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Ozcan Ozeke,1 Vildan Ozeke,2,3 Ozlem Coskun,3 Isil Irem Budakoglu31Health Sciences University, Ankara City Hospital, Department of Cardiology, Ankara, Turkey; 2Gaziosmanpasa University, Department of Computer Education and Instructional Technology, Tokat, Turkey; 3Gazi University, Department of Medical Education and Informatics, Ankara, TurkeyCorrespondence: Ozcan Ozeke Sağlik Bilimleri Üniversitesi, Ankara Şehir Hastanesi, Kardiyoloji Klinigi, Ankara 06800, TurkiyeTel +90 505 383 6773Email ozcanozeke@gmail.comAbstract: Medical errors are a serious public health problem and the third-leading cause of death after heart disease and cancer. Every day, the health care professionals (HCPs) practice their skill and knowledge within excessively complex situations and meet unexpected patient outcomes. These unexpected complications and unintentional errors will always be a part of the medical system due to the universal nature of human fallibility and technology. While not all errors are life-threatening, they can significantly compromise a patient’s quality of life. However, the victims of medical error reach far beyond the patient. The second victim (SV), which defined for the first time by Albert Wu in his description of the impact of errors on HCPs by both personally and professionally, is a medical emergency equivalent to post-traumatic stress disorder. When the errors occur, it causes a domino effect including the four groups: the patient and family (first victim), the HCP [SV], the hospital reputation (third victim), and patients who are harmed subsequently (fourth victims). The rights of our patients to safe, reliable, and patient-centered care are critical and most important as a primary and utmost aim of medicine. However, we also have to take care of our own (SVs), especially when we have good people who mean to do well and then find themselves in an emotionally complex situation. There is a need to articulate to the public, politicians, and media how system failure leads to medical error even in hand of well-educated and competent HCPs are given an increasing clinical workload. Furthermore, despite several leading institutions in western countries have developed formal support programs that allow HCPs to cope with their emotional distress by obtaining timely support in an emphatic, confidential, non-judgmental environment, we need to raise awareness of this phenomenon and appropriate institutional responses both to harmed patients and their families and HCPs.Keywords: second victim, defensive medicine, medical malpractice, medical errors, clinical-judicial syndrome, second victim syndrome

Aim: This study aimed to evaluate the real-life performance of clinical vignettes and multiple-choice questions generated by using ChatGPT., Methods: This was a randomized controlled study in an evidence-based medicine training program. We randomly assigned seventy-four medical students to two groups. The ChatGPT group received ill-defined cases generated by ChatGPT, while the control group received human-written cases. At the end of the training, they evaluated the cases by rating 10 statements using a Likert scale. They also answered 15 multiple-choice questions (MCQs) generated by ChatGPT. The case evaluations of the two groups were compared. Some psychometric characteristics (item difficulty and point-biserial correlations) of the test were also reported., Results: None of the scores in 10 statements regarding the cases showed a significant difference between the ChatGPT group and the control group ( p > .05). In the test, only six MCQs had acceptable levels (higher than 0.30) of point-biserial correlation, and five items could be considered acceptable in classroom settings., Conclusions: The results showed that the quality of the vignettes are comparable to those created by human authors, and some multiple-questions have acceptable psychometric characteristics. ChatGPT has potential in generating clinical vignettes for teaching and MCQs for assessment in medical education.

Background: Manually creating multiple-choice questions (MCQ) is inefficient. Automatic item generation (AIG) offers a scalable solution, with two main approaches: template-based and non-template-based (AI-driven). Template-based AIG ensures accuracy but requires significant expert input to develop templates. In contrast, AI-driven AIG can generate questions quickly but with inaccuracies. The Hybrid AIG combines the strengths of both methods. However, neither have MCQs been generated using the Hybrid AIG approach nor has any validity evidence been provided., Methods: We generated MCQs using the Hybrid AIG approach and investigated the validity evidence of these questions by determining whether experts could identify the correct answers. We used a custom ChatGPT to develop an item template, which were then fed into Gazitor, a template-based AIG (non-AI) software. A panel of medical doctors identified the answers., Results: Of 105 decisions, 101 (96.2%) matched the software's correct answer. In all MCQs (100%), the experts reached a consensus on the correct answer. The evidence corresponds to the 'Relations to Other Variables' in Messick's validity framework., Conclusions: The Hybrid AIG approach can enhance the efficiency of MCQ generation while maintaining accuracy. It mitigates concerns about hallucinations while benefiting from AI.

Background: This study aimed to determine whether surgical multiple-choice questions generated by ChatGPT are comparable to those written by human experts (surgeons)., Methods: The study was conducted at a medical school and involved 112 fourth-year medical students. Based on five learning objectives in general surgery (colorectal, gastric, trauma, breast, thyroid), ChatGPT and surgeons generated five multiple-choice questions. No change was made to the ChatGPT-generated questions. The statistical properties of these questions, including correlations between two group of questions and correlations with total scores (item discrimination) in a general surgery clerkship exam, were reported., Results: There was a significant positive correlation between the ChatGPT-generated and human-written questions for one learning objective (colorectal). More importantly, only one ChatGPT-generated question (colorectal) achieved an acceptable discrimination level, while other four failed to achieve it. In contrast, human-written questions showed acceptable discrimination levels., Conclusion: While ChatGPT has the potential to generate multiple-choice questions comparable to human-written ones in specific contexts, the variability across surgical topics points to the need for human oversight and review before their use in exams. It is important to integrate artificial intelligence tools like ChatGPT with human expertise to enhance efficiency and quality., Competing Interests: The authors report no funding or conflicts of interest., (Copyright © 2024 Baylor University Medical Center.)

Background: Medical records, encompassing patient histories, progress notes, and more, play a crucial role in patient care and treatment, healthcare communication, medico-legal matters, and supporting financial documentation., Objective: Despite their significance, literature suggests inconsistencies in record quality and insufficient formal medical record-keeping education for medical students and residents. The study aimed to identify and evaluate the effectiveness of educational interventions by conducting a systematic review., Method: A literature search covering 2003-2023 and review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was undertaken., Results: The literature search identified 44 relevant studies for inclusion. Educational methods, including lectures, feedback, workshops and discussions, addressed different components of the clinical record. The review revealed positive impacts on participant satisfaction, skills and attitudes related to record-keeping. However, some studies reported no significant positive outcomes, emphasising the need for higher-level evidence. Most studies adopted a single-group pretest-posttest design, presenting challenges in control group implementation. The Kirkpatrick evaluation levels were primarily at level 2, with few studies reaching level 3. The absence of studies at level 4 suggested the need for more robust evidence. Studies targeted medical residents more frequently than medical students, with a lack of interventions during the first year of medical education., Conclusion: Despite limitations including language bias and methodological variations, the review revealed diverse educational strategies and highlighted the necessity for more randomised controlled trials and studies providing higher-level evidence to enhance clinical record-keeping skills among medical students and residents., Implications: Medical record-keeping educational interventions can significantly improve the documentation skills of medical students and residents, thereby enhancing patient care, communication and medico-legal compliance., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship and/or publication of this article.

Objective: The aim was to determine whether preclinical medical students can develop their illness scripts to a level comparable to that of clerkship students through test-only learning using repeated formative online testlets., Methods: In this experimental study, participants were 52 preclinical and 53 clinical medical students. The intervention group consisted of preclinical medical students, and the control group consisted of clinical medical students. The intervention group responded to online testlets containing feedback, an innovative formative assessment method called ContExtended Questions, on general surgery for 8 days by spending no more than 30 minutes each day. The control group completed the general surgery clerkship. The performances were assessed using 20 Key-Feature Question items. The intervention group was assessed twice: immediately after the intervention (the immediate test), and again 1 month later (the delayed test). The control group was assessed once, immediately after the clerkship. All performance tests were identical., Results: The preclinical students had a significantly higher mean score on the immediate test (83.1 ± 9.6) compared to the clinical students (75.4 ± 8.9), P < .001. The effect size (Cohen's d ) was .83. However, the mean score in the delayed test (76.9 ± 13.6) was not significantly different from clinical students' mean score (75.4 ± 8.9), P > .05., Conclusions: Test-only learning as a spaced repetition of online formative testlets is effective in preparing preclinical medical students to the clinical clerkship. Through using this approach in preclinical period, they can prepare themselves for the clinical environment to optimize the benefits derived from clerkships., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Purpose: Artificial intelligence, specifically large language models such as ChatGPT, offers valuable potential benefits in question (item) writing. This study aimed to determine the feasibility of generating case-based multiple-choice questions using ChatGPT in terms of item difficulty and discrimination levels., Methods: This study involved 99 fourth-year medical students who participated in a rational pharmacotherapy clerkship carried out based-on the WHO 6-Step Model. In response to a prompt that we provided, ChatGPT generated ten case-based multiple-choice questions on hypertension. Following an expert panel, two of these multiple-choice questions were incorporated into a medical school exam without making any changes in the questions. Based on the administration of the test, we evaluated their psychometric properties, including item difficulty, item discrimination (point-biserial correlation), and functionality of the options., Results: Both questions exhibited acceptable levels of point-biserial correlation, which is higher than the threshold of 0.30 (0.41 and 0.39). However, one question had three non-functional options (options chosen by fewer than 5% of the exam participants) while the other question had none., Conclusions: The findings showed that the questions can effectively differentiate between students who perform at high and low levels, which also point out the potential of ChatGPT as an artificial intelligence tool in test development. Future studies may use the prompt to generate items in order for enhancing the external validity of the results by gathering data from diverse institutions and settings., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Objective: The homogeneous distribution of physicians is important for ensuring patients' access to health services. To encourage physicians to work in underserved areas, policymakers create incentives. Understanding physicians' employment preferences is essential when developing these incentive packages. This study aims to quantitatively reveal the preferences of cardiologists in Türkiye using a discrete choice experiment (DCE)., Methods: A DCE questionnaire was distributed electronically to all cardiologists in Türkiye. It included 14 different pairs of hypothetical job offers based on seven parameters likely to influence their employment preferences. The data were analyzed using a conditional logit model. The coefficients (CEs) of conditional logistic regression and the willingness-to-accept (WTA) values were calculated., Results: The analysis included 278 cardiologists. It revealed that the most influential parameter was location (CE: 2.86). To move to an undesirable location, the average participant would require an earnings increase of at least 123.3% relative to the average potential earnings of a cardiologist. Other parameters included availability of suitable facilities (CE: 1.07, WTA: 46.3%), harmony with co-workers (CE: 0.92, WTA: 39.61%), working conditions (CE: 0.68, WTA: 29.26%), and the number of night shifts (CE: 0.61, WTA: 26.34%)., Conclusion: 'Location' emerged as the most important factor in the employment preferences of cardiologists in Türkiye. However, several other monetary and non-monetary factors were also influential, suggesting that policymakers should adopt a holistic approach when developing incentives for cardiologists.

Background: Anatomy is a crucial part of medical education, and there have been attempts to improve this field by utilizing various methods. With the advancement of technology, three-dimensional (3D) materials have gained popularity and become a matter of debate about their effectiveness compared to two-dimensional (2D) sources. This research aims to analyze the effectiveness of 3D PDFs compared to 2D atlases., Methods: This study is a randomized controlled trial involving 87 Year-1 and Year-2 medical students at Gazi University Faculty of Medicine, Turkey. The study was conducted in two steps. In Step-1, students were randomized to watch lecture videos on liver anatomy and male genitalia anatomy supplemented with either a 3D PDF (intervention group) or 2D atlas (control group) images. Following the video lectures, a test (immediate test) was administered. In Step-2, the same test (delayed test) was administered 10 days after the immediate test. The test scores were compared between the intervention and control groups. In addition to the descriptive analyses, Chi-square and Mann-Whitney U tests were performed., Results: In the immediate test, while there was no significant difference between the groups for the liver test (p > 0.05), 3D PDF group's scores (Median = 24.50) was significantly higher than the 2D atlas group's in the genitalia test (Median = 21.00), (p = 0.017). The effect size (Cohen's d) was 0.57. In the delayed test, there was no significant difference between the groups in the liver and genitalia tests (p > 0.05). However, the effect size in the immediate genitalia test was 0.40. Year-1 students' immediate test of genitalia performances were significantly higher in the 3D PDF group (Median = 24.00) than the 2D atlas group (Median = 19.00), (p = 0.016). The effect size was 0.76. Also, Year-1 students' 3D PDF group (Median = 20.50) presented with significantly higher performance than the 2D atlas group (Median = 12.00), (p = 0.044) in the delayed test of genitalia, with the 0.63 effect size., Conclusion: 3D PDF is more effective than 2D atlases in teaching anatomy, especially to initial learners. It is particularly useful for teaching complex anatomical structures, such as male genitalia, compared to the liver. Hence, it may be a valuable tool for medical teachers to utilize during lectures., (© 2023. The Author(s).)

Aim: It was aimed to explore the relationship between evidence-based medicine (EBM) training and medical students' views on traditional, complementary, and alternative medicine (TCAM) and their views on conspiracies about COVID-19., Background: Medical students constitute the future workforce of primary health care services. The relationship between EBM training and their views on conspiracies about COVID-19 is critical to explore for providing a better primary health care. The relationship EBM training and medical students' views on TCAM is also important in this regard., Methods: This is a cross-sectional study. Turkish medical students were surveyed about EBM training, TCAM, and COVID-19 conspiracies. The electronic survey form consisted of five parts: Demographic characteristics, views and self-perceived knowledge about TCAM and the methods, views on the origin of SARS-COV-2, participation in EBM training, and views on TCAM training. A total of 49 medical schools provided response. Along with descriptive statistics, Chi-square test was utilized., Findings: Among 2577 participants, 24.0% of them believed SARS-COV-2 was artificially designed. The students who have participated in EBM training via both lecture and small group discussions have a less positive view on TCAM than both the students who have not participated in any EBM training ( p < 0.05) and the students who participated in only-lectures ( p < 0.05). There was a significant association between EBM training and whether believing COVID-19 (SARS-COV-2) has been designed purposefully by some people or it has emerged naturally χ 2 (1) = 17.21 p < 0.001. The odds of thinking COVID-19 emerged naturally was 1.85 times higher (95% CI: 1.38-2.47) if the students have participated in EBM training via both lectures and small group discussions than if they have not participated in any EBM training. EBM training affects medical students in terms of beliefs on COVID-19 conspiracies.

A testlet is a cluster of questions related to a single content area. F-type testlet is a specific type of linear testlets that contains evolving scenarios. There is no study that carried out a factor analysis of an F-type testlet exam in the context of medical education and related disciplines. We aimed to determine to what extent disciplinary domains account for the variability of student performance on an online case-based F-type testlet variant. Final year undergraduate medical students ( N  = 441) participated in the online exam that consisted of ten case-based F-type testlets. Six of the testlets were pediatrics, four were internal medicine. Exploratory factor analysis was carried out. It revealed that the structure has two factors. Pediatrics testlets loaded factor 1 (loadings between 0.56 and 0.77), and internal medicine testlets loaded factor 2 (loadings between 0.65 and 0.79). The results showed that disciplinary domains account for the variability of the performance on F-type testlets. The results suggest that context specificity still exists in this type of exam. In order to more thoroughly evaluate the clinical reasoning skills of students, medical educators must still ensure that clinical reasoning exams include a comprehensive representation of all relevant content areas., Competing Interests: Competing InterestsThe authors declare no competing interests., (© The Author(s) under exclusive licence to International Association of Medical Science Educators 2023. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.)

Aim: This study aimed to determine how watching lecture videos at 1× and 2× speeds affects memory retention in medical students., Methods: A posttest-only experimental design was utilized. The participants were 60 Year-1 and Year-2 medical students. The participants were assigned to one of two groups through stratified randomization: Group 1 would watch the video at 1× speed, and Group 2 at 2× speed. Their performance was assessed using a test comprising 20 multiple-choice questions. The test has been applied immediately after watching the video (Immediate test), and, again after one week (Delayed test). Parametric and non-parametric statistical tests were performed., Results: In the Immediate test, the mean score of the 1× speed group was 11.26 ± 4.06, while 2× speed group's mean score was 10.16 ± 2.46. The difference was not significant t(58) = 1.26, p  > .05. In the Delayed test, the mean score of 1× speed group was 9.66 ± 3.94, while 2× speed group's mean score was 8.36 ± 2.80. The difference was not significant t(55) = 1.42, p  > .05., Conclusions: Watching the video lecture at 2× speed did not impair memory retention in medical students. This may help students to save time in their dense curricula.[Box: see text].

Background: This study was conducted to explore the effectiveness of online problem-based learning (e-PBL) with multimedia animation scenarios by comparing the face-to-face (f2f) PBL method with paper-based scenarios. Adapting different f2f teaching methodologies to online environments is a significant problem that urgently needs attention, particularly in health education., Methods: This study is part of design-based research and consists of three phases, which comprise design, analysis, and re-design. First, the animation-based problem scenarios were developed, and the learning environment (e-PBL) elements were organized. Then animation-based scenarios and the e-PBL environment were used, and problems related to the use of the environment were determined with an experimental study which was based on a pretest-posttest control group design. Finally, we used the following three measurement tools in the data collection process: a scale to determine the effectiveness of PBL, an attitude scale toward PBL, and the Clinical Objective Reasoning Exams (CORE). The study group in this research comprised 92 medical undergraduates (47 female and 45 male)., Results: There were similar scores between the two groups (e-PBL and f2f) in terms of the effectiveness of the platforms, the attitudes of the medical undergraduates, and the CORE scores. Also, there were positive relationships between the attitude scores, grade point average (GPA), and PBL scores of the undergraduates. Another significant positive relationship was found between the CORE scores and the GPA., Conclusions: The animation-supported e-PBL environment positively effects the participants' knowledge, skills, and attitude. Students who have high academic scores attitude positively towards e-PBL. Providing problem scenarios as multimedia animations is the innovative face of the research. They have been produced inexpensively with off-the-shelf web-based animation apps. These technological advances may democratize the production of video-based cases in the future. Although the results of this study were obtained before the pandemic, they showed no differences between e-PBL and f2f-PBL in terms of effectiveness., (© 2023. The Author(s).)

Background: IFMSA Social Accountability Assessment Tool has been developed for medical students by medical students to assess medical schools. However, its psychometric characteristics are unknown since it was developed without any analysis. We aimed to reveal its reliability and validity., Methods: 1122 undergraduate medical students from various years in Gazi University Faculty of Medicine have participated in the study. They have answered the Turkish version of IFMSA Social Accountability Assessment Tool created through a translation process by experts. Exploratory and confirmatory factor analyses were carried out., Results: Exploratory factor analysis showed that factor loadings were between 0.46 and 0.73 for Factor 1, 0.68 and 0.87 for Factor 2. The two-factor model, which consists of "Community Centeredness" and "Socio-Demographic Characteristics", was evaluated through confirmatory factor analysis. The goodness-of-fit statistics of the model showed well-fit: CMIN/df 4.46, GFI 0.96, CFI 0.95, RMSEA 0.05, SRMR 0.03. Standardized regression weights were between 0.43 and 0.77., Conclusion: The tool has acceptable psychometric characteristics, with good reliability and validity. It could be considered as a point of departure for the change in the way of being socially accountable since it enables medical students to explore the weak areas of their medical schools in terms of social accountability., (© 2023. The Author(s).)

Aim: This study aimed to reveal the current status of the literature on rational prescribing training in undergraduate medical education., Methods: This study followed the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. An online search using 50 keywords in four databases was performed to access the studies published between 2008 and 2020. Specific features of the training such as aims or objectives of teaching, methods or model, and evaluation of effectiveness were extracted. Kirkpatrick levels were used to evaluate the effectiveness of teaching., Results: Of 74 studies included in the full review, 16 (21.6%) of them reported the use of WHO 6-Step Model for Rational Prescribing in their educational interventions. In terms of effectiveness, only two of the studies investigated changes in learner behavior in the context for which they are being trained, and only one study showed the effect of training on patient outcomes., Conclusion: The evidence on the effectiveness of rational prescribing training has been presented mostly by using student satisfaction surveys and test of knowledge and skills. A higher level of evidence such as patient outcomes of the training needs to be reported., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Abstract: There is no study in the literature that reveals the adequacy of obstetric ultrasonography (US) training in Turkey. We aimed to evaluate the adequacy of obstetric US training radiologists had received during their residency and determine how competent they considered themselves to be in this regard.A survey (27 items for residents, 21 items for specialists) was sent to all the radiology residents and specialists in Turkey through the mail list of the Turkish Society of Radiology.Ninety-one residents and 217 specialists participated in our study. Sixteen residents (17.6%) had received theoretical courses, 21 residents (23.1%) and 59 specialists (27.2%) had attended in-house obstetric US rotations, and 5 residents (5.5%) and 23 specialists (10.6%) had attended obstetric US rotations in another institution. When questioned separately for each trimester, only 11% to 36.3% of the residents stated that they took care of a sufficient number of patients. In general, 62.6% of the residents and 25.3% of the specialists did not consider themselves to be absolutely competent in obstetric US. The competency sources were specified as residency training by 44 residents (48.6%) and 55 specialists (25.3%), postgraduate training by 2 residents (2.2%) and 78 specialist (35.9%).In Turkey, current obstetric US training does not provide the experience that will allow physicians with radiology training to easily perform and interpret obstetric US. The main reasons for this situation include the limited number of patients the physicians took care of as a resident, insufficient rotation time, and lack of theoretical courses they attended., Competing Interests: The authors declare no conflict of interest., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

Background: The aim of this study was to find out specialty training preferences of senior medical students from three medical schools in Turkey, Spain, and Pakistan., Methods: A Discrete Choice Experiment was carried out using an electronic form for students in three countries in 2021-2022 term. Each choice set in the form consisted of two hypothetical specialty training positions. The attributes were location, earnings, working conditions, personal perspective, quality of education, probability of malpractice, and prestige. Conditional logit model was used to estimate participants' preferences and "willingness to accept" values., Results: The most valued attribute was "personal perspective on specialty area" for Turkish and Spanish students, while this attribute was not meaningful for Pakistani students. Turkish students needed a 204% of change in their income for a swap between the specialty that they like and not like. This tradeoff necessitated a 300% change for Spanish students. The most valued attribute for Pakistani students, which was "working conditions", necessitated a 97% increase in income to switch from working in good conditions to working in poor conditions., Conclusion: In this first multinational DCE study in the medical education literature, we found the preferences of medical students in Turkey, Spain, and Pakistan are affected to various extents by several factors., (© 2022. The Author(s).)

This article was migrated. The article was marked as recommended. The COVID-19 (Coronavirus Disease of 2019) pandemic, as the modern world's gravest health crisis, has rapidly required more health facilities and health care providers (HCPs). The education system in general and medical education, in particular, has also changed dramatically with the school closures. Teaching and learning activities are undertaken remotely and on digital platforms. Academicians, HCPs, and medical students have gained new skills and experienced to manage their own learning process online. Many sources became easily reachable, open, and free. Open and democratized medicine, as we have seen during this pandemic, offers an interactive, egalitarian educational model. Governments, global organizations, and companies collaborated in order to keep all students learning and all instructors teaching. Many societies are faced with the digital divide and exclusion of learners. In this paper, we discussed the effect of COVID-19 on medical education at all levels and its' democratization and shared our recommendations for sustaining these achievements after the pandemic., (Copyright: © 2021 Ozeke V et al.)

We present demographic, clinical, laboratory characteristics and outcomes of the patients with solid malignancies and novel coronavirus disease (COVID-19) collected from the National COVID-19 Registry of Turkey. A total of 1523 patients with a current or past diagnosis of solid tumors and diagnosed with COVID-19 (confirmed with PCR) between 11 March and 20 May 2020 were included. The primary outcome was 30-day mortality. Median age was 61 (range: 18-94), and 752 (49%) were male. The most common types of cancers were breast (19.8%), prostate (10.9%) and colorectal cancer (10.8%). 65% of the patients had at least one comorbidity. At least one COVID-19-directed therapy was given in 73% of the patients.. Hospitalization rate of the patients was 56.6% and intensive care unit admission rate was 11.4%. Seventy-seven (5.1%) patients died within 30 days of diagnosis. The first multivariate model which included only the demographic and clinical characteristics showed older age, male gender and presence of diabetes and receipt of cytotoxic therapy to be associated with increased 30-day mortality, while breast and prostate cancer diagnoses were associated with lower 30-day mortality. In the second set, we further included laboratory parameters. The presence of leukocytosis (OR 6.7, 95% CI 3.3-13.7, P < .001), lymphocytopenia (OR 3,1, 95% CI 1,6-6,1, P = .001) and thrombocytopenia (OR 3,4 95% CI 1,5-8,1, P = .005) were found to be associated with increased 30-day mortality. Relatively lower mortality compared to Western countries and China mainly results from differences in baseline risk factors but may also implicate the importance of intensive supportive care., (© 2020 UICC.)

The number of patient-doctor appointments carried out using telemedicine has surpassed in-person appointments. In spite of this, it is unclear that telemedicine curricula in undergraduate medical education reflect the real importance by means of the effectiveness of these approaches. We aimed to systematically search and review the studies that are on undergraduate telemedicine curricula. We searched the Web of Science, PubMed, and Scopus using the keywords such as telemedicine, medical education, and curriculum. Our search was limited to publication dates between January 1, 2000, and February 1, 2020. We elicited the information of the curricula as to their countries, participants, aims or objectives, teaching methods, and evaluation of effectiveness. We also evaluated the quality of the studies using the Joanna Briggs Institute Qualitative Appraisal and Review Instrument. Out of 461 studies, seven articles were selected based on selection criteria for further review. The studies were mostly from the USA. The participant numbers were between seven and 268. There were several modes of delivery but lectures and patient encounters were used mostly. In four studies, the effectiveness was evaluated only by using satisfaction surveys, and the results were satisfactory. A study reported the acquisition and application of skills as a result. There is no well-established telemedicine curriculum in the undergraduate years. The methods vary but the effectiveness of the educational programs does not have a robust evidence base. It is evident that undergraduate medical education needs a curriculum backed by strong scientific data on its effectiveness., Competing Interests: Conflict of interestThe authors declare that there is no conflict of interest., (© IUPESM and Springer-Verlag GmbH Germany, part of Springer Nature 2021.)

Aim: Hydatid cystic disease is an endemic parasitic disease that is common in the world. We aimed to review the demographic, clinical and laboratory findings, and treatments and outcomes of children with hydatid cyst disease, and to determine the factors affecting treatment response in two pediatric pulmonology centers in the central region of Turkey., Material and Methods: The clinical records of patients aged below 18 years who were followed up between January 2006 and December 2016 because of hydatid cyst disease were reviewed retrospectively. The patients' ages at the time of diagnosis, sexes, living areas (rural /urban), dog contact history, presence of hydatid cyst in other family members, symptoms, organs involved, dimensions of cysts, laboratory results, treatments and post treatment responses, follow-up, and outcomes were noted., Results: In a period of 10 years, 50 pediatric patients were followed up with a diagnosis of hydatid cyst. The mean age was 9.3±0.5 years and 33 (66%) of the patients were male. Fifteen patients were living in a rural area and 35 were living in an urban area. Fifteen patients had a history of contact with a dog and 10% had a positive family history. Thirty-six patients had lung involvement, 25 had liver involvement, 14 (28%) had both lung and liver involvement, and six patients had organ involvement other than lung and liver. The indirect hemagglutination test for hydatid cyst was positive in 24 of 40 patients and Echinococcus granulosus-specific IgE positivity was detected in 8 of 17 patients. Surgery was performed in 31 patients with lung involvement and PAIR was performed in 13 patients who had liver involvement. Cyst excision was performed in two patients who had isolated spinal involvement. All patients were treated with albendazole, and additional praziquantel treatment was given to seven patients. Relapse occurred in seven patients in this period. The relapse frequency was higher in patients who had organ involvement other than in the lung and liver (p<0.05), and these patients' treatment durations were longer compared with the others (p<0.05)., Conclusion: Hydatid cysts can involve different organs in children. Patients with organ involvement other than the lung and liver should be followed up carefully in terms of recurrence., Competing Interests: Conflict of Interest: The authors have no conflicts of interest to declare., (Copyright: © 2019 Turkish Archives of Pediatrics.)

Background: Primary ciliary dyskinesia (PCD) patients have higher incidence of sleep disordered breathing which lead neurocognitive impairments such as attention-deficit/hyperactivity disorder (ADHD). It may effect academic performance of children and may cause impairment in emotional relationships. This study aim to evaluate hyperactivity and attention deficiency in PCD patients and investigate the relationship between sleep and hyperactivity and attention deficiency in PCD patients., Method: Fifteen PCD patients aged 8-18 years and 31 age-matched healthy controls were compared. Ear, nose, and throat examination and home sleep testing were performed in PCD patients. Pediatric sleep questionnaire, Conners' Parents and Teacher scale and Stroop test were applied in both groups in order to investigate the relation between sleep disordered breathing and ADHD in PCD children., Results: PCD patients had chronic rhinosinusitis (100%), tonsillar hypertrophy (80%) and adenoidal hypertrophy (60%). FEF25-75 was low in pulmonary function test. Sixty percent of the PCD patients had mild obstructive sleep apnea syndrome in home sleep testing. Mean AHI was 1.54 ± 0.27. Compared with the controls PCD patients had higher PSQ scores. Hyperactivity scores on Conners' Parents scale and inattention findings in Stroop test were higher in PCD patients than the healthy controls (P < 0.05)., Conclusion: Most of PCD children had mild obstructive sleep apnea syndrome. Hyperactivity and inattention findings were higher in PCD patients. Sleep disordered breathing assessment should be a routine part of PCD patients management and these patients should be carefully monitored in terms of hyperactivity and inattention., (© 2018 Wiley Periodicals, Inc.)

Altan H, Budakoğlu Iİ, Şahin-Dağlı F, Oral R. Measuring awareness about child abuse and neglect: Validity and reliability of a newly developed tool-child abuse and neglect awareness scale. Turk J Pediatr 2018; 60: 392-399. In this study, we aimed at determining child abuse and neglect awareness of medical students attending one of the top medical schools in Turkey. The study group comprised 350 third-year medical students at Gazi University, School of Medicine, Ankara. The items in the scale were prepared by two experienced pediatricians and revised according to feedback received from two pilot studies and experts in this field of study. A 20-item `Child Abuse and Neglect Awareness` scale (CANA-S) was developed by an expert panel. Exploratory and confirmatory factor analyses were performed. We also measured test-retest reliability and internal consistency. Conformity for factor analysis of the scale`s construct validity revealed a Kaiser-Meyer-Olkin sample concordance coefficient of 0.799. For the Bartlett Sphericity test, χ2 value was 1157.750 (p < 0.01). Based on these analyses, the scale explains 44.9% of the total variance and consists of 20 items and 4 subscales. Cronbach`s alpha value and correlation coefficient were 0.768 and r=0.204 (p=0.045), respectively. This scale is a valid and reliable measurement tool for evaluating awareness about child abuse and neglect among the medical students.

Unlabelled: Severe anemia is reported to occur rarely in patients with cystic fibrosis (CF). This study aimed to determine the factors associated with early severe anemia in infants with CF. This study included 231 infants with CF from 3 pediatric CF centers ten year period that were retrospectively reviewed in terms of severe anemia as the first sign of CF. Factors that could affect anemia, such as age, pancreatic insufficiency, mutations, vitamin A and E, and albumin level were evaluated. Clinical and laboratory findings in CF patients that presented with severe anemia and no respiratory symptoms were compared to those in CF patients that did not present with severe anemia. Severe anemia as the first sign of CF was noted in 17 of 231 patients. Patient age, prolonged PT/INR and the albumin level differed significantly between the 2 groups of patients (P < 0.001). Feeding pattern, pancreatic insufficiency, vitamin E and A levels, and the types of genetic mutations did not differ between the 2 groups. The mean hemoglobin level was 5.59 ± 0.21 g/dL and respiratory symptoms began a mean 6.3 months after diagnosis of CF in the anemia group., Conclusion: In early infancy severe anemia in the absence of respiratory symptoms can be the first sign of CF. CF should be considered in the differential diagnosis of severe anemia in infants. Anemia can occur several months before respiratory symptoms in patients with CF and may be caused due to several reasons., What Is Known: • Severe anemia as a first sign is reported to occur rarely in patients with cystic fibrosis. • Although anemia is well known in cystic fibrosis, factors that cause severe anemia are not known clearly. What is New: • This study shows the importance of severe anemia as the first sign of cystic fibrosis. • Anemia can occur several months before respiratory symptoms in patients with CF.

Background: There is very little information available on self-perceived competence levels of junior medical doctors with regard to definitions by the National Core Curriculum (NCC) for Undergraduate Medical Education., Aims: This study aims to determine the perceived level of competence of residents during undergraduate medical education within the context of the NCC., Study Design: Descriptive study., Methods: The survey was conducted between February 2010 and December 2011; the study population comprised 450 residents. Of this group, 318 (71%) participated in the study. Self-assessment questionnaires on competencies were distributed and residents were asked to assess their own competence in different domains by scoring them on a scale of 1 to 10., Results: Nearly half of the residents reported insufficient experience of putting clinical skills into practice when they graduated. In the theoretical part of NCC, the lowest competency score was reported for health-care administration, while the determination of level of chlorine in water, delivering babies, and conducting forensic examinations had the lowest perceived levels of competency in the clinical skills domain., Conclusion: Residents reported low levels of perceived competency in skills they rarely performed outside the university hospital. They were much more confident in skills they performed during their medical education.

Objective: We aimed to search if the renal parenchymal attenuation measurements on unenhanced CT scans could be useful in differentiating acutely obstructed kidneys from chronic cases or unobstructed kidneys., Material and Methods: Unenhanced CT scans of 101 patients were retrospectively reviewed. Thirty-two patients with unilateral acute renal obstruction, 34 patients with unilateral chronic renal obstruction due to various reasons and 35 control subjects were included in the study. The parenchymal densities of both kidneys were measured, from the upper poles, middle portions, and lower poles of each kidney. The mean parenchymal densities of both kidneys were calculated in all three groups of subjects. Secondary signs of renal obstruction such as perinephric stranding, size of ureteral stone, degree of hydronephrosis were also noted for each kidney., Results: The mean parenchymal attenuation value on the acutely obstructed side was lower than the unobstructed side, 24.21 ± 3.68 and 30.68 ± 4.75 respectively (p<0.001). The mean parenchymal attenuation value on the acutely obstructed side (24.21 ± 3.68) was lower than both the chronically obstructed side (30.85 ± 4.53), and the control subjects (29.62 ± 3.03 on corresponding side). There was no statistically significant attenuation difference between right and left kidneys in the control group and chronic obstruction group., Conclusion: Renal parenchymal attenuation measurements and attenuation differences of both kidney of same patient could be useful in differentiating acute unilateral obstruction from chronic cases., (Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.)

Background: Type 2 diabetes mellitus (DM) is a significant cause of morbidity and premature mortality especially in adults. In Turkey, there are few studies on DM incidence. This study aimed to determine the incidence of type 2 DM in women 15 years or older in Turkey., Methods: This prospective cohort study was performed from December 2002 to May 2003. Preliminary population-based screening was performed in 1997 and 1998 on women 15 years or older living in 4 villages in the Gölbaşi, Ankara province. Five hundred sixty-three women who were considered nondiabetic in the first study comprised the population for the present study. Data collection was accomplished by using a questionnaire and randomly measuring the blood glucose levels of the women. The chi and Fisher exact tests were used to analyze the risk factors for DM., Results: The 5-year incidences of type 2 DM, impaired glucose tolerance, and impaired fasting glucose were 2.3%, 0.4%, and 0.7%, respectively. The 5-year incidence of type 2 DM increased with age (P < 0.05). The DM incidence was 6.2% in those with mixed-type hypertension and 4.0% in those with a body mass index of 30 kg/m or higher. At 5-year follow-up, age (>or=35 years), hypertension, and body mass index (>or=30 kg/m) were the risk factors for incidence of abnormal glucose metabolism (P < 0.05)., Conclusions: The incidence of abnormal glucose metabolism in this study is in accord with that in the literature. Our results will contribute to our understanding of the incidence of DM in women in Turkey.

Background: A recent study showed first sign of reduction in goiter prevalence and elimination of iodine deficiency state among school-age children in Turkey after a decade of mandatory iodination of table salt. However, iodine status among pregnant women is a still debated issue in our country., Aim: To investigate iodine status, iodized salt consumption rate, and goiter prevalence in 1st trimester pregnant women 8 yr after the mandatory iodination. MATERIAL/ SUBJECTS AND METHODS: One hundred and forty-one 1sttrimester pregnant women who had been followed-up between January and October 2006 in the obstetric outpatient clinics in Turkey were included. Besides a physical examination, subjects underwent laboratory investigations for free T(3), free T(4), and urinary iodine concentration (UIC). All subjects completed a questionnaire regarding sociodemographic parameters, use of iodized salt, and pregnancy history. Goiter status was revealed by a palpation method according to World Health Organization (WHO) guidelines., Results: In this study, we found that the median UIC of pregnant women was 149.7 microg/l (range 20.9-275.1 microg/l). Almost half of the subjects were below the WHO, United Nations Children's Fund, and International Council for the Control of Iodine Deficiency Disorders lower median reference limits of 150 microg/l. Total goiter prevalence was 24.8%, of which 9.2% were visible goiters. Among the study patients, 2.1% had subclinical hypothyroidism, and 0.7% had overt hypothyroidism. The rate for iodized salt use among the pregnant women was 95%., Conclusion: Our study revealed that iodine deficiency still remains a serious problem for pregnant women. Based on our results, antenatal follow-up protocols in the primary care setting in Turkey must include iodine supplementation.

Objective: To determine menopause-related symptoms and quality of life in women aged 40-80 years living in a rural area of Turkey., Methods: A total of 338 women were evaluated in this cross-sectional study. As data sources we used a questionnaire that elicited information on the descriptive, fertility and menopausal characteristics of the women, the Menopause Rating Scale (MRS) and the Short Form-36 (SF-36)., Results: The mean age at menopause was 46.5 +/- 0.4 years. The complaint stated most often as 'severe or very severe' was 'hot flushes and sweating' (50.7%). The physical functioning, physical role, bodily pain, general health, social functioning, emotional role and mental health scores of postmenopausal women were statistically higher (p < 0.05) than those of premenopausal women. Scores on physical function, physical role, general health and social function decreased significantly with age in postmenopausal women (p < 0.05), while none of the quality-of-life domain scores differed significantly with age in premenopausal women., Conclusions: Quality of life is worse in postmenopausal women than premenopausal women, and in older than younger women in the postmenopausal period. Thus rural populations are primarily in need of public health care in the postmenopausal period.

Objectives: We compared patients who underwent functional endoscopic sinus surgery combined with septoplasty or septorhinoplasty and evaluated the concurrent applicability of septorhinoplasty and endoscopic sinus surgery., Patients and Methods: We retrospectively analyzed 145 patients (96 males, 49 females; age range 16 to 78 years) who underwent endoscopic sinus surgery in conjunction with septoplasty or septorhinoplasty. The two patient groups were compared with respect to demographic characteristics, systemic diseases, allergy histories, the presence of nasal polyposis, preoperative paranasal sinus tomographies, Lund-Mackay scores, surgical procedures, operation times, and complication rates., Results: Patients who underwent septorhinoplasty were younger than those undergoing septoplasty. There were no significant differences between the two groups in terms of paranasal sinus tomography scores, allergy histories, systemic diseases, and complication rates (p>0.05). The number of patients with nasal polyposis was significantly greater in the septoplasty group (p<0.05). Septorhinoplasty in conjunction with endoscopic sinus surgery required a significantly longer operation time (p<0.05)., Conclusion: Complications and the severity of sinus pathologies were similar in the two groups. Concurrent applications of septorhinoplasty and endoscopic sinus surgery significantly increase operation time.