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Objective: We aimed to determine myo-inositol oxygenase (MIOX) activity in gestational diabetes mellitus (GDM)., Material and Methods: The insulin, HbA1c, and MIOX levels of 80 pregnant women were analysed after 75 g OGTT. Group I included patients with no risk factor for GDM, Group II: patients with high risk for GDM, and Group III: GDM patients., Results: Fasting plasma glucose and Homeostatic Model Assessment for Insulin Resistance index were significantly higher in GDM cases (Group 3). Regarding the MIOX levels, significantly higher levels were recorded at 0-h in Group 3 compared to Groups 1 and 2. Significant alteration in MIOX activity was found between 0- and 2-h in Group 3 compared to Groups 1 and 2 ( p  < .029)., Conclusions: MIOX levels were higher in GDM cases so, it may be have a role in myo-inositol catabolism.

Objectives: To evaluate the relationship between Coronavirus Disease 2019 (COVID-19) in pregnancy and adverse perinatal outcomes. The secondary aim is to analyze the diagnostic value of hematologic parameters in COVID-19 complicated pregnancies., Methods: The current study is conducted in a high volume tertiary obstetrics center burdened by COVID-19 pandemics, in Turkey. In this cohort study, perinatal outcomes and complete blood count indices performed at the time of admission of 39 pregnancies (Study group) complicated by COVID-19 were compared with 69 uncomplicated pregnancies (Control group)., Results: There was no significant difference between the obstetric and neonatal outcomes of pregnancies with COVID-19 compared to data of healthy pregnancies, except the increased C-section rate (p=0.026). Monocyte count, red cell distribution width (RDW), neutrophil/lymphocyte ratio (NLR), and monocyte/lymphocyte ratio (MLR) were significantly increased (p<0.0001, p=0.009, p=0.043, p<0.0001, respectively) whereas the MPV and plateletcrit were significantly decreased (p=0.001, p=0.008) in pregnants with COVID-19. ROC analysis revealed that the optimal cut-off value for MLR was 0.354 which indicated 96.7% specificity and 59.5% sensitivity in diagnosis of pregnant women with COVID-19. A strong positive correlation was found between the MLR and the presence of cough symptom (r=41.4, p=<0.0001)., Conclusions: The study revealed that, pregnancies complicated by COVID-19 is not related with adverse perinatal outcomes. MLR may serve as a supportive diagnostic parameter together with the Reverse Transcriptase Polymerase Chain Reaction (RT-PCR) in assessment of COVID-19 in pregnant cohort., (© 2020 Walter de Gruyter GmbH, Berlin/Boston.)

Introduction: Vitamin D deficiency and chronic obstructive pulmonary disease (COPD) are both world-wide health problems. Vitamin D has known to be important in infectious pathologies. However, there are conflicting results in the role of vitamin D in COPD exacerbation. This study was design to evaluate the prevalence of vitamin D deficiency among patients with COPD exacerbation in relation with surrogate markers of exacerbation and long-term mortality in hospitalized patients with COPD., Materials and Methods: 117 hospitalized COPD patients were included between January 2010 to June 2013. Information was obtained through the patients' records and the electronic database of the hospital. The patients who had on vitamin D and/or calcium therapy, and who were suspected of asthma were excluded from the study., Result: The study included 117 patients and none of them were on vitamin D replacement on entry. The mean age was 67.95 ± 9.8 years. The number of male/female patients was 104/13. The mean forced expiratory volume in one second in percent predicted (FEV1%) was 39.97 ± 18.45. One hundred fifteen patients had vitamin D deficiency whereas only two patients had vitamin D ≥ 30 ng/dL. Seventy nine (69.5%) of the patients had severe vitamin D deficiency (< 10 ng/dL). The percentage of frequent exacerbators, patients who had microorganism growth and the median duration of hospital stay, mean FEV1 and survival did not differ between the group of vitamin D < or ≥ 10 ng/dL. There was no meaningful correlation of vitamin D level and any of the surrogate markers of exacerbation., Conclusions: Severe vitamin D deficiency is heavily prevalent in Turkish COPD patients. However, it did not have an association on exacerbation and long term survival.

Background: The participation of the people in health decisions may be structured in various levels. One of these is participation in decisions for the treatment. "Advanced directives" is one of the examples for the participation in decisions for the treatment., Aim: We wanted to determine the decisions on advanced life support at the end-stage of life in case of a life-threatening illness for the people themselves and their first degree relatives and the factors effecting these decisions., Design and Setting: The cross-sectional study was conducted with volunteers among patients and patient relatives who applied to all polyclinics of the Ankara Numune Training and Research Hospital except the emergency, oncology and psychiatry polyclinics between 15.12.2012 and 15.03.2013., Method: A questionnaire, the Hospital Anxiety Depression (HAD) scale, and Templer's Death Anxiety Scale (TDA) were applied to all individuals. SPSS for Win. Ver. 17.0 and MS-Excel 2010 Starter software bundles were used for all statistical analysis and calculations., Results: The participants want both themselves and their first degree relatives included in end-stage decision-making process. Therefore, the patients and their families should be informed adequately during decision making process and quality communication must be provided., Conclusion: Participants who have given their end-stage decisions previously want to be treated according to these decisions. This desire can just be possible by advanced directives.When moral and material loads of end-stage process are taken into consideration, countries, in which advanced directives are practiced, should be examined well and participants' desire should be evaluated in terms of practicability.

Objectives: The healthcare transformation program in Turkey has shown its success with improvements in important health indicators, increased access to healthcare services and expansion of coverage to all citizens. Turkey has been relatively able to bear the burdens associated with this due to rapid economic growth. The need for health technology assessment (HTA) was believed as a result of the expansion of coverage, pressure of new technologies, and increased expenditures. This study outlines the background and current formalization of HTA and shares the current use of HTA in decision making, while summarizing the transformation of the Turkish healthcare system for developing a high-quality, equal, and accessible care system., Methods: We reviewed and analyzed policy changes in the Turkish healthcare system, universal health coverage, healthcare expenditures, and pricing and reimbursement policies to identify the changes leading to HTA. We reviewed existing HTA functions in Turkey and outlined their activities. Finally, we outlined a set of major challenges for HTA in Turkey over the next decade., Results: HTA was formalized in Turkey in 2012-2013 with three national HTA structures and one hospital-based HTA unit. These functions currently run independent from each other. There are three major challenges in this country for HTA in the next decade: clarification of the assessment scope and methods, building a strong supporting system for HTA, and defining the role of HTA in the future vision of Turkish healthcare policy., Conclusion: HTA, despite challenges, has a good opportunity to develop further with clear action plans and strong political will.

Background: Clinical practice guidelines (CPGs) are systematically developed statements to assist practitioner and patient decisions about appropriate healthcare for specific clinical circumstances. There is a limited number of studies on guidelines in Turkey. The quality of Ministry of Health guidelines have formerly been assessed whereas there is no information on the other guidelines developed in the country., Aim: This study aims to assess the quality of CPGs that are developed by professional societies that work for the health sector in Turkey, and compare the findings with international guidelines., Methodology: Professional societies that work for the health sector were determined by using the data obtained from the Ministry of Internal Affairs. Inclusion and exclusion criteria were defined for selecting the CPGs. Guidelines containing recommendations about disease management to the doctors, accessible online, developed within the past 5 years, citing references for recommendations, about the diseases over 1% prevalence according to the "Statistical Yearbook of Turkey 2012" were included in the study. The quality of CPGs were assessed with the AGREE II instrument, which is an internationally recognized tool for this purpose. Four independent reviewers, who did not participate in the development of the selected guidelines and were trained in CPG appraisal, used the AGREE instrument for assessment of the selected guidelines., Findings: 47 professional societies were defined which provided access to CPGs in their websites; 3 of them were only open to members so these could not be reached. 8 CPGs from 7 societies were selected from a total of 401 CPGs from 44 societies. The mean scores of the domains of the guidelines which were assessed by the AGREE II tool were;, Scope and Purpose: 64%, stakeholder involvement: 37.9%, rigour of development: 35.3%, clarity and presentation: 77.9%, applicability: 49.0% and editorial independence: 46.0%., Conclusion: This is the first study in Turkey regarding quality appraisal of guidelines developed by the local professional societies. It adds to the limited amount of information in the literature that comes from Turkey as well as other developing countries.

Objective: Pregnancy is a special period of increased nutritional needs during which conscious nutritional support is required. Insufficient and imbalanced nutrition in this period of life causes serious conditions that affect both child and mother. This study aimed to evaluate the relationship between pregnancy and nutrition/nutritional habits during pregnancy., Materials and Methods: In this descriptive study, a questionnaire was conducted on a voluntary basis to pregnant women who were admitted to the Pregnancy Outpatient Clinic of Obstetrics and Gynecology Department at Ankara Numune Training and Research Hospital. Questions about general information, pregnancy-related information, thoughts and knowledge about breastfeeding, nutritional habits, and meal frequency were asked to pregnant women. Three hundred fourteen questionnaires were assessed in the study. SPSS for Windows Version 16.0 and MS-Excel 2007 were used for statistical evaluations. P<0.05 was accepted as statistical significance., Results: There was a statistically significant relationship between pre-pregnancy body mass index (BMI) and number of pregnancies; level of education and income levels; number of children and history of caesarian section as an additional problem within previous pregnancies. The change of nutritional habits during pregnancy was examined; we found that consumption of fruits (51%) and vegetables (40.8%) increased the most, while intake of tea (26.1%) and redmeat (21%) mainly decreased during pregnancy. It was found that during pregnancy 20.4% of pregnant women had never consumed fish, 13.1% abstained from red meat, and 12.4% excluded white meat from their diet., Conclusions: We believe that this study will help to raise awareness about adequate and balanced nutrition during pregnancy and to define special nutritional recommendations., Competing Interests: Conflict of Interest: No conflict of interest was declared by the authors.

Background: Because of the growth of the older population and the prevalence of chronic diseases, home care services (HCS) have become an important aspect of healthcare worldwide. However, various difficulties and deficiencies are present in the provision of these recently implemented services in Turkey. Modifications to home healthcare services are in progress., Objective: Physicians have an active role in home healthcare services. The present study was performed to examine physicians' attitudes toward this service in detail., Methods: Twenty-six physicians who provide home healthcare services in the city of Ankara were included in the study. We conducted in-depth, semi-structured, face-to-face interviews. The interviews were audio-recorded, transcribed, and qualitatively analysed., Results: Most physicians thought that home care could be provided to patients who are bedridden, are very old, have a chronic disease, have problems leaving the house, or do not have family support. They also expressed displeasure about the abuse of services and discordance of organization between hospitals and primary care centres. They noted that real circumstances in practice were not compatible with regulations and that cooperation and coordination between departments are necessary and important., Conclusion: The current study underlines physicians' interest in and support of the home care system, which has various drawbacks and limitations. Legislation needs to be further changed to improve the quality of service and eliminate deficiencies in home healthcare.

Objectives: To understand how decisions are made in Intensive Care Unit (ICU) settings where critically-ill children require life-support decisions and what are the perceptions of health professionals and parents., Methods: In this qualitative study, in-depth, semi-structured, face to face interviews with 8 doctors, 9 nurses and 6 parents of critically ill children were conducted. Interviews were digitally recorded and transcribed. The transcriptions were further analyzed following open coding and formation of themes., Results: The themes were discussed in two major titles: perceived roles and emotions during the decision-making process. All nurses and patients agreed that the decision maker should be the physician. Nurses understood patients' emotions better and had a closer relation with the parents. Both doctors and nurses thought that parents could not have all responsibilities about treatment choices, because they do not have the required knowledge. Similarly parents were afraid to make a wrong decision, thus they wanted to leave this to the doctors., Conclusions: The present study revealed that shared-decision making is not well understood by health care professionals in Turkey. Doctor is the major decision-making authority and this is also accepted and preferred by the patients and nurses.