Characteristics of diabetes mellitus patients in Turkey: An analysis of national electronic health records.

BACKGROUND: It was estimated that there were 537 million people with diabetes mellitus in 2021, representing 10.5% of the global adult population. Diabetes prevalence in Turkey is 13.5%, according to a meta-analysis and 17.3% according to a recent study. Although the primary purpose of Electronic Health Records (EHRs) is clinical, researchers can use them to conduct epidemiologic investigations. This study aims to document the prevalence of diabetes and to evaluate the healthcare utilization of people with diabetes compared to the people without diabetes, based on national EHR. METHODS: Only people over 14 years old were included in the analysis. Our criteria for being diabetic were 1) having an HbA1c over 6.5% (48 mmol/mol), 2) having a prescription with DM diagnosis, ICD-10 codes E10-E14, or 3) having at least two fasting blood glucose measurements over 126 mg/dl. RESULTS: At the end of 2020, there were 7,178,674 individuals with diabetes, with 11.12% prevalence, 13.10% in women while 9.12% in men. Age-adjusted healthcare facility admission per capita was 15.5 for people with diabetes, 9.5 for people without diabetes, while the number of prescriptions was 7.9 for people with diabetes while 4.5 for people without diabetes in 2019. The mean number of prescriptions containing antidiabetics was 2.88 per person with diabetes in 2019. DISCUSSION: Approximately 11% of Turkish people have diagnosed with diabetes. We estimate that about one-third of people with diabetes are undiagnosed and the majority of these people are men. The results show that such large databases have the capability of supplying a vast amount of information to the scientific community.

Nationwide content analysis of undergraduate obstetrics and gynaecology clinical curricula in Turkish medical schools.

The aim was to perform a document content analysis of the subject titles in the undergraduate obstetrics and gynaecology (OG) curricula in Turkish medical schools regarding the National Core Curriculum revised in 2014 (NCC-2014). Two mini-focus group discussions with four voluntary OG faculty members in each session and one of the authors as the moderator were employed within a 1-week time frame to identify the primary (n = 36) and secondary (n = 15) NCC-2014 OG titles that were then compared for the alignment with the curricula of the various medical schools published on their website. The internet search and data analyses were each completed within 3 months. Overall, about 80% and 23% of primary and secondary OG topics were present in 54 medical schools, respectively. Teaching sessions on high-risk pregnancy and ovarian cancer were present in all of the curricula. Chromosomal disorders (11 schools), candidiasis/vaginal discharge (13 schools) and female sexual dysfunction (15 schools) were the least represented primary topics. None of the curricula had a title on neural tube defects or oncological emergencies. Obesity (one school), iron deficiency anaemia (four schools), genitourinary trauma (four schools) and domestic violence (four schools) were among the underrepresented secondary subject titles. This nationwide analysis revealed deficiencies in undergraduate OG core curricular content of the medical schools.

Factors Affecting Nursing Students' Readiness and Perceptions Toward the Use of Mobile Technologies for Learning.

The purpose of this study was to determine the current usage of mobile devices, preferences of mobile learning environments and examine the readiness of nursing students in a public university. In order to investigate preferences and attitudes with respect to mobile technology use in nursing education, 387 students at a state university have been surveyed. It has been observed that while students preferred their current portable laptops, those in higher classes were more inclined to favor mobile phones. The common problems of battery life and high cost of communication, both in smartphones and tablet systems, suggest that hardware quality and financial constraints seem to be two main factors in determining these technologies. While more than half of students expressed readiness for mobile learning, one quarter indicated indecision. Through multivariate regression analysis, readiness to use mobile learning can be described in terms of perceived ease of use, perceived usefulness, personal innovativeness, self-management of learning, perceived device limitation, and availability. Class level, perceived ease of use, personal innovativeness, and self-management of learning explain intention to use mobile learning. Findings obtained from these results can provide guidance in the development and application of mobile learning systems.

Estimating Cognitive Load in a Mobile Personal Health Record Application: A Cognitive Task Analysis Approach.

OBJECTIVES: Mobile health applications that are designed without considering usability criteria can lead to cognitive overload, resulting in the rejection of these apps. To avoid this problem, the user interface of mobile health applications should be evaluated for cognitive load. This evaluation can contribute to the improvement of the user interface and help prevent cognitive overload for the user. METHODS: In this study, we evaluated a mobile personal health records application using the cognitive task analysis method, specifically the goals, operators, methods, and selection rules (GOMS) approach, along with the related updated GOMS model and gesture-level model techniques. The GOMS method allowed us to determine the steps of the tasks and categorize them as physical or cognitive tasks. We then estimated the completion times of these tasks using the updated GOMS model and gesture-level model. RESULTS: All 10 identified tasks were split into 398 steps consisting of mental and physical operators. The time to complete all the tasks was 5.70 minutes and 5.45 minutes according to the updated GOMS model and gesture-level model, respectively. Mental operators covered 73% of the total fulfillment time of the tasks according to the updated GOMS model and 76% according to the gesture-level model. The inter-rater reliability analysis yielded an average of 0.80, indicating good reliability for the evaluation method. CONCLUSIONS: The majority of the task execution times comprised mental operators, suggesting that the cognitive load on users is high. To enhance the application's implementation, the number of mental operators should be reduced.

Subjective Cognitive Load Evaluation of a Mobile Personal Health Record Application.

Mobile Personal Health Records (mPHRs), which make it possible to track and manage users' health information, can be an important aid in improving people's health. Despite its potential benefits, poor usability of systems can hinder the adoption and use of mPHRs. This study aims to evaluate the usability of a mobile health application in terms of perceived cognitive workload and performance. The cognitive workload experienced by 30 volunteers (15 experienced and 15 inexperienced), was measured while performing the given tasks with the NASA-Task Load Index (NASA-RTLX) scale, and the duration of the fulfillment of the tasks by eye tracking device. While there was no significant difference between the two user groups in the completion time of the tasks, a significant difference was found in the perceived cognitive load. "Making an appointment", which could take much longer to complete than other tasks, resulted in the highest cognitive load for all users. Further usability research using think-aloud protocols and user interviews could provide insights into design improvements for reducing cognitive load and enhancing performance.

Cohen's d and physicians' opinion on effect size: a questionnaire on anemia treatment.

A well-known effect size (ES) indicator is Cohen's d. Cohen defined d measures of small, medium, and large ES as 0.2, 0.5, and 0.8, respectively. This approach has been criticized because practical and clinical importance depends on the context of research. The aim of the study was to examine physicians' perception of ES using iron deficiency anemia treatment as an example and observing the effects of pretreatment level and duration of treatment on the magnitude of ES. We prepared a questionnaire describing four different clinical studies: (1) 1 month of treatment of anemia in a group of patients with a mean hemoglobin (Hb) of 10 g/dL; (2) 3 months of treatment at an Hb level of 10 g/dL; (3) 1 month of treatment at an Hb level of 8 g/dL; and (4) 3 months of treatment at an Hb level of 8 g/dL. In each scenario, respondents were required to evaluate six various levels of Hb improvement as being very small, small, medium, large, or very large effect: 0.1 g/dL, 0.3 g/dL, 0.7 g/dL, 1.1 g/dL, 1.7 g/dL, and 2.8 g/dL. The responses of 35 physicians were evaluated. For 10 mg/dL, the Cohen's d for small, medium, and large ES was 0.5, 0.8, and 1.2 respectively, for 1 month of treatment. In terms of 3 months of treatment, the Cohen's d was 0.8, 1.2, and 2, respectively. Two separate pretreatment Hb levels (8 g/dL and 10 g/dL) demonstrated a minor difference. Determination of ES during the planning phase of studies requires thorough evaluation of specific clinical cases. Our results are divergent from the classic Cohen's d values. Additionally, duration of treatment affects ES perception.

A Web-based Game for Teaching Facial Expressions to Schizophrenic Patients.

BACKGROUND: Recognizing facial expressions is an important social skill. In some psychological disorders such as schizophrenia, loss of this skill may complicate the patient's daily life. Prior research has shown that information technology may help to develop facial expression recognition skills through educational software and games. OBJECTIVES: To examine if a computer game designed for teaching facial expressions would improve facial expression recognition skills of patients with schizophrenia. METHODS: We developed a website composed of eight serious games. Thirty-two patients were given a pre-test composed of 21 facial expression photographs. Eighteen patients were in the study group while 14 were in the control group. Patients in the study group were asked to play the games on the website. After a period of one month, we performed a post-test for all patients. RESULTS: The median score of the correct answers was 17.5 in the control group whereas it was 16.5 in the study group (of 21) in pretest. The median post-test score was 18 in the control group (p=0.052) whereas it was 20 in the study group (p<0.001). CONCLUSIONS: Computer games may be used for the purpose of educating people who have difficulty in recognizing facial expressions.

Web-based training: readiness and perceptions of nurses.

This study was conducted as a descriptive study in order to determine the views of nurses working a university hospital on web-based training. Population consisted of all the nurses working in the hospital. It was found out that nurses use computer at the moderate level (46.5 %), they benefit from Internet at a good level (46.5 %), almost all of them use Internet to make searches about professional issues (94.6%), they want to update their professional knowledge (90.1%) and they find it difficult to reach information on such grounds as time constraint (81.1 %) and lack of appropriate environment (62.1 %) and they want to receive a web-based training (87.1 %). It is important that web-based training programmes be generalised in the field of nursing where there exists a time problem, studies as regards to how to integrate these programmes into continuing education be increased and their results be reflected on the practices.

Analysis of social networks among physicians employed at a medical school.

Social network analysis is a well-known method for discovering the social complexities of relationships. In this paper, we present the results of its application in a healthcare environment, i.e. a state university hospital. The sociometric method was adopted to collect social network data. The analysis was performed using Pajek. The medical practice/academic and technological networks among physicians of a state university hospital were explored. Monomorphic and polymorphic opinion leaders (OLs) within the networks were identified using the in-degree measure. Cohesiveness were investigated based on network density and average degree. In addition, it was checked if the mentor system may present impact on the formation of social networks among physicians.

Evaluation of the usability of a serious game aiming to teach facial expressions to schizophrenic patients.

In some psychological disorders such as autism and schizophrenia, loss of facial expression recognition skill may complicate patient's daily life. Information technology may help to develop facial expression recognition skill by educational software and games. We designed and developed an interactive web-based educational program with which we performed a usability study before investigating its effectiveness on the schizophrenia patients' ability of emotion perception. The purpose of this study is to describe the usability evaluation for a web-based game set that has been designed to teach facial expressions to schizophrenic patients. The usability study was done at two steps; first, we applied heuristic evaluation and the violations were rated in a scale from most to least severe and the major problems were solved. In the second step, think-aloud method was used and the web site was assessed by five schizophrenic patients. Eight experts participated in the heuristic evaluation, in which a total of 60 violations were identified with a mean severity of 2.77 (range: 0-4). All of the major problems (severity over 2.5) were listed and the usability problems were solved by the development team. After solving the problems, five users with a diagnosis of schizophrenia used the web site with the same scenario. They reported to have experienced minor, but different problems. In conclusion, we suggest that a combination of heuristic evaluation and think-aloud method may be an effective and efficient way for usability evaluations for the serious games that have been designed for special patient groups.

A web-based intensive care clinical decision support system: from design to evaluation.

The aim of this study is to develop and evaluate a web-based clinical decision support system (CDSS) containing clinical guidelines and protocols that will support intensive care unit (ICU) providers in making decisions more effectively and quickly. First, a survey was carried out with 38 physicians in order to determine their preferences, needs and concerns regarding decision support tools. After the survey, guidelines were prepared by a group of specialists in ICU, and a medical informatician converted the guidelines into algorithm forms. Ten CDSS were developed using the algorithms, and placed onto the Intensive Care Decision Support Website (ICDSW). In order to evaluation of the website, 15 physicians were asked to answer 10 questions in 10 different scenarios first using a paper-based approach, then with ICDSW. When the answers were analyzed, it was found that the answers given by using ICDSW were significantly better than the paper-based approach (p < 0.001). However, there was no significant difference in terms of the time needed to answer the questions (p = 0.138). The usability score of the website was 85.6 ± 8.89. The study demonstrated the successful implementation of an ICDSW within intensive care units.

Usability of a web-based personal nutrition management tool.

'Personal Nutrition Management Tool' (PENUMAT) is an interactive web-based application which aims to help individuals seeking nutrition information on the Internet. However, little is known about the usability of such applications. The purpose of this study was to evaluate the usability of PENUMAT using multi-method approach. For an in-depth usability analysis, using a multi-method approach involving protocol analysis, interviews and a system usability scale (SUS) was adopted. The sample consisted of 10 healthy (five males and five females) volunteers between the ages of 22 and 60. The overall usability score was calculated; usability problems and users' opinions were obtained. All usability problems were classified according to the heuristics and listed with their frequencies. Overall, the usability score ranged from 77.5 to 100, with a median of 88.7. In-depth usability analysis exposed several usability problems mostly related to content, navigation and interactivity. Interview results showed that 'being personal and private' (70%) and 'providing personal feedbacks' (60%) were the most appreciated characteristics of the tool. Although the tool has an acceptable overall usability score, several unnoticed usability problems of the interface design were realised with the in-depth analysis. Therefore, the importance of using a multi-method analysis of usability was pointed out.

[E-learning and problem based learning integration in cardiology education]. / Kardiyoloji egitiminde e-ögrenme ve probleme dayali ögrenme entegrasyonu.

OBJECTIVE: The aim of this study was to determine students' satisfaction with an e-learning environment which is developed to support classical problem-based learning (PBL) in medical education and its effect on academic achievement. METHODS: In this cross-sectional study, students were provided with a web-based learning environment including learning materials related to objectives of the subject of PBL module, which could be used during independent study period. The study group comprised of all of the second year students (164 students) of Akdeniz University, Medical Faculty, during 2007-2008 education period. In order to gather data about students' satisfaction with learning environment, a questionnaire was administered to the students. Comparison of students' academic achievement was based on their performance score in PBL exam. Statistical analyses were performed using unpaired t test and Mann Whitney U test. RESULTS: Findings indicated that 72.6% of the students used e-learning practice. There is no statistically significant difference between mean PBL performance scores of users and non-users of e-learning practice (103.58 vs. 100.88) (t=-0.998, p=0.320). It is found that frequent users of e-learning application had statistically significant higher scores than non-frequent users (106.28 vs. 100.59) (t=-2.373, p=0.01). In addition, 72.6% of the students declared they were satisfied with the application. CONCLUSION: Our study demonstrated that the most of the students use e-learning application and are satisfied with it. In addition, it is observed that e-learning application positively affects the academic achievement of the students. This study gains special importance by providing contribution to limited literature in the area of instructional technology in PBL and Cardiology teaching.

Instructional technology adoption of medical faculty in teaching.

Despite large investment by higher education institutions in technology for faculty and student use, instructional technology is not being integrated into instructions in the higher education institutions, including medical education institutions. While diffusion of instructional technologies has been reached a saturation point with early adopters of technology, it has remained limited among mainstream faculty. This study explored technology adoption patterns and perceptions of medical faculty about barriers and incentives to technology adoption in teaching.Complete data was obtained from 155 participants by using survey methodology and analyzed on the basis of theories of diffusion of innovation.Findings provided evidence for limited adoption of relatively new tools associated with instruction into mainstream faculty. Inadequate hardware for students and faculty, lack of reward structure, insufficient traing oppurtunites were identified as major barriers to faculty technology adoption.