An Eastern Europe and Middle East multinational expert Delphi consensus study on the prevention, diagnosis, and treatment of developmental dysplasia of the hip before walking age.

PURPOSE: The incidence of developmental dysplasia of the hip (DDH) is higher in Eastern Europeans and Middle Easterners. This study aimed to establish consensus among experts in this geographical area on the management of DDH before walking age. METHODS: Fourteen experienced orthopedic surgeons agreed to participate in a four-round online consensus panel by the Delphi method. The questionnaire included 31 statements concerning the prevention, diagnosis, and treatment of DDH before walking age. RESULTS: Consensus was established for 26 (84%) of 31 statements. Hip ultrasonography is the proper diagnostic tool under six months in DDH; universal newborn hip screening between three and six weeks is necessary; positive family history, breech presentation, female gender, and postnatal swaddling are the most important risk factors; Ortolani, Barlow tests, and limitation of abduction are the most important clinical findings; Pavlik harness is the first bracing preference; some Graf type IIa hips and all Graf type IIb and worse hips need abduction bracing treatment; the uppermost age limit for closed and open reductions is 12 months and 12-24 months, respectively; anatomic reduction is essential in closed and open reductions, postoperative MRI or CT is not always indicated; anterior approach open reduction is better than medial approach open reduction; forceful reduction and extreme positioning of the hips (> 60° hip abduction) are the two significant risk factors for osteonecrosis of the femoral head. CONCLUSION: The findings of the present study may be useful for clinicians because a practical reference, based on the opinions of the multinational expert panel, but may not be applicable to all settings is provided.

The Effect of Training Given to Patients with Septorhinoplasty on Nose Obstruction and Sleep Quality: A Randomized Controlled Prospective Trial.

PURPOSE: Clinical nurses play a primary role in the surgical adjustment of patients, to include monitoring and training patients in septorhinoplasty, which has a long recovery period. The effect of repetitive patient training nasal obstruction and sleep quality is unknown. This study aimed to determine the effect of repetitive training given to patients undergoing septorhinoplasty on nasal obstruction and sleep quality. DESIGN: The study is a randomized controlled prospective study. METHODS: The study was conducted on a total of 180 patients (intervention: 90, control: 90) who underwent septorhinoplasty. In the intervention group, repeated training was given before and after (12 months) septorhinoplasty. The control group received routine care. Data were collected with Personal Information Form, Nasal Obstruction Symptom Evaluation (NOSE), and Pittsburgh Sleep Quality Index (PSQI). FINDINGS: A total of 66.7% of the intervention group and 71.1% of the control group reported that the primary symptom triggering the operation was the inability to breathe through the nose. The intervention group's PSQI and NOSE scale total score averages in the 6th and 12th months after septorhinoplasty were significantly lower than the control group. Correlation revealed a moderate-to-strong and positive correlation between PSQI and NOSE scores. CONCLUSIONS: Results supported that repetitive training was effective in reducing nasal obstruction symptoms and improving sleep quality in the intervention group compared to the control group.

Reliability and validity of new isokinetic strength assessment for rotator cuff muscles in a muscle architecture-based position.

Background/aim: Isokinetic strength assessment of the rotator cuff muscle is frequently applied in a variety of shoulder postures, but none of these consider muscular architecture, which is one of the most important aspects of improving strength development. This study aimed to examine the test and retest reliability and validity of the muscle architecture-based position (MABP), which is 25° abduction and 20° external rotation, in healthy subjects to be able to select a better isokinetic assessment position for shoulder rotator cuff muscles. Materials and methods: A total of 54 healthy males with a mean age of 21.0 ± 1.2 years and mean body mass index of 22.8 ± 1.7 kg/m2 completed an isokinetic measurement session. All of the tests were performed on an IsoMed 2000 isokinetic dynamometer concentrically and eccentrically for both upper limbs at 60°/s angular velocity. All of the participants completed 3 measurement sessions: the first represented the isokinetic testing and was performed in the scapular neutral position (SNP) (45° shoulder flexion and abduction), the second represented the MABP (25° abduction and 20° ER) for shoulder rotator cuff muscles, and the third represented the test and retest of the MABP. Results: The correlations between the 2 techniques for assessing concurrent validity ranged from 0.908 to 0.994. The values obtained from the MABP were higher than those obtained in the SNP. There was no systematic bias for any measurements between the MABP and the retest of the MABP (p > 0.05). The intraclass correlation coefficients representing the test and retest reliability results for each variable measured with the MABP was higher than 0.98 and this value was considered as excellent reliability. Conclusion: In conclusion, the MABP can be used to assess the isokinetic strength of the rotator cuff muscles safely and confidently, with increased quantities of force being released and measurement at optimal muscle tension.

Evaluation of the Effect of Antibacterial Toothpastes Containing Chlorhexidine and Amine Fluoride on Oral Flora in Patients Undergoing Orthodontic Treatment-A Randomised Controlled Trial.

OBJECTIVES: To compare the efficacy of chlorhexidine (CHX) and amine fluoride (AF) toothpastes on oral flora in fixed orthodontic treatment patients. METHODS: Thirteen patients were given toothpaste containing AF, and 12 patients were given toothpaste containing CHX. Microbial and periodontal records were taken before, 1 week, and 5 weeks after the bonding procedure. Gingival index (GI), plaque index (PI), and bleeding on probing (BOP) values were recorded by the same expert calibrated before the study. Biofilm samples were taken, and then colony counts of the samples were evaluated. Whether the variable values obtained in the groups at the time of measurement were different was examined by Nonparametric Analysis of Longitudinal Data in Factorial Experiments-Nonparametric Tests for the F1_LD_F1 design for longitudinal data. RESULTS: Gender distribution was similar in the study groups (χ2 = 1.944; p = 0.163). The mean age of the patients did not differ in the groups (t = 0.502; p = 0.620). In general, the variable values analysed within the scope of the study did not show significant differences between groups and time (p > 0.05). When the pairwise interactions were analysed, it was found that there was a significant difference only for PI values (F = 3.411; p = 0.035). CONCLUSIONS: While there were no significant differences observed in BOP, GI, and S. mutans levels and changes in IgA and IgE values between toothpastes containing CHX and AF, the PI index of CHX-containing toothpastes exhibited a notably lower level. Both AF- and CHX-containing toothpastes can be used for managing biofilm, controlling bacteria, and minimising gingivitis in subjects undergoing fixed orthodontic treatment.

Prevalence and risk factors of psychological symptoms and quality of life in COVID-19 survivors: A cross-sectional study of three different populations.

AIM: Studies of the effects of COVID-19, especially post-acute COVID-19 syndrome, on psychological health in non-severe cases are limited. We aimed to evaluate the prevalence and associated risk factors of psychological symptoms, and quality-of-life in three groups of outpatients, hospitalized and intensive care patients. METHODS: A total 276 patients, previously confirmed with SARS-CoV-2 infection, attending the COVID-19 follow-up outpatient clinic from December 2020 to July 2021 were interviewed face-to-face. In this cross-sectional, retrospective study, all participants were asked our self-designed demographic and screening questions to assess their psychological symptoms and administered the WHQOOL-BREF survey to evaluate quality of life. RESULTS: In screening questions, major depressive disorder symptoms were detected at a rate of 20.3%, generalized anxiety disorder symptoms at a rate of 16.7%, panic attack symptoms at a rate of 10.9%, post-traumatic stress disorder symptoms at a rate of 28.6% and obsessive-compulsive disorder symptoms at a rate of 18.1%. The outpatient group with COVID-19 infection had a higher risk of developing psychological symptoms and decreased quality of life. CONCLUSION: COVID-19 infection was found to have a considerable psychological impact on those treated as outpatients despite the less severe course of their illness.

Postoperative Telenursing During the COVID-19 Pandemic: Improving Patient Outcomes.

PURPOSE: This study was conducted to determine if postoperative nurse-driven telehealth visits for patients undergoing septorhinoplasty decreased patient anxiety while improving comfort and satisfaction levels. DESIGN: The present study was an intervention-control study completed with a total of 320 participants (n = 160, intervention group; n = 160, control group). The intervention postseptorhinoplasty training using the telenursing method was conducted at three time points in this study; preoperatively-postoperatively, on days 3, and 10. METHODS: Data were collected from a group of patients undergoing septorhinoplasty in the Ear, Nose, and Throat department of a University Hospital in Turkey between October 2021 and February 2022. The data collected in the study were evaluated with the SPSS 23.00 program and were analyzed with the independent sample t test for two independent groups and the F test (ANOVA) for more than two groups. Correlation analysis was performed to examine the relationship between scales, and P < .05 was considered statistically significant. FINDINGS: In the postoperative period, the mean anxiety inventory score of the experimental group was found to be significantly lower than that of the control group (P < .01). Telenursing increased the satisfaction and comfort of the patients and shortened the discharge time. There was a negative and statistically significant relationship between satisfaction and State Anxiety Inventory and Trait Anxiety Inventory (r = -0.715, r = -0.739, P < .01). CONCLUSIONS: This study confirms the importance of postoperative telenursing for septorhinoplasty patients in promoting continuity of care, reducing anxiety and discharge time, improving comfort and satisfaction levels during the Covid-19 pandemic. Remote care was well received during the study and should be used more frequently. There is a need for further research regarding telehealth; and the international incentives and regulations which will be needed to make telenursing a standard of care should be pursued.

The effects of a 6-Week balance training in addition to conventional physiotherapy on pain, postural control, and balance confidence in patients with cervical disc herniation: a randomized controlled trial.

PURPOSE: Impaired postural control and fear of falling are common symptoms in patients with neck disorders, but the effects of balance training have not yet been sufficiently investigated. The aim of this study was to determine the effects of balance training on neck pain, postural control, and balance confidence in patients with cervical disc herniation (CDH). MATERIALS AND METHODS: Thirty patients (21 females and 9 males) aged 18-55 years were randomly assigned into two groups and followed up for 6 weeks, with a 3-day weekly treatment program. Both groups received hot pack therapy, interferential current, and myofascial relaxation and cervical dynamic isometric exercises. The training group also received additional balance training on a force platform with the visual feedback technique. All patients were evaluated using the visual analogue scale for pain intensity, activity specific balance confidence scale (ABC) for balance confidence, centre of pressure with eyes closed-eyes open (CoP-EO/CoP-EC), and the limits of stability tests (LoS) for postural control with a monoaxial bipodal stabilometric force platform pre- and post-intervention. RESULTS: The pain intensity was significantly reduced in both groups (p = 0.01). CoP-EO/CoP-EC and LoS results improved in the training group (p = 0.036, p = 0.020, p = 0.23, respectively), whereas no effects were observed in the control group (p = 0.955, p = 0.307, p = 0.363, respectively). Although ABC scores increased significantly in both groups (p = 0.001, p = 0.009, respectively), the increase in the training group was significantly higher than that of the control group (p = 0.003). CONCLUSIONS: The results of our study revealed that balance training added to the treatment protocol of CDH may have positive results in the treatment of neck problems. Accordingly, balance training in the treatment of chronic neck problems should also be considered for a comprehensive management of CDH.

Does Short Foot Exercise Combined with Breathing Exercise Increase Muscular Activity in Individuals with Pes Planus?

BACKGROUND: Improvements in muscle oxygenation and exercise posture can significantly impact muscle contraction. The aim of this study was to compare the effects of combined breathing and exercise posture (sitting or standing) on the muscle activity of the foot and ankle during short foot exercises (SFE) in individuals with pes planus. METHODS: The study included 15 subjects aged 21.53 ± 1.06 years, diagnosed with pes planus. Short foot exercises were performed with and without breathing exercises (BE) in sitting and standing positions. Surface electromyography was used to measure the activity of the tibialis anterior (TA), peroneus longus (PL), and abductor hallucis longus (ABDH) muscles during four different SFE. Four-way repeated analyses of variance were used to assess the addition of BE to SFE and muscle activities of the foot and ankle. RESULTS: Muscle activity in the TA, PL, and ABDH was significantly higher in the SFE with BE than without BE in the standing position than in the sitting position. The SFE performed with BE when standing significantly increased the ABDH and ankle muscle activity compared to without BE. CONCLUSIONS: SFE with BE may represent a new strengthening program for ABDH and PL foot muscles in rehabilitation programs for individuals with pes planus.

Pulmonary rehabilitation in interstitial lung diseases.

INTRODUCTION: Interstitial lung diseases are characterised by dyspnea on exertion, low quality of life, cough and exercise intolerance. The aim of this study was to evaluate the effects of comprehensive pulmonary rehabilitation in patients with interstitial lung disease. MATERIALS AND METHODS: Data from patients who were referred to pulmonary rehabilitation with the diagnosis of interstitial lung diseases were included to this study. Ten patients with interstitial lung disease participated to our outpatient, 8 weeks, comprehensive pulmonary rehabilitation programme. Dyspnea was assessed with the Medical Research Council (MRC) scale; health related quality of life was assessed with the St.George's Respiratory Questionnaire (SGRQ). Exercise capacity was measured using the incremental shuttle walk test (ISWT) and endurance shuttle walk test (ESWT); anxiety and depression were assessed with the hospital anxiety depression scale (HADS). All parameters were recorded before and after pulmonary rehabilitation programme. RESULTS: Dyspnea sensation, anxiety and depression scores decreased after pulmonary rehabilitation (p: 0.023, p: 0.026, p: 0.039 respectively). Also impact domains of SGRQ significantly reduced (Z= 1.988; p= 0.047).The difference between median values of ISWT results before and after pulmonary rehabilitation was 60 meters. Although it was not statistically significant (Z= 1.863; p= 0.063), the level of increment was higher than the minimaly important clinical differance for ISWT. CONCLUSION: Our results showed that comprehensive pulmonary rehabilitation programmes were benefical for patients with interstitial lung diseases and it should be regarded as a standard care in this population from the early stages.

A Delphi consensus study on the treatment of slipped capital femoral epiphysis: Considerable consensus in mild and moderate slips and limited consensus in severe slips.

Purpose: The aim of this expert consensus study was to establish consensus on the treatment of different types of slipped capital femoral epiphysis and on the use of prophylactic screw fixation of the contralateral unaffected side. Methods: In this study, a four-round Delphi method was used. Questionnaires including all possible theoretical slip scenarios were sent online to 14 participants, experienced in the field of children's orthopedics and in the treatment of hip disorders in children. Results: In-situ fixation was considered to be the first treatment choice in all types of mild slip scenarios and in moderate, stable ones. Performing in-situ fixation was not favored in moderate, unstable, and in all severe slip scenarios. In moderate to severe, unstable slip scenarios, there was consensus on the use of gentle closed or open reduction and internal fixation. Any consensus was not established in the optimal treatment of severe, stable slips. There was also consensus on the use of prophylactic screw fixation of the contralateral side in case of co-existing endocrine disorder and younger age. Conclusions: The establishment of consensus on the treatment of all types of slipped capital femoral epiphysis even among the experienced surgeons does not seem to be possible. The severity of the slip and stability of the slip are the primary and secondary determinants of the surgeons' treatment choices, respectively. In-situ fixation is still the preferred treatment option in several slip types. Gentle capital realignment by closed or open means is recommended in displaced, unstable slips. Prophylactic screw fixation of the contralateral side is indicated under certain circumstances. Level of evidence: level V.

Cross-cultural adaptation of the Revised Neurophysiology of Pain Questionnaire into the Turkish language based on Rasch analysis.

BACKGROUND: The Revised Neurophysiology of Pain Questionnaire (Revised-NPQ-Tr) is used to evaluate the change in pain knowledge. No study has explored its validity and reliability for the Turkish language. OBJECTIVES: This study aims to determine the psychometric properties of the Turkish version of the Revised-NPQ-Tr in chronic spinal pain patients. METHODS: A total of 182 chronic spinal pain patients were included in the study. The Revised-NPQ-Tr results were analyzed using Rasch analysis to measure the psychometric properties. RESULTS: The Revised-NPQ-Tr indicates misfit to the Rasch model, as evidenced by the borderline significant p value (LR test = 27.626; df = 11; p = .004; Bonferroni-adjusted α = 0.004). Two items were differentially affected by educational status. Removal of poor-functioning items did not improve the psychometric properties of the questionnaire. The Revised-NPQ-Tr is unidimensional and there was no local dependence between items. The questionnaire exhibits known group validity. Test-retest reliability of the questionnaire was moderate [intraclass correlation coefficient (ICC) = 0.629]; however, the internal consistency of the questionnaire was found to be low (Cronbach's α = 0.330; person separation index = 0.373). CONCLUSION: Although the internal validity of the Revised-NPQ-Tr version was acceptable, its reliability was found to be low. Consequently, the results of Revised-NPQ-Tr should be interpreted carefully in the clinic.

Developing a common metric using current scales for assessing functioning in patients with knee osteoarthritis.

Objectives: Various scales exist to assess different domains of functioning in knee osteoarthritis (OA). This study aimed to explore whether it is possible to develop a common metric (CM) from the frequently used scales to assess functioning in knee OA. Patients and methods: The methodological study evaluated 411 patients (81 males, 330 females; mean age: 61.8±10.5 years; range, 41 to 88 years) with knee OA. Data from the Health Assessment Questionnaire, Oxford Knee Score, Medical Outcomes Study Short Form 36, Knee Injury and Osteoarthritis Outcome Score, Western Ontario and McMaster Universities Arthritis Index, and the Nottingham Health Profile were used, and the items focusing on self-care, mobility, and domestic activity domains based on the activities and participation component of the International Classification of Functioning, Disability, and Health were included. Concurrent calibration was performed to combine the items of the scales. The CM parameters were estimated using the Rasch measurement model. Reliability was assessed using the person separation index. The CM was utilized to generate a transformation table to convert the scale scores to each other based on the reference metric score. Results: Each scale fitted the Rasch model. Item invariance was achieved for the CM (p=0.775). The CM had a person separation index of 0.827. Age, sex, and disease duration did not cause difference in item functions. The CM satisfied the assumptions of unidimensionality and local independence. Conclusion: A reliable CM was created from the commonly used scales to measure functioning in individuals with knee OA. Thus, clinicians and researchers can refer to the transformation table to directly compare scores of those scales and use them interchangeably.

Validity and reliability of the Turkish version of the Ottawa Sitting Scale in patients with acute stroke.

PURPOSE: To investigate the validity and reliability of the Turkish version of the Ottawa Sitting Scale (OSS-T) in patients with acute stroke. MATERIALS AND METHODS: The Berg Balance Scale (BBS) and Trunk Impairment Scale (TIS) were used to determine the validity of the OSS-T. The OSS-T was re-applied by the same rater after an interval of 7 days to determine the reliability. To test inter-rater reliability, the evaluation was repeated by a second rater 1 day after the first evaluation. Reliability was quantified using intraclass correlation coefficients (ICC), and validity was assessed by correlating the OSS-T scores with the results of the other measures. RESULTS: The ICC of the total OSS-T score for inter-rater reliability was 0.996 and for intra-rater reliability, it was 0.951. The Cronbach's α coefficient used to determine internal consistency was 0.980, which indicates excellent reliability. A strong positive correlation was found between OSS-T and TIS (rho = 0.861, p < 0.001), and between OSS-T and BBS (rho = 0.875, p < 0.001). An evident 2-factor structure was shown by the results of the factor analysis. CONCLUSIONS: The results of this study indicated that the OSS-T has strong measurement properties, making it a valid and reliable tool for research and clinical practice in patients with acute stroke.IMPLICATIONS FOR REHABILITATIONIndependent sitting function is an important indicator of functional recovery and discharge from hospital.Unlike other sitting balance tools, the Ottawa Sitting Scale can even categorize patients with low balance reserve by applying all the items with and without foot support.The Turkish version of the Ottawa Sitting Scale is a valid and reliable tool to evaluate sitting balance in patients with acute stroke.

The validity and reliability of the Turkish version of the 12-item Örebro musculoskeletal screening questionnaire (ÖMSQ-12-TR).

PURPOSE: The 12-item Örebro Musculoskeletal Screening Questionnaire (ÖMSQ-12) is a multidimensional questionnaire assessing general musculoskeletal problems. This study aimed to investigate its construct validity and reliability. MATERIALS AND METHODS: Confirmatory factor analysis (CFA) was performed for construct validity. The Tampa Scale for Kinesiophobia (TSK) and the SF-12 and Pain Numerical Rating Scale (P-NRS) were used for convergent validity. Reliability (ICC), internal consistency (Cronbach's alpha), reproducibility, and known-group validity were assessed. The cut-off value was measured. RESULTS: A total of n = 378 individuals (aged 35.7 ± 12.4 years, female = 73.3%) with a musculoskeletal problem participated in the study. P-NRS score of the individuals was 5. Results showed that a 3-factor model did fit well under CFA (χ2/df = 2.76 ≤ 3). The questionnaire had good reliability (ICC = 0.865) and internal consistency (α = 0.810). There were no floor or ceiling effects (<%15). Total ÖMSQ-12-TR scores had a correlation with the TSK, SF-12 and P-NRS (r = 0.303-0.609). The AUC for the risk of absenteeism from work was obtained as 0.738 (p < 0.001). The risk of absenteeism was high in individuals with an ÖMSQ-12-TR score of ≥57.5. CONCLUSIONS: The ÖMSQ-12-TR is a valid and reliable questionnaire that can be used in determining the risk of absenteeism in musculoskeletal disorders and is convenient for online use. CLINICAL TRIAL NUMBER: NCT04723615.

The validity and reliability of the Turkish version of the Brief Fear of Negative Evaluation Scale - straight forwardly in patients with systemic sclerosis.

Objective: This study aimed to examine the validity and reliability of Turkish version of Brief Fear of Negative Evaluation Scale-Straightforwardly (BFNE-S (TR)) in patients with Systemic Sclerosis (SSc). Materials and Methods: 35 individuals (mean age: 53.3±13.0 years) diagnosed as SSc were included. Data on demographics, were collected via structured interview. All participants were evaluated by same investigator. The disability was evaluated with Scleroderma Health Assessment Questionnaire (SHAQ), disease severity with Medsger's Disease Severity Scale, and skin involvement with Modified Rodnan Skin Score. BFNE-S (TR) was applied to the patients with SSc who did not receive any treatment for test retest at one-week intervals. Results: The one-factor structure was provided for all indices except Chi-Square. Factor loadings were significant. The patient responses to the BFNE-S (TR) demonstrated excellent internal consistency (Cronbach's α: 0.95). The floor effect (20%) percentage of patients who scored at floor level, was observed. Test-retest reliability of the scale was excellent with 0.91 (95%CI: 0.78-0.96). BFNE-S (TR) total score had positive correlation with SHAQ_Digestive (r=0.503) and SHAQ_Raynaud phenomenon (r=0.343)(p<0.05). Conclusions: The BFNE-S (TR) is a reliable and valid scale and can be used for measurement of fear of negative evaluation in SSc.

The effect of biacromial and bideltoid distance on shoulder dystocia and birth weight in newborns

Objective: To evaluate the relationship between neonatal biacromial and bideltoid diameter (BDD), birth weight and shoulder dystocia (SD). Material and Methods: This was a prospective observational study conducted on 161 pregnancies who applied to Private Lokman Hekim Hospital for follow-up between February 2021 and August 2021. Maternal height, weight, parity, and presence of SD in the second stage of labor were evaluated in the patients included in the study. The weight, height, head circumference, biacromial and BDD measurements of newborn babies were taken within the first two hours after birth. The primary purpose of the study was to evaluate the relationship between the biacromial and BDD and SD. The secondary purpose of the study was to evaluate the relationship between the biacromial and BDD and macrosomia. Results: The mean age and post-pregnancy body mass index of the participants were 31.3±4.4 years and 29.0±4.0 kg/m2, respectively, and 42.9% (n=69) delivered vaginally. The incidence of macrosomia was 6.8% (n=11) in all women and the incidence of SD was 7.2% (n=5) in women who had vaginal deliveries. The mean biacromial diameter (BAD) was 12.4±1.0 cm and the mean BDD was 18.2±1.7 cm. A correlation rate of 0.373 was found between SD and the BAD, and 0.484 between SD and the BDD. The correlation coefficients between macrosomia and the biacromial and BDD were 0.213 and 0.420, respectively. In cases in which the BDD was ≥21 cm, the sensitivity for SD was 100%, the specificity was 90.63%, and the accuracy was 91.30%. The cut-off point for the BAD was ≥14 cm, and the sensitivity and specificity for SD was 63.64% and 89.33%, respectively. The highest correlation for SD was obtained in cases in which there was a history of SD (0.648). Conclusion: The relationship between neonatal biacromial and BDD, and macrosomia and SD were significant. There was no difference between the correlation values of the two measurements in terms of SD. However, the correlation coefficient of the BDD was greater for macrosomia.

Evaluation of unilateral corneal collagen cross-linking on fellow untreated eyes of patients with keratoconus.

PURPOSE: This study aimed to examine the effects of unilateral corneal collagen cross-linking treatment on visual acuity and the topographic findings of the fellow untreated eye of patients who had bilateral progressive keratoconus. METHODS: Patients with progressive keratoconus who underwent cross-linking treatment were screened retrospectively. A total of 188 untreated eyes of 188 patients whose eyes were treated unilaterally with either standard or accelerated cross-linking and refused cross-linking procedure for the fellow eye were included. Visual acuity and topographic findings of the fellow untreated eyes were obtained preoperatively and postoperatively at the 1st, 3rd, 6th, 12th, 24th, 30th, and 36th months. RESULTS: The change over time of variables examined was similar in the untreated eyes of patients who received standard and accelerated cross-linking methods (p>0.05). At the 12th month, 136 (95.8%) untreated eyes were stable according to progression criteria. Only 4 (8%) eyes were progressive at the 24th month. No progression was observed in any of the 16 patients with a 36-month follow up. CONCLUSIONS: The results showed that the fellow untreated eyes of patients with bilateral progressive keratoconus did not have significant progression rates after unilateral cross-linking treatment.

Validity and Reliability of the Turkish Version of the DASH-TR Questionnaire in Rheumatoid Arthritis Patients, Based on Rasch Analysis.

AIM: This study aimed to examine the validity and reliability of the Turkish version of the Disabilities of the Arm, Shoulder and Hand Problems (DASH-TR) questionnaire in rheumatoid arthritis (RA) using the Rasch analysis. METHOD: A total 97 individuals (13 men, 84 women; mean age:51.99 ± 11.12 years, range: 20-65 years) diagnosed as having RA according to the criteria of the American College of Rheumatology were included. The functional status of the upper extremities was evaluated with the DASH-TR questionnaire, patient global health with a visual analog scale (VAS), disease activity with Disease Activity Score 28-C-reactive protein (DAS28-CRP), and disability with Health Assessment Questionnaire (HAQ). DASH-TR was applied to the patients with RA who did not receive any treatment for test-retest at 1-week intervals. DASH-TR results were analyzed using the Rasch analysis. RESULTS: In the sample of patients with RA, it was determined that the DASH-TR scale did not provide a unidimensional structure and the items were collected in two dimensions. The first 20 items and the last nine items were differentiated in the two-dimensional structure, and the factor load of m21 was low. Person separation index was obtained as 0.948. Internal consistency reliability was quite high. A significant positive correlation was found between the DASH-TR and VAS, DAS28 and HAQ. There was excellent test-retest reliability according to the intra-class correlation coefficient (0.921, 95% CI 0.882-0.947; P < 0.001). CONCLUSION: The DASH-TR is a reliable and valid questionnaire and can be used for measurement of functional status of the upper extremities in RA.

Hospital-at-home for chronic obstructive pulmonary disease exacerbation: Will it be an effective readmission avoidance model?

OBJECTIVES: Hospital-at-home (HAH), a pioneering health care model, is an accepted alternative to hospital treatment for patients with a chronic obstructive pulmonary disease (COPD) exacerbations. The aim of the present study was to analyze the effectiveness of HAH for patients with COPD exacerbations. METHODS: Two hundred six patients with COPD exacerbations who were admitted to our emergency room (ER) received the HAH model between January 2008 and March 2010. The number of patient's hospitalization, admission to emergency room, unscheduled outpatient attendance, and the length of stay in hospital (day) were recorded before and after a one-year period of HAH. RESULTS: After a one-year follow-up period of the HAH program, the number of patient who had hospitalization, admission to ER, unscheduled outpatient attendance rates was decreased 41.3%, 54.4%, 49.5% respectively. The decreases for all parameters were found to be statistically significant (P < 0.001). Additionally the total number of length of stay in hospital (day) after a one-year period after HAH was decreased (46.5%). CONCLUSION: Integrated care services, including home care units where HAH models are performed, are necessary to improve the health of patients with COPD, as well as to better manage their condition in terms of disease burden. Physicians should consider this form of management, especially because there is increasing pressure on inpatient bed requirement in Turkey.

An investigation of biomechanics, muscle performance, and disability level of craniocervical region of individuals with temporomandibular disorder.

OBJECTIVE: To investigate biomechanics, muscle performance, and disability of the craniocervical region in temporomandibular disorder (TMD) patients and compare them with controls. METHODS: Craniocervical posture was evaluated using lateral photography and radiography. Range of motion, muscle performance, disability, and TMD severity were assessed using an inclinometer, Functional Strength Testing of Cervical Spine, Neck Disability Index, and Fonseca Anamnestic Index, respectively. RESULTS: Compared to the control group, the TMD group demonstrated higher cervical flexion angle (p=0.005) and neck disability (p<0.001) as well as lower cervical extension (p=0.040), right cervical rotation (p=0.005), left cervical rotation (p<0.001), and tragus-C7-horizontal (p=0.048) angles, and reduced muscle performances (p≤0.001). Most patients had higher than normal craniocervical angle (p<0.001). Muscle performance in each cervical motion (p<0.005) and disability (p<0.001) were associated with TMD severity in the TMD group. CONCLUSION: Biomechanics, muscle performance, and disability of craniocervical region were altered in the TMD group.