OBJECTIVE:The objective of this study was to identify the frequency and severity of diabetic ketoacidosis in the diagnosis of type 1 diabetes mellitus in the pre-, during-, and post-COVID-19 pandemic periods at a state-reference pediatric center. METHODS:Observational, cross-sectional period study, including medical records of patients diagnosed with type 1 diabetes mellitus from 2018 to 2024. The association between the diagnosis period and the presence of diabetic ketoacidosis was assessed using odds ratios with 95%CIs. The association between the diagnosis period and the need for intensive care unit admission, symptom duration, and previous incorrect diagnoses was assessed using Fisher's exact test. Temporal trends in diabetic ketoacidosis severity were assessed using the Cochran-Armitage trend test. p<0.05 were considered significant. RESULTS:Of the 184 type 1 diabetes mellitus cases, 55.4% presented with diabetic ketoacidosis at diagnosis. Patients diagnosed during the pandemic had a higher chance of developing diabetic ketoacidosis compared to the pre-pandemic period (OR 3.17; 95%CI 1.52-6.64; p=0.002) and the post-pandemic period (OR 2.90; 95%CI 1.37-6.16; p=0.005). There was no significant association between the diagnosis period and the occurrence of previous incorrect diagnoses, between the diagnosis period and the time of symptom progression, and intensive care unit admission. Regarding the severity of diabetic ketoacidosis, no significant temporal trend was identified (p>0.05). CONCLUSION:An association was observed between the pandemic period and the occurrence of diabetic ketoacidosis, without inference of causality. There are no significant differences in the proportion of severe diabetic ketoacidosis during the pandemic period.
OBJECTIVE:Artificial intelligence-driven conversational models are increasingly used for patient education, yet whether information patients find clear and satisfying also meets expert accuracy standards remains unclear. The aim of this study was to compare patient and physician evaluations of ChatGPT-5 and DeepSeek V3.1 responses to questions on Hashimoto's thyroiditis. METHODS:In a cross-sectional, double-blind, within-participant study, twenty standardized, endocrinologist-developed questions across six domains were submitted to both models in October 2025. Seventeen adults with confirmed Hashimoto's thyroiditis (mean age 47.6±13.5 years; 88.2% female; 64.7% bachelor's degree or higher) rated each blinded response for clarity and satisfaction on 10-point Likert scales and selected a preferred response. Two endocrinologists also rated responses blindly; with only two physicians, their ratings were summarized descriptively. Paired t-tests with Holm correction compared ratings, and preference was analyzed with mixed-effects logistic regression. RESULTS:Patients rated ChatGPT-5 higher than DeepSeek V3.1 for clarity (9.15±0.70 vs. 8.41±1.14; Holm-adjusted p=0.005; Cohen's d_z=0.87) and satisfaction (8.93±0.94 vs. 8.19±1.37; Holm-adjusted p=0.005; d_z=0.85), and preferred ChatGPT-5 in 68.8% of selections (odds ratio 2.20; 95%CI 1.75-2.77; p<0.001). In exploratory analyses, this advantage was concentrated among higher-education participants and was undetectable in the small lower-education subgroup (n=6). Owing to the small physician sample (n=2) and low inter-rater agreement (κ=0.12; accuracy intraclass correlation coefficient=0.48), physician accuracy ratings (5.90 and 5.70/10) are exploratory and do not support a robust patient-physician comparison. CONCLUSION:Patients preferred ChatGPT-5 for clarity and satisfaction, though this advantage may not extend to lower-health-literacy populations; high patient satisfaction should not be taken as a proxy for clinical accuracy. Physician-supervised deployment and language-specific validation are recommended for responsible integration of artificial intelligence into patient education.
OBJECTIVE:Older adults increasingly use artificial intelligence-based tools to obtain health information. Although artificial intelligence chatbots such as ChatGPT may enhance access, the quality, readability, and patient safety of fall-prevention information remain uncertain. This study aimed to evaluate the quality, readability, and patient safety implications of ChatGPT-generated responses to common questions about fall risk and home safety in older adults. METHODS:Ten frequently asked fall-related questions were submitted to ChatGPT (version 5.2). Responses were independently assessed by a multidisciplinary panel including physiotherapists, a geriatrician, a physical medicine and rehabilitation physician, an occupational therapist, and an orthopedic specialist. Quality was evaluated using the Mika classification. Readability was measured with the Flesch-Kincaid Grade Level. Interrater reliability was analyzed using a two-way random-effects intraclass correlation coefficient model with absolute agreement (intraclass correlation coefficient [2,k]). RESULTS:Three responses were rated as "excellent," while seven responses were rated as "satisfactory requiring minimal clarification." No response received a rating corresponding to "moderately satisfactory" or "unsatisfactory." The mean Flesch-Kincaid Grade Level was 8.4 (range 4.3-11.9). Five responses exceeded the readability levels commonly recommended for patient education materials. Interrater reliability demonstrated fair agreement (intraclass correlation coefficient [2,k]=0.72; 95%CI 0.64-0.80). CONCLUSION:While ChatGPT provided generally acceptable clinical information, variability in readability and expert ratings raises patient safety concerns. AI-generated health content should be reviewed and tailored to older adults' health literacy needs before clinical use.
OBJECTIVE:The objective of this study is to evaluate the demographic and clinical characteristics of cases consulted with the ear, nose, and throat department in a tertiary hospital, the consultation indications, and independent factors associated with the need for procedural intervention. METHODS:This retrospective single-center study included patients undergoing ear, nose, and throat consultation. Demographics, consultation characteristics, indications, imaging, procedures, and hospitalization were recorded. Procedural intervention rates and independent factors associated with intervention requirements were also examined. RESULTS:Consultations for 1,366 patients were analyzed. The great majority of consultations (76.5%) originated from the emergency department, and procedural interventions were performed in approximately half the cases (48.8%). The most common reasons for consultation were suspected foreign bodies (n=248, 18.2%), nasal fracture (n=231, 16.9%), and epistaxis (n=132, 9.7%). The highest procedural intervention requirements were in the soft tissue trauma group (n=118; 90.7%) and in the epistaxis (87.9%) and nasal fracture (78.3%) cases. Consultation indication was the strongest independent predictor. Epistaxis, trauma-related consultations, and suspected foreign bodies were significantly associated with the need for procedural intervention. CONCLUSION:Consultation indication was the main determinant of intervention. Epistaxis, trauma-related conditions, and suspected foreign bodies were significantly independently associated with intervention requirements. Early identification of these high-risk indications may assist in the optimization of ear, nose, and throat emergency resource planning and consultation triage.
OBJECTIVE:The aim of this study was to investigate the effects of the Emotional Freedom Technique on depressive and menopausal symptoms among postmenopausal women. METHODS:The study sample consisted of 70 postmenopausal women (Emotional Freedom Technique group: 34; control group: 36). Participants in the intervention group received Emotional Freedom Technique at least once daily for 8 weeks. The control group received only routine care. Data were collected using a personal information form, the Menopause Rating Scale and the Beck Depression Inventory. All assessments were conducted before and after the intervention. Analyses were conducted using G*Power and Statistical Package for the Social Sciences 25. RESULTS:Emotional Freedom Technique significantly reduced the Beck Depression Inventory scores (p<0.001), as well as Menopause Rating Scale total (p<0.001) and subdimension scores: somatic (p<0.001) and psychological (p<0.001), and urogenital (p=0.005). Following the intervention, Beck Depression Inventory score decreased by 62.8%, Menopause Rating Scale total score by 46.3%, somatic subscale score by 52.1%, psychological subscale score by 45.0%, and urogenital subscale score by 20.4%. CONCLUSION:Emotional Freedom Technique shows promise as a potential adjunctive intervention, but further blinded, controlled trials are needed. The Emotional Freedom Technique was effective in reducing depression and menopausal symptoms among postmenopausal women after 8 weeks of daily practice. It is suggested that its use alongside standard care may help alleviate depressive and menopausal symptoms.
OBJECTIVE:The aim of this study was to evaluate the knowledge, attitudes, and vaccination practices of family physicians in Muğla, Turkey, regarding rotavirus infection and vaccination. METHODS:This descriptive cross-sectional study included family medicine residents and family physicians working in primary care settings in Muğla. Data were analyzed using Kruskal-Wallis, Mann-Whitney U, and Pearson chi-square tests. A p<0.05 was considered statistically significant. RESULTS:Among the participants, 88.6% recommended at least one vaccine not included in the national immunization schedule, with rotavirus vaccine being the most frequently recommended (91.9%). Rotavirus vaccine knowledge scores were significantly associated with age and the recommendation of vaccines not included in the national immunization schedule (p<0.001). Physicians who had vaccinated their own children had significantly higher knowledge scores (p=0.011). CONCLUSION:Although family physicians demonstrated adequate general knowledge of rotavirus infection, vaccine-related knowledge was insufficient. Knowledge level appears to play a key role in shaping vaccination attitudes and behaviors, highlighting the need for targeted continuing medical education.
OBJECTIVE:The aim of this study was to evaluate the responses generated by ChatGPT-5, Gemini, and Grok to the "six most frequently asked patient questions" on cryptorchidism published by the European Association of Urology, assessing them in terms of quality, understandability, actionability, and readability. METHODS:ChatGPT-5, Gemini, and Grok were asked these six frequently asked questions listed on the European Association of Urology patient information page on cryptorchidism. The quality of the responses was evaluated using the Quality Assessment Tool for Patient Health Information instrument, understandability and actionability were assessed using Patient Education Materials Assessment Tool scores, and readability was measured with the Coleman-Liau Index. All evaluations were performed by four urologists. RESULTS:Among the three artificial intelligence-based large language models, Gemini achieved the highest mean Quality Assessment Tool for Patient Health Information and Patient Education Materials Assessment Tool for Printable Materials scores. Kruskal-Wallis analysis demonstrated a statistically significant difference in Quality Assessment Tool for Patient Health Information scores among the groups (p=0.005); pairwise comparisons revealed that Gemini scored significantly higher than ChatGPT-5 (p=0.001). No significant differences were observed among the models for Patient Education Materials Assessment Tool-Understandability Section or Patient Education Materials Assessment Tool-Actionability Section scores (p>0.05). In the readability analysis, Grok had the highest Coleman-Liau Index value (Coleman-Liau Index=14.68), and all models produced texts requiring a university-level reading ability. Although the Gemini model achieved higher overall quality scores, all artificial intelligence-based large language models provided good-quality but difficult-to-read information. CONCLUSION:The responses generated by all three models demonstrated high levels of understandability and strong actionability. We anticipate that future, more advanced versions of artificial intelligence-based large language models will further improve these outcomes and contribute positively to the existing literature.
OBJECTIVE:We conducted this study to examine the attitudes and metaphorical perceptions of violence against women among midwifery students. METHODS:This Convergent Mixed-Methods study involved 383 midwifery students enrolled in a health sciences department during the 2024-2025 academic year. Data were collected using the Student Information Form, the Scale of Attitude Toward Violence Against Women, and the Metaphor Identification Form on Violence Against Women. RESULTS:Of the midwifery students, 21.5% reported exposure to at least one form of violence, with emotional and verbal violence being the most commonly reported. A substantial proportion of midwifery students remained silent when exposed to violence. The total mean attitude score for violence against women was 27.32±6.46, indicating non-traditional and non-myth-supporting attitudes. The metaphor analysis yielded eight overarching themes. CONCLUSION:The findings suggest that midwifery students hold contemporary and critical attitudes toward violence against women; however, their help-seeking behaviors remain limited due to sociocultural barriers. The metaphors produced reflect a deep understanding of the destructive, cyclical, and structurally oppressive nature of violence. Overall, our findings demonstrate that midwifery students possess a multidimensional and detailed understanding of violence against women; however, persistent barriers to help-seeking behavior indicate that sociocultural norms remain powerful.
OBJECTIVE:This case-control study aims to investigate the relationship between low pregnancy-associated plasma protein-A levels and serum urotensin-II concentrations between the 11th and 14th weeks of pregnancy. METHODS:This study was conducted between October 2024 and October 2025 at the perinatology outpatient clinic of a Training and Research Hospital in Istanbul. A total of 84 women were consecutively included and divided into case and control groups based on pregnancy-associated plasma protein-A results. Written consent and a descriptive form were obtained. Combined screening tests were performed, and blood samples were collected for urotensin-II measurement. RESULTS:No significant difference was observed between the case and control groups in terms of urotensin-II concentration. A statistically significant positive correlation was found between pregnancy-associated plasma protein-A levels and urotensin-II concentrations. Each 1 mIU/mL increase in pregnancy-associated plasma protein-A concentration was associated with an approximate 36.45 ng/mL increase in urotensin-II concentration. CONCLUSION:In this study, no significant association was demonstrated between pregnancy-associated plasma protein-A levels and urotensin-II levels in case and control groups; however, a correlation was identified between pregnancy-associated plasma protein-A levels and urotensin-II concentrations.
OBJECTIVE:The aim of this study was to examine the relationship between smartphone distraction and clinical decision-making among nurses. METHODS:This descriptive, cross-sectional study was conducted with 140 nurses working in a state hospital in a provincial center in the Mediterranean region of Turkey between 12 and 31 December 2024. Data were collected using the "Descriptive Information Form," "Smartphone Distraction Scale," and "Clinical Decision-Making in Nursing Scale." RESULTS:A statistically significant weak negative correlation was observed between Smartphone Distraction Scale and Clinical Decision-Making in Nursing Scale scores (p<0.05). In addition, professional experience duration showed a weak positive relationship with Clinical Decision-Making in Nursing Scale scores (p<0.001). CONCLUSION:In this study, higher levels of smartphone distraction were associated with lower levels of clinical decision-making among nurses. In addition, longer professional experience was associated with higher levels of clinical decision-making.
OBJECTIVE:Genetic susceptibility is increasingly recognized in cardiac arrhythmias. human leukocyte antigen-DQ2 and human leukocyte antigen-DQ8 alleles are established markers of immune-genetic dysregulation and chronic inflammation. This study investigated the association between human leukocyte antigen-DQ2/DQ8 positivity and incident atrial fibrillation in patients with heart failure with reduced ejection fraction. METHODS:This study was based on a prospectively followed cohort; the present retrospective analysis evaluated 50 heart failure with reduced ejection fraction patients (left ventricular ejection fraction <40%) and 50 age- and sex-matched controls. Participants were screened for human leukocyte antigen-DQ2/DQ8 alleles. All subjects were in sinus rhythm at baseline and followed for 24 months for the primary endpoint of incident atrial fibrillation. RESULTS:Incident atrial fibrillation occurred in 16% (n=8) of the heart failure with reduced ejection fraction group and 2% (n=1) of the control group. Among heart failure with reduced ejection fraction patients, human leukocyte antigen-positive status (positivity for DQ2 and/or DQ8) was found in 20 patients. Interestingly, all eight incident atrial fibrillation cases in the heart failure with reduced ejection fraction group occurred within the human leukocyte antigen-positive subgroup (40 vs. 0% in human leukocyte antigen-negative heart failure with reduced ejection fraction, p=0.031). human leukocyte antigen-positive heart failure with reduced ejection fraction patients exhibited a significantly higher atrial fibrillation risk compared to human leukocyte antigen-positive controls (p=0.0069), suggesting that structural heart disease and genetic predisposition synergistically increase arrhythmic risk. CONCLUSION:Human leukocyte antigen-DQ2/DQ8 positivity is significantly associated with incident atrial fibrillation in heart failure with reduced ejection fraction patients. These findings suggest human leukocyte antigen-related immune-genetic susceptibility contributes to atrial electrical vulnerability, positioning human leukocyte antigen typing as a potential novel biomarker for arrhythmic risk stratification in heart failure.
OBJECTIVE:Osteoporosis is a prevalent but often overlooked condition in hemiplegic patients that increases the risk of fracture. The aim of this study was to evaluate osteoporosis knowledge and awareness levels and determine associated factors in adult hemiplegic individuals. METHODS:A cross-sectional study was conducted with 88 hemiplegic participants (45 males, 43 females) in a tertiary rehabilitation clinic. Demographic and clinical data were documented. Cognitive function was assessed using the Mini-Mental State Examination, while osteoporosis knowledge was evaluated through the 31-item Osteoporosis Awareness Scale in addition to a structured question ("Have you ever heard of osteoporosis?"). Statistical analyses included independent t-tests, one-way analysis of variance with Tukey post-hoc testing, Pearson correlations, and multiple linear regression (significance: p<0.05). RESULTS:The mean Osteoporosis Awareness Scale score was 72.55±32.29 (range: 32-124). Seventy-two (81.8%) participants reported having heard of osteoporosis. In univariate analysis, Osteoporosis Awareness Scale scores were higher in females (76.58±33.81 vs. 68.73±30.52, p=0.036), postmenopausal women (78.92±33.45 vs. 58.40±26.31, p=0.042), those with higher education levels (p<0.001), and individuals with better cognitive function (p<0.001). Multiple linear regression confirmed that education level (p<0.001) and Mini-Mental State Examination score (p=0.002) were significant independent predictors of Osteoporosis Awareness Scale scores. Gender (p=0.052) and menopausal status (p=0.087) were not significant in the multivariate model. CONCLUSION:Education level and cognitive function were significant independent predictors of osteoporosis knowledge in hemiplegic patients. Gender and menopausal status were not significant after adjustment for education and cognitive function. These findings highlight the need for targeted educational strategies in rehabilitation settings, particularly for patients with lower educational backgrounds and cognitive impairment.
OBJECTIVE:The aim of this study to evaluate the effects of utilizing a stress ball during cesarean delivery under spinal anesthesia as a simple, non-pharmacological intervention on maternal anxiety, hemodynamic parameters, and lactation outcomes, in order to provide information f77or clinical practice. METHODS:Cases were randomly separated into two groups. cases in the intervention group were given stress balls and instructed to squeeze them continuously throughout the procedure, from 15 min before spinal anesthesia in the preoperative room until 15 min after newborn delivery. Demographic and surgical data, intraoperative hemodynamic parameters, maternal anxiety and pain levels, lactation adequacy, milk adequacy, and supplemental feeding needs were recorded and analyzed. RESULTS:Maternal anxiety levels were lower in the stress ball group compared to the control group. Although there was no significant difference in postoperative pain levels, lactation success and perceived milk adequacy were higher in the stress ball group, and supplemental feeding needs were reduced; this highlights the positive effect of the intervention on early lactation outcomes. CONCLUSION:Although stress ball use did not have a significant effect on pain, we believe that its ability to reduce maternal anxiety may be a supportive, non-pharmacological method that benefits early breastfeeding success.
OBJECTIVE:The aim of this study was to evaluate physician awareness, attitudes, and prescribing practices regarding menopausal hormone therapy in Türkiye and to identify specialty-related practice gaps in the context of evolving evidence. METHODS:A cross-sectional online survey was conducted between January and June 2025 among physicians in obstetrics and gynecology, endocrinology, and internal medicine. A 15-item structured questionnaire assessed menopausal hormone therapy knowledge, attitudes, and prescribing behaviors. Descriptive statistics and chi-square tests were used, with p<0.05 considered statistically significant. Multivariable logistic regression was performed to identify factors associated with willingness to initiate menopausal hormone therapy. RESULTS:A total of 235 physicians participated. Overall, 53.2% reported familiarity with menopausal hormone therapy guidelines, with significant differences across specialties (p<0.001); internal medicine physicians demonstrated the lowest awareness and the highest self-reported inadequate knowledge (94.4%). Willingness to prescribe menopausal hormone therapy for symptomatic women aged 50-59 years differed significantly by specialty (p<0.001), highest among obstetrics and gynecology physicians and lowest among internal medicine physicians. In adjusted analysis, internal medicine (aOR 0.179, 95%CI 0.067-0.474; p=0.001) and endocrinology (aOR 0.252, 95%CI 0.120-0.531; p<0.001) were independently associated with lower willingness to initiate menopausal hormone therapy. CONCLUSION:Significant specialty-dependent gaps in menopausal hormone therapy knowledge and prescribing confidence persist in Türkiye. Targeted education and improved dissemination of contemporary guidelines may help reduce undertreatment of symptomatic menopausal women.
