in favor of experimental group has arisen. Based on the reviews made with the students, it is noticed that the interest of students to mathematics lesson has increased as a result of creative drama applications.  Article visualizations

Göreve Yeni Başlayan Ortaokul Matematik Öğretmenlerinin Öz Yansıtma Süreçleri

In this case study the aim is to examine the self-reflection processes (self-evaluation, causal attribution, emotional reactions and inferences) of novice mathematics teachers. The participants were six middle school (grades of 5-8) mathematics teachers who have less than five years teaching experience working in the Western and Central Anatolia Regions of Turkey. The data of the study were collected through the semi-structured interviews developed based on classroom observations. First, the instructional situations were determined by observing the mathematics lessons of the participants (approximately 10 hours for each participant). Afterwards, through semi-structured interviews, the participants were asked to reflect on these instructional situations. During the data analysis, first within case analyses were made, and the self-reflection of each teacher was described. Then by comparing the data obtained from six teachers, it was defined which self-reflection processes the novice mathematics teachers performed and to what extent they performed them. The findings suggest that the participants did not consider their teaching behaviors when they were asked to evaluate the lesson. They attributed the cause of the failure in their lessons to factors beyond their control (e.g., low involvement of parents, insufficient physical facilities of the school). In addition, it is observed that they were less likely to develop positive emotional responses for the observed lessons and were insufficient in taking adaptive decisions for their future lessons. These findings indicate the necessity of pre-service and in-service practices that will support newly recruited middle school mathematics teachers to gain much more comprehensive self-reflection skills.Bu durum çalışmasında göreve yeni başlayan ortaokul (5-8. sınıflar) matematik öğretmenlerinin öğretim faaliyetlerine ilişkin öz yansıtma süreçlerinin (öz değerlendirme, neden atfetme, duygusal tepki ve sonuç çıkarımı) incelenmesi amaçlanmıştır. Araştırmada, Türkiye’nin Batı ve İç Anadolu bölgelerinde görev yapmakta olan, meslek yaşamlarında ilk beş yılını doldurmamış altı ortaokul matematik öğretmeni ile çalışılmıştır. Araştırmanın verileri, sınıf içi gözlemlerden hareketle geliştirilmiş olan yarı yapılandırılmış görüşmeler aracılığıyla elde edilmiştir. Veri toplama sürecinde ilk olarak katılımcıların matematik dersleri (her bir katılımcı için yaklaşık 10 saat) gözlemlenerek öğretim durumları belirlenmiştir. Ardından gerçekleştirilen yarı yapılandırılmış görüşmelerle katılımcılardan tespit edilen öğretim durumları için öz yansıtmalar yapmaları istenmiştir. Analiz sürecinde ilk olarak durum içi analizler yapılmış ve her bir öğretmenin öz yansıtma faaliyetleri betimlenmiştir. Ardından altı öğretmenden elde edilen bulgular karşılaştırmalı olarak incelenerek göreve yeni başlayan ortaokul matematik öğretmenlerinin hangi öz yansıtma faaliyetlerini ne derece gerçekleştirdiği tanımlanmıştır. Bulgular, katılımcıların dersi değerlendirmeleri istendiğinde kendi öğretim davranışlarını dikkate almadıklarını göstermektedir. Derslerindeki başarısızlığı, kendi kontrolleri altında olmayan faktörlere (örneğin ebeveynlerin ilgisizliği, okulun fiziksel imkânlarının yetersizliği) atfetmişlerdir. Ayrıca gözlemlenen dersleri için ortaya koymuş oldukları olumlu duygusal tepkilerin ve sonraki dersleri için almış oldukları uyarlamacı (gelişimsel) kararların yetersiz olduğu gözlemlenmiştir. Bu bulgular, göreve yeni başlayan ortaokul matematik öğretmenlerinin öz yansıtma becerilerini kazanmalarını destekleyecek hizmet önceci ve hizmet için uygulamaların gerekliliğine işaret etmektedir

Bibliometric Analysis of The Last 40 Years of Chest Journal

Chest Journal, which began to be scanned in the Web of Science in 1980, is one of the leading journals in the field of Critical Care Medicine and Respiratory System (quartile 1). In this study, the research trends of the publications in the Chest Journal were examined using three different bibliometric analysis programs (Bibliometrix, VOSviewer, and CiteSpace) in the period between 1980-2019. Along with the main statistics, keyword co-occurrence network map, density document co-citation, time map, and burst (references) analysis were performed. According to the results of the analysis, the research trends of Chest Journal were subject to discussion. The countries with the most publications are America, Canada, the United Kingdom, France, and Japan. According to the Co-Occurrence network map analysis, Chest journal's publications consist of clusters of cellular structures, thoracic oncology, chest infection, pulmonary and cardiovascular, sleep and pulmonary function test, and obstructive lung diseases. The studies in the "COPD / Formoterol Metered Dose inhaler" and "Patients / VTE disease chest guideline" clusters were found to be the most recent studies. This article has the potential to provide a valuable reference for scientists to understand Chest Journal's research trends and to grasp current issues in the field

A Study Investigating the Perceived Service Quality Levels of Sport Center Members: A Kano Model Perspective

The purpose of this study is to investigate sport center members' perceived service quality levels with a view to Kano customer expectations and requirements model. To that end, a descriptive approach and a correlational research design featuring survey method is adopted. Research group consists of 680 (300 women, 380 men) sport center members who are chosed through multistage sampling (Cluster). “Sport Fitness Centers Perceived Service Quality Scale and Expectation Scale are used as data collection tools. Independent samples t-test, Pearson Correlation analysis and Multiple Linear Regression tests are used to analyzed the data. In the light of the findings, it is seen that all the subdimensions have medium or high level positive significant relationships with the expectation when the subdimensions of the expectation scale and the SFC-PSQS are compared.According to the results of the Independent Samples T-test, the expectation levels of the customers stating that the programme fee is expensive are significantly lower. In conclusion, as the customers’ perception of service quality in the sport center increases, their expectation levels also generally increase significantly. The customers expect that the quality of service they receive to be high and to meet their expectations exceedingly. However, it is also predicted that physical and psychosocial factors affecting the expectation can also affect the perception of service quality at a significant level. Since the service quality and meeting the expectations of the customers is an important indicator to maintain the businesses’ existence, studying with multiple factors attempting to understand the nature of service quality and the customer expectations should be conducted

Jejunoileal diverticulosis: a case report

Ince barsak divertikülleri çok nadirdir ve genellikle asemptomatiktir. Bu nedenle tanıları genellikle bizim hastamızda oldugu gibi ince barsak pasaj grafilerinde veya operasyonlarda tesadüfen konulmaktadır. Bulantıkusma, karın agrısı gibi nonspesifik semptomlar da olusturabilen bu divertiküller nadiren barsak tıkanması, gastrointestinal kanama,perforasyon, divertikülit gibi ciddi komplikasyonlara da neden olabilmektedirler.Ancak jejunoileal divertiküllerin yol açabilecegi nonspesifik semptomlar ve ciddi akut komplikasyonlar konusunda uyanık davranılması durumunda erken tanı konulabilir ve jejunoileal divertiküllere baglı morbidite ve mortalite oranları düsebilir Biz bu yazıda 5-6 yıldır devam eden kronik karın agrısı ve buna zaman zaman ilave olan ishal sikayetleri arastırılırken jejeunoileal divertikülleri saptanan bir olgu ile önemi yeterince bilinmeyen bir durumu gözden geçirdik.Small bowel diverticulosis are very rare and they are usually asemptomatic. Because of that, as it has been done in our case, they are mostly diagnosed with small bowel follow through examination or during the operation by chance. These diverticulosis which can cause nonspesific semptoms such as nausea and vomiting and abdominal pain and they not so common can cause serious complications such as diverticulitis, gastrointestinal bleeding, perforation, intestinal obstructions. In this article we discuss a case whose jejenoileal diverticulosis has been found while it has been searched for chronic diarrhea and abdominal pain. Only if we be aware about the nonspesific symptoms and acute severe complications jejunoileal diverticulosis can cause, it can be diagnosed early and also morbidity and the mortality ratios of jejenoileal diverticulosis can be reduced by this way. In this article ,we had a look at a case who had chronic abdominal pain attacks for 5-6 years and sometimes had diarrhea besides aching attacks. While case was searched for these symptoms, jejunoileal diverticulosis have been found which had an unknown importance before

Investigation of miR221 and miR222 as biomarkers in non-small cell lung cancer

Background/Aim: MicroRNAs (miRNA) are a class of small non-coding RNAs of 18-25 nucleotides, which regulate gene expression at the post-transcriptional level by disrupting or blocking translation of messenger RNA targets. Non-small cell lung cancer (NSCLC) represents approximately 85% of all lung cancers. Early and accurate diagnosis of the disease affects the probability of success of treatment. The purpose of this study was to investigate the expression levels of serum specific miRNA221 and miRNA222 as a biomarker in NSCLC. Materials and Methods: Thirty-two NSCLC cases and 30 healthy control cases that were diagnosed at Istanbul Yedikule Chest Diseases and Thoracic Surgery Training Hospital were included in this study. miRNAs were detected using miRNAspecific quantitative real-time-PCR. The relative expression of miRNAs was calculated using the 2-ccCt method. Results: miR221 and miR222 showed 1.46 and 1.63-fold higher expression in the samples from patients with NSCLC compared to controls, and the difference of expression was statistically significant for miR221 (p=0.000095) but not for miR222 (p=0.084470). In the presence of metastasis in NSCLC patients, miR221 levels were 2.33-fold higher compared to non-metastatic cases (p=0.014), and those of miR221 and miR222 were expressed 1.44 and 1.52-fold higher, respectively, in advanced stage compared to early stage (p=0.000387, p=0.000302). Conclusion: The levels of miR221 and miR222 in the serum of patients could be used as biomarkers for the diagnosis, treatment, and prognosis of NSCLC.Istanbul Universit