A Model Proposal for Developing a Solution and Determining the Administrative Problems of Hospitals in Turkey: The BUY Model.

Background and Purpose: This study was conducted in line with the request of the senior management of a hospital. The objective of the current research is to identify managerial problems through the relationship between health employees' perceptions of organizational justice, trust in the manager and the organization, and job satisfaction; develop a solution proposal over the relationships between these variables and motivation variables; and present a model proposal (BUY Model) as a result. Methods: The study sample is comprised of 673 employees. The study data were collected online using a questionnaire consisting of five scales. The data were analyzed by descriptive statistical methods, correlation analysis, and regression analysis. Results: The findings obtained from the study showed that the participants' perceptions of organizational justice, trust in the manager and the organization, job satisfaction and motivation were generally at a moderate level. The study also determined that trust in the manager and the organization had a partial mediation effect on the effect of organizational justice on job satisfaction and the variables of trust in the organization, organizational justice, and trust in the manager, respectively, and especially, the job satisfaction variable also affected motivation. Conclusion: The BUY model was developed to identify problems related to the management of healthcare human resources and solve these problems. Considering the importance of the concepts of job satisfaction and motivation in terms of employee performance, health service quality, and patient satisfaction, it is thought that the developed model will benefit managers of health institutions in increasing the job satisfaction and motivation levels of health employees.

Family Physicians' Perspectives on the Pros, Cons, and Application Areas of Telemedicine: A Qualitative Study.

Background: There is evidence that telemedicine can be used safely, easily, and cost-effectively in primary health care services. This study aims to determine family physicians' opinions regarding the potential advantages, disadvantages, and usage areas of telemedicine in primary health care services. Methods: This study was designed with a qualitative case study. The Standards for Reporting Qualitative Research (SRQR) checklist was followed throughout the research process. Interviews were conducted with family physicians working in a provincial center using snowball sampling in the study. MaxQDA 20 software was used for analysis process, and themes and subthemes were identified through a deductive-reflective thematic analysis method. The family physicians who participated in the study are between 29 and 56. In addition, family medicine specialists, general practitioners, and academic department heads were included in the study. Family physicians are evenly distributed in terms of gender and professional experience. Results: All interviewed family physicians stated that they had not received professional or technical training in delivering telemedicine. It was observed that family physicians had different perspectives on telemedicine in primary care. The data obtained in the study were analyzed under the main themes of the advantages, disadvantages, and services that can be provided in primary telemedicine. Physicians have different views on telemedicine, including negative, undecided, and positive opinions. Conclusion: It is understood that many services could be delivered remotely if the scope, procedures, and processes of the services to be provided are determined with guidelines. It is recommended that family physicians receive professional and technical training in telemedicine.

A New Experience in the Turkish Health System in Response to COVID-19.

OBJECTIVE: A substantial amount of work addressing strategies on how to respond to the coronavirus disease (COVID-19) crisis already exists. However, there is simply not enough evidence to support a systematic and all-encompassing approach. This study aims to systematically review and present the roadmap of Turkiye's response to COVID-19. METHODS: This study is based on a thematic content analysis of official policy documents to present the roadmap in Turkiye's fight against COVID-19. The analysis included 46 press releases accessed from the Ministry of Health's website. The coding structure was created by the researchers based on the literature. Documents were analyzed by dividing them into 3 periods: the panic period, the controlled normalization period, and the normalization period. Each document was sub-coded under the main themes of "concerns" and "strategies" and interpreted by comparing them with each other. RESULTS: The study results show that different categories and coding structures were formed between periods. Some categories that emerged under the theme of concerns were "vaccine concerns" and "social concerns." Similarly, some categories that appeared under the theme of strategies were "vaccine strategies," "monitoring and surveillance strategies," and "intervention strategies." CONCLUSION: The results provide policy-makers with an appropriate conceptual framework to deal with the pandemic crisis that may be encountered in the future.

An Evaluation of Cesarean Delivery Rates According to Robson Classification in the Black Sea Region of Turkey.

OBJECTIVE: To analyse cesarean deliveries (CD) using the Ten Group Classification System (TGCS) for reducing cesarean rates. STUDY DESIGN: Cross-sectional study. PLACE AND DURATION OF STUDY: Ordu University Medical Faculty Training and Research Hospital, Ordu, Turkey, from 1st January 2008 to 31st December 2020. METHODOLOGY: A total of 29,885 deliveries during the 13-year study period were analysed. Group sizes and annual, overall, absolute, and relative CD rates were calculated to analyse the effect of the Robson groups (RGs)/TGCS. The data were analysed using the two-way Chi-square test and two-proportion Z-test with Bonferroni correction. RESULTS: The overall CD rate was 59.22% (17,697). The principal contributors to the overall CD rate were RG5 (54.48%), RG1 (12.52%), and RG2 (10.06%). The relative CD rate in preterm pregnancies (RG10) increased approximately five-fold over the 13-year study period due to the increase in both group size and absolute CD rate (p<0.001). CONCLUSION: TGCS shows the cesarean delivery trends in terms of cesarean rates and identifies those groups requiring special precautions. The target groups (RG5, RG1, RG2 and RG10) need more in-depth research to reduce CD rates. Various approaches need to be implemented including individualised cesarean indication, encouragement of vaginal delivery after cesarean delivery, expectant management in nulliparous women, and spontaneous labor for preterms labor. KEY WORDS: Cesarean section, Elective cesarean section, Induction of labor, Vaginal birth after cesarean section, Robson classification, Preterm deliveries.

Evaluating scientific research barriers by gender and other characteristics from the perspective of ophthalmologists in Turkey: A multicenter survey study.

BACKGROUND/AIM: The ever-increasing population and life expectancy worldwide increase the prevalence of ophthalmic diseases, and the need for ophthalmic research expands accordingly. In our study, we aimed to evaluate many aspects of the barriers, especially gender disparities, confronting ophthalmologists who aspire to conduct scientific research (SR). MATERIALS AND METHODS: In this descriptive quantitative study, we distributed an online questionnaire to ophthalmologists in Turkey with 21 questions presented on a five-point Likert scale and two open-ended questions. The survey was prepared with Google forms. Participants were recruited via e-mail and social networks. A multicenter survey was conducted between January 29 and February 20, 2021, and a total of 210 valid responses were recorded. RESULTS: Participants' responses were grouped into four types of barriers: motivation, time constraints, research support, and competence. Participants' motivation to conduct research was above average (3.54±0.96), but most stated that they have time constraints (3.74±0.97). Participants did not agree that there is adequate support for research (2.35±0.76), and they self assessed their level of the required competence to be average (2.87±1.08). Women were more motivated to do SR than men (p = 0.008), but there were no statistically significant differences between women and men in terms of time constraints, research support, and level of competence (p = 0.853, p = 0.482, and p = 0.558, respectively). Although there is no statistically significant difference between men and women regarding time constraints, female physicians mentioned more about the barriers arising from their personal responsibilities (p = 0.038). CONCLUSIONS: Our study revealed that ophthalmologists are enthusiastic about doing SR but encounter obstacles with regard to time availability and research support. In addition, there is a need to reinforce competence in SR. Although female physicians are more motivated than men, they must deal with competing domestic responsibilities.

A significant predictor of in-hospital and long-term mortality and progression in COVID-19 patients: The end-stage liver disease (MELD) score model.

The aim of this study is to investigate the relationship between the model for end-stage liver disease (MELD) score and disease progression and mortality in COVID-19 patients. The files of 4213 patients over the age of 18 who were hospitalized with the diagnosis of COVID-19 between March 20, 2020 and May 1, 2021 were retrospectively scanned. Sociodemographic characteristics, chronic diseases, hemogram and biochemical parameters at the time they were diagnosed with COVID-19 of the patients, duration of hospitalization, duration of intensive care unit (ICU), duration of intubation, in-hospital mortality from COVID-19 and outside-hospital mortality for another reason (within the last 1 year) and recurrent hospitalization (within the last 1 year) were recorded. The MELD scores of the patients were calculated. Two groups were formed as MELD score < 10 and MELD score ≥ 10. The rate of ICU, in-hospital mortality from COVID-19 and outside-hospital mortality from other causes, intubation rate, and recurrent hospitalization were significantly higher in the MELD ≥ 10 group. The duration of ICU, hospitalization, intubation were significantly higher in the MELD ≥ 10 group (p < 0.001). As a result of Univariate and Multivariate analysis, MELD score was found to be the independent predictors of ICU, in-hospital mortality, intubation, and recurrent hospitalization (p < 0.001). MELD score 18.5 predicted ICU with 99% sensitivity and 100% specificity (area under curve [AUC]: 0.740, 95% confidence interval [CI]: 0.717-0.763, p < 0.001) also MELD score 18.5 predicted in-hospital mortality with 99% sensitivity and 100% specificity (AUC: 0.797, 95% CI: 0.775-0.818, p < 0.001). The MELD score was found to be the independent predictors of in-hospital mortality, ICU admission, and intubation in COVID-19 patients.

The Effects of Demographic, Training, and Specialization Differences of Physicians in COVID-19 Treatment in Turkey.

INTRODUCTION: The study aimed to determine how physicians' professional and institutional characteristics affect their treatment approaches for COVID-19 antiviral and supportive treatment, as well as their demographic characteristics and participation in COVID-19 trainings that may influence these orientations. METHODS: After researching the literature and conducting interviews with the experts, a questionnaire was prepared. The convenience sampling method was used to distribute the questionnaire online to 408 physicians across the nation in January 2021. Exploratory factor analysis was used to verify the research scale, and the Cronbach's Alpha test was used to confirm its reliability. During the data analysis, descriptive and inferential statistical tests were used. RESULTS: It was observed that the physicians were willing to give COVID-19 patients the antivirals but hesitant to provide and suggest supportive care. The training status for COVID-19 treatment was varied. Female physicians prescribed more antiviral drugs than male physicians, received more training, and scored higher across the scale than male physicians ( p = 0.001). The treatment approaches of physicians varied according to their specializations ( p = 0.002) all over the scale. CONCLUSION: The publication of current Ministry of Health guidelines on a variety of themes related to COVID-19 treatment, as seen in Turkey, is both beneficial and important. However, because all physicians, regardless of specialty, are affected by current and will be in the future pandemics, it is necessary to design and maintain a continuous training program on pandemics and their management for all physicians.

Mental disorders among pregnant women during the COVID-19 pandemic. A cross-sectional study

ABSTRACT BACKGROUND: Pregnancy is the most important event in women's lives and can lead to psychological lability. Several risk factors (such as disasters, events and pandemics) have been correlated with greater prevalence of mental disorders during pregnancy. OBJECTIVES: To research how pregnant women have been affected by the coronavirus disease-19 (COVID-19) pandemic process, in order to contribute to the limited literature. DESIGN AND SETTING: Cross-sectional survey study conducted at the Training and Research Hospital of the Faculty of Medicine, University of Ordu, Ordu, Turkey, from February 1 to March 1, 2021. METHODS: In total, 356 pregnant women were enrolled and completed the survey. Intention of going to hospital and the Beck anxiety, Beck depression, Beck hopelessness and Epworth sleepiness scales were applied to detect mental disorders. RESULTS: Among the participants, the anxiety, depression, hopelessness and sleepiness scores were 29.2%, 36.2%, 58.1% and 11.8%, respectively. The pregnant women stated that they avoided going to hospital in unnecessary situations by obeying the 'stay at home' calls, but also stated that they were afraid of the potential harmful effects of inadequate physician control. However, most of them stated that they would go to the hospital in emergencies. CONCLUSIONS: This paper illustrated the effect of the COVID-19 pandemic on the mental health of pregnant women and emphasized their high rates of anxiety, depression, hopelessness and sleepiness. Since presence of mental disorders is indirectly related to poor pregnancy outcomes, preventive strategies should be developed, especially during this pandemic process.

Mental disorders among pregnant women during the COVID-19 pandemic. A cross-sectional study.

BACKGROUND: Pregnancy is the most important event in women's lives and can lead to psychological lability. Several risk factors (such as disasters, events and pandemics) have been correlated with greater prevalence of mental disorders during pregnancy. OBJECTIVES: To research how pregnant women have been affected by the coronavirus disease-19 (COVID-19) pandemic process, in order to contribute to the limited literature. DESIGN AND SETTING: Cross-sectional survey study conducted at the Training and Research Hospital of the Faculty of Medicine, University of Ordu, Ordu, Turkey, from February 1 to March 1, 2021. METHODS: In total, 356 pregnant women were enrolled and completed the survey. Intention of going to hospital and the Beck anxiety, Beck depression, Beck hopelessness and Epworth sleepiness scales were applied to detect mental disorders. RESULTS: Among the participants, the anxiety, depression, hopelessness and sleepiness scores were 29.2%, 36.2%, 58.1% and 11.8%, respectively. The pregnant women stated that they avoided going to hospital in unnecessary situations by obeying the 'stay at home' calls, but also stated that they were afraid of the potential harmful effects of inadequate physician control. However, most of them stated that they would go to the hospital in emergencies. CONCLUSIONS: This paper illustrated the effect of the COVID-19 pandemic on the mental health of pregnant women and emphasized their high rates of anxiety, depression, hopelessness and sleepiness. Since presence of mental disorders is indirectly related to poor pregnancy outcomes, preventive strategies should be developed, especially during this pandemic process.

Effect of COVID-19 pandemic on anxiety depression and intention to go to hospital in chronic patients.

OBJECTIVE: The aim of this study was to investigate the effects of the COVID-19 pandemic on anxiety depression and intention to go to the hospital in chronic patients. METHODS: The Bostan Intention to Go to Hospital Scale developed by one researcher (SB) as the data collection tool and the Beck Anxiety-Depression Inventories were used. RESULTS: Of all patients, 56.8% stated that they would go to the hospital in case of emergency and 28.3% expressed that they did not want to go to the hospital even in this case. 50% of the participants said that they did not want to go to the hospital under any circumstances during the pandemic process. As a result of the correlation analysis, there was an inverse correlation between the anxiety-depression levels and encountering COVID-19 patients and having a relative with COVID-19 (P = .001). Inverse correlation was found between intention to go to hospital and encountering COVID-19 patients (P = .001). CONCLUSION: It was revealed that chronic patients did not have any intentions to go to hospital during the COVID-19 pandemic and only half of the people were willing to go to the hospital in case of emergency. Anxiety and depression levels were found to increase when COVID-19 patients were encountered or a relative had COVID-19.

The evolution of the changes in the clinical course: a multicenter survey-related impression of the ophthalmologists at the peak of the COVID-19 pandemic in Turkey.

PURPOSE: The coronavirus disease-2019 (COVID-19) has become a difficult pandemic to control worldwide. The high transmission risk and mortality rates of COVID-19 cause serious concerns in ophthalmologists and may cause disruptions in clinical functioning. This study aims to identify changes in the clinical approaches of ophthalmologists, understand their anxiety levels, and exhibit how patients' follow-up processes progress during the pandemic. METHODS: A questionnaire that including demographic information, ophthalmology clinical activity scale, and Beck anxiety scale was sent to ophthalmologists in Turkey. Google Forms was used as a survey platform in this study. RESULTS: A total of 121 ophthalmologists participated in the study. The participants stated that they could not continue routine interventional diagnosis and treatment practices during the outbreak. It was clearly stated that there were changes in their clinical approach and decreased patient examination quality. For this reason, 14.9% of physicians said to missed the diagnosis in this process. Physicians who encounter infected patients state that it is more difficult to provide ophthalmological services and their clinical approaches are affected more negatively. Anxiety levels of physicians who could access personal protective equipment (PPE) and show positive solidarity with their colleagues in the process were found to be lower. CONCLUSION: Our study revealed that ophthalmologists, like other healthcare professionals, were severely affected by the COVID-19 outbreak. Accordingly, healthcare managers should provide adequate PPE for ophthalmologists, organize the clinical operation, and support the mental health of ophthalmologists.

The Effect of the COVID-19 Pandemic on Functioning of Neurosurgery Clinics and the Anxiety Levels of Neurosurgeons in Turkey.

AIM: To reveal the impacts of the novel coronavirus 2019 (COVID-19) pandemic on the functioning of neurosurgery clinics and to determine the anxiety levels and attitudes of Turkish neurosurgeons towards their profession during the pandemic. MATERIAL AND METHODS: The Beck anxiety inventory and a clinical activities scale were utilized as data collection tools and distributed to neurosurgeons in Turkey as an online survey. Descriptive statistical methods, significance tests and correlation and regression analyses were employed to analyze the data. The data analysis was carried out in a 95% confidence interval. RESULTS: Of the 240 neurosurgeons who participated in the study, 63.8% had encountered cases of COVID-19 and 53.8% had handled patients diagnosed with COVID-19. The study results showed that the pandemic did not cause anxiety in 62.9% of the respondents, but it caused mild anxiety in 13.8% and moderate anxiety in 12.12%. The findings also revealed a low linear correlation between the anxiety values and occupational anxiety of the neurosurgeons and low inverse correlation between anxiety values and the protection factor in the pandemic period. CONCLUSION: The COVID-19 pandemic has caused serious disruptions in the routine functioning of neurosurgery clinics and changes in the attitudes of neurosurgeons. Healthcare organizations should take the necessary precautions and measures to resolve the anxiety problems of healthcare professionals, such as providing professional support, and ensure that they can work in a safer environment.

The Effects of Covid-19 Pandemic on Syrian Refugees in Turkey: The Case of Kilis.

The objective of this study; is to find out the sensitivity, the concern that are created by the Covid-19 pandemic on the Syrian refugees, who live in Kilis province of Turkey and have different life standards and status and to find out their possibilities and attitudes of prevention from and combating the pandemic. The data of the study were collected between 12-16 April 2020 by applying a questionnaire on 414 refugees. According to the study results, it has been discovered that the refugees have concerns about Covid-19 and their insensitivity levels are low. It has been seen that there is a group who are not aware of the seriousness of the pandemic, who do not have enough information about the pandemic and cannot reach personal protective equipment (such as masks, gloves). In general, in the fight against pandemic; the levels of refugees' following the rules and their finding the decisions taken and implemented proper, can be defined as close to each other and good.

Patient (customer) expectations in hospitals.

The expectations of patient are one of the determining factors of healthcare service. The purpose of this study is to measure the Patients' Expectations, based on Patient's Rights. This study was done with Likert-Survey in Trabzon population. The analyses showed that the level of the expectations of the patient was high on the factor of receiving information and at an acceptable level on the other factors. Statistical meaningfulness was determined between age, sex, education, health insurance, and the income of the family and the expectations of the patients (p<0.05). According to this study, the current legal regulations have higher standards than the expectations of the patients. The reason that the satisfaction of the patients high level is interpreted due to the fact that the level of the expectation is low. It is suggested that the educational and public awareness studies on the patients' rights must be done in order to increase the expectations of the patients.