[Awareness and Expectations of Primary Care Clinicians in Chronic Heart Failure Management]. / Kronik Kalp Yetersizligi Yönetiminde Birinci Basamak Hekimlerinin Farkindaligi ve Beklentileri.

OBJECTIVE: Chronic heart failure (CHF) management requires a multidisciplinary approach, and it's very important for primary care physicians (PCC) to cooperate with cardiology physicians in this process. In this study, we tried to reveal the awareness and expectations of PCC about CHF management. METHODS: The study was designed as a descriptive survey in a single region and included 549 PCC. Data were collected through a survey study. RESULTS: A total of 389 PCC participated in our study. Of these, 137 (35.2%) stated that they had an average of more than 40 CHF patients registered with them, and 331 (85.1%) stated that they had identified them thanks to their medical treatment. The symptoms that physicians most frequently question in CHF patients are shortness of breath (27.5%), swelling in the ankle (27%), orthopnea (23.9%) and palpitations (20.5%). The physical examination findings that they question most frequently are peripheral edema (% 29.2), tachycardia (18.5%), crepitus in the lungs (16.8%), and irregular pulse (15.2%). 203 (55.9%) of PCC stated that measurements of natriuretic peptides could be implemented in their institutions if the necessary training and opportunity were provided. Most physicians (46.8%) stated that they should be given priority in referring CHF patients; 172 of them (44.2%) stated that they received in-service training regarding CHF and 278 of them (71.5%) stated that their training was not at a sufficient level. CONCLUSION: It is clear that better results can be obtained in the management of CHF as the education level and professional experience of PHCs increases. It seems that PCC need training on CHF and need to improve the quality of communication with cardiologist's.

Behavior of nonplastic silty soils under cyclic loading.

The engineering behavior of nonplastic silts is more difficult to characterize than is the behavior of clay or sand. Especially, behavior of silty soils is important in view of the seismicity of several regions of alluvial deposits in the world, such as the United States, China, and Turkey. In several hazards substantial ground deformation, reduced bearing capacity, and liquefaction of silty soils have been attributed to excess pore pressure generation during dynamic loading. In this paper, an experimental study of the pore water pressure generation of silty soils was conducted by cyclic triaxial tests on samples of reconstituted soils by the slurry deposition method. In all tests silty samples which have different clay percentages were studied under different cyclic stress ratios. The results have showed that in soils having clay content equal to and less than 10%, the excess pore pressure ratio buildup was quicker with an increase in different cyclic stress ratios. When fine and clay content increases, excess pore water pressure decreases constant cyclic stress ratio in nonplastic silty soils. In addition, the applicability of the used criteria for the assessment of liquefaction susceptibility of fine grained soils is examined using laboratory test results.