Association of nutritional status, frailty, and rectus femoris muscle thickness measured by ultrasound and weaning in critically ill elderly patients Introduction Sarcopenia and frailty are critical factors linked with poor clinical outcomes among elderly individuals. This study aims to investigate the association between nutritional assessment tests and frailty with muscle thickness measured by ultrasound and their relationship with weaning among crtically ill elderly patients. Materials and Methods Patients who were over 65 years old and required invasive ventilation were assessed for nutritional status and clinical frailty scale upon admission to the intensive care unit. Additionally, the thickness of their rectus femoris and vastus intermedius muscles were measured by ultrasound within 48 hours of intubation. Correlation analysis was conducted to examine the relationship between screening tests, frailty, and ultrasound results. The association between these parameters and weaning success was also evaluated. Results Between May and August 2022, 32 consecutive patients were enrolled in the study. The mean age was 79.3 ∓ 7.9, and 18 (56.3%) of them were female. Median APACHE-II- and first-day SOFA scores were 22.5 (16.2-29.7) and 7 (5-10.75), respectively. There was a moderate negative correlation between the thickness of the rectus femoris and frailty (r= -0.41, p= 0.036), and there was a moderate positive correlation between the rectus femoris and geriatric nutritional risk index (r= 0.45, p= 0.017). Of them, 18 (56.3%) patients were classified as weaning failure in which the mean frailty score was higher (7.6 ∓ 0.9 vs 6.5 ∓ 1.7, p= 0.035), sepsis (18 vs 7, p< 0.001) and use of vasopressor (17 vs 6, p= 0.004) more common, and in-hospital mortality were higher (18 vs 5, p< 0.001). Conclusion Bedside ultrasound could be beneficial for detecting nutritional high-risk patients. Frailty was associated with muscle thickness, and it was also associated with weaning failure.
Objective:To determine whether the workers’ periodic chest x-ray screening techniques in accordance with the quality standards is the responsibility of physicians. Evaluation of differences of interpretations by physicians in different levels of education and the importance of standardization of interpretation.Methods:Previously taken chest radiographs of 400 workers who are working in a factory producing the glass run channels were evaluated according to technical and quality standards by three observers (pulmonologist, radiologist, pulmonologist assistant). There was a perfect concordance between radiologist and pulmonologist for the underpenetrated films. Whereas there was perfect concordance between pulmonologist and pulmonologist assistant for over penetrated films.Results:Pulmonologist (52%) has interpreted the dose of the films as regular more than other observers (radiologist; 44.3%, pulmonologist assistant; 30.4%). The frequency of interpretation of the films as taken in inspiratory phase by the pulmonologist (81.7%) was less than other observers (radiologist; 92.1%, pulmonologist assistant; 92.6%). The rate of the pulmonologist (53.5%) was higher than the other observers (radiologist; 44.6%, pulmonologist assistant; 41.8%) for the assessment of the positioning of the patients as symmetrical. Pulmonologist assistant (15.3%) was the one who most commonly reported the parenchymal findings (radiologist; 2.2%, pulmonologist; 12.9%).Conclusion:It is necessary to reorganize the technical standards and exposure procedures for improving the quality of the chest radiographs. The reappraisal of all interpreters and continuous training of technicians is required.
Objective: Detailed examination of occupational and environmental exposure of the individuals and their use of cigarette during history-taking stage in Chest Diseases is crucial. This study was planned to investigate the qualities of occupational anamneses carried out in the Outpatient Clinic of Chest Diseases. Methods:The recordings of 320 consecutive outpatients (158 female and 162 male) admitted to the Outpatient Clinic of Chest Diseases in the Faculty of Medicine were evaluated retrospectively. During this evaluation, whether occupational histories of the patients had been taken in detail or not and the manner in which questioning was performed regarding environmental exposure and smoking were assessed. Results:The mean age was 51.6±17.3 years in female patients and 55.1±16.1 years in male patients. The most common occupations were housewife (37.5%), farmer (12.8%) and worker (12.2%). Detailed occupational history-taking rate was 21.9% and was found to be higher in males (79%) than in females (31%) (p=0.001). Of the workers, 60% had been questioned regarding their current workplaces, while only 10.6% had been questioned about their previous workplaces. In total, 9 patients (2.8%) had been asked about the environment in which they live. The smoking habits had been questioned in 90.6% of the cases. Of the 290 patients who had been smoking, 183 (63.1%) had been questioned about the amount of cigarettes smoked in a year (packs.year). Conclusion:It was observed that extensive occupational anamnesis and a history of environmental exposure and smoking were not taken adequately in the Outpatient Clinic of Chest Diseases.
This study is an attempt to analyze the relation between the optimal informal employment ratio and improvement level of the country. Informal employment has advantages and disadvantages. Informal employment causes revenue losses consisting of both tax and social security premium. But also it causes economic growth. The previous study analyzed the optimal informal employment ratio for Turkey and in this study, the relationship between the Gross Domestic Product (GDP) and informal employment ratio (IER) for other economies will be analyzed according to their improvement level. Because in the literature there is an opinion about low informal employment ratio for high income countries and high ratio for low income countries. Because of the effect of public policy and economical structure on underground economy, it will be tried to to assess the place of Turkey according to the development level.Keywords: informal economy, developed and developing countries
This study is an attempt to analyse and deep the social security premium rate/load as a factor that influences the premium revenues for the Turkish Social Security Administration by using the Laffer curve logic and to identify relation and the premium load that maximizes premium revenues and assessing the revenue increase for the Administration. Turkish Social Security system separates the employees in three main groups: Indıvıduals working on service contract who are subject to SSK (Social Insurance Administration), Individuals working on their own names and accounts who are subject to Bag-Kur (Craftsmen And Artisans And Other Self-Employed Social Insurance Institution) and public employees or civil servants who are subject to ES (Retirement Fund General Directorate) before the social security reform. The previous studies; “Model Proposal for Investigating and Increasing the Social Security Administration’s Premium Collection Revenue” analysed the relationship between the premium revenue and premium rate/load for all the employees, make a total analyse for premium rate and revenue and “The Laffer Effect at Turkish Social Security Administration’s Premium Revenue” analysed the most crowded group of the Turkish Social Security system SSK.In this study it will be focused on Bag-Kur and ES premium revenue. The monthly data for the period between January 2009 and December 2012 were used in this study.Keywords: Premium Rate; Premium Revenue; Earnings Based On Premium; The Laffer Curve
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