Assessment of the Turkish Version of the King's Stool Chart for Evaluating Stool Output and Diarrhea Among Patients Receiving Enteral Nutrition.

The purpose of this study was to evaluate the reliability and validity of the Turkish version of the King's Stool Chart (KSC-Tr) in patients receiving enteral nutrition. In total, 212 stool samples taken from 25 patients receiving enteral nutrition during 393 sick days in two intensive care units were assessed using the KSC-Tr. Overall, 110 of 212 stools (51.9%) were characterized as liquid and 111 of 212 stools (52.4%) were characterized as less than 100 g. The daily stool score of patients receiving antibiotics, a risk factor for diarrhea, was higher (mean = 13.6; SD = 10.1) than that of patients not receiving antibiotics (mean = 9.3; SD = 5.0) (p = .001). Diarrhea occurred on more days when patients received antibiotics (62/329; 18.8%) than on days when they did not (3/64; 4.7%) (p = .005). Interobserver agreement of two independent nurses' assessments on 44 stool samples was examined and was good for both stool consistency (κ = 0.76) and stool weight (κ = 0.75). In the intensive care unit, the KSC-Tr can be used as a valid and reliable tool for monitoring diarrhea and stool output in patients receiving enteral nutrition.

Comparison of predictor approaches for longitudinal binary outcomes: application to anesthesiology data.

Longitudinal data with binary repeated responses are now widespread among clinical studies and standard statistical analysis methods have become inadequate in the answering of clinical hypotheses. Instead of such conventional approaches, statisticians have started proposing better techniques, such as the Generalized Estimating Equations (GEE) approach and Generalized Linear Mixed Models (GLMM) technique. In this research, we undertook a comparative study of modeling binary repeated responses using an anesthesiology dataset which has 375 patient data with clinical variables. We modeled the relationship between hypotension and age, gender, surgical department, positions of patients during surgery, diastolic blood pressure, pulse, electrocardiography and doses of Marcain-heavy, chirocaine, fentanyl, and midazolam. Moreover, parameter estimates between the GEE and the GLMM were compared. The parameter estimates, except time-after, Marcain-Heavy, and Fentanyl from the GLMM, are larger than those from GEE. The standard errors from the GLMM are larger than those from GEE. GLMM appears to be more suitable approach than the GEE approach for the analysis hypotension during spinal anesthesia.

Risk prediction using a neonatal therapeutic intervention scoring system in VLBW and ELBW preterm infants.

BACKGROUND: The Neonatal Therapeutic Intervention Scoring System (NTISS) is a therapy-based severity-of-illness index, The aim of the present study was to evaluate whether: (i) NTISS can predict the severity of illness with the same accuracy both in very low-birthweight (VLBW) and extremely low-birthweight (ELBW) infants, using all parameters; and (ii) the performance of NTISS can be increased by using only the significant variables. METHODS: All inborns <1500 g, and all outborns <1500 g transferred in the first 12 h of postnatal life, were included. NTISS using 63 variables was assessed for all infants at the 24th hour. Predictive performance for the overall variables was assessed using area under the curve (AUC) for group 1 (500-1499 g), 2 (1000-1499 g) and 3 (500-999 g). Variables with good prediction were identified for each group and a second AUC was assessed using only sensitive variables. Receiver operating characteristic (ROC) curve area for all variables was compared with the ROC area for sensitive variables. RESULTS: A total of 364 preterm infants fulfilled the eligibility criteria. The AUC of groups 1, 2 and 3 with all variables were 0.851; 0.834 and 0.749, respectively. The number of parameters with good prediction was 33 in group 1, 30 in group 2 and 18 in group 3. The AUC for sensitive variables was 0.848 in group 1; 0.821 in group 2 and 0.823 in group 3. When compared, increase in the description of outcome was significant only for group 3 patients (P = 0.02). CONCLUSION: NTISS using all parameters seems to be less predictive in ELBW infants. It is probably related to the use of some interventions, done as a routine procedure in almost all ELBW preterm infants, therefore NTISS may be modified according to birthweight in order to obtain a more sensitive prediction.

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.

Informal social networks amongst administrative staff at a university hospital.

In this study we apply Social Network Analysis and Agent Based Simulation techniques to visualize and explore informal social networks amongst staff at the Akdeniz University Hospital to assess and evaluate properties of the organization in terms of its ability to share knowledge and innovate, which is crucial for healthcare organizations delivering a health service. We first prepared an e-mail-based questionnaire, and asked administrative staff at Akdeniz University Hospital, a number of questions including (i) who they would contact if they had an innovative idea regarding their work (ii) who they would consult if they wanted to implement their idea, and (iii) to whom they would talk when they wanted to find out what is going on socially in the work place. We use a bespoke software tool called Organizational Forms Simulator to visualize and analyze informal social networks obtained from the questionnaire. The analysis reveals hubs, lynchpins, and unknown leaders as well as communications bottlenecks, and overall connectivity in the organization. The software tool we use also allows us to run what-if scenarios, to see how long it would take for an 'epidemic' of a good idea to spread across the staff social networks, using the informal links obtained from the questionnaire. We believe the study will help us to assess the current state of informal social networks amongst staff, and help the hospital management to improve connectivity in the organization.

Agent based simulations in healthcare.

Agent Based Simulations (ABS) is a relatively recent computer paradigm. As opposed to "top down" conventional computer simulations, the ABS approach is a "bottom-up" modelling technique where a medium to high number of independent agents is modelled. These agents' interactions sometimes cause unexpected "emergent" system behaviour. ABS is particularly suitable in the social context such as healthcare where a large number of human agents interact and co-operate for common goals. Today ABS in the social context is often used together with the recently introduced network analysis techniques and network visualization tools for modelling and simulating social agents within organisations. At Akdeniz University we are starting a number of projects for applying ABS technology in healthcare. In this paper we present two of the ongoing projects in this field. Firstly we have developed a prototype simulator for the long term monitoring of Chronic Obstructive Pulmonary Disease (COPD) as a major public health problem. We present the COPD simulator, its agents, parameters and working principles. Secondly we want to apply ABS and the network analysis techniques to visualise and explore informal social networks amongst staff at the Akdeniz University Hospital to assess and evaluate properties of the organisation in terms of its ability to innovate and share knowledge. In our applications, we primarily aim to use ABS in a web-based platform to create a virtual environment for discussion, visualising and running what-if scenarios to test out various options for managing healthcare, as well as sharing information and creating a virtual community.

Prevalence and risk factors of obesity in school children in Antalya, Turkey.

OBJECTIVE: To determine the prevalence and risk factors of obesity and to obtain the age and gender-specific body mass index (BMI) percentiles in a cohort of children aged 6-17 years, living in the province of Antalya, Turkey. METHODS: The study included 15 schools throughout the city center of Antalya, Turkey during the period November 2002-March 2003. A total of 2465 school children (boys 1233, girls 1232) aged 6-17 years were chosen using a population based stratified cluster sampling method. We calculated the BMI (kg/m2) by measuring the weight and standing height. Overweight was defined as BMI between 85th and 95th percentile, and obesity as BMI above the 95th percentile. A questionnaire was distributed to the parents to determine obesity-related risk factors. RESULTS: The overall prevalence of obesity was 3.6% while overweight was 14.3%. According to gender, the prevalence of obesity in boys was 3.9% and overweight was 12.8%, while in girls, obesity was 3.2% and overweight was 15.8%. We found that obesity might be related with some factors such as number of regular meals, number of siblings, high birth weight, having computer at home, skipping breakfast and high socioeconomic status of parents. CONCLUSION: There is no difference in obesity prevalence among school children according to gender, but the mean BMI of girls is significantly higher than that of boys. Obesity prevalence among children in Antalya is very low compared to Europe and the United States.

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.

Endoscopic transnasal dacryocystorhinostomy and bicanalicular silicone tube intubation.

PURPOSE: To evaluate the results of endoscopic transnasal dacryocystorhinostomy (ETDCR) combined with bicanalicular silicone tube intubation (BSTI) performed in 49 patients with nasolacrimal canal obstructions secondary to chronic dacryocystitis. MATERIAL AND METHODS: ETDCR combined with BSTI was applied as a primary procedure in 47 cases, and as a secondary procedure in 2 cases. All patients underwent dacryocystography, and 41 patients underwent radionuclide dacryoscintigraphy before the surgery. Silicone tubes were left in place for about 6.2 months. The patency of the lacrimal passages was controlled with a clinical examination, nasolacrimal canal lavage, and dacryoscintigraphy. RESULTS: Patients were followed up for a mean period of 25.1 months after the removal of the tubes. The epiphora symptom disappeared and a successful drainage could be maintained in 43 out of 49 cases (87.7%). The obstruction rate found in the dacryoscintigraphy performed 15 days after extubation was 22.9%, while it was found to be 14.2% in the nasolacrimal canal lavage. CONCLUSION: ETDCR combined with BSTI proved to be an effective surgical method in chronic dacryocystitis. The sensitivity and specificity of the postoperative dacryoscintigraphy in determining the surgical success were lower than those of the nasolacrimal canal lavage.

The effect of duodenogastric reflux on Helicobacter pylori presence and gastric histopathologic changes.

BACKGROUND/AIMS: In this study, we investigated the presence of Helicobacter pylori infection and gastric histological changes in unoperated patients with and without duodenogastric reflux. METHODS: Twenty-two women and 15 men, mean age of 51.17 years, who had duodenogastric reflux during endoscopy were included. Thirty-seven age-and gender-matched patients without duodenogastric reflux served as controls. The Helicobacter pylori infection was detected by histology. The Helicobacter pylori density and gastric histology according to the modified Sydney system were evaluated with specimens from antrum, corpus and fundus. RESULTS: The presence of Helicobacter pylori, Helicobacter pylori density, chronic inflammation score, lymphoid follicles, atrophy, and intestinal metaplasia were similar in patients with and without duodenogastric reflux (p>0.05). Acute inflammation was found to be lower in the antrum (p<0.05) in the duodenogastric reflux-positive group. CONCLUSION: Duodenogastric reflux does not affect the presence of Helicobacter pylori and gastric histopathologic changes.