Acıbadem Üniversitesi Açık Erişim Sistemi
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Novel Once-daily Extended-release Tacrolimus Versus Twice-daily Tacrolimus in De Novo Kidney Transplant Recipients During the Early Posttransplant Period
No full textObjective: Tacrolimus is used in more than 80\% of kidney transplant recipients due to its ability to avoid rejection. Irregularities in tacrolimus level may affect clinical outcomes by subjecting patients to adverse events associated with graft rejection or immunosuppressive therapy. There are two forms of tacrolimusimmediate-release (IR-T) and prolonged release (PR-T). This study is designed to compare the clinical follow-up of kidney transplant patients who are receiving prolonged-release (PR-TAdvagraf) and immediate-release (IR-TPrograf) tacrolimus in the posttransplant first week. Methods: This study included 78 de novo, adult kidney transplant patients to prolonged-release tacrolimus 0.15 mg/kg/day (group 1, n=39) and immediate-release tacrolimus 0.15 mg/kg/day (group 2, n=39) for the first week in the posttransplant period. Demographic features, whole blood tacrolimus levels and kidney function were compared between the two groups. The presence of acute rejection and adverse events, antihypertensive drug use and arterial blood pressure of all patients were considered. Drug doses were determined according to the previously targeted tacrolimus level. SPSS 22 for Windows was used for statistical analysis. Results: Acute rejection was not seen in any patient and there were no adverse events in the posttransplant first week. However, group 2 patients were found to have higher tacrolimus levels on the posttransplant 1st, 4th and 7th days (p=0.02, p=0.009 and p=0.013 respectively). Serum creatinine levels were significantly increased in group 2 patients on the posttransplant 7th day (p=0.02). Systolic, diastolic or mean arterial blood pressure were not different between the groups. Conclusion: Prolonged-release tacrolimus is effective in preventing acute rejection when adequate blood levels are maintained, and appears promising as it makes it possible to avoid interindividual variation in absorption and early calcineurin inhibitor toxicity.2JUN141-1451
Systematic review and meta-analysis of within-subject and between-subject biological variation estimates of serum Zinc, Copper and Selenium
No full text4MAR 28479-4826
The classification of scoliosis braces developed by SOSORT with SRS, ISPO, and POSNA and approved by ESPRM
No full textPurpose Studies have shown that bracing is an effective treatment for patients with idiopathic scoliosis. According to the current classification, almost all braces fall in the thoracolumbosacral orthosis (TLSO) category. Consequently, the generalization of scientific results is either impossible or misleading. This study aims to produce a classification of the brace types. Methods Four scientific societies (SOSORT, SRS, ISPO, and POSNA) invited all their members to be part of the study. Six level 1 experts developed the initial classifications. At a consensus meeting with 26 other experts and societies' officials, thematic analysis and general discussion allowed to define the classification (minimum 80\% agreement). The classification was applied to the braces published in the literature and officially approved by the 4 scientific societies and by ESPRM. Results The classification is based on the following classificatory items: anatomy (CTLSO, TLSO, LSO), rigidity (very rigid, rigid, elastic), primary corrective plane (frontal, sagittal, transverse, frontal \& sagittal, frontal \& transverse, sagittal \& transverse, three-dimensional), construction-valves (monocot, bivalve, multisegmented), construction-closure (dorsal, lateral, ventral), and primary action (bending, detorsion, elongation, movement, push-up, three points). The experts developed a definition for each item and were able to classify the 15 published braces into nine groups. Conclusion The classification is based on the best current expertise (the lowest level of evidence). Experts recognize that this is the first edition and will change with future understanding and research. The broad application of this classification could have value for brace research, education, clinical practice, and growth in this field.4APR980-9893
Immersive virtual reality on childbirth experience for women: a randomized controlled trial
No full textObjective: To evaluate the effectiveness of immersive virtual reality (VR) on patient satisfaction as a distractive tool and pain relief among laboring women. Methods: This was a randomized, controlled clinical trial with 42 laboring women allocated to VR intervention and control groups. Among women in the VR group, patient satisfaction with the use of VR was assessed by a Virtual Reality Satisfaction Survey, measured by a Visual Analog Scale (VAS) score and evaluated by questioning them about whether they would choose VR in future labor. As a primary outcome, patient satisfaction scores regarding the overall childbirth experience were compared between women in the two groups. A secondary outcome was pain assessed by a visual pain rating scale in the early and active phases of labor in women in both groups. Psychometric information was also collected from participants in each group using the Beck Anxiety Inventory and Beck Depression Inventory. Results: We observed a high level of patient satisfaction with the use of immersive VR during labor. The VAS revealed a mean satisfaction score of 87.7 +/- 12.9 out of a maximum of 100. Twenty out of 21 (95\%) women in the VR group stated that they would like to use VR again in future labor. VR improved pain scores in early labor and contributed positively to the overall childbirth experience. The mean pain score pre-VR was 2.6 +/- 1.2 compared to 2.0 +/- 1.3 post-VR (p < 0.01). Anxiety and depression scores were similar in participants in the intervention and control groups (p = 0.1 03 and p= 0.13, respectively). Conclusion: Immersive VR application during labor was associated with higher patient satisfaction based on our study findings. VR also improved participants' pain scores in early labor before epidural administration. Immersive VR may find a place as an adjunct in labor and delivery units to improve lengthy labor experiences for women. Studies with larger groups of participants are needed to confirm these observations.1APR 232
Applications of lean in human resources management in healthcare
No full textRecent challenges brought by the coronavirus disease-2019 pandemic have underscored the importance of coping with pressures on the workforce in healthcare around the world and have emphasised the continuing need to improve quality and operation efficiency of healthcare services even in such dire circumstances. Over the years, lean thinking has gained recognition in the healthcare industry, where lean has been associated with benefits, such as improved healthcare delivery quality, reduced costs and increased effectiveness of the healthcare delivery processes. Lean thinking has also been analysed in human resources with benefits, such as increased job satisfaction and perceived job autonomy. The current narrative review was planned to analyse and discuss the application and implementation of lean strategies with a particular focus on human resource management in healthcare. The review is complemented by a case study in a private healthcare group in Turkey, aiming to demonstrate in practice the effect of lean strategies on the satisfaction of patients and relatives, the job satisfaction of the employees, and the level of turnover rates within healthcare enterprises.3MAR532-5367
Did Dermatological Hospital Referrals and Practice of Dermatologists Change in Between Pre-covid and Covid Era? A Short-term Preliminary Evaluation
No full textObjective: In this descriptive study, we aimed to evaluate features of dermatology referrals before and after Covid-19 pandemic. Materials and Methods: The patients referred to dermatology outpatient clinics of Acibadem Group Hospitals in Istanbul between the time intervals 2019 March 1st and August 31st (Group G1) and 2020 March 1st and August 31st (Group G2) were included in this study. G1 and G2 groups were compared in terms of age, gender, mean duration of complaints, the most common five anatomic regions and the most common five dermatoses. Results: Referral rate after Covid-19 pandemic was decreased by 40\%. Face (p=.0013, OR= 1.20, 95\% CI=1.07-1.34), scalp (p=.02, OR=1.23, 95\% CI=1.02-1.48) and hand (p=.04, 95\% OR=1.24, 95\% CI=1.00-1.54) were more common locations in 2020 (group G2) than in 2019 (G2 group). The most common five dermatoses were contact dermatitis (8.3\%), acne (8,1\%), wart (7,0\%), seborrheic dermatitis (5,7\%) and pyoderma (5,5\%) in G1 (2019), while the order was contact dermatitis (10,6\%), acne (7,5\%), seborrheic dermatitis (6,5\%), wart (6,4\%) and pyoderma (4,9\%) in G2 (2020). Contact dermatitis showed a significant increase after pandemic (p=.0017, OR=1.29, 95\% CI=1.10-1.51). In 2020, psoriasis and lichen planus showed a two-fold increases (P <.001, OR=2.00, 95\% CI=1.43-2.79 and p=.03, OR=1.92, 95\% CI=1.09-3.38, respectively), whereas frequency of molluscum contagiosum decreased significantly (p=.03, OR=0.49, 95\% CI=0.26-0.92). Conclusion: Although we found some remarkable results, relatively short-term period design with the limited patient population of this study needs to be verified in more comprehensive studies.2APR-JUN57-611
Cosmetic Outcome of Robotic Surgery Compared to Laparoscopic Surgery for Benign Gynecologic Disease
No full textBackground and Objectives: This study was designed to compare patients who have undergone conventional laparoscopic surgery with those who undergone multiport robot-assisted laparoscopic surgery for benign gynecological diseases regarding cosmetic results, patient satisfaction, and quality of life. Methods: Sixty-four patients who underwent either robot-assisted or conventional laparoscopic surgery for benign gynecological diseases from July 1, 2019 to March 31, 2020 at Acibadem Mehmet Ali Aydinlar University Hospital were enrolled. Patients were evaluated using the Patient and Observer Scar Assessment Scale, visual analog scale for cosmetic satisfaction, body image questionnaire, and 12-item Short Form Survey six months postoperatively. Results: The median patient assessment scale and observer assessment scale (general) values were significantly higher in the robotic group than in the laparoscopic group. The mean body image questionnaire (cosmetic section) and visual analog scale values were significantly higher in the laparoscopic group than in the robotic group. No significant differences in body image scale, body image questionnaire 9-10, and 12-item Short Form Survey values were observed between the groups. The number of patients with previous surgical history was significantly higher in the laparoscopic group than in the robotic group. Conclusion: Although esthetic concerns are not a priority consideration when deciding an appropriate surgical method, the higher cosmetic satisfaction rate in the laparoscopic group than in the robotic group suggests that cosmetic results should be discussed with patients after evaluating other factors.2APR-JUN2
