Effect of a workshop in rational pharmacotherapy for interns during family medicine clerkship in Samsun- Turkey.

OBJECTIVE: We aimed to investigate the effect of rational pharmacotherapy workshop for interns on the rationality, cost and number of drugs prescribed. METHODS: The participants were asked to prescribe a medication for acute noninflammatory osteoarthritis (ANOA), acute bacterial rhinosinusitis (ARS), acute otitis media (AOM), acute uncomplicated cystitis (AC), and acute bacterial tonsillopharyngitis (ABT) before and after workshop. Total 3000 prescriptions were scored regarding rationality of the drug choice (0-10), format (0-5), instructions (0-4), legibility (0-1) and total (0-20 points). The mean number of drug(s) and total costs per prescription were calculated. Paired samples t-test was used to compare the pre- and post score means. RESULTS: Total pre- and post-prescribing scores (0-20) were significantly different (p=0.00 for each): ANOA (13.59±0.27, 18.33±0.18), ARS (13.26 ±0.18, 15.15 ±0.17), AOM (12.58 ± 0.26, 14.66±0.27), AC (13.53±0.17, 15.76±0.20), ABT (13.54±0.24, 15.49 ±0.28). Mean number of drugs per prescription for the indications in the pre-test and post-test were: ANOA (1.24 ±0.29, 1.02±0.01, p=0.00), ARS (2.08±0.04, 2.00±0.04, p=0.16), AOM (1.66±0.04 and 1.69±0.03, p=0.54), AC (1.55±0.04, 1.39±0.03, p=0.00) and ABT (2.10±0.05, 1.81±0.05, p=0.00). Mean costs per prescription in Turkish Liras: ANOA (6.31±0.29, 4.60±0.05, p=0.00), ARS (13.80±0.38, 4.63±0.04, p=0.00), AOM (10.18±0.28, 4.41±0.07, p=0.00), AC (11.33±0.21, 10.68±0.18, p=0.01) and ABT (12.03±0.34 and 10.41±0.35, p=0.00). CONCLUSION: Training produced a significant improvement in rational prescribing.

Women's perceptions and attitudes about cervical cancer in Turkey: Kato's device as an alternative to the Pap smear.

AIMS: To determine the status of women's perception and attitudes about cervical cancer and their thoughts on Kato's self-sampling device. MATERIALS AND METHODS: This descriptive research was conducted between July- December 2012 with a study populationof married women older than 18 years. RESULTS: A total of 246 women volunteered, with a mean age of 34.9±9.22 (19-52). In the last year, 52.0% had been examined by a gynecologist to address a complaint or for a periodic health check. Of the 118 who had not had a gynecological examination, 42.4% indicated negligence, 26.3% stated the reason was no complaint, 14.4% feared they might receive bad results from the examination, and 8.5% stated that were shy or embarrassed. Of all of the women, 35.0% answered that they had information about cervical cancer, and 0.7% had heard about the HPV vaccine. No one in their families had received the vaccine. Of the women, 28.5% had had a Pap smear, and 71.4% of those had normal results. Of those who had never had a Pap smear, 47.2% had never heard about the test; 18.8% explained the reason for not having a test as shyness or embarrassment with a male doctor. None of the women had heard about Kato's device. Once the women were informed, 73.6% expresseed interest in use; 51.9% answered they could use it and not be embarrassed, 30.9% would use it because they did not have to see a doctor, and 17.1% would use it as it allows them to take a smear in all conditions and whenever they want. Of the women, 60.0% thought that they could not successfully use Kato's device; 40.0% thought that a smear should be taken by a doctor. CONCLUSIONS: Most of the women in our population had never had a Pap smear and wanted to use the Kato's device.

Characteristics and quality of life analysis of caregivers of cancer patients.

Cancer affects not only the individuals with cancer, but also their families considerably. The aim of this study was to determine the sociodemographic characteristics and home care needs of caregivers of cancer patients receiving chemotherapy and evaluate their quality of life scores. A total of 126 primary caregivers of patients receiving chemotherapy who were eligible for inclusion criteria participated in the study. Data were collected using a questionnaire that included sociodemographic questions for both patients and caregivers and the World Health Organization Quality of Life-Short Form, Turkish Version (WHOQOL-BREF(TR)) for the caregivers. The mean domain scores of WHOQOL-BREF(TR) were 15.3 +/- 2.8 for physical, 14.6 +/- 2.8 for psychological, 14.4 +/- 3.3 for social, 13.7 +/- 2.8 for environment, and 14 +/- 2.5 for national environment domains. Caregivers were, on average, younger than the patients and the mean age of the caregivers was 45 years. Around 70% of caregivers were living with the patients, 60.3% of caregivers shared the care-giving process with someone else, and his/her children supported in care-giving activities in 20.6%. According to caregivers, patients needed assistance for one or more daily living activities. Caregivers' higher age, unemployment status, female gender, low education level, their own diagnosed health problems, care duration above 18 months, and having difficulties to continue social activities had negative effects on their quality of life. Cancer patients' families are also affected from cancer. We may suggest that including caregivers in the context of home care and universalizing home care programs can reduce caregivers' burden.

Teaching medical students how to break bad news: a Turkish experience.

BACKGROUND: To assess the effect of teaching breaking bad news. METHODS: The session incorporated brainstorming, presentation, discussion, small-group exercises using standardized patients. Course was evaluated through a pre-objective structured clinical examination (OSCE), first post-OSCE (post-OSCE1), second post-OSCE (post-OSCE2) (6th month), and questionnaires. RESULTS: Pre-OSCE, post-OSCE1, post-OSCE2 scores: preparing the environment 5.83 +/- 0.23, 7.93 +/- 0.19, 9.78 +/- 0.07; understanding what patient knows and wants to learn 1.83 +/- 0.33, 6.47 +/- 0.27, 9.68 +/- 0.11; giving information 3.25 +/- 0.34, 7.43 +/- 0.19, 9.67 +/- 0.10; developing empathy 2.50 +/- 0.32, 6.92 +/- 0.28, 9.87 +/- 0.06; closing the interview 2.28 +/- 0.28, 6.98 +/- 0.25, 9.83 +/- 0.07. The differences between OSCEs were significant. In the questionnaire, 54.1% of 146 students perceived more competent. CONCLUSIONS: Course seems beneficial.

Factors affecting choice of specialty among first-year medical students of four universities in different regions of Turkey.

AIM: To determine the factors affecting medical students' choice of the specialty of family medicine. METHODS: The study was conducted in the period from 2004-2006 and comprised 770 first-year medical students from Ondokuz Mayis, Karadeniz Technical, Kocaeli, and Adnan Menderes Universities, Turkey. The questionnaire included questions on demographic data and 6 "yes/no" or open-ended questions on students' career aspirations and the specialty of family medicine. RESULTS: The response rate was 93.1% (n=717, 54.7% male). Nearly all students (n=714, 99.6%) showed an intention to specialize after receiving the medical doctor degree. A total of 187 students (26.2%) showed an intention to work in primary care without specialization "for a temporary period" to "gain some experience." Family medicine was the least preferred specialty (n=7, 0.9%). The most important reasons for the choice of specialty were "better financial opportunities" and "prestige" (n=219, 30.5%), followed by "personal development" (n=149, 20.8%), "more benefits for the patient" (n=128, 17.9%), and "wish to work in an urban area" (n=32, 4.5%). The most preferred specialties were cardiology (n=179, 25.0%), pediatrics (n=121, 16.9%), ophthalmology (n=47, 6.6%), physical therapy and rehabilitation (n=34, 4.7%), and obstetrics and gynecology (n=32, 4.5%). CONCLUSION: Prestige, money, and personal development are important factors in career decision-making among medical students in Turkey. This should be taken into consideration when conducting reforms at the primary level.

Evaluation of the effect of periodic health examination in Samsun, Turkey.

OBJECTIVE: To investigate the effect of periodic health examination. METHODS: The follow-up results of 2005-2006 of periodic health examination clinic of the Department of Family Medicine of Ondokuzmayis University Medical School were evaluated using a questionnaire and constant follow-up. RESULTS: A total of 387 (195 women, 192 men) patients were provided a periodic health examination. In 186 patients, the total cholesterol values were high at the time of the first visit. The mean total cholesterol value was 241.97+/-36.47 mg/dl (201 min-489 max) in the first visit and 217.67+/-33.64 mg/dl (155 min-420 max) in last visits (p<0.001). Mean triglyceride values were 287.94+/-82.60 mg/dl (202 min-547 max) in the first visit while 231.60+/-66.99 mg/dl (74.5 min-450 max) in the last visits (p<0.001). Mean glucose values for the hyperglycemic patients were 150.37+/-56.85 (111 min-400 max) in the first visit and 125.79+/-32.49 (68 min-239 max) in the last visits (p<0.001). Of the total group, 140 (36.18%) patients had high blood pressure values at the first visit, 90 (64.29%) of them were normotensive at the last visit. Mean blood pressure values of the hypertensive patients were 152.13+/-19.04/ 93.98+/-8.78 mmHg in the first visit and 136.18+/-15.91/ 86.97+/-18.62 mmHg in the last visits (p<0.001). Of the 135 current smokers, 7 (5.2%) patients quit. Regarding all lifestyle changes, 201 (51.94%) patients had an overall note as acceptable, good or excellent. CONCLUSION: Significant improvement was found in more than half of the patients.

A case-control study on the etiology of urinary bladder cancer in Istanbul, Turkey.

BACKGROUND: Urinary bladder cancer is the third leading cancer in male in Turkey. The incidence rates of bladder cancer are 13.0 and 2.1/100,000 for males and females, respectively, in Turkey. Smoking and occupation are the main causes of urinary bladder cancer. Our goal was to investigate the etiologic factors of urinary bladder cancer in our region to improve our preventive services. METHODS: We conducted a hospital-based case-control study of patients with bladder cancer and of controls drawn randomly from the acute non-urinary patients of three hospitals in Istanbul. Controls were matched for age, sex, and residence. RESULTS: We interviewed 290 cases and 580 controls. Smoking and occupation were found to be related factors in urinary bladder cancer. CONCLUSION: Preventive measures should be planned regarding smoking and occupational factors for urinary bladder cancer in Turkey.

Does instructor evaluation by students using a WEB-based questionnaire impact instructor performance?

BACKGROUND: Student feedback is a valuable method to evaluate the quality of education. Using a WEB-based questionnaire, the objective of this study was to evaluate the factors that may affect the ratings given by the students and the impact of those ratings on the instructor's teaching performance. METHODS: The questionnaire was organized into four areas: containment, presentation skills, measurement and assessment, and communication skills. In addition, there was a final area in which the students could express their opinions about their instructor. The students were asked to rank their instructors in each of the four areas using a scale of 1-5. In both May 2002 and 2003, the students ranked their instructors using the WEB-based questionnaire. RESULTS: In 2002, 468 students evaluated 146 instructors; while in 2003, 360 students evaluated 144 instructors. Of the total number of instructors evaluated, 140 were evaluated both in 2002 and 2003. The mean point scores for these 140 instructors were 3.64 +/- 0.51 in 2002 and 3.65 +/- 0.54 in 2003. There was no statistically significant difference according to the titles of the instructors. For both 2002 and 2003, regarding the last section in the questionnaire where students could present their opinions, 80 of the students, indicated the instructors had communication problems. All instructors with low scores were mentioned to have poor communication skills. The changes in the mean point scores were evaluated comparing results from 2002 and 2003. Fourteen professors, four associate professors, three assistant professors, two lecturers were found to have higher scores, three professors, seven associate professors, five assistant professors, and one lecturer were found to have lower scores. CONCLUSION: No significant improvement was found in the mean points of the total group. In the second year, only 16.4 of the instructors were affected positively.

A case of rosiglitazone exposure in the second trimester of pregnancy.

AIM: Data about rosiglitazone use in pregnancy is limited. We aimed to present a pregnant woman who exposed to rosiglitazone in the second trimester and the fetal outcome. SUBJECT: The case was a 42-year-old, multigravid Caucasian woman with a history of diabetes mellitus type II for 4 years prior to her current pregnancy. Her diabetes was managed by diet and exercise and she has not received any drug therapy until the 13th week of her sixth (present) and unplanned pregnancy. The case was exposed to rosiglitazone (4 mg/day) between 13th and 17th gestational weeks. After the diagnosis of pregnancy at the 17th week, rosiglitazone was stopped and insulin therapy was started. At the 37th week, she had a healthy male infant (4500 g, 50 cm). The baby was examined and no major or minor malformations were observed. CONCLUSION: This is the first case present in the literature exposed to rosiglitazone in the second trimester of her pregnancy. The data from the present case may contribute to the existing limited knowledge about rosiglitazone in pregnancy.

Psychotropic drugs in pregnancy: a case-control study.

Psychotropic drug exposure during pregnancy is a common problem. Among the 601 cases exposed to drugs during pregnancy, who were followed by our Toxicology Information and Follow-up Service, 124 cases had used psychotropic drugs for depression, anxiety, or psychotic disorders. As the control group, 248 women, who did not use any drugs were selected. Of the 124 cases, 80 (64.5%) had healthy babies, and 17 (13.7%) decided to terminate the pregnancy. Spontaneous abortions, intrauterine death (in the 38th week) and premature deliveries were observed in the 9 (7.3%), 1 (0.8%) and 3 (2.4%) cases, respectively, in the drug exposure group. Pregnancies of the 14 (11.3%) cases were continuing during the preparation of this manuscript. Of the 248 controls, 151 (60.9%) had healthy babies, 9 (3.6%) experienced spontaneous abortion and 3 (1.2%) decided to terminate their pregnancies, 3 (1.2%) had premature deliveries, and we observed one (0.4%) congenital abnormality, 81 (32.7%) cases were still pregnant. Odds Ratio (95% confidence interval) for spontaneous abortion was found to be 1.35 (1.27-11.82) in the cases exposed to psychotropic drugs (P=0.02). No developmental problems were observed in the babies followed for 12 months. These data may give information about the early- but not the late-term effects of psychotropic drugs used in pregnant women.

Newer antidepressants in pregnancy: prospective outcome of a case series.

Antidepressant drug choice in pregnancy is a complex problem especially for new drugs. Among 590 cases exposed to drugs during pregnancy who were followed by our center, 21 cases used newer antidepressants, i.e., venlafaxine, mirtazapine, nefazodone. We present the gestational findings and fetal outcomes of these cases. Ten cases had used venlafaxine, one case had used both venlafaxine and mirtazapine, eight had used mirtazapine alone or with some other drugs and two had used nefazodone, in the first trimester. Of the 21 cases, 17 (80.9%) had healthy babies, 3 (14.3%) decided to terminate the pregnancy, and 1 (4.8%) spontaneous abortion was observed in a case exposed to mirtazapine, alprazolam, diazepam and trifluoperazine. All obstetrical findings were normal during the pregnancy of each case. No congenital abnormality and developmental problem was observed in the babies followed up for 12 months. The aim of the present study is to contribute the data to the limited knowledge available in the literature regarding human pregnancy.

Sibutramine use in pregnancy: report of two cases.

BACKGROUND: Sibutramine is a drug used for the medical treatment of obesity. No data are available on sibutramine use in pregnancy. We report the fetal outcomes of two pregnant women exposed to sibutramine. CASES: The first woman was exposed to 10 mg/day of sibutramine during gestational weeks 4-6. The second woman was exposed to 10 mg/day of sibutramine during gestational weeks 5-8. At weeks 37 and 39, they delivered healthy infants. CONCLUSIONS: To our knowledge, this is the first report of sibutramine exposure in pregnancy. These cases may contribute to the knowledge about sibutramine use during pregnancy.

Story of benzene and leukemia: epidemiologic approach of Muzaffer Aksoy.

In 1974, Professor Muzaffer Aksoy established a link to leukemia in humans as a result of occupational exposure to benzene. The aim of this study is to evaluate his epidemiological approach for his investigation on the effects of benzene and to bring attention to the benzene problem in Turkey. Dr. Aksoy observed that a large group of leukemic patients were shoemakers, or they worked in leather manufacturing. In the 1960s, benzene was a popular solvent in the leather industry. Dr. Aksoy conducted a field investigation in Gedikpasa- Istanbul, where the shoemakers worked so that he could draw his key observations from actual environmental conditions. With a gas detector, he found the concentration of benzene in these work places to be 150-210 ppm and up to 650 ppm on rare occasions. He performed an epidemiological study and health education among 28,500 shoe, slipper and handbag workers during the period from 1967 to 1974. He published these data, establishing an association between benzene and leukemia. The incidence of leukemia among the shoe workers was decreased by screening, health education, and legislative actions in Turkey, but it began to increase again because of lack of an occupational health policy and underestimation of the problem. These results suggest the importance of primary prevention of occupational cancers. Dr. Aksoy's epidemiologic approach may highlight the necessity for detailed investigations of the occupational status of patients who need medical aid in order to diagnose the real underlying factor.

Normal pregnancy outcome following inadvertent exposure to rosiglitazone, gliclazide, and atorvastatin in a diabetic and hypertensive woman.

The subject is a diabetic and hypertensive woman treated early during an unplanned pregnancy with a multi-drug regimen that included three drugs with no prior history for use in pregnant women (rosiglitazone, gliclazide, atorvastatin). She was under care for chronic hypertension, which she suffered for 14 years, and diabetes mellitus, hypercholesterolemia, anxiety disorder, morbid obesity and epilepsia for 5 years. She was exposed to rosiglitazone (4mg/day), gliclazide (60mg/day), and atorvastatin (40mg/day) in addition to acarbose, spironolactone, hydrochlorothiazide, carbamazepine, thioridazine, amitryptiline, chlordiazepoxide, and pipenzolate bromide during the first 7 weeks of gestation while unaware of pregnancy. Pharmacotherapy was adjusted following clinical recognition of pregnancy during the 8th week. She gave birth to a normal healthy infant at the 36th week of gestation. This is the first reported case of human exposure to rosiglitazone, gliclazide, and atorvastatin during pregnancy. Although the normal pregnancy outcome does not address the safety of these drugs for use in pregnancy, these data contribute to a limited knowledge regarding human exposure to these antidiabetic drugs.

Use of polypharmacotherapy in pregnancy: a prospective outcome in a case.

PURPOSE: Little is known about the risks associated with prenatal exposure to atypical antipsychotics. Our objective is to present a case of exposure to risperidone and quetiapine in pregnancy, and additionally to some other drugs. CASE: Our case (36-year old) has suffered schizophrenia (DSM-IV) for 5 years and used these drugs (risperidone, quetiapine, mirtazapine, thioridazine, diazepam, hydroxyzine, clomipramine, fluvoxamine, alprazolam, carbamazepine, biperiden, haloperidol, ampicillin+sulbactam, enoxaparin, oxerutine) in her third pregnancy. Because of her psychotic condition, Mrs. N.B. was not aware of her pregnancy until 22nd week and the pregnancy could not be terminated. She had a female infant (3000 g, 50 cm) with APGAR scores of 8-9 at the first and fifth minutes at 37th week with an uncomplicated vaginal delivery. The baby was normal. CONCLUSION: This case may contribute to the existing knowledge regarding use of atypical antipsychotics in pregnancy.