Make your choice: Angiography or periodical health examination?

Periodical health examination is one of the important factors influencing a healthy lifestyle. Patients undergoing routine physical examination in primary care are included in the scope of preventive medical services, which is the most basic principle of primary care. Identifying the risk factors enables individuals to adopt healthier lifestyle practices. In our study, we examined the correlation between patients undergoing coronary angiography for suspected coronary stenosis and the extent of primary care services they had received in their medical history, along with the severity of stenosis observed during the angiography. Patients were interviewed using a pre-structured questionnaire to gather information about their past utilization of primary healthcare services related to coronary matters and their cardiovascular (CV) risk profile as documented in their medical history. The necessary standard tests for angiography procedures were retrieved from patient records. The SYNTAX score, a tool that aids in the objective assessment of the severity of coronary artery disease (CAD), was computed and documented. This score was then compared with the history of primary care utilization. The patients' utilization of services from the Primary Healthcare Center (PHC) was evaluated using a scoring system, with an average score of 29.27 ±â€…11.27 out of 100 points (minimum: 20; maximum: 60). The average SCORE Türkiye indicating the 10-year risk of CV events for all patients was calculated as 14.31% ±â€…8.65% (high-very high risk), while the average SYNTAX score was 15.20 ±â€…9.97. There was a positive and significant correlation found between fasting blood glucose and creatinine values with both SYNTAX score and SCORE Türkiye (respectively; R = 0.238, P = .013; R = 0.289, P = .002). Factors such as smoking and metabolic syndrome were associated with CAD severity. It important to highlight that individual recommended for angiography had a notably lower utilization of healthcare services from the PHC based on their medical histories. This circumstance has resulted in individuals who do not undergo CV event screenings at PHCs having higher SYNTAX scores, indicating more severe CAD that necessitates angiography. Conducting regular periodical health examinations at PHCs can help mitigate these statistics.

Enhancing Primary Care for Nursing Home Patients with an Artificial Intelligence-Aided Rational Drug Use Web Assistant.

Polypharmacy can result in drug-drug interactions, severe side-effects, drug-disease interactions, inappropriate medication use in the elderly, and escalating costs. This study aims to evaluate nursing home residents' medication regimens using a rational drug use web assistant developed by researchers to mitigate unnecessary medication usage. This analytical, cross-sectional study included data from nursing home residents recently recorded in a training family health center. Sociodemographic information, medical conditions, and prescribed medications of all patients in the nursing home (n = 99) were documented. Medications were assessed using an artificial intelligence-aided rational drug use web assistant. Instances of inappropriate drug use and calculations of contraindicated drug costs were also recorded. The study revealed that 88.9% (n = 88) of patients experienced polypharmacy, with a mean value of 6.96 ± 2.94 drugs per patient. Potential risky drug-drug interactions were present in 89.9% (n = 89) of patients, contraindicated drug-drug interactions in 20.2% (n = 20), and potentially inappropriate drug use in 86.9% (n = 86). Plans to discontinue 83 medications were estimated to reduce total direct medication costs by 9.1% per month. After the assessment with the rational drug use web assistant, the number of drugs that patients needed to use and polypharmacy decreased significantly. This study concludes that the rational drug use web assistant application, which is more cost-effective than the traditional manual method, assisted by artificial intelligence, and integrated into healthcare services, may offer substantial benefits to family physicians and their geriatric patients.

Artificial intelligence-supported web application design and development for reducing polypharmacy side effects and supporting rational drug use in geriatric patients.

Introduction: The main complications of polypharmacy, which is known as the simultaneous use of more than five drugs, are potentially inappropriate medicines(PIMs), drug-drug, and drug-disease interaction. It is aimed to prepare an auxiliary tool to reduce the complications of polypharmacy and to support rational drug use(RDU), by evaluating the patient with age, drugs, and chronic diseases in this study. Materials and methods: In the first phase of this study, as methodological research, an up-to-date and comprehensive auxiliary tool as a reference method was generated with a database containing interaction information of 430 most commonly used drug agents and chronic diseases in geriatrics in the light of current and valid 6 PIM criteria for geriatric patients, and medication prospectuses, relevant current articles, and guidelines. Then, an artificial intelligence(AI) supported web application was designed and developed to facilitate the practical use of the tool. Afterward, the data of a cross-sectional observational single-center study were used for the rate and time of PIM and drug interaction detection with the web application. The proposed web application is publicly available at https://fastrational.com/. Results: While the PIM coverage rate with the proposed tool was 75.3%, the PIM coverage rate of EU(7)-PIM, US-FORTA, TIME-to-STOPP, Beers 2019, STOPP, Priscus criteria in the web application database respectively(63.5%-19.5%) from the highest to the lowest. The proposed tool includes all PIMs, drug-drug, and drug-disease interaction information detected with other criteria. A general practitioner detects interactions for a patient without the web application in 2278 s on average, while the time with the web application is decreased to 33.8 s on average, and this situation is statistically significant. Discussion: In the literature and this study, the PIM criteria alone are insufficient to include actively used medicines and it shows heterogeneity. In addition, many studies showed that the biggest obstacle to drug regulation in practice is "time constraints." The proposed comprehensive auxiliary tool analyzes age, drugs, and diseases specifically for the patient 60 times faster than the manual method, and it provides quick access to the relevant references, and ultimately supports RDU for the clinician, with the first and only AI-supported web application.

The effect of cancer diagnosis in first-degree relatives on participation of healthy individuals in cancer screening programs and on their attitudes towards healthy lifestyle changes.

Background: Ensuring that first-degree relatives of patients diagnosed with cancer are included in the cancer screening programs will reduce the negative effects that may arise both for the individuals having the risk of cancer and for the community. In our study, we aimed to investigate the awareness and attitudes of the first-degree relatives of patients, who have received diagnosis of a cancer, toward cancer screening programs and to determine the risk factors for cancer. Methods: A questionnaire prepared by the researchers was conducted over the relatives of 234 cancer patients for determining their awareness about cancer and their attitudes toward participation in cancer screening programs. The data were analyzed using SPSS 22 software package. Results: 72.6% of the participants never heard about Cancer Early Diagnosis, Screening and Training Center, which has been established to carry out cancer screening programs in Turkey. Approximately half of the female participants did not participate in breast cancer and cervical cancer screenings (54.9% and 51.1%, respectively). The rate of those who had screening tests for colon cancer was less than one-fifth of all participants (19.8%). The above data show the low level of awareness of the participants about cancer. Conclusion: It has been observed that diagnosis of cancer in the first-degree relatives of the participants did not create awareness in these people at a level that would enable them to participate in cancer screening programs and make healthy lifestyle changes.

Approaches and awareness of family physicians on diabetes management during Ramadan.

AIM: This study aimed to determine the approaches of family physicians in Turkey towards the fasting of diabetic patients and whether they used international treatment guidelines when making recommendations. In addition, this study also aimed to increase the awareness of family physicians about this issue before Ramadan, which is a month of fasting. MATERIAL AND METHOD: The study herein comprised cross-sectional, observational research. Before Ramadan 2018, a structured questionnaire form, which was unique to this study, was prepared based on the guidelines of the International Diabetes Federation (IDF) and the American Diabetes Association (ADA), through platforms where family physicians gather via social media and mail groups, and sent to family physicians in Turkey via a link using an electronic questionnaire preparation and application programme. Moreover, the total knowledge level, attitude, and approach scores were calculated from the questions prepared from the relevant guidelines. RESULTS: Participating in the survey were 262 family physicians. Only 22% of the family physicians stated that they were aware of the international guidelines for Ramadan and diabetes management, and only 10% said that they had read them. The mean knowledge level, attitude, and approach scores were determined to be lower than expected, and a significant difference was found between the scores and academic titles. CONCLUSION: The lack of international guidelines on the subject, and of knowledge and experience about Diabetes Mellitus (DM) patient management during the month of fasting, stood out as the biggest problems. This study revealed that the awareness and competence of family physicians in disease management should be increased, in addition to that of fasting before, during, and after Ramadan in patients with DM, which has increasing prevalence in Turkey.

The association between micronutrient and hemogram values and prognostic factors in COVID-19 patients: A single-center experience from Turkey.

AIM: The contribution of micronutrients to the immune system has been known for a long time. This study aimed to investigate the association between the micronutrient levels and hemogram values and prognostic factors of the disease in COVID-19 patients in Ankara City Hospital. MATERIALS AND METHODS: Our study is a descriptive observational study based on a retrospective review of patient files. COVID-19 patients over 18 years of age who were admitted to our hospital between 14 March and 1 June 2020, and with a complete micronutrient profile were included in the study. Age, gender, chronic diseases, micronutrient concentrations in the last 6 months, hemogram data on the day of hospitalization, total length of stay in hospital, and hospitalization to Intensive Care Unit (ICU)-intubation-death status of the patients were obtained from the patient files. RESULTS: A total of 310 patients whose parameters were thoroughly examined were included in our study; 51.9% of them were men and the mean age of all patients was 57.02 ± 18.28 years, and the most common comorbid disease was hypertension. The percentage of patients who were followed in the ICU, were intubated, and died was 34.5%, 13.9%, and 9.4%, respectively. The mean length of hospital stay was 15.87 ± 12.79 days. Low folate, iron, vitamin D, and hemoglobin levels of the patients and high vitamin B12 concentration were more related to poor prognostic factors. The number of white blood cells was significantly higher in patients with a worse prognosis, and the number of lymphocytes was lower in patients with ICU admission but higher in intubated and dead patients. CONCLUSION: Micronutrient and hemogram values, advanced age, being male, and having comorbid diseases were correlated with the poor prognosis of COVID-19 infection. Deficiency of Iron, Folate, and vitamin D should be well-considered in COVID-19. Excessive vitamin B12 and multivitamin supplementation should be avoided by choosing supplement wisely. In addition, attention should be paid to leukocytosis, lymphocyte counts, and anemia during COVID-19 patient follow-up. What's known Some micronutrients have an immunomodulatory and anti-inflammatory effect with antioxidant effects and thus play a protective role in respiratory tract infections as COVID-19. Vitamin D deficiency is found to be associated with poor prognostic factors in COVID-19. Lymphopenia is found to be associated with poor prognostic factors in COVID-19. What's new According to the results obtained from our study, low iron and folate levels should be controlled first in patients diagnosed with COVID-19, low vitamin D levels should also be well-considered, and supplementation should be provided in the case of deficiencies. On the other hand excessive use of vitamin B12 should be avoided. The fact that all micronutrients should be evaluated and managed by choosing wisely rather than a complete multivitamin supplement approach was demonstrated by the differences in the poor prognosis levels of vitamin B12 versus the other micronutrients. In addition, it was found in our study that leukocytosis, lymphocyte counts, and anemia should be taken into consideration together when evaluating hemogram parameters in the follow-up of COVID-19 patients.

Awareness of family physician residents of their roles in disaster health management: a cross-sectional study in Turkey.

AIM: Family physicians are role models for their societies in disaster management and have an important place in it. This study was carried out during the specialty training of the residents, who are currently family physicians fighting against COVID-19 in the field, and was aimed to identify the awareness levels of residents regarding the roles and duties of family physicians before, during, and after disasters and to increase their awareness of disaster medicine and management. BACKGROUND: The duties and responsibilities of a family physician in disasters should be a part of their specialty training. This study has contributed to the limited literature, increased awareness, and opened a new avenue of research for studies to be conducted with family physicians by demonstrating the current situation of family physicians in disaster management. METHODS: This is an observational and descriptive study. The knowledge, experience, opinions, willingness, attitudes of the residents, and the awareness levels of the residents regarding their roles and duties in a disaster were evaluated along with their sociodemographic information. The surveys were applied in the family medicine clinics of the all residents by the interview method (n = 233). FINDINGS: Only 9.2% of the residents stated that they had received training on disaster medicine where they currently work. The knowledge level of the residents on this subject was found as 'Unsure'. In total, 80% of the residents stated that family physicians should have a role in disasters. It was found that 83.3% of the residents had never joined a disaster drill, 94.3% had never participated in making or applying a disaster plan, and 97.7% had never worked in any disaster. CONCLUSION: The residents participating in the study lacked not only information on disaster management but also experience. The residents' willingness to receive training, work voluntarily, significantly question the curriculum, and specialize in disaster medicine were a positive outcome.

Occupational Health and Disease Knowledge and Practices of Family Physicians.

OBJECTIVE: This study aims to evaluate the awareness and approaches of all family physicians from one province in Turkey regarding occupational diseases. METHODS: This study is a cross-sectional, descriptive study. A questionnaire was applied to family physicians between November 2018 and February 2019. The questionnaire investigates family physicians' knowledge, attitude, behavior, proficiency, and approaches to occupational diseases. RESULTS: Three hundred twenty four family physicians participated in our study. 59.3% had received training on occupational diseases and only 22.9% of these physicians indicated that this training was adequate. Physicians identified "lack of occupational anamnesis" as the most common reason behind the underreporting of occupational diseases, and "difficulties in identifying occupational diseases" as the second. CONCLUSIONS: Family physicians believe that they inadequately evaluate occupational diseases and find the occupational disease-related training to be insufficient.