Effects of beta-glucan addition on the physicochemical and microbiological characteristics of fermented sausage.

The objective of this study was to investigate the effects of added beta-glucan (ß-glucan) levels on the lipid oxidation, physicochemical, microbiological, textural and sensorial properties of fermented sausage produced with various amounts of beef fat during fermentation and storage periods. To determine the effects of ß-glucan, twelve sausage treatments included four controls (no ß-glucan) with or without beef fat and starter culture addition and eight ß-glucan incorporated groups produced with addition of starter culture, various levels of ß-glucan (0, 1, 2%) and different levels (0, 10, 15, 20%) of beef fat were manufactured. The results indicated that addition of ß-glucan decreased thiobarbituric acid reactive substances (TBARS) values compared to control groups which had 20% beef fat (P < 0.05). ß-glucan enhanced the growth of lactic acid bacteria during fermentation and storage periods (P < 0.05). The addition of ß-glucan caused a decrease in water activity and pH values of sausage during the fermentation and storage (P < 0.05). Color values, fatty acid composition, protein, fat, moisture and ash content were not influenced by the use of ß-glucan (P < 0.05). Higher levels of ß-glucan in sausage formulation caused an increase in the hardness values of sausage (P < 0.05).

Evaluation of reproductive and renal toxicity of varenicline in male rats.

OBJECTIVES: Varenicline is a selective partial agonist for the nicotinic acetylcholine receptor a4b2 subtype, which is widely used to treat smoking addiction. However, there is still no data about its potential toxic effects on tissues. In this study, we aimed to determine the varenicline-induced toxicity on reproductive and renal tissues in rats. MATERIALS AND METHODS: Rats were randomly divided into two groups: control (n=10) and varenicline (n=24). Then, rats in each group were sub-divided equally as acute and chronic groups. The control rats were orally given distilled water only. Varenicline was administrated orally as follows: 1st-3rd days 9 µg/kg/day, 4th-7th days 9 µg/kg twice daily, and 8th-90th days 18 µg/kg twice daily. The rats of acute and chronic groups were sacrificed on the 45th and 90th days, respectively. Some tissue markers related to oxidative stress were measured, and sperm characteristics were observed. RESULTS: In the acute group, varenicline led to a significant decrease in SOD activities in both kidney and testis tissues. In the chronic group, varenicline significantly increased MDA and MPO production, and reduced CAT and GPx levels in the kidneys and testes. Also, SOD and GSH levels significantly decreased in the testes. Moreover, sperm characteristics were negatively affected; histopathological deformation was observed in the testes and kidneys in all groups. CONCLUSION: This study showed that varenicline could detrimentally affect the kidneys and testes in both acute and chronic term usage. Further studies will provide more insights into the molecular dynamics of this damage.

Organisational silence among nurses and physicians in public hospitals.

AIMS AND OBJECTIVES: To define the underlying reasons that lead physicians and nurses who provide patient care and treatment, to maintain silence in their work and how they perceive the consequences of such silence in public hospitals. BACKGROUND: The concept of organisational silence is described as employees' avoidance of stating his/her opinions, thoughts and suggestions, which would improve the organisation and enable it to provide better processes or services. This concept has been examined more frequently in the international literature in the past decade, and it has drawn attention as one of the most important barriers to employees' contributions to their organisation. DESIGN: Descriptive and cross-sectional study. METHODS: The study sample consisted of 601 physicians and nurses who work in five hospitals with bed capacities of 100 or more. The data were collected using a two-part form: an introductory information form and an organisational silence scale. RESULTS: Administrative and organisational topics were prominent among the reasons for employees of healthcare organisations to remain silent for both physicians and nurses. CONCLUSIONS: The results of this study should be considered by physicians and nurses to realise and improve themselves. Also, decision makers and managers of public hospitals might evaluate and remove organisational and communicative barriers to employees' contributions to their organisations based on these results. RELEVANCE TO CLINICAL PRACTICE: Physicians and nurses are responsible for the fulfilment of highly important tasks for their organisations. Their contributions help their organisations remain competitive, improve the health services, ensure and sustain patient safety. Hence, these results will provide information to facilitate an understanding of the topics, causes and consequences of organisational silence among physicians and nurses, two key healthcare professions, and will be helpful in the development of medical and nursing human resources in clinical settings.

Physicians' and nurses' medical errors associated with communication failures.

OBJECTIVE: To determine medical errors associated with communication failures among physicians and nurses. METHODS: This cross-sectional, descriptive study was conducted at 20 state hospitals and 14 training and research hospitals affiliated with the Istanbul City Health Directorate in Turkey, and comprised physicians and nurses. Data were collected between August 2012 and February 2013. A 16-item questionnaire was used that included questions regarding socio-demographic features such as age, gender, educational status, institution, occupation and working years. Questions also aimed at determining medical errors related to communication failures. The questionnaire was completed by the participants during face-to-face interviews. RESULTS: Of the 2,273 participants, 1,654(72.8%) were nurses and 619(27.2%) were physicians. Besides, 340(54.9%) physicians and 811(49.03%) nurses worked in state hospitals. The mean age of the physicians was 37.76±9.20 years (range: 22-62 years), and that of the nurses was 32.61±7.38 years (range: 17-62 years). Moreover, 137(22.1%) physicians and 258(15.3%) nurses had previously experienced medical errors. Also, 74(54%) physicians and 135(52.3%) nurses had experienced medical errors due to some communication error. The most common medical errors by physicians were incorrect drug administration 45(32.8%), and delivery of drugs to the wrong patient by nurses 103(40.7%). In addition, 58(42.3%) physicians made medical errors in adult surgical clinic services while 102(39.5%) nurses made medical errors in adult internal medicine clinics. CONCLUSIONS: The majority of medical errors originated from communication failures.

Community Palliative Care in Turkey: A Collaborative Promoter to a New Concept in the Middle East.

The Middle East has been struggling with basic issues of cancer care, and in specific, palliative care, at the primary health care level in the communities. The Middle East Cancer Consortium designated this issue as the highest priority of its activities in the region. Following basic and advanced courses and national and international workshops, local governments recognized the essentiality of developing palliative care services in their respective countries. As the result of these training activities, in 2010, the Ministry of Health in Turkey initiated a novel program whereby population-based and home-based palliative care teams were developed throughout the country, including peripheral regions in the countries where appropriate care was not available. This initiative led to a dramatic increase in the number of cancer patients receiving palliative care at their homes. The Turkish initiative can serve as a model to other countries in the Middle East and beyond it.

Turkish critical care nurses' views on end-of-life decision making and practices.

BACKGROUND: Life-sustaining treatments are increasingly used in intensive care units (ICUs) for EOL care, but the decision to use these may cause ethical issues. AIMS AND OBJECTIVES: The aim of this study was to investigate the views and practices of critical care nurses in Turkey on the end-of-life (EOL) care. DESIGN: This was a cross-sectional study. METHODS: The research was conducted in 32 second- and third-level ICUs of 19 Ministry of Health research hospitals in Turkey. The Views of European Nurses in Intensive Care on EOL Care tool was used for data collection. RESULTS: The total sample size was 602. While half of the nurses stated that the withholding and withdrawal of life support were ethically different decisions, 40% felt both decisions were unethical. The expected quality of life as viewed by the patient, the medical team, the family and the nursing team (90·4%, 85·4%, and 83·4%, respectively) was an important factor in EOL decision making. The majority of the nurses (75·7%) were not directly involved in the EOL decision making and 78·4% of nurses were committed to family involvement in EOL decisions. When withdrawing treatment, 87·2% of ICU nurses agreed that the patient and family members should perform their final religious and spiritual duties. Further results showed that after withdrawing treatment, a majority of nurses (86%) agreed to continue pressure sore prevention, effective pain relief (85·5%), nutritional support (77·6%) and hydration (64·8%). Almost half (48·2%) indicated that keeping the patients in the ICU was unnecessary. CONCLUSION: ICU nurses expressed a range of experiences and practices regarding EOL care. ICU nurses should be more involved in the decision-making process about EOL care. RELEVANCE TO CLINICAL PRACTICE: Due to their unique relationship with patients, nurses should be involved in EOL care decision making; however, patients, families or nurses are not often involved in the decision-making process in Turkey.

Use of drugs subject to controlled prescriptions: a retrospective analysis.

OBJECTIVE: Use of drugs that may lead to abuse or dependence are subject to controlled prescriptions (CPs) in many countries, and these are closely monitored by health authorities. According to national regulations in Turkey, CPs may be red coloured (RCPs) or green coloured (GCPs). The aim of this study was to evaluate the use of such drugs in Istanbul. STUDY DESIGN: Retrospective case-control study. MATERIAL AND METHODS: During the study period (01/01-31/12 2009), 502874 CPs were reported. Among these, 4000 CPs each month were randomly selected and evaluated. RESULTS: The majority of GCPs were issued to women (55.6%), while the majority of RCPs were issued to men (68.4%). GCPs were most frequently prescribed by physicians working in private hospitals (33.6%) while RCPs by physicians working in university hospitals (39.7%). GCPs were mostly prescribed by psychiatrists (37.6%) while for RCPs were child and adolescent psychiatrists (35.9%). Psycholeptics (ATC code N05) were the most prescribed controlled drugs (CDs) (43.8%). Methylphenidate (53.9%) was the mostly prescribed on RCPs and alprazolam (39.6%) was on GCPs. CONCLUSION: We demonstrate that utilization of CDs shows demographical and institutional differences. These data could be of help to improve surveillance of CDs as well as to train prescribers and patients.

Evaluation of controlled prescriptions with a diagnosis of surgical intervention.

OBJECTIVE: Drugs subject to control (DSC) are commonly used in the preoperative, per-operative and postoperative periods. In this study, details of DSC use, that are required to be prescribed to green prescriptions (GP) or red prescriptions (RP), for a surgical diagnosis were evaluated. MATERIAL AND METHODS: Controlled drug prescriptions (CDP) between January to December 2009 were investigated in the archives of the Istanbul Local Health Authority. 660 CDPs indicating a surgical diagnosis were retrospectively evaluated and those prescribed by surgical departments (SD)were compared to those written by internal medicine departments (ID). RESULTS: SD physicians prescribed 72.7% of CDPs and 89.5% of prescriptions were for GP, and 10.5% were for RP. The physicians of SD were found to prescribe more RP than ID physicians. Most of the CDPs were written for women (58.8%) and mostly in private hospitals (40.9%). Among all the physicians, orthopedic surgeons prescribed these drugs the most (20.9%). Tramadol was the most common drug found in CDPs (55.5%). CONCLUSION: DSCs, which have difficult prescription procedures, are used frequently in surgical interventions. The study shows that not only SD physicians, but also ID physicians prefer CDP. The study provides important clues to the usage patterns of DSCs. Recently evolving health care systems including prescriptions should use these findings obtained from the study.

Rudolf Nissen (1896-1981): his contributions to surgery and his role in Turkey.

Eminent surgeon Rudolf Nissen performed innovative studies in surgery during his time in Turkey, to which he fled from Germany before the Second World War. This paper discusses Nissen's invaluable contribution not only to Istanbul University's surgical department but also to the universal field of surgery.