Artificial intelligence in medical education: a cross-sectional needs assessment.

BACKGROUND: As the information age wanes, enabling the prevalence of the artificial intelligence age; expectations, responsibilities, and job definitions need to be redefined for those who provide services in healthcare. This study examined the perceptions of future physicians on the possible influences of artificial intelligence on medicine, and to determine the needs that might be helpful for curriculum restructuring. METHODS: A cross-sectional multi-centre study was conducted among medical students country-wide, where 3018 medical students participated. The instrument of the study was an online survey that was designed and distributed via a web-based service. RESULTS: Most of the medical students perceived artificial intelligence as an assistive technology that could facilitate physicians' access to information (85.8%) and patients to healthcare (76.7%), and reduce errors (70.5%). However, half of the participants were worried about the possible reduction in the services of physicians, which could lead to unemployment (44.9%). Furthermore, it was agreed that using artificial intelligence in medicine could devalue the medical profession (58.6%), damage trust (45.5%), and negatively affect patient-physician relationships (42.7%). Moreover, nearly half of the participants affirmed that they could protect their professional confidentiality when using artificial intelligence applications (44.7%); whereas, 16.1% argued that artificial intelligence in medicine might cause violations of professional confidentiality. Of all the participants, only 6.0% stated that they were competent enough to inform patients about the features and risks of artificial intelligence. They further expressed that their educational gaps regarding their need for "knowledge and skills related to artificial intelligence applications" (96.2%), "applications for reducing medical errors" (95.8%), and "training to prevent and solve ethical problems that might arise as a result of using artificial intelligence applications" (93.8%). CONCLUSIONS: The participants expressed a need for an update on the medical curriculum, according to necessities in transforming healthcare driven by artificial intelligence. The update should revolve around equipping future physicians with the knowledge and skills to effectively use artificial intelligence applications and ensure that professional values and rights are protected.

Irrational prescribing of over-the-counter (OTC) medicines in general practice: testing the feasibility of an educational intervention among physicians in five European countries.

BACKGROUND: Irrational prescribing of over-the-counter (OTC) medicines in general practice is common in Southern Europe. Recent findings from a research project funded by the European Commission (FP7), the "OTC SOCIOMED", conducted in seven European countries, indicate that physicians in countries in the Mediterranean Europe region prescribe medicines to a higher degree in comparison to physicians in other participating European countries. In light of these findings, a feasibility study has been designed to explore the acceptance of a pilot educational intervention targeting physicians in general practice in various settings in the Mediterranean Europe region. METHODS: This feasibility study utilized an educational intervention was designed using the Theory of Planned Behaviour (TPB). It took place in geographically-defined primary care areas in Cyprus, France, Greece, Malta, and Turkey. General Practitioners (GPs) were recruited in each country and randomly assigned into two study groups in each of the participating countries. The intervention included a one-day intensive training programme, a poster presentation, and regular visits of trained professionals to the workplaces of participants. Reminder messages and email messages were, also, sent to participants over a 4-week period. A pre- and post-test evaluation study design with quantitative and qualitative data was employed. The primary outcome of this feasibility pilot intervention was to reduce GPs' intention to provide medicines following the educational intervention, and its secondary outcomes included a reduction of prescribed medicines following the intervention, as well as an assessment of its practicality and acceptance by the participating GPs. RESULTS: Median intention scores in the intervention groups were reduced, following the educational intervention, in comparison to the control group. Descriptive analysis of related questions indicated a high overall acceptance and perceived practicality of the intervention programme by GPs, with median scores above 5 on a 7-point Likert scale. CONCLUSIONS: Evidence from this intervention will estimate the parameters required to design a larger study aimed at assessing the effectiveness of such educational interventions. In addition, it could also help inform health policy makers and decision makers regarding the management of behavioural changes in the prescribing patterns of physicians in Mediterranean Europe, particularly in Southern European countries.

How parental attitudes affect the risky computer and Internet usage patterns of adolescents: a population-based study in the Bursa District of Turkey.

BACKGROUND: We aimed to evaluate the computer usage patterns of adolescents and to determine the effects of family life and parental attitude on these patterns. METHODS: This was a descriptive, cross-sectional, population-based survey that included 935 children between 11 and 16 years of age who were students in the second level of primary school and their parents as well. The following instruments were used in the survey: student and parent questionnaires on computer usage patterns and the Parental Attitude Research Instrument (PARI) to assess parental attitudes towards child-rearing and family life. RESULTS: Of the study population, the majority of the students had a computer in their homes and spent a lot of time on the Internet. Parental control over the amount of time spent on the Internet and the websites that were visited had sometimes limited and contradictory effects on computer usage among the students. A democratic parental attitude was the best approach. Using the computer as a reward or punishment had a negative impact on the children's computer usage patterns. CONCLUSIONS: Although parents are confused concerning the benefits and harms of the Internet for their children and not certain how to manage their children's use of the computer and safe navigation of the Internet, a democratic parental attitude appears to be the best approach for reaching the most beneficial computer usage patterns for students.

Intriguing connection between diminished ovarian reserve and childhood traumatic experiences, a prospective case-control study.

INTRODUCTION: Diminished ovarian reserve (DOR) presents a complex challenge in the field of infertility, with factors like age and genetics traditionally under scrutiny. However, the potential influence of adverse childhood experiences on ovarian reserve remains a relatively unexplored area. This research aims to contribute novel insights to the understanding of diminished ovarian reserve etiology, shedding light on previously unexplored risk factors and their potential implications. DESIGN: This case-control study was conducted at an Assisted Reproductive Technology (ART) Center of a university hospital. Infertile patients admitted to the ART center were enrolled in the study. The case group consisted of 102 infertile women diagnosed with diminished ovarian reserve, and the control group consisted of 103 healthy women with male factor infertility. An interview lasting approximately 30 min was held in a separate room with those who volunteered to participate in the study. Due to the sensitivity of the research subject, the data was collected anonymously. The Childhood Trauma Questionnaire was used to measure adverse childhood experiences, and the Hospital Anxiety and Depression Scale (HADS) was used to assess anxiety and depression in the study. The results were compared between the case and the control groups. RESULTS: Overall, the total score of the Childhood Trauma Questionnaire and all subscale scores were higher in the case group (38.28 ± 9.86) than in the control group (35.10 ± 9.52). According to HADS, the total score was 15.92 ± 7.98 in the case group and 14.22 ± 6.87 in the control group. CONCLUSIONS: Our pioneering study is designed to investigate a previously unexplored risk factor in low ovarian reserve. Considering our data and other studies in the literature examining childhood traumas as a risk, it makes us think that the issue is worth examining.

Menstrual pattern following tubal sterilization.

BACKGROUND: We sought to investigate the effects of tubal sterilization over menstrual parameters and determine the timing of the detected influences. MATERIAL/METHODS: We questioned 97 voluntary patients among 301 women who had been subjected to tubal sterilization in our clinic between 1996-2006. Patients were asked via questionnaire about menstrual parameters concerning the 5 years before and after the surgery, which focused on each year separately. Statistical analyses were carried out by considering the preoperative data of patients as controls and postoperative data as the study group. RESULTS: Some kind of pattern change was detected in 7.6% of all patients. Hemorrhage with chunky clots of blood incidence decreased significantly by the second postoperative year (31.9%, 21.6%; P<.05). We had a significant decrease in dysmenorrhea postoperatively in the third, fourth, and fifth years (38.1%, 21.6%, 16.4%, 13.4%; P<.05). While the premenstrual syndrome was 45.3% before surgery, it was 30.9% and 24.7% postoperatively in the fourth and fifth years (P<.05). CONCLUSIONS: Hemorrhage and dysmenorrhea were most frequently seen after tubal sterilization. The statistically significant drop in the mean weekly coital frequency during postoperative period indicates a need for further studies, which might evaluate the reasons behind this reduction.

Residents' views about family medicine specialty education in Turkey.

BACKGROUND: Residents are one of the key stakeholders of specialty training. The Turkish Board of Family Medicine wanted to pursue a realistic and structured approach in the design of the specialty training programme. This approach required the development of a needs-based core curriculum built on evidence obtained from residents about their needs for specialty training and their needs in the current infrastructure. The aim of this study was to obtain evidence on residents' opinions and views about Family Medicine specialty training. METHODS: This is a descriptive, cross-sectional study. The board prepared a questionnaire to investigate residents' views about some aspects of the education programme such as duration and content, to assess the residents' learning needs as well as their need for a training infrastructure. The questionnaire was distributed to the Family Medicine Departments (n = 27) and to the coordinators of Family Medicine residency programmes in state hospitals (n = 11) by e-mail and by personal contact. RESULTS: A total of 191 questionnaires were returned. The female/male ratio was 58.6%/41.4%. Nine state hospitals and 10 university departments participated in the study. The response rate was 29%. Forty-five percent of the participants proposed over three years for the residency duration with either extensions of the standard rotation periods in pediatrics and internal medicine or reductions in general surgery. Residents expressed the need for extra rotations (dermatology 61.8%; otolaryngology 58.6%; radiology 52.4%). Fifty-nine percent of the residents deemed a rotation in a private primary care centre necessary, 62.8% in a state primary care centre with a proposed median duration of three months. Forty-seven percent of the participants advocated subspecialties for Family Medicine, especially geriatrics. The residents were open to new educational methods such as debates, training with models, workshops and e-learning. Participation in courses and congresses was considered necessary. The presence of a department office and the clinical competency of the educators were more favored by state residents. CONCLUSIONS: This study gave the Board the chance to determine the needs of the residents that had not been taken into consideration sufficiently before. The length and the content of the programme will be revised according to the needs of the residents.

Getting better or worse? General health status of 9th grade students in Orhangazi, Bursa, Turkey.

Adolescence is a transition phase from childhood to adulthood. In this period, rapid changes and development in their physical, biological, psychological, and social lives take place. While adolescents have to acquire many qualifications, they are faced with many problems, especially those that risk their health. In Turkey, one of the most important issues contributing to risky behaviors is the 1st Phase Nationwide High School Exam. Students must pass this phase in order to be in good high schools and to then pass the 2nd Phase University Exam. Most of their time is spent studying in school or in private teaching institutions, and less time is spent with their families or participating in social activities. In order to examine the effects on 9th grade students after the 1st Phase exams, we conducted this study with 1192 students in Bursa, Orhangazi. Data to evaluate students by socioeconomic status, body mass index (BMI), dietary, smoking, and physical activity behaviors and psychological status were collected via classroom questionnaires. We aimed to determine and evaluate the general characteristics and physical examination findings, to some extent, in a nationally representative sample of 9th grade students a year following the Nationwide High School Exam.

Students' views about doctor-patient communication, chronic diseases and death.

CONTEXT: Students start their medical study with the opinion that saving lives and preventing deaths are the main goals of medicine. So, what will they do when faced with dying patients? How will they feel; how will they communicate? These are important, but often unspoken and neglected, issues. OBJECTIVES: We assessed the attitudes and opinions of first-year medical students regarding doctor-patient communication, chronic diseases, death, and dying patients at Uludag University Medical School in Bursa/Turkey. Our secondary objective was to delineate the educational needs related to this field. METHODS: Cross-sectional survey of the first-year students in the class of 2004-2005. Students were evaluated using a questionnaire consisting of six questions and 18 Likert-type statements. RESULTS: Completed questionnaires were received from 253 of the 265 (95.5%) students. According to the students, the most fatal diseases were cancer and AIDS. Students strongly agreed with the importance of talking to patients, where female students agreed more than males with this statement (p<0.05). Most students disagreed that patients should be informed that they are dying. Older students feared less for the death of patients. Female students would like to work in an environment where they can communicate with their patients and where they can be with them for a longer period. CONCLUSIONS: The results of this survey indicate that the need of providing palliative care, enhancing communication skills with terminally ill patients, and integrating different teaching strategies are important aspects of the undergraduate medical curriculum.

A Meta-Analysis and an Evaluation of Trends in Obesity Prevalence among Children and Adolescents in Turkey: 1990 through 2015.

OBJECTIVE: Obesity in childhood and adolescence is one of the most serious public health problems due to a remarkable increase in prevalence in recent years and its close relationship with non-communicable diseases, such as diabetes and hypertension, resulting in increased adult morbidity and mortality. This study aims to quantify the secular trend in different regions of Turkey from 1990 to 2015 by performing a meta-analysis of childhood and adolescent obesity prevalence studies conducted. METHODS: Uludag University Library Database was searched for relevant articles published prior to March 2017. The heterogeneity of the studies in the meta-analysis was tested by the I2 statistic and Cochran's Q test. The obesity trend analyses were examined by chi-square trend analysis with respect to five year periods. The statistical significance level was taken as α=0.05. RESULTS: A total of 76 papers were initially identified addressing childhood and adolescent obesity in Turkey. Fifty-eight papers were selected for analysis. The prevalence of obesity increased from 0.6% to 7.3% with an 11.6-fold increase between the periods 1990-1995 to 2011-2015. The prevalence of obesity increased in both genders. However, boys were more likely to be obese than girls. CONCLUSION: Studies on obesity prevalence in the 5-19 age group in Turkey have gained importance, especially in the 2000s. While a remarkable number of prevalence studies, mostly regional, have been conducted between 2005-2011, a gradual decline was observed thereafter. Further national and population-based surveys on prevalence of obesity in children and adolescents are definitely needed in Turkey.

Smoking patterns among primary school students in Turkey.

Cigarette smoking continues to be a threat to global health. The number of cigarettes smoked per person tends to increase each year, and the age of starting seems to be dropping. The research related to cigarette smoking conducted among young people generally studied high school or university students. However, studies have shown that students usually start smoking during the primary school period out of curiosity or imitation. The purpose of the present study was to find the prevalence of cigarette smoking among primary school students and the reasons for starting smoking, and to determine the characteristics of cigarette smoking of their parents. This study was conducted among 17 primary schools chosen according to their socioeconomic situations in different municipality districts in Turkey, with 9,408 students participating. Data were obtained by questionnaire. The mean age to start smoking was 11.7 +/- 1.6; 82.9% of the students who took part in this study had never smoked before, 13.4% had tried smoking at least once, and 3.7% had been smoking regularly. The biggest reason for smoking was just curiosity or imitation. It was determined that a risk factor for students to start smoking was parents who smoke. The 17% smoking rate among primary school students was high in our opinion and prevention studies initiated. In addition, the effects of cigarette-smoking parents on students who start smoking should also be considered.

Relationship between Symptoms of Disruptive Behavior Disorders and Unsafe Internet Usage in Early Adolescence.

INTRODUCTION: Children and adolescents are at the highest risk for negative effects of internet usage. Risk taking and erroneous decision making have been described as major behavioral characteristics of patients with attention deficit hyperactivity disorder (ADHD). ADHD and its association particularly with oppositional defiant disorder/conduct disorder are correlated with risk-taking behaviors. This study was conducted to evaluate how disruptive behavior disorder symptoms are associated with internet usage, particularly unsafe internet usage, in early adolescents. METHODS: A sample of 1389 secondary school students was invited to the survey. All children were given an invitation letter and Conners' Parent Rating Scale (CPRS) forms were sent to their parents. The accepted participants filled in questionnaire forms, which consisted of questions interrogating demographic information and internet usage habits. RESULTS: Responses indicated that 27.4% (n=249) of the participants encountered unwanted content unintentionally and nearly one-third (n=280, 30.4%) had chatted online with people they did not know. Additionally, respondents who had more severe ADHD symptoms were more likely to report surfing online mainly for the purpose of chatting than respondents with milder ADHD symptoms. Students with comparatively higher attention deficit scores were also significantly more likely to report meeting in person with strangers they knew only from internet chatting. Analyses have demonstrated the presence of a significant difference between study participants with and without conduct disorder as for internet overusage or meeting with their internet acquaintances. CONCLUSION: This study suggests that there may be a significant relation between ADHD symptoms, conduct disorder and pathological and unsafe internet usage. Evaluating adolescents with ADHD and conduct disorder with this risk in mind is important in the development of both preventive and interventional strategies.

Diagnosis of acute tonsillopharyngitis in primary care: a new approach for low-resource settings.

BACKGROUND: Diagnosing GABHS (Group A-beta Hemolytic Streptococcus) tonsillopharyngitis by clinical scoring is a recommended approach in developed countries, but there is still much controversy for low resource settings. AIM: We aimed to assess the impact of Centor criteria with the support of practical laboratory tests. METHODS: We prospectively included patients complaining sore throat (N = 282). We evaluated them in terms of Centor scoring and performed white blood cell count (WBC), C-reactive protein (CRP), rapid antigen detecting test, and throat culture. RESULTS: In GABHS cases (N = 32, 11·3%), two of the criteria were observed to be positive in more than half of the cases (N = 19, 59·3%), while 13 (40·7%) cases met three/four criteria. The specificity of having two criteria was found to be 65·5% and increased to 91·5% after including CRP and WBC. CONCLUSION: Centor criteria could be safely used to reduce unnecessary antibiotic usage for tonsillopharyngitis in developing countries.

Job related affective well-being among primary health care physicians.

BACKGROUND: Job related affective well-being is important for a healthy life and job satisfaction for all individuals, including physicians. The later group, however, is most often compromised. OBJECTIVES: We aimed to investigate a group of Turkish primary health care physicians' job related emotional perceptions and to assess their reactions in terms of stress, anxiety and depression. METHODS: A descriptive, cross-sectional, self-reported questionnaire study was conducted. A total of 60 primary health care centres and 274 general practitioners who were working at these centres participated in the study. The response rate was 74%. Printed questionnaires were completed by the participants anonymously. We used the Job Related Affective Well-Being Scale (JAWS) and Depression Anxiety Stress Scale (DASS 42). Correlation analysis and hierarchic regression were performed. RESULTS: Correlations between JAWS and DASS total scores were negative and statistically significant (r = -0.52; P< 0.01). Low pleasure/high arousal (LPHA) and low pleasure/low arousal (LPLA) variations that describe negative emotional states show a positive and significant relationship with depression, anxiety and stress values. The highest mean score was obtained for the high pleasure/low arousal (HPLA) status that can be interpreted to mean that our study group was pleased with their job but was not motivated. CONCLUSIONS: Physician's job related negative emotional perceptions are associated with reactions in terms of stress, anxiety and depression. For this reason, it is critical to consider primary care physicians' job related affectations and job related stimuli.

ACTH stimulation test in lean polycystic ovary syndrome patients with insulin resistance.

OBJECTIVE: To determine whether insulin resistance in nonobese polycystic ovarian syndrome (PCOS) patients is associated with a higher response to ACTH stimulation. DESIGN: Controlled prospective study. SETTING: University hospital ambulatory care unit. PATIENT(S): Twenty nonobese PCOS syndrome patients with insulin resistance and a body mass index-matched control group of 20 nonobese PCOS patients without insulin resistance. INTERVENTION(S): A 75-g oral glucose tolerance test and an ACTH stimulation test. MAIN OUTCOME MEASURE(S): Blood insulin and glucose levels after ingestion of 75 g oral glucose; blood androstenedione (A), 17(OH)-progesterone [17(OH)-P], free and total T, DHEAS, and progesterone (P) response to ACTH stimulation. RESULT(S): The proportional increases in the blood levels of total and free T, DHEAS, A, 17(OH)-P, and P following ACTH stimulation were similar in the two groups. Only the insulin area under the curve (AUC) values were significantly different among the two groups. The insulin AUC values were positively correlated to the free T blood levels and the homeostasis model assessment scores. CONCLUSION(S): Within the population of nonobese PCOS patients, insulin resistance is not associated with a more pronounced response to ACTH stimulation. The pathogenesis and management of PCOS in nonobese patients may be different from in obese patients.

The effects of different hormone replacement therapy regimens on tear function, intraocular pressure and lens opacity.

OBJECTIVE: Estrogen may have adverse effects on the ocular surface, intraocular pressure (IOP), lens opacity and tear function. The aim of the present study was to elucidate the effects of different hormone replacement therapy (HRT) protocols on tear function, IOP and lens opacity. DESIGN AND SETTING: This was a prospective, uncontrolled study carried out at the Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Faculty of Medicine, Uludag University, Turkey. PATIENTS AND INTERVENTIONS: Thirty postmenopausal patients who had spontaneous or surgical menopause for at least 1 year and were not taking any medications were assigned to one of three groups. Group 1 comprised 19 patients (n = 38 observations) given conjugated equine estrogen 0.625 mg plus medroxyprogesterone acetate 2.5 mg (Premelle 2.5) daily; Group 2 contained six patients (n = 12 observations) given tibolone 2.5 mg (Livial) daily; and Group 3 comprised five patients (n = 10 observations) treated with estradiol patch, 3.9 mg/12 cm2 (Climara). Tear function, evaluated with Schirmer's test, IOP and lens opacity were determined before treatment and at 6 and 12 months of treatment. RESULTS: Mean Schirmer's test score in each group and all eyes (n = 60) did not change significantly after 6 months of treatment but decreased significantly at 12 months. The percentage decrease in tear function was greatest in the estrogen-only group (Group 3). Mean IOP did not change significantly in Groups 1 and 2; however, in Group 3, IOP showed a statistically significant decrease from 14.63 +/- 0.84 mmHg before treatment to 12.60 +/- 0.68 mmHg (mean +/- standard error) at the end of treatment. Lens opacity in women of all groups did not change during treatment. CONCLUSIONS: HRT decreased tear production, the decrease being greater in the estrogen- only group. Woman who are taking or considering HRT should be informed of the potential increased risk of dry eye syndrome with this therapy. In addition, estrogen-only treatment decreased IOP while estrogen plus progesterone and tibolone had no effect. HRT did not affect lens opacity after 12 months of treatment.

Pregnant women quit smoking; what about fathers? Survey study in Bursa Region, Turkey.

AIM: To evaluate maternal and paternal smoking habits during pregnancy and determine their correlation with pregnancy complications and newborn status. METHODS: The study included 499 pregnant women who delivered at the Department of Obstetrics and Gynecology in Uludag University School of Medicine, over a period of one year. Women were interviewed about their smoking habits before and during pregnancy. They were also asked about the smoking habits of their spouses. The relationship between smoking habits and pregnancy complications and newborn status was researched. The outcomes measured included pregnancy complications, gestational age at the onset of labor, Apgar scores during labor, and fetal birth weight and height. RESULTS: The percentage of maternal smoking before pregnancy was 26.5% (n=132) and decreased to 9.8% (n=49) at the end of pregnancy, with 52.5% (n=262) of the fathers who continued to smoke at home during their wife's pregnancy. Low birth weight and preterm delivery rate were significantly higher in maternal (n=15 [30.6%], and n=12 [24.5%], respectively) and paternal smoking groups (n=52 [22.4%] and n=54 [23.3%], respectively). Paternal smoking had no effect on intrauterine growth retardation (n=10 [4.3%]) and prenatal death (n=4 [1.7%]), although maternal smoking had such an effect (n=7 [14.3%] and n=3 [6.1%], respectively). CONCLUSION: Maternal smoking is a major risk factor for preterm delivery, low birth weight, intrauterine growth retardation, and intrauterine death, but paternal smoking also carries risk for the fetus. During perinatal care, we should educate the expectant parents about the side effects, not only of maternal, but also of paternal smoking.