The factors that have a role in variability for temperature.

Our objective was to determine the factors that affect (i) the rectal-axillary temperature measurement difference (RATD) for digital and mercury-in-glass thermometers and (ii) the difference between mercury-in-glass and digital thermometer readings taken by the rectal and axillary routes. Children (between the ages of 2 and 48 months) who were admitted to Hacettepe University Children Hospital and Corum Children's Hospital in 2 months period were included in this study. Two measurements were taken from each patient within 2 days at two different occasions including day/night and sleep/awake by the same physician. A total of 135 patients were enrolled. RATD was 0.61 + 0.54 degrees C in the mercury-in-glass thermometer, and 0.81 +/- 0.57 degrees C in the digital thermometer. The mean differences between digital and mercury-in-glass thermometers were 0.16 degrees C for rectal routes and -0.02 degrees C for axillary routes. Children at older age with hypoalbuminemia and children exposed to higher ambient temperatures had lower values of RATD than others. Temperature recordings from different sites might change with ambient temperature and individual characteristics of children.

Midwives and nurses awareness of patients' rights.

AIM: to determine the level of awareness of patients' rights among midwives and nurses working in the third and fourth largest cities in Turkey. METHODS: cross-sectional descriptive survey conducted among participants working in university hospitals, state hospitals and village clinics. Questionnaires were distributed to 150 midwives and 350 nurses working in university hospitals (n = 200), state hospitals (n = 100) and village clinics (n = 100); 60% (n = 298) of the forms were returned. FINDINGS: fifty-one per cent (n = 152) of midwives and nurses stated that they had not read any legislation related to patients' rights. Seventy-five per cent (n = 222) of respondents were aware of the legal arrangements. Only 34% (n = 74) of participants who knew of any legal basis for patients' rights said that legislation was in the form of a directive. No significant differences were observed in midwives' answers compared with nurses' answers. CONCLUSION: violation of patients' rights and health professionals' ignorance of appropriate practice means that there is an urgent need to reconsider how to approach this issue. It should be included in continuing education programmes at both graduate and postgraduate midwifery and nursing schools, and also demands more research.

The approach taken by the physicians working at educational hospitals in Izmir towards patient rights.

OBJECTIVE: Considered as a reflection of human rights in our modern day, patient rights have been gaining increasing importance. This particular subject has been discussed from various perspectives in different countries and legal sanctions imposed. "Patient Rights Directives" in Turkey came into effect in 1988. The present study was carried out in order to determine how well the physicians working in Izmir, the third largest city of Turkey, are aware and informed of these directives. METHODS: Our study is an observational-cross sectional descriptive one. The research was conducted among the physicians working in nine training hospitals in Izmir province using a random sampling method. 1,500 questionnaires with 19 multiple-choice questions were distributed in the study. 567 of the forms were returned. Statistical assessment of the data obtained was carried out using the x(2) test on SPSS 10.0 Windows Program. RESULTS: Of the physicians participating in the study, 43% were female and 57% male. The average age was 32 +/- 7.76 years. 40% of the participating physicians were not aware of the legal arrangements (directive). 63% of the participants stated that they had not read any kind of legislation related to patients' rights. Only 34% of the participants knew that the legal sanctions were put into effect in the form of "directive." CONCLUSION: Legal arrangements related to patient rights in the world are being put into effect within the framework of human rights. Turkey is one of the first countries to have completed the legal procedures in this field. PRACTICE IMPLICATIONS: We believe it is necessary that this particular issue be included both in the training programs of the medical faculties and supported by all parts of the society including physicians if these legal procedures are to work effectively.

Randomized clinical trial comparing primary closure with the Limberg flap in the treatment of primary sacrococcygeal pilonidal disease.

BACKGROUND: The purpose of the study was to compare the outcome of excision and primary closure with that of rhomboid excision and the Limberg flap procedure in patients with primary sacrococcygeal pilonidal disease (SPD). METHODS: Two hundred consecutive patients with SPD were randomly allocated to undergo either excision and primary closure (group 1, n = 100) or rhomboid excision and the Limberg flap procedure (group 2, n = 100). Duration of operation, postoperative pain, time to first mobilization, length of hospital stay, postoperative complications, time to resumption of work, recurrence and time to recurrence were recorded for all patients. RESULTS: : Duration of operation was longer in group 2 than in group 1 (P = 0.001). However, postoperative pain was less (P < 0.001), mobilization earlier (P < 0.001), duration of hospital stay shorter (P < 0.001), time to resumption of work shorter (P < 0.001) and postoperative complications fewer (P < 0.001) in group 2. During a median follow-up of 28 months, no recurrence was detected in patients in group 2 versus 11 patients in group 1 (P = 0.001). CONCLUSION: Because of its low complication rate and acceptable long-term results, rhomboid excision and the Limberg flap procedure is preferable to simple excision and primary closure in the treatment of SPD.

Dental malpractice cases in Turkey during 1991-2000.

OBJECTIVES: Doctors can face punitive and legal consequences if patients are not satisfied with the medical treatment. The purpose of this study is to provide a database for dental malpractice cases in Turkey. METHODS: This study is based on the decisions of High Health Council (HHC) in medical malpractice cases. Between 1991 and 2000, 1548 decisions were made by the HHC. 14 (0.9%) of these decisions were related to dentistry. This study examines the 8 decisions under which the dentists are found to be at fault. RESULTS: As three of these cases are based on the same facts they are examined together. Of the dentists consulted on 11 decisions, nine were male and two were female. In four cases the HHC gave its expert opinion before the trial, in five cases during criminal trial and in two cases during compensation trial. In five cases patients received surgical treatment, in four cases prosthetic treatment and in two cases endodontic treatment. Nine of these treatments were carried out at private dental practice. In eight reported decisions negligence and inadequate treatment were identified. Most of negligence was caused during surgical intervention. In two cases, treatments resulted in death. CONCLUSIONS: Like all other medical staff dentists are under the obligation to comply with the legal rules in the country they practice. They also have to consider ethical principles as well as the acceptable standards and protocols of diagnosis and treatment.

Signet ring cell carcinoma of the breast as a source of pelvic floor metastatic mass. A case report.

Primary signet ring cell carcinoma of the breast is a very rare tumour. We present a case with pure signet ring cell carcinoma of the breast, which was recognized as metastasis on the pelvic floor, before developing breast symptoms and signs. A 40-year old woman was admitted with abdominal pain. First diagnostic effort revealed a cystic mass on the pelvic floor, compressing the colon and other neighbouring organs. A biopsy of the pelvic mass was performed. The histopathological examination revealed metastatic signet-ring cell carcinoma. At the time of the first operation, the mammary glands were not suspicious. No other sources of primary tumour were evidenced. An inflammatory sign developed in right breast two months after biopsy of the pelvic metastasis. The histopathology of the breast incisional biopsy revealed primary pure signet ring cell carcinoma of the breast. Because the oestrogen and progesterone receptor were negative in the tumoral tissue, the patient underwent chemotherapy followed by modified radical mastectomy, chemotherapy, and palliative resection of the metastatic mass. The patient was followed up for eight months. To our knowledge, in English literature, we believe that this case is the first report of signet ring cell carcinoma of the breast presenting with pelvic floor metastasis without breast sign.

Bond strength of a self-etching adhesive system to caries-affected dentin.

This in vitro study evaluated the microtensile bond strengths of sound versus caries-affected dentin using a self-etching adhesive system, Clearfil SE Bond, with or without additional acid pre-conditioning. Extracted human mandibular molars with occlusal caries extending halfway through the dentin were used. In the first group, the teeth were bonded with the self-etching adhesive Clearfil SE Bond according to the manufacturer's instructions. In the second group, prepared dentin surfaces were etched with 37% phosphoric acid prior to applying the same self-etching adhesive. After the bonding procedure, all specimens were built up with composite resin and stored in water for 24 hours. The teeth were serially sectioned vertically into 0.7-mm slabs and trimmed into an hourglass shape for measuring microtensile bond strength. Each specimen was attached to a Bencor device and stressed in tension at a crosshead speed of 1 mm/minute. Statistical analysis was performed using two-way ANOVA and the Tukey HSD test (p<0.05). The microtensile bond strengths of Clearfil SE Bond to sound dentin (32.9) were significantly higher than to caries-affected dentin (15.9). In the second group where acid etching was performed prior to applying Clearfil SE Bond, there were no statistically significant differences between the microtensile bond strengths of sound (19.2) and caries-affected dentin (16.3). While bond strengths to sound dentin were decreased by using additional acid etching prior to applying Clearfil SE Bond, this procedure revealed no statistically significant differences in bond strengths for the caries-affected dentin.

Efficacy and safety of reuse of disposable laparoscopic instruments in laparoscopic cholecystectomy: a prospective randomized study.

BACKGROUND: The aim of this prospective randomized study was to investigate the efficacy and safety of the reuse of disposable laparoscopic instruments (DLI) in laparoscopic cholecystectomy. METHODS: A total of 125 consecutive patients with symptomatic cholelithiasis were randomly assigned to undergo laparoscopic cholecystectomy with single-use DLI (group 1, n = 62) or DLI that were reused (group 2, n = 63) after high-level disinfection by alkalinized 2% glutaraldehyde. Operative and postoperative outcomes were investigated. RESULTS: There was no significant difference between group 1 and group 2 in mean operating time, linear analogue pain scale score, duration and amount of analgesic administration, or hospital stay. Total incidence of complications (3.2% vs 4.8%, p = 0.50) and infection rates (1.6% vs 3.2%, p = 0.57) were also similar when group 1 was compared to group 2. CONCLUSION: This study showed that reusing DLI did not change the operative and postoperative outcomes or the infection rate for laparoscopic cholecystectomy when strict rules for disinfection were followed.