Dağıtılmış liderliğin iş stresi kapsamında hizmet kalitesine etkileri : İzmir Merkez Kamu Hastaneleri Örneği

xx, 188 sayfa : tablo, şekil29 cm. 1 CDÖZETKaliteli hizmet sunumu sağlık kurumlarının temel çıktısıdır ve etkililiğinin temelgöstergesidir. Bunun yanında, sağlık kurumları sunulan hizmetin özelliğinden dolayıstres faktörünü her süreçte içinde barındırmaktadır. Stres faktörlerinin çok ve etkiliolduğu bu kurumlarda liderlik faktörünün önemi büyük olabilir. Bu kapsamda daçalışmanın temel amacını, liderliğin iş stresi kapsamında hizmet kalitesi üzerindeetkisinin olup olmadığı oluşturmaktadır. Sağlık personelinin dağıtılmış liderlik, işstresi ve hizmet kalitesi algılarının değerlendirilmesi amacıyla gerçekleştirilen çalışmakesitsel türdedir. Araştırma, Nisan 2018 – Haziran 2018 tarihleri arasında İzmirmerkezde bulunan kamu hastanelerinden bir eğitim araştırma, bir genel ve bir de özeldal hastanesinde çalışan hekim, hemşire, idari ve diğer tüm personele anket yoluylagerçekleştirilmiştir. Toplam 407 sağlık personeli araştırmaya katılmıştır. Dağıtılmışliderlik, iş stresi ve hizmet kalitesi yönelik çalışanların algılarını belirlemeye yönelikoluşturulan anket ile elde edilen veriler istatistiksel olarak değerlendirilmiştir.ABSTRACTHigh quality service delivery is the foundation of healthcare institutions and isthe main indication of its effectiveness. In addition, because of the nature of thehealthcare service, the healthcare institutions contain stress factors in every processes. The leadership factor can be a significant effect in these organizations, which have many stress factors. In this context, the main purpose of the study is to determine the distributed leadership effects on service quality in terms of job stress. The study is a cross-sectional study, which is conducted to assess the healthcare worker’s perceptions of distributed leadership, work stress and quality of service. The research was carried out from April 2018 to June 2018 through a questionnaire survey, which is filled, by physicians, nurses, administrators and all other personnel from a public hospital in İzmir urban area. 407 healthcare personnel participated in the research. The data obtained by the questionnaire designed to determine employees' perceptions of distributed leadership, work stress and service quality

Syntactic and Prosodic Processing of Quantifier Ambiguity in Turkish

There is a robust debate on different linguistic levels of quantifier ambiguity resolution. Many accounts of the quantifier ambiguity are extensively examined in Turkish by semantic-prosodic and syntactic-semantic levels in previous studies. In this study, we aimed to investigate the prosodic and syntactic processes of the universal quantifier (her (‘every’) and existential quantifier bir (‘a/an’)) by using an on-line picture matching experiment with 75 young adults and native speakers of Turkish. Our stimuli consisted of 120 sentences (30×4) for each of the conditions with order (her–bir (‘every–a/an’) vs. bir–her ‘a/an–every’) × focus (subject position vs. object position), respectively. In each trial, participants were asked to listen to the auditory stimuli and to judge sentences they heard. Our findings showed that the focused existential quantifier bir (‘a/an’) assigned wider scope than the universal quantifier her (‘every’) for the judgment task rates. This finding suggested that participants preferred the collective reading both for the focused universal quantifier her (‘every’) and focused existential quantifier bir (‘a/an’). For reaction times (RTs), participants favored distributive reading since the reaction times were faster in distributive reading than collective reading. This study supported the previous claims that syntactic processing has an initial role in disambiguation between collective and distributive readings

Comparison of pediatric antibiotic prescribing practice between low and high prescribers for children in primary care

Background. Antibiotic prescribing is more prevalent in children. Many factors influence this practice, including the burden of outpatient visits. We aimed to compare antibiotic prescribing for children by low prescribers (LP) and high prescribers (HP) in primary care. Methods. We analyzed pediatric prescriptions in primary care in Istanbul. Among the physicians randomly selected by systematic sampling, those generating ≥1 pediatric prescription/day (n=1218) were defined as LP or HP when they belonged to the lowest (n=305) or highest (n=304) quartile of prescribing, respectively. The antibiotic prescribing characteristics of these groups were compared. Results. We identified that 38.5% of the prescriptions written by physicians included antibiotics, significantly higher in HPs (38.8%) than in LPs (37.2%), (p=0.04). Among antibiotic-containing prescriptions, the mean number of drugs and boxes and the percentage of prescriptions containing injectable drugs/antibiotics were significantly higher in HPs compared to that in LPs. We detected that co-amoxiclav was the most frequently prescribed antibiotic in the LP and HP groups (61.1% and 48.3%, respectively). Stratification of antibiotics by their spectra showed that 11.2% were narrow, 79.8% were broad and 0.5% were ultra-broad-spectrum drugs. LPs were significantly more likely to prescribe broad-spectrum antibiotics (82.5%) than do HPs (78.9%,p<0.001). Conclusions. Antibiotic prescribing remains excessive in pediatric primary care, slightly more marked in HPs. While HPs also tend to prescribe a higher number of overall and injectable drugs/antibiotics, broad-spectrum anti-biotherapy seems to be more practiced by LPs surprisingly. Both physician groups appeared to prefer either narrow-or broad-spectrum drugs without paying enough attention to their pharmacodynamic properties

Investigation of allergy management in primary care: Child vs. adult prescriptions

Objective: Allergic diseases are conditions that are frequently encountered in primary care, and different drug groups can be used in their treatment. This study aimed to compare the use of drugs in allergy in children and adults applied to primary care. Methods: We analyzed prescriptions written by those who were selected by systematic sampling (n=1431) among family physicians serving in İstanbul between January 1 and December 31, 2016. Among these, single-diagnosis prescriptions containing “T78.4-allergy, unspecified” were included in the study, and the prescriptions were divided into those written to children (<18 years old) and adults (≥18 years old). The demographic characteristics of the patients and drug details in the prescriptions were compared according to the groups. Results: A total of 37,042 prescriptions with a single diagnosis of allergy were identified, and 55.9% of which were for adults. Allergy diagnosis was higher in men (52.4%) among children and in females (67.7%) among adults. Antihistamines (85.3% and 83.4%, p<0.001), systemic steroids (5.4% and 1.6%, p<0.001), and inhalants (1.8% and 1.3%; p<0.001) were more likely prescribed to adults, whereas topical drugs were prescribed more in children (51.7% and 42.7%, p<0.01). Monotherapy was more preferred in children (45.8%) than in adults (41.6%, p<0.0001). Although antihistamine monotherapy was similar in these groups, topical drug monotherapy was used more in children (10.3%) than in adults (5.6%). Prescriptions with first-generation antihistamines were higher in adults (6.8%) than in children (5.4%; p<0.001). Desloratadine was the most commonly encountered drug in the prescriptions of both pediatric and adult patients (21.2% and 10.3%, respectively). Conclusion: The study revealed that antihistamines, mostly second-generation agents, are frequently preferred. Apart from the higher prescription of systemic corticosteroids for adults and topical drugs for children, it is understood that the pharmacological management of allergic conditions in primary care shows overall similarities in both age groups

Comparison of laying performance, egg quality and bone characteristics of commercial and türk laying hen genotypes kept in a free-range system

This study was designed to compare of laying performance, egg quality and bone characteristics of commercial and Türk laying hen genotypes kept in free-range system. A total of 720 laying hens (Atabey, Lohmann White, Atak-S, Lohmann Brown; n=180 hens/genotype) were used in the experiment. Production performance was determined as the mean of egg production, egg weight, and FCR value between 54 and 66 weeks of age. Egg quality parameters and bone characteristics of tibia and femur were measured at 66 weeks of age. The mean value of egg production was found to be higher in Lohmann Brown and Lohmann White genotypes compared to Atak-S and Atabey genotypes between 54 and 66 weeks of age (P<0.01). The brown eggs obtained from (Lohmann Brown, Atak-S) genotypes tended to be heavier than the white hen genotypes (Lohmann White, Atabey). The lowest mean value of FCR was observed in Lohmann White hens ranged from during the experimental period. The Lohmann Brown and Atak-S eggs obtained from (3.350 g/cm2 and 3.300 g/cm2) had a stronger shell strength compared to the Lohmann White and Atabey (2.847 g/cm2 and 2.910 g/cm2, P<0.01). The breaking strength of tibia was found to be higher in brown hens (366.0 N and 381.2 N) than white hens (267.0 N and 322.2 N) (P<0.01). These findings related to different genotypes could be instructive for arranging new management rules and nutritional advice for stronger eggshell and bone strength of hens in free range system

Gerçekçi Matematik Eğitiminin İlköğretim 7.Sınıf Öğrencilerinin Tam Sayılarla Çarpma Konusundaki Başarılarına Etkisi

Realistic Mathematics Education (RME) is a mathematics education approach found by Hans Freudenthal to find answers to the need to reform the teaching and learning of mathematics and a domain-specific instruction theory for mathematics education. In this research, the effects of realistic mathematics education (RME) were investigated in 7th grade students’ achievements on multiplication of integers. The resea rch wa s ca rried out with two different groups of the seventh grade pupils of Saltukbey Primary School in Erzurum. Pre and post-test with control group design were applied in the research. In the analysis of the data, mean, standard deviation and the t test in independent groups were used. Results of this study showed that the experiment group carried out RME approach while the control group carried out conventional teaching approach. Furthermore, it was found that there had been a significant difference in favor of experiment group.Gerçekçi Matematik Eğitimi, matematik öğretimi ve öğreniminde ihtiyaç duyulan reformu gerçekleştirmek amacıyla, Hollandalı matematikçi ve eğitimci Hans Freudenthal tarafından temeli atılan bir matematik öğretimi yaklaşımı ve alana özel bir eğitim teorisidir. Bu araştırmada yedinci sınıf öğrencilerinin tam sayılarla çarpma konusundaki başarılarına gerçekçi matematik eğitiminin(GME) etkisi incelenmiştir. Erzurum ilindeki Saltukbey İlköğretim Okulu 7. sınıf öğrencilerinden iki grup üzerinden yürütülen bu araştırmada kontrol gruplu ön test son test deseni kullanılmıştır. Denkleştirme ve tam sayılarla çarpma başarı testi olmak üzere iki veri toplama aracı yardımıyla elde edilen verilerin analizinde aritmetik ortalama, standart sapma ve bağımsız gruplarda t-testi kullanılmıştır. Araştırma sonucunda, tam sayılarla çarpma konusunda GME yaklaşımının uygulandığı deney grubu ile geleneksel öğretimin uygulandığı kontrol grubu arasında başarı ortalamaları bakımından deney grubu lehine anlamlı bir fark bulunmuştur

The concept of chirality and its association with drug safety: Traditional review

Literatürde biyolojik sistemlerde yer alan objelerin ayna görüntüleriyle örtüşmeme durumları üzerinden ifade edilen kiralite, ilaçların vücutta ortaya çıkardığı etkiler bakımından önemli bir rol oynamaktadır. 1950’li yıllarda sentetik ilaç üretiminde görülen artışla birlikte izomer karışımı formundaki ilaçların piyasada yaygınlaştığı görülmektedir. İlacın yapısında bulunan her bir izomerin, farmakolojik olarak birbirinden farklı etki ve advers ilaç reaksiyonlarına yol açabildiği bilinmektedir. Bu durum, klinikte ilaç etkililiğini olumsuz yönde değişebilmesi riskinin yanı sıra potansiyel güvenlilik sorunlarına da zemin hazırlayabilir. Örneğin farmakovijilans tarihçesinde önemli bir kilometre taşı olan talidomid trajedisinde de farklı klinik sonuçlar alınmasında molekülün farklı izomerlerinin rol oynadığı literatürde gösterilmiştir. Kiralite kavramı ile ilgili söz konusu gelişmeler ışığında uluslararası sağlık otoriteleri, yeni üretilen ilaçların mumku ̈ n oldu ̈ ğunca saf enantiyomer olarak üretilmesi yönünde pek çok tavsiyede bulunmuştur. Farmasötik teknoloji alanında kaydedilen ilerlemelerin de katkısıyla piyasaya giren yeni ilaçlarda saf izomerlerin payı eskiye kıyasla giderek artmıştır. Ayrıca mevcut olan izomer karışımı formundaki ilaçların saflaştırılarak piyasaya sürülmesi prensibine dayanan “kiral dönüşüm” örnekleri de ilaç pazarında görülmeye başlanmıştır. Hâlihazırda ilaçların saf izomer olarak geliştirilmesi gibi bir zorunluluk bulunmamakla birlikte, izomer karışımlar ile ilgili guvenl ̈ ilik endişelerinin gelecekte yeni yaklaşımlara kapı aralamasının mumku ̈ n olab ̈ ileceği düşünülmektedir. Bu derlemede; kiralite kavramı ve söz konusu kavramın ilaçlardaki güvenlilik sorunları ile olası ilişkisi ele alınmıştır.Chirality, which is expressed in terms of non-overlapping of mirror images of objects in biological systems, plays an important role for drugs to exert their effects on the body. With the increase in the manufacture of synthetic drugs in the 1950s, drugs in the form of isomeric mixtures became widespread in the market. Each isomer in the structure of the drug can cause pharmacologically different effects and adverse drug reactions. This situation may adversely affect the clinical efficacy of the drug, as well as lay the groundwork for safety problems. For example, in the thalidomide tragedy, which is an important milestone in the history of pharmacovigilance, different isomers of the molecule have been shown to play a role in obtaining different clinical outcomes. In the light of these developments in chirality concept, health authorities have recommended that new drugs be produced as pure enantiomers as much as possible. With the contribution of the advances in pharmaceutical technology, the share of pure isomers in new drugs entering the market has gradually increased. In addition, examples of “chiral switch” based on the purification of existing isomeric mixture drugs have begun to be introduced. Although there is currently no obligation to develop drugs as pure isomers, it is possible that safety concerns regarding isomeric mixtures will leads to new approaches in the future. In this review, the concept of chirality is discussed from the perspective of its possible relationship with the safety problems in drugs

A research on milk and offspring yields of cattle raised in Tahirova Agricultural Plant

Araştırma, Türkiye'nin batı kesiminde yer alan, Tahirova Tarım işletmesi'nde yetiştirilen Siyah-Alaca sığırlarda döl ve süt verimlerini inceleme amacına yöneliktir. Araştırmanın materyalini Tahirova Tarım işletmesi'ndeki 58 boğanın 663 dişi dölüne ait 2110 laktasyon kaydı oluşturmuştur. Elde edilen sonuçlar maddeler halinde aşağıda özetlenmiştir. a) İlkine damızlıkta kullanma yaşına ait gerçek genel ortalama 17.97 ay, yıl ve mevsime göre düzeltilmiş ortalama değer ise 18.91 ay olarak bulunmuştur. b) ilkine buzağılama yaşına ait gerçek genel ortalama 28.83 ay, yıl ve mevsime göre düzeltilmiş ortalama değer 27.41 aydır. c) Buzağılama aralığına ait gerçek genel ortalama 385 gün, yıl ve mevsime göre düzeltilmiş ortalama değer 388 gün olarak saptanmıştır. d) Kuruda kalma süresine ait gerçek genel ortalama 85.4 gün, yıl ve mevsime göre düzeltilmiş ortalama değer 89 gündür. e) Servis periyoduna ait gerçek genel ortalama 107.78 gün, yıl ve mevsime göre düzeltilmiş ortalama değer 109.58 gün olarak saptanmıştır. f) Gebelik başına tohumlama sayısına ait gerçek genel ortalama 1.45, yıl ve mevsime göre düzeltilmiş ortalama değer 1.43'dür. g) Laktasyon süresine ait gerçek genel ortalama 307.7 gün, yıl ve mevsime göre düzeltilmiş ortalama değer 309.7 gün olarak hesaplanmıştır. h) 305 günlük süt verimine ait gerçek genel ortalama 4822.23 kg, yıl ve mevsime göre düzeltilmiş ortalama değer 4581.53 kg'dır. Bu sonuçlara göre, bu ırk için gerek yurtdışmda, gerekse ülkemizde yapılan araştırma sonuçlarıyla karşılaştırıldığında Tahirova Tarım işletmesi'nde olumlu sonuçlar alınmıştır.The research was undertaken with the aim of investigating fertility and milk yields of Holstein cattles raised at the Tahirova fgrm in the Western part of Turkey. The material of the research complied 2110 lactation records belonging to 663 d ughters of 58 bulls of Tahirova State Farm. The results obtained from the research can be summarized as follows: a) The real mean value for the first breedıng age was found as 17.97 months and the corrected mean was 18.91 months. b) The value for the first calving age was calculated as 28.83 months as the real mean and as 27.41 months after correction. c) The mean for calving interval derived from real figures was 385 days and 388 days after correction. d) The average dry period was 85.41 days and after correction the mean was 89 days. e) The real mean days öpen (service period) was 107.78 days and the corrected average was 109.58 days. f) Insemination number per pregnancy was 1.45 and 1.43 as corrected. g) The real average lactation period was 307.7 days and it was corrected as 309.7 days. h) The average 305 days milk yield was 4822.23 kg and the corrected value was 4581.53 kg. Ali the results summarized above seems much better, when compared with results obtained from similar research carried out both in Turkey and abroad