Czynnościowe efekty usunięcia polipropylenowej taśmy podcewkowej z powodu jej odsłonięcia/wystawania: czy prowadzi to do nawrotu nietrzymania moczu?

Objectives The Burch colposuspension, which was regarded as the gold standard treatment for stress urinary incontinence for several years, has been replaced by minimally invasive sling devices. Although these procedures are simple and minimally invasive, they are associated with complications such as infection, mesh erosion, chronic pain, and de novo detrusor overactivity, which may necessitate surgical resection or tape removal.The aim of the study was to assess urinary function outcomes including continence, after partial resection of suburethral tapes. Material and methods Patients were admitted for resection of tape due to extrusion/exposure , between 2011 and 2014.Patients were evaluated with physical examination, transvaginal ultrasound, cough stress test, 24-hour bladder diary, Incontinence Impact Questionnairre-7 form and Urogenital Distress Inventory-6 form. Results Minimum followup time was 2 months after treatment of the tape complication (mean 20, range 2 to 38).Recurrence of incontinence after partial tape resection was observed in 9% (3/32) cases.In two patients due to stress urinary incontinence recurrence repeat anti-incontinence surgery was necessary.Although one patient had suffered from incontinence after resection of tape, she did not desire operation. Conclusions The results of this study indicated that preservation of the anti-incontinence effects of slings might not be dependent on the intactness of the sling.Recurrence of incontinence after partial tape resection is uncommon and in the majority of cases this stress incontinence is minimally and does not require repeat operation.Cel: Operacja Burcha uważana dotąd za złoty standard w leczeniu wysiłkowego nietrzymania moczu, została zastąpiona przez małoinwazyjne zabiegi slingowe. Chociaż procedury te są proste i małoinwazyjne, to wiążą się z powikłaniami, takimi jak: zakażenie, erozja taśmy, przewlekły ból, pęcherz nadreaktywny, które mogą wymagać chirurgicznego wycięcia lub usunięcia taśmy. Celem badania była ocena trzymania moczu po częściowej resekcji taśmy podcewkowej. Materiał i metoda: Do analizy włączono pacjentki, które pomiędzy 2011 a 2014 rokiem zostały przyjęte do szpitala celem usunięcia taśmy z powodu jej obnażenia lub wystawania. U pacjentek wykonano badanie fizykalne, USG przezpochwowe, test kaszlowy, 24-godzinny dzienniczek mikcyjny oraz kwestionariusze: Incontinence Impact Questionnairre-7 i Urogenital Distress Inventory-6. Wyniki: Najkrótszy czas obserwacji po operacji naprawczej z powodu powikłań wynosił 2 miesiące (średnio 20, zakres 2 do 38). Nawrót nietrzymania moczu po częściowym usunięciu taśmy obserwowano w 9% przypadków (3/32). U dwóch pacjentek z powodu nawrotu nietrzymania moczu konieczna była ponowna chirurgiczna interwencja. Jedna pacjentka mimo nawrotu dolegliwości po usunięciu taśmy, nie zdecydowała się na ponowną operację. Wnioski: Wyniki naszego badania pokazują, że utrzymywanie się efektu założenia taśmy w postaci trzymania moczu, nawet po jej usunięciu, może nie być uzależnione od nienaruszalności taśmy. Nawrót nietrzymania moczu po częściowym usunięciu taśmy występuje rzadko, jest minimalny i w większości przypadków nie wymaga ponownej operacji

Güneydoğu Anadolu Bölgesindeki Bir Özel Hastanede Hasta Güvenliği Kültürü

ÖZCAN, Taner Hasan. Culture of Patient Safety in a Private Hospital in Southeastern Anatolia, Postgraduate Thesis, Ankara, 2018. By assuming that people can make mistakes, the conditions under which people work can be changed and improved in order to avoid mistakes. The measurement of the patient safety culture of workers is the first thing that must be done for patient safety culture to be adopted and developed in health institutions. In this study, it was aimed to determine the attitudes and patient safety culture of all employees about patient safety in a private hospital in Southeastern Anatolia. Another aim of this study was to assess the attitudes and cultures of all employees according to sociodemographic and professional characteristics. The survey aimed to reach the entire population (340 people), and 284 people were reached (participation rate of 84%). The Safety Attitudes Questionnaire (SAQ) developed by Sexton et al. (2006) was used as a data collection tool. SQA is in 5 Likert type, consists of 30 articles and 6 dimensions. In the study, the Cronbach alpha values of the dimensions were found to be reliable between 0.69-0.88. The coefficients of relationship between the dimensions except for the stress acceptance dimension are moderate and strong (0.62-0.76); however, the coefficients of correlation between stress acceptance dimension and other dimensions are very low and weak (0,19-0,32). While the “I like my job” statement of the SQA has the highest mean (4.55 ± 0.99) and participation rate (88.4%); “Excessive fatigue during emergency situations (eg. emergency resuscitation, bleeding) disrupts my performance” has been the statement to have the lowest mean (2.93 ± 1.54) and participation rate (43%). The dimension of the SQA with the highest mean is "job satisfaction" (4,04 ± 1,04), while the lowest is "acceptance of stress (3,25 ± 1,25)". The mean of other dimensions (working conditions [3,59 ± 1,14], management perceptions [3,57 ± 1,09], safety climate [3,49 ± 0,88], teamwork climate [3,54 ± 0 , 92]) are close to each other. In the study, generally female, age ≤29, education level high school and university, position nurse, interacting with patients, working hours daytime-night, hospital work period ≥11 months, professional work period 13-72 months or ≥73 months groups were found to have a more negative patient safety culture than the other groups. At the end of the study; suggestions were made to investigate why the perception of patient safety culture is low, to improve patient safety, to measure employees' attitudes and cultures of patient safety at certain intervals in these groups.KABUL VE ONAY i BİLDİRİM ii YAYIMLAMA VE FİKRİ MÜLKİYET HAKLARI BEYANI iii ETİK BEYAN iv TEŞEKKÜR v ÖZET vi ABSTRACT vii İÇİNDEKİLER viii SİMGELER VE KISALTMALAR DİZİNİ x ŞEKİLLER LİSTESİ xii GİRİŞ 1 I. BÖLÜM: HASTA GÜVENLİĞİ KÜLTÜRÜ 3 1.1. KÜLTÜR KAVRAMI 3 1.2. GÜVENLİK KÜLTÜRÜ KAVRAMI 4 1.3. HASTA GÜVENLİĞİ KAVRAMI VE TIBBİ HATALAR 6 1.4. HASTA GÜVENLİĞİ KÜLTÜRÜ KAVRAMI 13 1.5. HASTA GÜVENLİĞİ KÜLTÜRÜNÜN OLUŞTURULMASI 14 1.6. DÜNYADA HASTA GÜVENLİĞİ KÜLTÜRÜ 17 1.7. TÜRKİYE’DE HASTA GÜVENLİĞİ KÜLTÜRÜ 21 1.8. HASTA GÜVENLİĞİ KÜLTÜRÜNÜN DEĞERLENDİRİLMESİ 30 2. BÖLÜM: GEREÇ VE YÖNTEM 33 2.1. ARAŞTIRMANIN AMACI 33 2.2. PROBLEM CÜMLESİ 33 2.3. EVREN VE ÖRNEKLEM 33 2.4. SINIRLILIKLAR 34 2.5. VERİ TOPLAMA ARACI 34 2.6. VERİLERİN TOPLANMASI 38 2.7. VERİLERİN ANALİZİ 39 2.7.1. Bağımlı Değişkenler 40 2.7.2. Bağımsız Değişkenler 40 3. BÖLÜM: BULGULAR 41 3.1. HASTANE PERSONELİNE İLİŞKİN TANIMLAYICI BULGULAR 41 3.2. GÜVENLİK TUTUMLARI ANKETİNE İLİŞKİN TANIMLAYICI BULGULAR 43 3.3. GÜVENLİK TUTUMLARI ANKETİNİN BOYUTLARININ DEĞERLENDİRİLMESİ 47 3.3.1. Ekip Çalışmasi İklimi Boyutunun Değerlendirilmesi 47 3.3.2. Güvenlik İklimi Boyutunun Değerlendirilmesi 50 3.3.3. İş Doyumu Boyutunun Değerlendirilmesi 54 3.3.4. Stresin Kabulü Boyutunun Değerlendirilmesi 57 3.3.5. Yönetime İlişkin Algılar Boyutunun Değerlendirilmesi 60 3.3.6. Çalışma Koşulları Boyutunun Değerlendirilmesi 63 3.4. GÜVENLİK TUTUMLARI ANKETİ BOYUT ORTALAMALARININ DEĞERLENDİRİLMESİ 66 3.5. GÜVENLİK TUTUMLARI ANKETİNİN BOYUTLARI ARASINDAKİ İLİŞKİLER 78 4. BÖLÜM: TARTIŞMA 80 5. BÖLÜM: SONUÇ ve ÖNERİLER 95 KAYNAKÇA 99 EK 1. ANKET FORMU 108 EK 2. TEZ ORİJİNALLİK RAPORU 110ÖZCAN, Taner Hasan. Güneydoğu Anadolu Bölgesindeki Bir Özel Hastanede Hasta Güvenliği Kültürü, Yüksek Lisans Tezi, Ankara, 2018. İnsanın hata yapabileceği varsayımından yola çıkarak, hatanın olmaması için insanların çalıştığı koşullar değiştirilebilir ve geliştirilebilir. Sağlık kuruluşlarında hasta güvenliği kültürünün yerleştirilmesi ve geliştirilmesi için yapılacakların başında çalışanların hasta güvenliği kültürünün ölçülmesi gelmektedir. Bu araştırmada, Güneydoğu Anadolu Bölgesindeki özel bir hastanede tüm çalışanların hasta güvenliği ile ilgili tutumlarını ve buna bağlı olarak hasta güvenliği kültürünü belirlemek amaçlanmıştır. Çalışanların, hasta güvenliği ile ilgili tutumlarının ve kültürünün soyodemografik ve mesleki özelliklerine göre değerlendirilmesi bu araştırmanın diğer bir amacıdır. Araştırmada tüm everene (340 kişi) ulaşmak hedeflenmiş, 284 kişiye (katılım oranı %84) ulaşılmıştır. Veri toplama aracı olarak Sexton ve diğerleri (2006) tarafından geliştirilen Güvenlik Tutumları Anketi (GTA) kullanılmıştır. GTA, 5’li Likert tipindedir, 30 madde ve 6 boyuttan oluşmaktadır. Çalışmada, boyutların Cronbach alpha değerleri 0,69-0,88 arasında güvenilir düzeyde bulunmuştur. Stresin kabulü boyutu hariç diğer boyutlar arasındaki ilişki katsayıları orta düzeyde ve kuvvetli (0,62-0,76); stresin kabulü boyutu ile diğer boyutlar arasındaki ilişki katsayıları ise çok düşük ve zayıftır (0,19-0,32). GTA’daki ifadelerden “İşimi severim.” en yüksek ortalama (4,55±0,99) ve katılma oranına (%88,4) sahipken; “Acil durumlar (örneğin, acil resüsitasyonlar/ canlandırmalar, kanamalar) sırasında aşırı yorgunluk performansımı bozar.” en düşük ortalama (2,93±1,54) ve katılma oranına (%43) sahip ifade olmuştur. GTA’nın boyutlarından ortalaması en yüksek boyut “iş doyumu (4,04±1,04)” iken, ortalaması en düşük boyut “stresin kabulü (3,25±1,25)” boyutudur. Diğer boyutların ortalamaları (çalışma koşulları [3,59±1,14]; yönetime ilişkin algılar [3,57±1,09]; güvenlik iklimi [3,49±0,88]; ekip çalışması iklimi [3,54±0,92]) ise birbirine yakındır. Çalışmada genel olarak cinsiyeti kadın, yaşı ≤29, eğitim düzeyi lise ve üniversite, pozisyonu hemşire, hastalarla etkileşim içinde olan, çalışma saatleri gündüz-gece, hastanede çalışma süresi ≥11 ay, meslekte çalışma süresi 13-72 ay veya ≥73 ay olan grupların hasta güvenliği kültürü algısı, diğer gruplara göre daha olumsuz bulunmuştur. Çalışmanın sonucunda; bu gruplarda hasta güvenliği kültürü algısının neden düşük olduğunun araştırılması, hasta güvenliğinin iyileştirilmesi, çalışanların belirli aralıklarla hasta güvenliği ile ilgili tutumlarının ve kültürünün ölçülmesi yönünde önerilerde bulunulmuştur

A new Teucrium L. (Lamiaceae) Species from South Anatolia (Turkey)

WOS:000672827500008In this study, a member of sect. Teucrium, hitherto undescribed as a new species, was analyzed based on morphological and micromorphological features and molecular findings. The closest species of the new species were defined according to leaf morphology via morphological characters. Leaf, stem, and nutlet trichome types were obtained and compared with resembling species. Moreover, two different DNA region sequences were used to evaluate its proper phylogenetic position in the section. The new species was described as Teucrium turcicum Cecen & Ozcan based on the results of using different approaches. According to our observations, flower color, leaf structure, and shape were the main distinctive morphological characters, leaf and nutlet trichomes were separative and informative, and nrITS DNA data had more informative characters than chloroplast DNA region data (trnL-F and rpl32) to determine phylogenetic relationship of the new species and its close relatives in sect. Teucrium

Investigation of surface mophology and integrity in multi axis abrasive waterjet machining (AWJM)

Abrasive particle embedment leads to surface issues in AWJM, which may require further surface treatment, delamination in composites and decrease in fatigue life of metals are major consequences. In this paper, abrasive particle embedment and morphological effects after AWJM of Al6061-T6 are investigated experimentally. It is observed that increase in feed rate, lead and tilt angles reduces waviness. It is also seen that distance between two valleys in cross feed direction is equal to two times step length if step length is given lower than nozzle diameter. It is found that embedded grits are much lower than the average abrasive sizes. Exothermic reaction was seen in some experiments, resulting in melt pools as observed in SEM and EDX

Experimental investigation on tool path patterns in controlled depth abrasive water jet machining

Abrasive waterjet machining (AWJM) is used for machining of difficult-to-cut materials, i.e. very soft or very hard, which may be problematic when conventional milling is used. Unlike potential benefits, AWJM is mostly used for 2D through thickness cutting purposes. Controlled depth milling with AWJ is relatively rare, which can be achieved by adjusting the feed rate. In this paper, tool path patterns, for extended use of AWJ in controlled depth is experimentally studied. It is aimed to identify tool path strategies to achieve even, smooth cut quality in terms of the removed material depth. So that, AWJM can be used in a milling manner for roughing purposes of difficult-to-cut materials

CELAL BAYAR ÜNİVERSİTESİ ÖĞRENCİLERİNİN ALKOL KULLANMA SIKLIĞI VE ALKOL KULLANIMINI ETKİLEYEN FAKTÖRLER

CELAL BAYAR ÜNİVERSİTESİ ÖĞRENCİLERİNDE ALKOL KULLANMA SIKLIĞI % 40.2 DİR (1995-1996

A new hybrid of Origanum (Lamiaceae) from the Aegean Island of Karpathos (Dodecanese, Greece): Origanum × karpathicum.

This study aims to describe a new hybrid of Origanum, which occurs on Karpathos (Greece), by examining its morphology and molecular structure. Nuclear ribosomal DNA (ITS) data of the alleged hybrid specimens, and its putative parents, O. onites and O. vetteri, were examined. Hybrid and parent individuals sharing the same location with the new hybrid from Karpathos and different specimens belonging to ancestral taxa from Turkey, were used for molecular analysis. According to molecular data, there are some polymorphic nucleotide regions showing the hybridization evidence between the new hybrid and its parents. Molecular results show that the new hybrid is more similar to O. vetteri. Also, the new hybrid has some intermediate morphological characteristics ranging between its parents. Consequently, it was deemed appropriate to present the studied putative hybrid to the scientific world as a new hybrid taxon