SDG 3 · Sağlık ve Kaliteli Yaşam · SDG · Gümüşhane Üniversitesi

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MakaleYalnız künye2026/r/gumushane/13772
Nurses’ Experiences in Preventing or Reducing Sensory Deprivation and Sensory Overload in Intensive Care Patients: A Phenomenological Study
Uzun, Sevda; Aslan, Çimen
This study aimed to assess nurses’ experiences in preventing or reducing sensory deprivation and sensory overload in intensive care unit (ICU) patients, utilizing a phenomenological approach. The qualitative research involved face-to-face, semi-structured, in-depth interviews with 15 nurses working in a general ICU in the southern region of our country. Data collection continued until data saturation was achieved, and all interviews were audio recorded and transcribed. Colaizzi’s phenomenological analysis method was employed for data analysis, and adherence to the COREQ checklist was ensured throughout the study. The data analysis revealed 2 main categories (reflection on situations that may cause sensory deprivation and sensory overload in intensive care units and practices and coping experiences of nurses to avoid sensory deprivation and overload) and 6 themes (environment, disease, and its effects, being separated from the family environment and loved ones, challenges encountered, coping, and psychosocial applications). The results indicated that patients undergo sensory deprivation or sensory overload in the intensive care environment, with nurses playing a pivotal role in addressing these situations. It was observed that nurses encountered challenges in coping with sensory deprivation or sensory overload issues in patients. Nurses are advised to regularly assess training programs to ensure the ongoing promotion of safe nursing practices aimed at minimizing sensory deprivation or sensory overload in patients.
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MakaleAçık Erişim2026/r/gumushane/13767
Whole-genome characterization of clinical Enterococcus faecalis and Staphylococcus epidermidis Isolates reveals mecA-positive E. faecalis and a shared lnu(A)–rep7a resistance plasmid in Türkiye
Ejder, Nebahat; Özad Düzgün, Azer
Background: This study aimed to genomically characterize clinical Enterococcus faecalis and Staphylococcus epidermidis isolates obtained from aspirate and sputum samples at Bayburt State Hospital, focusing on antimicrobial resistance genes, virulence factors, and mobile genetic elements. Methods: Whole-genome sequencing (WGS) was performed on the isolates, and antimicrobial resistance genes, virulence determinants, multilocus sequence types (MLST), plasmid replicons, and mobile genetic elements were identified using bioinformatics tools. Results: The E. faecalis E5 (ST64) isolate, recovered from an aspirate sample, carried multiple antimicrobial resistance genes, including mecA, vanT, erm(B), tet(M), and qacA, along with a diverse virulence gene repertoire (cyl, ebp, ace, and agg), mobile genetic elements (Tn6009, ISL1a3), and four plasmid replicons (rep19C, rep9C, repUS43, and rep7a). The E. faecalis E184 and E187 isolates (ST124), obtained from sputum samples, harbored fewer acquired resistance genes but shared gyrA (T672A) and parC (V307I) mutations associated with fluoroquinolone resistance. The S. epidermidis ST59 isolate carried resistance genes lnu(A), fosB, and qacD, together with the plasmid replicon rep7a and insertion sequence ISSau4. The co-occurrence of lnu(A) and the rep7a plasmid in both species suggests a potential pathway for interspecies transmission of resistance determinants. Conclusions: This study reports the genomic detection of mecA in an E. faecalis isolate from Türkiye based on WGS analysis. However, this finding is based solely on genomic data and lacks phenotypic or experimental validation. The detection of a shared plasmid-associated resistance element (lnu(A)–rep7a) in both E. faecalis and S. epidermidis highlights the potential for interspecies resistance gene flow within the hospital environment.
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MakaleAçık Erişim2026/r/gumushane/13761
The impact of addictive substances on employees’ job performance and workplace safety: A phenomenologi̇cal study
Doğan, Onur
This study aims to explore the impact of substance addiction on employees’ job performance and workplace safety through a phenomenological lens. The research focuses on how individuals with substance use disorders perceive their professional experiences, emotional states, and social interactions within the work environment. The study was designed using a qualitative phenomenological method. Semi-structured in depth interviews were conducted with 15 mining employees selected via criterion sampling. The participants, all of whom had a history of substance use, were interviewed across different regions in Turkey. Audio recorded interviews were transcribed and analyzed through thematic analysis. The study adhered to ethical standards and was reported according to the COREQ checklist. Three main themes and related subthemes emerged from the analysis: (1) The impact of substance use on job performance and safety attitudes; (2) Alienation and loss of professional identity in the workplace; and (3) Inner emotional challenges and individual coping strategies. Participants described cognitive difficulties, emotional exhaustion, increased workplace errors, weakened safety compliance, social isolation, and loss of belonging. Some individuals also reported efforts to recover and reestablish self control through personal strategies and peer support. The findings reveal that substance use significantly disrupts professional functionality, emotional stability, and organizational connectedness. The study emphasizes the need for empathy driven, context sensitive support strategies to improve employee well being and workplace safety. By bringing forward the lived experiences of affected workers, this research contributes valuable insights for developing preventive approaches and reinforcing safety culture within occupational settings.
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MakaleYalnız künye2026/r/gumushane/13756
Emergency Nurses’ Experiences of Digital Silence: A Qualitative Study
Bal, Betül; Kulakaç, Nurşen
This study aimed to explore emergency department nurses’ perceptions and experiences of digital silence. A qualitative study was conducted with 14 emergency department nurses from two public hospitals in Turkey. Data were collected through semistructured in-person interviews and analyzed using the Framework Method for qualitative data analysis. Four overarching themes were identified: (i) awareness of digital silence, (ii) types of digital silence, (iii) causes of digital silence, and (iv) strategies for prevention. Digital silence manifests in several forms, including failure or partial completion of data entry, the use of alternative communication channels in place of official digital systems, and disregard for system alarms or alerts. The reasons underlying digital silence stem from both individual factors and organizational factors. Strategies to reduce digital silence involved training, development of user-friendly systems, establishment of nonpunitive reporting environments, and workload management. The results revealed that digital silence extends beyond individual attitudes, representing a multidimensional phenomenon closely associated with institutional structures, organizational culture, and the design features of digital systems. Enhancing system usability, reinforcing technical infrastructure, and promoting digital literacy were identified as key strategies for reducing digital silence behaviors.
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MakaleYalnız künye2026/r/gumushane/13753
Children's voices in disaster recovery: Lessons from the 2023 Turkey-Syria earthquake
Yildiz, Ayse; Simsek, Nurcan; Boluk, Aysegul
Disasters have a devastating impact on populations, with children being one of the most at-risk groups. Although their vulnerability in disasters is widely recognised, children's own voices are still largely missing from disaster recovery research and planning. This study aims to address that gap by listening directly to the experiences and perspectives of children aged 11 to 14 in Nurdağı, Gaziantep, one of the hardest-hit areas in Türkiye, on disaster relief and recovery. Using a qualitative, child-centred approach, grounded in a socio-ecological, rights-based framework, we conducted interviews with 58 children, alongside 47 additional interviews with parents, teachers, and first responders, to understand how young people coped with life after the earthquake, what challenges they faced, and what they believe would support recovery. The findings show that children struggled with difficult living conditions, trauma, disrupted education, and changing social relationships, but they also demonstrated remarkable insight, emotional intelligence, and a desire to be involved in rebuilding their communities. Many children questioned the fairness of aid distribution and called for more attention to mental health and safer schools. Rather than portraying children as passive victims, the study highlights their capacity to reflect, adapt, and contribute. It calls for more inclusive, responsive recovery strategies that treat children as active participants in disaster planning and post-disaster rebuilding. The study offers actionable recommendations for policymakers, educators, and humanitarian practitioners to better integrate children's perspectives into long-term recovery planning and resilience-building initiatives.
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MakaleYalnız künye2026/r/gumushane/13752
Integrating Artificial Intelligence Into Nursing Care Planning: A Comparative Evaluation of Psychosocial Care for Patients With a Stoma
Kulakaç, Nurşen; Tuncer, Metin
This methodological study evaluated and compared the content quality and appropriateness of nursing care plans developed by nurses and artificial intelligence (AI) for addressing the psychosocial problems of patients with stomas. Two nursing care plans addressing the psychosocial needs of a patient with a stoma were developed: 1 generated by nurses and 1 generated by an AI system. The content quality and appropriateness of the care plans were independently evaluated by 12 experts, including nursing academics and clinical nurses, using the DISCERN measurement tool. Inter-rater reliability was assessed using the intraclass correlation coefficient (ICC). The mean DISCERN score of the nurse-generated care plan was significantly higher than that of the AI-generated care plan (P=.008). Inter-rater agreement demonstrated good agreement. The findings indicate that nurse-generated care plans demonstrate superior content quality and overall integrity compared to AI-generated plans. AI-generated care plans exhibit potential as supportive tools in nursing care planning.
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MakaleYayıncıda açık erişim2026/r/gumushane/13750
The Effect of Music-Repeating Robotic Parrot Therapy and Different Instrumental Live Music Therapies on Anxiety and Fatigue Levels in Hemodialysis Patients: A Randomized Controlled Trial
Demirağ, Hatice; Cin, Aynur; Aktepe Coşar, Dilan; Uzun, Sevda; Türkmen, Osman Oğulcan
Aim: This study aimed to evaluate the effects of three different music-based interventions on anxiety and fatigue levels in patients undergoing hemodialysis, compared to a concurrent control group receiving standard care. Methods: This randomized controlled trial involved 64 patients receiving maintenance hemodialysis. They were randomly assigned to four equal groups (n = 16 each): live music, live ney sound therapy (using a traditional reed flute known for its soothing, breath-like tones), a music-repeating robotic parrot therapy (an interactive robotic parrot that repeats music or sounds provided by the patient), or a control group (no intervention). The experimental groups received 30-min sessions 3 days per week for 2 months. The “Beck Anxiety Scale” and “Fatigue Severity Scale” were used to measure anxiety and fatigue, respectively. Assessments were performed before the intervention, immediately after the 2-month intervention period, and at 2 months after the end of the intervention period. Results: Before the intervention, there were no significant differences in anxiety or fatigue scores across the four groups (p > 0.05). After the interventions, all three groups exposed to music therapy showed significant reductions in both anxiety and fatigue scores compared to the control group (p < 0.001). Conclusion: All three therapies were effective in managing anxiety and fatigue symptoms in hemodialysis patients. Among them, music-repeating robotic parrot therapy demonstrated the most superior and longest-lasting effects in reducing both anxiety and fatigue levels. Trial Registration: ClinicalTrials.gov identifier: NCT07238374.
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MakaleAçık Erişim2026/r/gumushane/13746
Place attachment of earthquake victims residing in Antakya (Hatay) after the Kahramanmaraş earthquakes on February 6, 2023
Fakıoğlu, Merve; Mızrak, Sefa
People affected economically, environmentally, physically, and psychologically by the earthquake may be reluctant to move to safer and more comfortable places for various reasons. Investigating the factors that influence people’s place attachment after devastating earthquakes will enable the creation of sustainable communities and cultures. This study examined the impact of earthquake experience, preparedness, place-protective behavior, social support, insecurity, price increase, the surrounding environment, self-efficacy, and risk perception on place attachment among earthquake victims in Antakya following the February 6, 2023, Kahramanmaraş earthquakes. Data were collected via surveys from 453 earthquake victims in the Antakya region of Hatay (Türkiye) province, one year after the earthquakes. Eleven ordered logistic regressions revealed the strength and direction of the factors affecting place attachment. Earthquake victims who were injured, lost relatives, were not evacuated, and were not disturbed by the rubble had higher place attachment. Earthquake preparedness, formal social support, post-earthquake insecurity, post-earthquake price increase, self-efficacy, and earthquake risk perception did not affect place attachment. Sustainability and place-protective behavior increased place attachment. Furthermore, place attachment was higher among men and those who lived longer in Antakya. This study is expected to guide managers, disaster experts, and non-governmental organizations who develop strategies to increase people's place attachment in disaster-affected regions.
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MakaleYalnız künye2026/r/gumushane/13742
Reflections of Employees' Digital Addiction Experiences on Workplace Distraction, Safety Perception, and Collective Responsibility: A Phenomenological Study
Doğan, Onur
This study aims to examine how digital addiction based experiences of employees influence attention processes, safety awareness, and collective responsibility in the workplace. It particularly seeks to identify challenges in digitally intensive environments regarding cognitive load, behavioral reflexes, and institutional risk communication. The research employed a phenomenological design with semi- structured interviews conducted with 19 employees from various sectors across Turkey. Criterion sampling was used, and interviews continued until data saturation was reached. All interviews were audio recorded, transcribed verbatim, and analyzed using Colaizzi's (1978) seven step method. Reporting followed the COREQ checklist to ensure rigor and transparency. Thematic analysis revealed three main themes: Cognitive Load and Deterioration in Safety Perception, Behavioral Disconnection and Erosion in Safety Attitudes, and Organizational Silence and Collective Collapse in Risk Awareness. These findings show that digital addiction negatively affects attention, reflexes, safety behaviors, and institutional reporting processes. Digitalization influences not only work efficiency but also employees' safety behaviors and organizational risk communication. Constant digital stimuli cause distraction, disrupt safety practices, and weaken collective responsibility. The study provides insights into how digital addiction transforms workplace safety culture and recommends comprehensive prevention strategies for employers, managers, and policymakers.
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MakaleAçık Erişim2026/r/gumushane/13740
A comparative interventional study on the effectiveness of acceptance and commitment therapy, emotion-focused therapy, and attachment-based therapy in improving emotion regulation among adolescents with digital game addiction
Güngör, Sunay
Background: Digital game addiction is a rapidly developing social and mental health concern that is closely related to emotion regulation difficulties. The present study aimed to compare the effectiveness of acceptance and commitment therapy (ACT), emotion-focused therapy (EFT), and attachment-based therapy (ABT) in improving emotion regulation among adolescents with digital game addiction. Methods: The present study was an interventional study employing a pretest–posttest design and a control group. The sample included 100 adolescents aged 13–18 years who were diagnosed with gaming disorder according to the 11th Revision of the International Classification of Diseases (ICD-11) criteria. Participants were selected using purposive sampling and were assigned to four groups of 25 individuals each, including three experimental groups and one wait-list control group. The 7-item Digital Game Addiction Scale (DGAS-7) and the Regulation of Emotions Questionnaire among Adolescents (REQ-A) were used to gather data. ACT and EFT were administered in eight sessions, whereas ABT was delivered in 10 sessions. Data were analyzed using repeated measures ANOVA in SPSS. Results: It was found that the three therapeutic strategies produced a significant increase in functional emotion regulation scores (internal and external) and a significant decrease in dysfunctional emotion regulation scores compared to the control group (p < 0.001). However, the effect sizes for the ACT and EFT groups were very large compared to the ABT group. There was no significant difference between ACT and EFT; nevertheless, both interventions were significantly more effective compared to ABT at both the posttest and follow-up stages. Conclusion: ACT and EFT are more effective interventions for improving emotion regulation among adolescents with digital game addiction because of their emphasis on psychological flexibility and emotionally profound processing. Although ABT was found to be moderately effective, it can be used as an adjunctive therapy, particularly in cases involving relational problems.
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Editöre MektupAçık Erişim2026/r/gumushane/13730
Reply to the Letter to the Editor: Assessing the Predictive Value of Kolmogorov–Arnold Networks for the No–Reflow Phenomenon in ST–Segment Elevation Myocardial Infarction: A Comparative Machine Learning Study; [Editöre Mektup Yanıtı: ST Segment Yükselmesi Miyokard Enfarktüsünde No–Reflow Fenomeni için Kolmogorov–Arnold Ağlarının Öngörü Değerinin Değerlendirilmesi: Karşılaştırmalı Makine Öğrenimi Çalışması]
Taşolar, Hakan; Bayramoğlu, Adil; Günen, Mehmet Akif; Levent, Sümeyye; Güral, Yunus; Halisdemir, Nurhan
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MakaleAçık Erişim2026/r/gumushane/13727
Association Between Health Literacy and Mediterranean Diet Adherence Among Adult Women in Türkiye
Çam, Alper Veli; Şik, Elif
Objective: Health literacy is widely recognized as an important determinant of informed health-related decision-making. However, evidence regarding whether health literacy translates into healthy eating behaviors, particularly adherence to the Mediterranean diet, remains limited. This study aimed to examine the association between health literacy levels and adherence to the Mediterranean diet among adult women living in Türkiye. Methods: This cross-sectional study was conducted with 400 women aged 18 years and older residing in Türkiye. Data were collected using a sociodemographic information form, the Turkish Health Literacy Scale–Short Form, and the Mediterranean Diet Quality Index (KIDMED). Health literacy levels were categorized as inadequate, problematic–limited, adequate, and excellent, while Mediterranean diet adherence was classified as low, moderate, or optimal. Ordinal logistic regression analysis was performed to examine the association between health literacy and adherence to the Mediterranean diet, adjusting for sociodemographic variables (age, education, income, and occupation). Findings: Among the participants, 25.3% had inadequate health literacy, 31.8% had problematic–limited health literacy, 34.0% had adequate health literacy, and 9.0% had excellent health literacy. Mediterranean diet adherence was low in 34.5% of participants, moderate in 52.3%, and optimal in 13.3%. The ordinal logistic regression analysis revealed that, after adjusting for sociodemographic variables, one dimension of health literacy (Cognitive Health Literacy) was significantly associated with Mediterranean diet adherence, whereas no significant association was observed for the other dimension. Conclusion: The findings suggest that certain dimensions of health literacy may be associated with adherence to the Mediterranean diet when sociodemographic factors are taken into account. These results highlight the importance of considering both individual knowledge and contextual factors in understanding dietary behavior. Future research should further explore the role of nutrition-specific literacy and structural determinants in shaping healthy eating practices.
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MakaleAçık Erişim2026/r/gumushane/13725
A leakage-free analytics framework for subject-wise electrocardiogram-based sleep apnea detection using machine learning
Melek, Negin
Sleep apnea is associated with impaired sleep quality and elevated cardiovascular risk, creating a need for reliable automated screening approaches. Although electrocardiogram (ECG)-based detection methods have shown promising results, reported performance values can be affected by evaluation strategies that allow information leakage between training and testing data. This study investigates ECG-based sleep apnea detection under strict subject-wise conditions using the PhysioNet Apnea-ECG database. Thirty-five annotated single-lead ECG recordings sampled at 100 Hz were divided into non-overlapping 60-s segments according to minute-wise apnea labels. Statistical ECG descriptors and time-domain heart rate variability features were extracted and evaluated using k-nearest neighbors (KNN), support vector machine (SVM), and Random Forest (RF) classifiers. In addition, a lightweight one-dimensional convolutional neural network (1D-CNN) was trained directly on filtered ECG segments. Repeated holdout validation with subject-level train-test separation was adopted, and normalization parameters were estimated exclusively from training data in each repetition to prevent information leakage. Model performance was assessed using accuracy, balanced accuracy, precision, recall, specificity, F1-score, ROC-AUC, Cohen's kappa, and Golden Distance (GD). In the representative subject-wise evaluation, Random Forest achieved the most balanced performance, yielding the highest balanced accuracy (0.70) together with the lowest GD (0.56). Across the repeated subject-wise holdout experiments, SVM achieved the strongest average overall performance, producing the highest mean accuracy (0.72), balanced accuracy (0.69), ROC-AUC (0.77), and Cohen's kappa (0.39), and the lowest mean GD value (0.58). The lightweight 1D-CNN converged stably during training, but its performance on unseen subjects remained lower than that of the handcrafted feature-based models.
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MakaleAçık Erişim2026/r/gumushane/13722
The Effect of Fatigue During Search and Rescue Efforts in Debris on the Quality of Cardiopulmonary Resuscitation
Çavuş, Kadir; Tiryaki, Oğuzhan; Tiryaki, Elif; Çelik, Suat; Saçar, Hüseyin Bora
Objectives: Cardiopulmonary resuscitation (CPR), which is used in cases of life-threatening cardiopulmonary arrest, is a physically exhausting procedure. Adding to that, sometimes, even before performing CPR, interventions to rescue the injured person from a challenging environment have caused significant fatigue. In this study, taking a novel research approach, we generated a scenario of fatigue during a rescue from earthquake debris and aimed to measure the effect of that fatigue on the quality of CPR performed by paramedics. Methods: The research followed an experimental design with 2 groups (experimental/control) and 2 measurements (pretest/post-test). The study population was selected using power analysis. The sample, consisting of 84 paramedic students, was randomly divided into 42 control and 42 experimental participants. Current American Heart Association (AHA 2020) and European Resuscitation Council (ERC 2021) guidelines were strictly followed when performing CPR. In order to assess the accuracy of CPR, a General Doctor GD-CPR200S-A (2010 standard) simulator was utilized. The participants were fatigued by practicing the process of extracting and transporting earthquake victims from rubble. A personal information form with 20 questions and a CPR measurement form were used to obtain the data. Results: In the analysis performed to measure the differences between the CPR indicators for the control and experimental groups in the post-test and pretest, the difference in compression (control: 6.5 ± 50.1 and experimental: −10.3 ± 46.0) was not significant. Meanwhile, we found that the difference in ventilation (control: 0.3 ± 5.4 vs. experiment: 8.1 ± 4.6) and the difference in CPR completion times (control: 0.2 ± 1.2 vs. experiment: −0.7 ± 0.7) between the post-test and pretest were significant. Conclusions: There was no significant difference in correct compressions between the control and experimental groups, but there was a significant difference in ventilation and CPR completion times. For this reason, it is recommended to focus on the effect of fatigue on CPR quality, especially on the ventilation process. It is also recommended to include fatigue scenarios in CPR trainings.
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MakaleYalnız künye2026/r/gumushane/13716
Multi-scale deep fusion architecture for brain tumor detection via local-contextual feature integration
Reis, Hatice Catal; Turk, Veysel
Early detection of brain tumors is crucial for enhancing treatment strategies and improving clinical prognosis. However, current conventional methods limit diagnostic accuracy and slow down diagnostic processes due to subjective interpretations and dependence on experts. Deep learning-based approaches have the potential to enhance diagnostic accuracy and facilitate early diagnosis by mitigating current limitations in automatic learning techniques for feature extraction and modeling processes. In this study, an advanced deep learning model, Multi-Scale Local-Context Fusion Network (MSLCFNet), is proposed for automatic diagnosis of brain tumors within the scope of oncological diseases. The proposed model evaluates local spatial features, global patterns, and long-range contextual relationships holistically through multi-layered representations, enabling effective identification of complex structures of tumor morphology. This architecture has the potential to increase diagnostic consistency and minimize the risk of misdiagnosis by reducing inter-observer variability, especially in cases where limited contrast and unclear boundaries lead to diagnostic uncertainty. The proposed model achieved accuracy rates of 96.51% and 98.17% on two different MRI brain tumor datasets, respectively. Additionally, a hybrid model based on MSLCFNet+ResNet50 was proposed in the study to obtain high-level feature representations for brain tumor diagnosis. The model offers a significant improvement in the diagnosis process by reducing misdiagnosis rates to 98.86% and 99.50% accuracy. The proposed methods make a significant contribution to enhancing diagnostic accuracy in clinical decision support systems, as they enable the efficient processing of complex morphological structures.
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MakaleAçık Erişim2026/r/gumushane/13712
Factors affecting hospital personnel’s disaster management performance
Kaya, Burak; Mızrak, Sefa
Background: Hospital personnel with strong disaster management skills will work effectively and efficiently during disasters, ensuring better health services for staff, patients, and injured individuals. Purpose: This study aimed to investigate the factors affecting the hospital personnel disaster management performance (HPDMP) of Giresun Training and Research Hospital (Türkiye) according to the opinions of all hospital personnel. Method: In this study, survey data were collected from 797 hospital personnel between July and August 2023. HPDMP was employed as a dependent variable. Demographic characteristics, working conditions of personnel, disaster education, awareness of hospital disaster plans, and hospital disaster plan duty were used as independent variables. In addition, the arrangement of the hospital in relation to disaster risks, personnel self-efficacy, personnel coordination, coordination with other institutions, and disaster preparedness were also employed as independent variables. Results: The hospital’s disaster management performance was good. Personnel who received sufficient disaster education and had more knowledge about hospital disaster plans believed that HPDMP was greater. According to hospital personnel, disaster preparedness and coordination with other institutions were the factors that most strongly increased HPDMP. Conclusion: This study will provide insight for scientists, decision makers, and practitioners working in the field of hospital disaster planning and management.
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MakaleYalnız künye2026/r/gumushane/13710
Financial Simulation of Remote Healthcare Implementation Strategies in Türkiye: A Monte Carlo Analysis Based on Specialty-Specific Eligibility
Demir, Hüseyin; Akar, Tuncay; Mertoğlu, Süleyman; Burmaoğlu, Serhat; Tekinarslan, Merve
The expansion of universal health coverage in Türkiye has intensified pressure on public healthcare providers through high outpatient volumes that strain capacity and financial sustainability. Remote healthcare delivery has emerged as a potential strategy to improve efficiency and access. However, limited evidence exists on how remote outpatient care should be implemented across medical specialties within a universal payer system, or how alternative implementation strategies perform financially. This study evaluates the specialty-specific feasibility and financial impact of remote outpatient care using comprehensive administrative data from a large public training and research hospital in Izmir, supplemented by qualitative input from clinical specialists. The analysis includes 577,984 outpatient visits recorded in 2022 across major medical specialties. Eligibility for remote delivery is identified using observable clinical proxies—imaging requests, laboratory tests, and prescription issuance—to capture visits not requiring physical examination or procedural intervention. Results show that 121,248 visits (21.0%) are suitable for remote delivery, accounting for 16.2% of expenditures ($0.68 million out of $4.20 million). Remote eligibility varies substantially across specialties, with high suitability in dermatology and infectious diseases but limited applicability in device-dependent fields such as pulmonology. Four implementation scenarios are simulated over a 10-year horizon: Regulatory Compliance, Evidence-Based Specialty-Specific, Follow-Up Only, and Hybrid Progressive. The Regulatory Compliance scenario yields the shortest break-even period (3 years) and highest ROI (1185%). The Hybrid Progressive scenario, incorporating phased specialty expansion and AI-supported triage, requires higher upfront costs but generates the largest cumulative net savings ($1.39 million). The findings demonstrate that financially sustainable remote outpatient care can be achieved through carefully designed, specialty-specific implementation strategies.
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MakaleAçık Erişim2026/r/gumushane/13702
Does Training Make a Difference? Evaluating a Targeted Child Abuse and Neglect Education Program on Teachers’ Awareness
Türkkan, Tuğba; Odacı, Hatice
This study examined the effect of a psycho-education program on the awareness levels of teachers regarding child abuse and neglect. The study was conducted with teachers working in regions characterized by the presence of at-risk groups. Within the scope of the study, 18 teachers were assigned to the experimental group and 18 teachers to the control group. The experimental group participated in a structured psycho-education program on child abuse and neglect, while no intervention was implemented for the control group. Prior to the intervention, pre-test measurements were conducted using the Child Abuse Awareness Scale for both groups. The psycho-education program consisted of 10 weekly online sessions, each lasting approximately 100–120 min. The findings revealed a significant difference between the pre-test and post-test scores of the experimental group compared with the control group, indicating the effectiveness of the psycho-education program in increasing teachers’ awareness levels. The results suggest that such training programs may play an important role in enhancing teachers’ knowledge and awareness of child abuse and neglect, particularly in recognizing signs of abuse and understanding reporting procedures.
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Derleme MakaleAçık Erişim2026/r/gumushane/13700
Postbiotics in Dairy: A Comprehensive Review of Applications and Health Impacts
Kaya, Yasemin; Aktaş, Haktan; Meral-Aktaş, Hacer; Ürkek, Bayram; Gürbüz-Kaçan, Zeynep; Çiftçi, Esengül; Erkaya-Kotan, Tuba; Şengül, Mustafa; Çetin, Bülent
Purpose of Review: This review aims to provide a comprehensive overview of postbiotics—defined as non-viable microbial cells, cell components, and microbial metabolites—and their emerging role in dairy products. It focuses on their functional, technological, and health-promoting properties in various dairy matrices, including yoghurt, cheese, kefir, fermented milk, and ice cream. Additionally, the review highlights the potential of postbiotics as stable and safe alternatives to probiotics in the development of functional dairy foods. Recent Findings: Recent evidence demonstrates that postbiotics such as exopolysaccharides (EPS), bacteriocins, short-chain fatty acids (SCFAs), bioactive peptides, and organic acids significantly enhance both the nutritional value and technological quality of dairy products. These compounds have been shown to improve texture, sensory attributes, shelf life, and microbial safety while exerting biological activities, including antimicrobial, antioxidant, immunomodulatory, and gut health–promoting effects. Compared with probiotics, postbiotics offer greater stability during processing and storage as well as reduced safety concerns, particularly for vulnerable populations. Summary: Postbiotics represent a promising strategy for advancing functional and sustainable dairy products by combining health benefits with technological improvements. Their applications in functional food formulation, biopreservation, and bioactive compound delivery are rapidly expanding. However, challenges remain regarding standardised production processes, accurate quantification of bioactive components, and clinical validation of health claims. Future research should focus on optimising postbiotic production and strengthening evidence for their physiological effects to support their broader incorporation into next-generation dairy products.
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MakaleYalnız künye2026/r/gumushane/13698
In sepsis-associated cardiotoxicity, remifentanil reduces oxidative stress, inflammation, and apoptosis to maintain mitochondrial biogenesis by inhibiting NFkB and cas-3 immunoexpressions and enhancing SIRT1 upregulation
Tepebaşi, Muhammet Yusuf; Aşci, Halil; Selçuk, Esma; Uysal, Dinçer; Bindal, Ahmet; Yüksel, Duygu; Özmen, Özlem
Objective: Sepsis-induced cardiotoxicity (SIC) is a critical complication characterized by inflammation, oxidative stress, and apoptosis, leading to myocardial dysfunction. The short-acting opioid analgesic remifentanil (REMI) possesses antioxidant and anti-inflammatory properties. This study aimed to evaluate the cardioprotective effects of REMI on lipopolysaccharide (LPS)-induced SIC by examining inflammation, oxidative stress, apoptosis, and mitochondrial function. Materials and methods: Thirty-two female Wistar albino rats were divided into four groups: control, lipopolysaccharide (LPS), LPS+REMI, and REMI. Myocardial and aortic tissues were analyzed for histopathology, immunoexpression of Caspase-3 (Cas-3), nuclear factor kappa beta (NF-κB), and tumor necrosis factor alpha (TNF-α). Oxidative stress markers, including total oxidant status (TOS), total antioxidant status (TAS), and oxidative stress index (OSI), were measured. Mitochondrial apoptosis-related gene expression of AMP-activated protein kinase (AMPK), BCL2 Associated X (BAX), B-cell lymphoma 2 (BCL-2), Sirtuin 1 (SIRT1), and Peroxisome proliferator-activated receptor gamma coactivator 1-alpha (PGC1α) was assessed. Results: LPS administration induced severe histopathological damage, increased oxidative stress (elevated TOS and OSI), and upregulated apoptotic (Cas-3, BAX/BCL-2 imbalance) and inflammatory (NF-κB, TNF-α) markers. REMI treatment significantly alleviated myocardial and aortic injury, reducing the histopathological score. It markedly decreased Cas-3, NF-κB, and TNF-α expression, lowered TOS and OSI levels, and modulated the BAX/BCL-2. Furthermore, REMI restored the expression of AMPK, SIRT1, and PGC-1α genes, indicating a protective effect on mitochondrial biogenesis and energy metabolism. Conclusions: REMI exhibits significant cardioprotective effects in LPS-induced SIC by attenuating inflammation, oxidative stress, and apoptosis while preserving mitochondrial homeostasis.
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