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Fibrosis- 4 index and survival in early breast cancer patients
No full textBackground: The objective of this study is to assess the correlation between survival outcomes and fibrosis-4 (FIB-4) index in patients with non-metastatic breast cancer treated with anthracyclines Methods: This study was conducted on individuals with non-metastatic breast cancer who were treated with at least one dose of anthracycline from 2018 to 2023. The FIB-4 index was calculated based on the following parameters: age, aspartate aminotransferase (AST) and alanine aminotransferase (ALT) serum levels, and platelet count for each patient before anthracycline treatment. Results: A total of 208 patients were included in the study. Patients below 35 years of age (n=28) and those above 65 years of age (n=11) were excluded from the study as the FIB-4 index is less reliable in these age groups. Patients were then divided into two subgroups, low and high, according to the pre-defined cut-off value of 1.45, which is obtained from the primary reference. In univariate analysis, hemoglobin (p=0.03), FIB-4 index (p=0.02), and diagnosis at stage (p=0.01) were statistically related to overall survival (OS). In multivariate analysis, patients with higher FIB-4 index (HR: 4.36, 95% CI 1.38-13.78 p=0.012), anemia (HR: 3.32, 95% CI 1.32-8.34, p=0.011 ), and stage 3 (HR: 4.53, 95% CI 1.22- 16.76, p=0.024 ) had decreased OS. An additional aim was to evaluate the association between anthracycline-induced cardiotoxicity and the FIB-4 index. Our study showed no relationship (p=0.738). Conclusions: The FIB-4 index, a marker easily obtained through routine biochemistry testing at low cost, could serve as an independent predictor of OS patients with non-metastatic breast cancer treated with anthracyclines. Routine lab tests performed for cancer patients may help clinicians identify high-risk patients in whom closer follow-up or protective measures should be considered
Sağlık Kurumları Yönetiminde Hekim-Yönetici İlişkileri
No full textGiriş ve Amaç: Hekimler ve hastane yöneticileri arasındaki ilişkiler ve bu ilişkilerin yönü sağlık kurumlarıişletmeciliğinin kalbinde yer alan bir konudur. Bu nedenle bu çalışmada Ankara ilinde faaliyet gösteren özel vekamu hastanelerinde aktif olarak çalışan hekimler ve hastane yöneticilerinin hastane yönetimi-hekim ilişkilerineyönelik görüşlerinin karşılaştırılması amaçlanmıştır.Gereç ve Yöntemler: Tanımlayıcı ve kesitsel nitelikte planlanan çalışmanın evrenini Ankara’daki özel ve kamuhastane yöneticileri ve hekimler oluşturmaktadır. Çalışma evreni hastanelerin 150 ve üzeri yatak sayısına sahipolması bakımından sınırlandırılarak 6 özel ve 5 devlet hastanesi belirlenmiştir. Çalışmada izin alınan 6 hastanede50 orta-üst düzey yönetici ve 229 hekime ulaşılmıştır. Veri toplamada orijinal olarak Thomas Rundall (2004)tarafından geliştirilen, Atefeh Samadi-Niya (2013) tarafından kullanılan Canadian National Study ofInterprofessional Relationshipships between Physicians and Hospital Administrators (CANSIRPH) StudyQuestionnaire soru formunun bir bölümü kullanılmıştır. Verilerin analizinde tanımlayıcı istatistiklerdenyararlanılmış olup Pearson Ki-Kare Testi, Fisher Kesin Ki-Kare Testi ve Mann-Whitney U testi kullanılmıştır.Bulgular: Çalışmada hekimler ve hastane yöneticileri arasında hastane yönetimi-hekim ilişkilerine yönelikgörüşlerinin karşılaştırılması, birbirlerini nasıl gördükleri, hastane yönetimi-hekim ilişkilerini geliştirmeye ayrılanzaman, enerji ve kaynaklardan memnuniyet düzeyi, hastane yönetimi-hekim ilişkilerinin gelecek yıllarda nasıldeğişeceğine ilişkin değerlendirmeleri bakımından (p≤0,001) istatistiksel olarak anlamlı farklılıklar olduğugörülmektedir.Sonuç: Çalışma sonucunda hastane yöneticilerinin hastane yönetimi-hekim ilişkilerini daha olumlu algılamaeğiliminde oldukları görülmektedir. Hastane yöneticileri ve hekimlerin değerlendirmelerine göre hastaneyönetimi-hekim ilişkilerinde en etkili faktörün ekip çalışması ve iletişim olduğu görülmektedir. Hekimler vehastane yöneticilerinin sağlık yönetimi alanında profesyonel eğitim almadıkları görülmektedir. Bu kapsamdasağlık kurumlarında ekip çalışması, iletişim stratejilerinin güçlendirilmesi, geri bildirim mekanizmalarınınoluşturulması önerilmektedir. </p
Enriching Science teachers' instructional noticing in the context of question-asking
No full textPurposeThis study explores the impact of an intervention program designed to foster science teachers' perceptive abilities in question-asking.MethodsConducted on a small-scale study with six participating teachers, the intervention employed written reflections, one-on-one sessions, and focused group interviews to dissect the teachers' instructional noticing of question-asking.ResultsTeachers within the intervention group adeptly crafted reflections spanning diverse themes, unveiling profound insights into the intricacies of the observed question-asking pedagogy, setting them distinctly apart from their non-interventional peers. The intervention group exhibited an elevated capacity to discern and interconnect fragments of observed question-asking activities, a skill less pronounced among peers in the alternate group. Their assertions were notably supported by meticulously extracted evidence from analytically dissected lessons. However, the discernible effects of the intervention seemed limited in compelling the teachers to establish tangible linkages between empirical data and abstracted educational principles while formulating reflective narratives.ImplicationsThe study assessed the intervention's effectiveness and limitations within the purview of existing educational literature. This amalgamation of intervention methodology and the nuanced concept of teacher noticing yields several insightful educational studies
Does Adding Chemotherapy to Radiotherapy Improve Outcomes in Stage II Nasopharyngeal Carcinoma?
No full textOBJECTIVE The benefit of adding chemotherapy (CHT) to radiotherapy (RT) in stage II nasopharyngeal carcinoma (NPC) remains uncertain. This study evaluates the impact of CHT on survival outcomes in these pa- tients. METHODS A retrospective analysis was conducted on 107 AJCC 8th edition stage II NPC patients treated with RT alone or combined RT and CHT between 1994 and 2021. RESULTS Of the cohort, 31% received RT alone, while 69% underwent combined RT and CHT. After a median fol- low-up of 98 months, locoregional recurrence and distant metastasis rates were similar between groups. The addition of CHT did not significantly improve 10-year overall, locoregional recurrence-free, or distant metastasis-free survival. Subgroup analyses revealed no survival benefit of CHT, even in patients with lymph node metastasis or those treated using two-dimensional RT techniques. CONCLUSION For AJCC 8th edition stage II NPC patients, RT alone is an effective treatment, with no additional sur- vival benefit from the inclusion of CHT. Further research is warranted to identify specific subgroups of patients who may derive benefit from the incorporation of CHT
Yürüyüş parametreleri fonksiyonel performans denge ağırlık aktarma ve yaşam kalitesi açısından travma ve diyabet nedenli transtibial amputelerin karşılaştırılması
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Enhancing protection against vector-borne diseases in forcibly displaced communities: evaluating the efficacy of spatial repellents for cutaneous leishmaniasis control in North-East Syria
No full textBackground In Syria, during the 14 years after the outbreak of civil war, 16.7 million people have been forced to flee their homes, of which 7.2 million remain internally displaced in 2025. Breakdown in waste management caused by aerial bombardment has created ideal conditions for cutaneous leishmaniasis (CL) transmission, vectored by phlebotomine sandflies. Displaced populations reside in flimsy shelters where conventional vector control tools are operationally unfeasible. A small, lightweight, portable transfluthrin-based spatial repellent (Mosquito Shield (TM)) has been developed which may circumvent some of these logistical issues and provide improved protection from vector-borne diseases in harsh environments. Methods A two-arm, non-randomised cluster trial was undertaken in Ar-Raqqa governorate, North-East Syria, to evaluate the efficacy of Mosquito Shield (TM) in reducing CL case incidence and sandfly densities in shelters. Weekly epidemiological monitoring was performed by MENTOR Initiative mobile clinics and supported health facilities. Entomological monitoring was performed fortnightly using indoor US Centers for Disease Control and Prevention light traps in 40 randomly selected households per study arm. Phlebotomine sandflies were morphologically identified; a subset were analysed for molecular species confirmation, blood-meal preferences and pyrethroid resistance. Household surveys and focus group discussions were used to assess intervention feasibility, acceptability and uptake. Results Assuming a 2-month diagnosis cut-off, the CL incidence rate was 9.9 and 5.2 per 1000 in the control and intervention arms, respectively; Mosquito Shield (TM) demonstrated a significant impact on rate of CL infection in all ages (incidence rate ratio; IRR: 0.52 [95% CI: 0.37-0.74]; p < 0.0001). Mosquito Shield (TM) demonstrated a significant impact on all female sandfly density (IRR: 0.22 [95% CI: 0.14-0.33]; p < 0.0001) and blood-fed female sandfly density (IRR: 0.21 [95% CI: 0.11-0.40]; p < 0.0001). Mosquito Shield (TM) was received positively and perceived to be easy to use, to protect from CL, sandflies and other insect bites and required minimal behaviour change. Conclusions Trial findings provide the first demonstrable impact of spatial repellents on CL transmission, strengthening the growing evidence basis for the effectiveness of this intervention against multiple vector species and their associated pathogens. Study results strongly support the deployment of spatial repellents to control CL in humanitarian crises
TÜRKİYE’DE İLAÇLARIN PAZARA ERİŞİMİ: KAPSAMLI BİR İNCELEME
No full textAmaç: Bu çalışma, Türkiye’deki ilaçların piyasaya giriş süreçlerini ayrıntılı bir şekilde inceleyerek, bu süreçleri şekillendiren ana unsurları ve uluslararası standartlarla olan uyum düzeylerini ele almaktadır. Çalışmanın hedefi, düzenleyici mekanizmaların, ekonomik stratejilerin ve sağlık teknolojisi değerlendirmesinin (STD), hastaların kaliteli ilaçlara erişimini sağlamadaki önemini ortaya koymaktır. Sonuç ve Tartışma: Türkiye'deki ilaç sektörü, yerli ve yabancı paydaşların önemli katkılarıyla dinamik ve gelişen bir endüstri haline gelmiştir. Türk İlaç ve Tıbbi Cihaz Kurumu’nun (TİTCK) kurulması gibi düzenleyici yenilikler, ruhsatlandırma, fiyatlandırma ve geri ödeme süreçlerini geliştirerek uluslararası standartlarla uyumlu hale getirmiştir. Bunun yanı sıra, sağlık teknolojisi değerlendirmesi (HTA), kanıta dayalı karar alma süreçlerinde önemli bir araç olarak öne çıkmış, sağlık kaynaklarının verimli kullanımıyla yenilikçi tedavilere sürdürülebilir erişimi desteklemiştir. Ancak, bu süreçlerin etkili kalabilmesi için, sürekli olarak güncellenmesi ve iyileştirilmesi gerekmektedir. Bu tür çabalar yalnızca sektöre değil, aynı zamanda hastalara ve topluma da önemli faydalar sağlayacaktır.Objective: This study provides a detailed analysis of the market entry processes for pharmaceuticals in Türkiye, examining the key factors shaping these processes and their alignment with international standards. The aim is to highlight the significance of regulatory mechanisms, economic strategies, and health technology assessment (HTA) in ensuring patients' access to high-quality medicines. Result and Discussion: The pharmaceutical sector in Türkiye has evolved into a dynamic and growing industry, supported by significant contributions from both domestic and international stakeholders. Regulatory advancements, such as the establishment of the Turkish Medicines and Medical Devices Agency (TİTCK), have improved licensing, pricing, and reimbursement processes, aligning them with international practices. Additionally, HTA has emerged as a critical tool in evidence-based decision-making, optimizing the efficient use of healthcare resources and supporting sustainable access to innovative treatments. However, to maintain their effectiveness, these processes require continuous updates and improvements. Such efforts will provide significant benefits not only to the industry but also to patients and society as a whole
Vibrational spectroscopic techniques as a tool in diagnosis of sudden cardiac death: a systematic review
No full textBackgroundIn the practice of forensic pathology, sudden cardiac death (SCD) takes place among leading causes of death. Despite the advancing postmortem diagnostic methods and pathological examinations, SCD presents significant postmortem diagnostic challenges. As emerging techniques in forensic investigations and medical diagnostics, vibrational spectroscopy, including Fourier transform infrared spectroscopy (FTIR) and Raman spectroscopy, rise as promising tools. Therefore, this paper evaluates the potential and effectiveness of vibrational spectroscopic methods in the diagnosis of SCD.Main bodyA systematic review was conducted through literature search in Scopus, PubMed, and Web of Science databases using predefined keywords. Studies utilizing FTIR and Raman spectroscopy for diagnosis of SCD were included in the scope of the study. The risk of bias was assessed using the PROBAST tool. Ten research papers met the inclusion criteria. FTIR and Raman spectroscopy demonstrated distinctive spectral differences in myocardial, pulmonary, arterial, and blood samples from SCD cases. Chemometric and machine learning models enhanced diagnostic accuracy, with some studies achieving over 95% specificity and sensitivity. However, a number of limitations such as small sample sizes, heterogeneous SCD classifications, not considering postmortem interval-related biochemical changes, comorbidities, and variability in spectral analysis methodologies limit the potential of applicability of studies.ConclusionsVibrational spectroscopic applications offer a promising, fast, non-destructive approach for postmortem diagnosis of SCD. However, further studies with standardized protocols, and involving larger series are needed to validate their applicability in routine for postmortem diagnosis
