Evaluation of clinical practice guideline quality: comparison of two appraisal tools.

OBJECTIVE: The tools used for critically appraising the quality of clinical practice guidelines are complex and not suitable for the busy end users. So rapid, effective and simple instruments are more preferred. The aim of this study is to compare two critical appraisal tools: iCAHE as a rapid instrument and AGREE II as a complex instrument on guideline quality assessment. MATERIAL AND METHODS: The diabetes mellitus guidelines of the Scottish Intercollegiate Guidelines Network (SIGN), the National Institute for Health and Clinical Excellence (NICE), the International Diabetes Federation (IDF) and the Society of Endocrinology and Metabolism of Turkey (SEMT) were assessed separately by four appraisers using the iCAHE and AGREE II instruments. The mean iCAHE criteria scores and the total and domain AGREE II scores given by the four appraisers are presented for each guideline. RESULTS: No statistically significant difference was detected between the iCAHE scale scores of the guidelines evaluated (P = 0.063). The rank of the guidelines according to their average total iCAHE and AGREE II instrument scores was similar. The iCAHE mean scores of the guidelines were as follows: NICE, 92.85%; SIGN, 92.85%; IDF, 66.07% and SEMT, 73.21%. The AGREE II mean scores of the guidelines were as follows: NICE, 87.13%; SIGN, 78.25%; IDF, 53.44% and SEMT, 53.22%. CONCLUSIONS: In addition to being a quality scale, the iCAHE checklist is easy, practical and short to implement. It also helps the users to understand the quality of the guideline in a shorter time. To increase the use of guidelines, it is important that users with little experience and time use the iCAHE scale as a rapid appraisal tool, but more studies are needed to decide the best appraisal tool.

Social adaptation status of Syrian refugee physicians living in Turkey.

OBJECTIVES: Since the beginning of the civil war in Syria, over 3.5 million Syrians have fled to Turkey. Considering the massive burden of healthcare service needs of this population, the Turkish government has launched an initiative as employing Syrian doctors to provide health services to their citizens in Refugee Health Centres. In this study, we aimed to explore the social adaptation status of Syrian physicians living in Turkey using a structured questionnaire and the Social Adaptation Self Evaluation Scale (SASS). METHODS: Between November 2016 and April 2018, 799 physicians who participated in "Syrian Physicians' Adaptation Training" were enrolled in the study and underwent a structured questionnaire that questioned socio-demographic data and the SASS. The participants were divided into two groups as having poor and normal/high SASS scores. The binary SASS groups were compared with some demographic data. RESULTS: The median SASS score of the respondents was found as 43 (min. 10, max. 60, IQR 10) which can be accepted as normal. In the binary grouping, it was seen that 107 (13.39%) participants had poor social adaptation, whereas 692 (86.61%) participants had normal or high social adaptation scores. The physicians who were certain about not going back to Syria had significantly higher SASS scores. CONCLUSION: The social adaptation scores of the Syrian physicians were considerably high. The adaptation status was found to be associated with some characteristics like living in Turkey for a long time and having pre-knowledge about the Turkish healthcare system.

Quality assessment of clinical practice guidelines for management of type 2 diabetes mellitus: Assessment of type 2 diabetes mellitus guidelines.

AIMS: Diabetes mellitus is one of the most significant global health emergencies of the 21st century. Every year, an increasing number of people succumb to the condition and therefore suffer life-changing complications. So management of this disease has an important role to prevent complications. In this study, our objective is to assess the quality of guidelines related to the significant public health problem diabetes that have been developed by international and national organizations using the AGREE II tool. METHODS: This observational study assesses the quality of clinical practice guidelines used in the management of diabetes with AGREE II tool. Statistical analysis was performed using the SPSS 20 program package. RESULTS: The overall quality score of the guidelines ranges between 3 and 6.25. While NICE's guidelines scored the highest, the guidelines of the National Diabetes Foundation scored the lowest. CONCLUSION: More comprehensive studies are needed for assessing the quality of guidelines in every subject.

Exploring guideline adaptation strategy for Turkey: Is "ADAPTE" feasible or does it need adaptation as well?

RATIONALE, AIMS, OBJECTIVES: Clinical Practice Guidelines are mostly developed by 3 methods; namely, de novo, adoption, and adaptation. Nonpublished studies and authors experience shows that most guidelines in Turkey are either by adoption or by adaptation. There is no available local tool for adaptation, so the process is not standardized and most of the time not explicitly defined. The objective of this study is to search for international guideline adaptation tools and test their feasibility in Turkish context, to serve a final goal of developing a unique local strategic tool for guideline adaptation. METHODS: The methodological design of this study includes selection of an international tool for Clinical Practice Guideline adaptation, piloting this tool with selected Turkish guidelines, identifying the feasibility of this tool and exploring the needs for adaptation of the tool, drawing recommendations for adaptation of the strategies, and validation of the process by local experts. RESULTS: The study from planning phase to finalizing the guidance, including pilot studies and panel but excluding translation of ADAPTE, lasted 18 months. Nine researchers were involved in the adaptation process and 15 more experts were involved in the validation panel. Following the suggestions of the research team on modifications and validation through the expert panel; 2 steps of the ADAPTE toolkit were rejected, 2 steps were accepted by modification, 7 steps were accepted by additional recommendations. In addition, 2 tools were suggested to be added to the toolkit. CONCLUSION: This is the first study on adaptation of guidelines in Turkey. Pilot adaptation of 2 guidelines with ADAPTE revealed that ADAPTE is a useful and feasible tool in Turkish setting, but might require certain changes in recommendations and revision of tools.

Nivel de conocimiento, actitud y experiencias de los profesionales de la salud respecto de la lactancia y la leche materna en una ciudad de Turquía: Estudio transversal / Knowledge level, attitude and own experience of health professionals about breastfeeding and breast milk in a city of Turkey: Cross-sectional study

Introducción. El consenso mundial acerca de la lactancia materna es que el bebé debe ser exclusivamente amamantado hasta los seis meses de vida. A pesar de ello, la tasa de lactancia materna exclusiva es baja durante los primeros seis meses de vida en muchos países, incluida Turquía. El objetivo de este estudio fue evaluar el conocimiento, las actitudes y las experiencias de los profesionales sanitarios en relación con la lactancia y la leche materna en una ciudad metropolitana de Turquía. Materiales y métodos. Este estudio se llevó a cabo entre julio de 2012 y diciembre de 2013. Los sujetos del estudio fueron profesionales de la salud que trabajaban en hospitales universitarios, hospitales de formación e investigación, hospitales públicos y privados, centros de servicios para niños, adolescentes, mujeres y de servicios de salud reproductiva, centros de salud general y centros de salud comunitarios ubicados en Ankara. Los datos se recogieron por medio de un cuestionario. El programa SPSS 11.5 se utilizó para el análisis estadístico. Resultados. En total, 715 personas participaron en este estudio. Entre los que tenían hijos propios, el 3,4% (n= 16) no había amamantado a sus bebés y el 7,6% (n= 36) había amamantado a sus bebés hasta el segundo año de vida. Se observó que el nivel de conocimiento sobre la lactancia y la lecha materna era deficiente en el 28,4% de los participantes, promedio en el 43,1% y adecuado en el 28,5%. Conclusión. Este estudio refleja la falta de conocimiento acerca de la lactancia y la leche materna entre los profesionales de la salud de Turquía. Si bien la gran mayoría de los participantes están de acuerdo con la recomendación de la OMS acerca de la duración de la lactancia materna, el porcentaje de profesionales de la salud que amamantaron durante el período recomendado fue muy bajo.

Introduction: Worldwide consensus about breastfeeding is that the infant should exclusively be breastfed until six months of life. Despite this, the rate of exclusive breastfeeding for the first six months of age is low in so many countries including Turkey. The aim of this study was to evaluate the knowledge, the attitudes and the own experiences of health professionals about breastfeeding and breast milk, in a metropolitan city in Turkey. Materials and methods: This study was performed between July 2012 and December 2013. Study subjects included healthprofessionals working in the university hospitals, research and training hospitals, public and private hospitals; child, adolescent, women and reproductive health services centers, family health centers, and community health centers located in Ankara. A questionnaire was used to collect data. SPSS 11.5 package program was used for statistical analysis. Results: A total of 715 people participated in this study. From those who had children themselves 3.4% (n= 16) had not breastfed their babies at all, and 7.6% (n= 36) had breastfed their baby until second year of age. It was found that 28.4% of the participants had poor, 43.1% had average and 28.5% had good knowledge level about breastfeeding and breast milk. Conclusion: This study reflects the lack of knowledge about breastfeeding and breast milk among the health professionals in Turkey. Although a great majority of participants agree the recommendation of WHO about the duration ofbreastfeeding, the percentage ofbreastfeeding of health care professionals during recommended period was very low.

Knowledge level, attitude and own experience of health professionals about breastfeeding and breast milk in a city of Turkey: Cross-sectional study. / Nivel de conocimiento, actitud y experiencias de los profesionales de la salud respecto de la lactancia y la leche materna en una ciudad de Turquía: Estudio transversal.

INTRODUCTION: Worldwide consensus about breastfeeding is that the infant should exclusively be breastfed until six months of life. Despite this, the rate of exclusive breastfeeding for the first six months of age is low in so many countries including Turkey. The aim of this study was to evaluate the knowledge, the attitudes and the own experiences of health professionals about breastfeeding and breast milk, in a metropolitan city in Turkey. MATERIALS AND METHODS: This study was performed between July 2012 and December 2013. Study subjects included healthprofessionals working in the university hospitals, research and training hospitals, public and private hospitals; child, adolescent, women and reproductive health services centers, family health centers, and community health centers located in Ankara. A questionnaire was used to collect data. SPSS 11.5 package program was used for statistical analysis. RESULTS: A total of 715 people participated in this study. From those who had children themselves 3.4% (n= 16) had not breastfed their babies at all, and 7.6% (n= 36) had breastfed their baby until second year of age. It was found that 28.4% of the participants had poor, 43.1% had average and 28.5% had good knowledge level about breastfeeding and breast milk. CONCLUSION: This study reflects the lack of knowledge about breastfeeding and breast milk among the health professionals in Turkey. Although a great majority of participants agree the recommendation of WHO about the duration ofbreastfeeding, the percentage ofbreastfeeding of health care professionals during recommended period was very low.

INTRODUCCIÓN: El consenso mundial acerca de la lactancia materna es que el bebé debe ser exclusivamente amamantado hasta los seis meses de vida. A pesar de ello, la tasa de lactancia materna exclusiva es baja durante los primeros seis meses de vida en muchos países, incluida Turquía. El objetivo de este estudio fue evaluar el conocimiento, las actitudes y las experiencias de los profesionales sanitarios en relación con la lactancia y la leche materna en una ciudad metropolitana de Turquía. MATERIALES Y MÉTODOS: Este estudio se llevó a cabo entre julio de 2012 y diciembre de 2013. Los sujetos del estudio fueron profesionales de la salud que trabajaban en hospitales universitarios, hospitales de formación e investigación, hospitales públicos y privados, centros de servicios para niños, adolescentes, mujeres y de servicios de salud reproductiva, centros de salud general y centros de salud comunitarios ubicados en Ankara. Los datos se recogieron por medio de un cuestionario. El programa SPSS 11.5 se utilizó para el análisis estadístico. RESULTADOS: En total, 715 personas participaron en este estudio. Entre los que tenían hijos propios, el 3,4% (n= 16) no había amamantado a sus bebés y el 7,6% (n= 36) había amamantado a sus bebés hasta el segundo año de vida. Se observó que el nivel de conocimiento sobre la lactancia y la lecha materna era deficiente en el 28,4% de los participantes, promedio en el 43,1% y adecuado en el 28,5%. CONCLUSIÓN: Este estudio refleja la falta de conocimiento acerca de la lactancia y la leche materna entre los profesionales de la salud de Turquía. Si bien la gran mayoría de los participantes están de acuerdo con la recomendación de la OMS acerca de la duración de la lactancia materna, el porcentaje de profesionales de la salud que amamantaron durante el período recomendado fue muy bajo.

Quality Assessment of Clinical Practice Guidelines Developed by Professional Societies in Turkey.

BACKGROUND: Clinical practice guidelines (CPGs) are systematically developed statements to assist practitioner and patient decisions about appropriate healthcare for specific clinical circumstances. There is a limited number of studies on guidelines in Turkey. The quality of Ministry of Health guidelines have formerly been assessed whereas there is no information on the other guidelines developed in the country. AIM: This study aims to assess the quality of CPGs that are developed by professional societies that work for the health sector in Turkey, and compare the findings with international guidelines. METHODOLOGY: Professional societies that work for the health sector were determined by using the data obtained from the Ministry of Internal Affairs. Inclusion and exclusion criteria were defined for selecting the CPGs. Guidelines containing recommendations about disease management to the doctors, accessible online, developed within the past 5 years, citing references for recommendations, about the diseases over 1% prevalence according to the "Statistical Yearbook of Turkey 2012" were included in the study. The quality of CPGs were assessed with the AGREE II instrument, which is an internationally recognized tool for this purpose. Four independent reviewers, who did not participate in the development of the selected guidelines and were trained in CPG appraisal, used the AGREE instrument for assessment of the selected guidelines. FINDINGS: 47 professional societies were defined which provided access to CPGs in their websites; 3 of them were only open to members so these could not be reached. 8 CPGs from 7 societies were selected from a total of 401 CPGs from 44 societies. The mean scores of the domains of the guidelines which were assessed by the AGREE II tool were; SCOPE AND PURPOSE: 64%, stakeholder involvement: 37.9%, rigour of development: 35.3%, clarity and presentation: 77.9%, applicability: 49.0% and editorial independence: 46.0%. CONCLUSION: This is the first study in Turkey regarding quality appraisal of guidelines developed by the local professional societies. It adds to the limited amount of information in the literature that comes from Turkey as well as other developing countries.

A case report of successful relactation.

Exclusive breastfeeding is recommended from birth until the first six months and then with complementary feeding up to age two. In our country, only 41.6% of infants are exclusively breastfed during the first six months, and the average duration of breastfeeding is 16 months.The term 'relactation' is used for the resumption of breastfeeding in infants who were not breastfed before or who quit suckling due to an illness of the mother or infant, breast problems, rejection of suckling by the infant, insufficient milk production, the mother's change of mind about breastfeeding, or adoption.Relactation is a laborious process that requires motivation and trained personnel. In our case, the process of achieving successful relactation in an eight-week-old infant who had not been breastfed before is described. The infant's young age and mother's strong motivation led to the success in relactation in this case.