Progress Test (PT) is a form of assessment that simultaneouslymeasures ability levels of all students in a certain educational program and theirprogress over time by providing them with same questions and repeating theprocess at regular intervals with parallel tests. Our objective was to generatean item bank for the PT and to examine the possible fit of CAT for PTapplication. This study is a descriptive study. 1206 medical studentsparticipated. During the analysis of the psychometric properties of PT itembank, “the Rasch model for dichotomous items was used”. Several CATsimulations were performed by applying various stopping rules of differentstandard errors. CAT simulation estimates were compared with the estimatesgenerated from the original calibration of the Rasch model where all itemswere included. After Rasch analysis, a unidimensional PT item bank consistingof 103 items was obtained. The item bank reliability was calculated as 0.77with Person Separation Index (PSI) and Kuder-Richardson Formula 20 (KR-20). A high correlation between θ estimations obtained from paper-and-pencil(θRM) and CAT applications (θCAT) was detected for simulation conditions([N(0,1)] and [N(0,3)]) at the end of our analysis. In CAT, estimation can bemade with an average of 14 questions (reduced 86,4%) and 17 questions(reduced 83,4%) [for N(0,1) and [N(0,3) respectively] with reliability of 0,75.This study reveals that it is possible to develop an appropriate item bank forthe PT, and the difficulty of administering large number of items in PT can bescaled down by incorporating CAT application.
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Objective: Breast cancer is the type of cancer that causes the most death in womenin the United States after lung cancer. The objective of this study was to predict breast biopsyresults using age, BI-RADS, Mass Shape, Mass Margin, Mass Density by Multilayer Perceptronand Random Forest algorithms. Material and Methods: The dataset contains a BI-RADS assessment, the patient’s age and three BI-RADS attributes together with the ground truth for 516benign and 445 malignant masses. WEKA software was used for data mining. The data miningmethods of the Multilayer Perceptron and Random Forest were used to predict the severity ofcancer. Results: Accuracy, F-measure and Root Mean Squared Error values of the MultilayerPerceptron model were found 0.837, 0.833 and 0.352, respectively while accuracy, F-measureand Root Mean Squared Error values of the Random Forest model were found 0.816, 0.814 and0.396, respectively. The Multilayer Perceptron method provided a better prediction of breastcancer diagnosis than the Random Forest method and a software was developed based on the bestmodel created by the Multilayer Perceptron method. Conclusion: Consequently, a model thatwas built with the MLP method can be used as an alternative in the diagnosis of patients and bean assistant tool for physicians.
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ŞEBNEM ATAMAN , İsmihan SUNAR, Gürkan YILMAZ,
HATİCE BODUR ,
KEMAL NAS , Fikriye Figen AYHAN,
ÖZGÜR AKGÜL ,
AYŞEN AKINCI ,
ZÜHAL ALTAY ,
MURAT BİRTANE , Derya SOY BUĞDAYCI, Erhan ÇAPKIN,
REMZİ ÇEVİK , Yeşim Garip ÇİMEN, M. Tuncay DURUÖZ,
ATİLLA HALİL ELHAN ,
GÜLCAN GÜRER ,
CAHİT KAÇAR ,
AYHAN KAMANLI , Ece KAPTANOĞLU, Taciser KAYA, Hilal KOCABAŞ,
ÖMER KURU ,
MELTEM ALKAN MELİKOĞLU , Sumru ÖZEL,
AYLİN REZVANİ ,
İLHAN SEZER , Fatma GÜL YURDAKUL
Objectives: This study aims to report the assessment of the Turkish League Against Rheumatism (TLAR) expert panel on the compliance and adaptation of the European League Against Rheumatism (EULAR) 2016 recommendations for the management of rheumatoid arthritis (RA) in Turkey. Patients and methods: The EULAR 2016 recommendations for the treatment of RA were voted by 27 specialists experienced in this field with regard to participation rate for each recommendation and significance of items. Afterwards, each recommendation was brought forward for discussion and any alteration gaining ≥70% approval was accepted. Also, Turkish version of each item was rearranged. Last version of the recommendations was then revoted to determine the level of agreement. Levels of agreement of the two voting rounds were compared with Wilcoxon signed-rank test. In case of significant difference, the item with higher level of agreement was accepted. In case of no difference, the changed item was selected.Results: Four overarching principles and 12 recommendations were assessed among which three overarching principles and one recommendation were changed. The changed overarching principles emphasized the importance of physical medicine and rehabilitation specialists as well as rheumatologists for the care of RA patients in Turkey. An alteration was made in the eighth recommendation on treatment of active RA patients with unfavorable prognostic indicators after failure of three conventional disease modifying anti-rheumatic drugs. Remaining principles were accepted as the same although some alterations were suggested but could not find adequate support to reach significance. Conclusion: Expert opinion of the TLAR for the treatment of RA was composed for practices in Turkish rheumatology and/or physical medicine and rehabilitation clinics.
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Objectives: This study aims to evaluate whether items in the Turkish version of the Nottingham Health Profile (NHP) function differentlyaccording to age, sex, and duration of pain using the Mixed Rasch Model (MRM).Patients and methods: The NHP data of patients with low back pain from a previous study was analyzed. To analyze differential itemfunctioning (DIF) within the items of the NHP, the MRM was used. Age, sex, and duration of pain were considered factors which could causeDIF. The most powerful factor to define latent classes derived from the MRM was estimated using the Rasch tree method.Results: The two-class mixture version of the nominal response model was identified as the best fitting model for the physical mobility, sleep,and social isolation sections. For the physical mobility dimension, some items showed DIF by age and for the social isolation dimension someitems showed DIF by sex. For the sleep dimension, latent classes were unable to be explained by age, sex, and duration of pain. Items in otherdimensions of the NHP were DIF-free and no items showed DIF according to age, sex, and duration of pain.Conclusion: The results of this study may shed light on explaining the different response behavior of patients on the items of the NHP. Ageand sex were found to be variables affecting item responses of NHP. Contrary to expectations, duration of pain did not cause DIF for anyitem. From the perspective of DIF, it can be concluded that NHP scale is a robust scale in terms of validity.
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Background: This study aims to identify the prognostic factorsfor stage I lung adenocarcinoma and to evaluate the surgicalmanagement of subsolid nodules.Methods: The study included 133 patients (90 males, 43 females;mean age 64.9 years; range, 29 to 82 years) who had undergoneoperation in our clinic for stage I lung adenocarcinoma betweenJanuary 2007 and December 2015. Clinical, radiological andpathological data were retrospectively evaluated and their effectson recurrence and survival were examined by Kaplan-Meier andCox regression analyses.Results: Comparing the histopathological tumor types accordingto the pathological tumors size, we determined that the prevalenceof invasive adenocarcinoma significantly increased with increasingtumor size (p<0.001). For all nodules, a tumor disappearance ratelower than 25% negatively influenced disease-free survival and amaximum standardized uptake value higher than 5.6 negativelyinfluenced overall survival (p=0.027 for both). The grouping,which was performed considering the maximum standardizeduptake value 5.6 as the cut-off value, was an independent prognosticfactor for overall survival (hazard ratio: 5.973, 95% confidenceinterval: 1.186-30.073, p=0.03). Five-year overall survival rate wasstatistically significantly higher in patients who underwent wedgeresection or segmentectomy for subsolid nodules compared tothose who underwent lobectomy (100% vs. 79.3%, p=0.044).Conclusion: Sublobar resections can be safely performed in subsolidnodules smaller than 2 cm in diameter with tumor disappearance rate≥25% and maximum standardized uptake value ≤5.6.
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Amaç: Alt solunum yolu enfeksiyonlarında (ASYE) erken tanı ve klinik ciddiyetin belirlenmesi yaşamı tehdit eden komplikasyonların önlenmesi ve tedavisi için şarttır. Laboratuvar bulguları her zaman hastalığın klinik ciddiyeti hakkında fikir vermemektedir. Çalışmamızın amacı çocukluk çağı ASYE'lerinin ciddiyeti ve hastane yatışı gerektirip gerektirmediğinin belirlenmesinde idrarda amino-terminal pro-brain natriüretik peptid (NT-ProBNP) düzeyi ölçümünün klinik değerlendirmeye katkısının değerlendirilmesidir. Gereç ve Yöntemler: Bu prospektif non-randomize çalışmaya 0-6 yaş aralığında ASYE tanısı alan toplam 160 hasta dahil edildi. [(Grup 1: Ayakta tedavi edilen hastalar (n=108) ve grup 2: Hospitalize edilerek tedavi edilen hastalar (n=52)]. Kontrol grubuna benzer yaş grubunda sağlıklı 46 hasta dahil edildi (grup 3). Hastaların idrar NT-ProBNP düzeyi ELİSA metodu ile ölçüldü. Bulgular: İstatistiksel olarak anlamlı olmasa da hastaların idrar NT-ProBNP düzeyi kontrol grubuna göre daha yüksekti (p=0,322). Üç grup ayrı ayrı karşılaştırıldığında; en yüksek değerlerin ayakta tedavi edilen hastalara ait olduğu ve hospitalize edilen hastaların idrar peptid düzeylerinin kontrol grubundan hafif olarak düşük olduğu, gruplar arası istatistiksel olarak anlamlı fark olmadığı görüldü (p=0,128). Hasta yenidoğanların bebeklerin kontrol grubundan daha yüksek değerler gösterdiği belirlendi (p=0,041). P<0,05 istatistiksel olarak anlamlı kabul edildi. Sonuç: Çocukluk çağı ASYE'lerinde idrar NT-ProBNP değerleri yükselse de sonuçlarımız bu değişikliğin hastalığın klinik şiddetinin tayininde değerli bir belirteç olarak görülmediğine işaret etmektedir. Gelecekte bu konuda özellikle yenidoğanların dahil edildiği daha fazla hasta sayısı ile yapılacak çalışmalara ihtiyaç olduğunu düşünüyoruz.
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PURPOSE We aimed to evaluate the diagnostic accuracy and safety of computed tomography (CT)-guided biopsy of pulmonary lesions with fine needle aspiration (FNA) using non-coaxial technique.METHODSWe analyzed 442 patients who underwent CT-guided lung biopsy with FNA and non-coaxial technique to determine the diagnostic outcomes, complication rates, and independent risk fac-tors for diagnostic failure and pneumothorax.RESULTSDiagnostic accuracy, sensitivity, and specificity were 97.6%, 97.3%, and 100%, respectively. Age and >35 mm lesion size were significant risk factors for diagnostic failure. The rates of pneu-mothorax and chest tube placement were 19% and 2.9%, respectively. Middle and lower lobe location, lesion to pleura distance >7.5 mm, and >45° needle trajectory angle were significant risk factors for pneumothorax.CONCLUSIONCT-guided FNA of pulmonary lesions with non-coaxial technique is a safe and reliable method with a relatively low pneumothorax rate and an acceptably high diagnostic accuracy.
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ZEYNEP ŞIKLAR , Mikayir GENENS,
ŞÜKRAN POYRAZOĞLU ,
FİRDEVS BAŞ ,
FATMA FEYZA DARENDELİLER ,
RÜVEYDE BUNDAK ,
ZEHRA AYCAN ,
ŞENAY SAVAŞ ERDEVE ,
SEMRA ÇETİNKAYA ,
AYLA GÜVEN ,
SAYGIN ABALI , Zeynep ATAY, Serap TURAN,
CENGİZ KARA , Gülay Can YILMAZ, Nesibe AKYÜREK,
AYHAN ABACI , Gamze ÇELMELİ, Erkan SARI, Semih BOLU, Hüseyin ANIL KORKMAZ,
ENVER ŞİMŞEK ,
GÖNÜL ÇATLI , Muammer BÜYÜKİNAN, Atilla ÇAYIR,
SAADET OLCAY EVLİYAOĞLU , Pınar İŞGÜVEN, Tolga ÖZGEN, Nihal HATİPOĞLU,
ATİLLA HALİL ELHAN ,
MERİH BERBEROĞLU
Objective: Noonan syndrome (NS) is a multisystem disorder, and short stature is its most striking manifestation. Optimal growth hormone (GH) treatment for NS is still controversial. In this study, using a nationwide registration system, we aimed to evaluate the growth characteristics and the clinical features of NS patients in Turkey and their growth response to GH treatment. Methods: Children and adolescents with a diagnosis of NS were included inthe study. Laboratory assessment including standard GH stimulation test results were evaluated. Height increment of patients with or without GH treatment were analyzed after three years of therapy.This study aimed to descript the characteristics of Noonan syndrome at a national level.Information about the clinical characteristics, especially in growth parameters of NS patients at national level is scarce. In this study, using a nationwide registration system, we aimed to evaluate the growth characteristics, clinical features, and response to GH treatment of NS patients in Turkey.MethodsIn this study, we retrospectively analysed the data of 124 children and adolescents with NS who were being followed in 20 centers in Turkey. Study approval was given by the Ankara University Ethics Committee. A nation-wide Results: A total of 124 NS patients from different centers were entered in the webbased system. Short stature and typical face appearance were the most frequently encountered diagnostic features of our patients. Of the 84 patients who were followed long-term, 47 hadreceived recombinant human GH (rhGH). In this group of 47 patients, height standard deviation score (HSDS) increased from -3.62±1.14 to -2.85±0.96 after three years of therapy, indicating significant differences from the patients who did not receive GH treatment. PTPN11 gene was analyzed in 61 patients, and 64% of these patients were found to have a mutation. HSDS at admission was similar in patients with or without PTPN11 gene mutation.Conclusion: A diagnosis of NS should be kept in mind in all patients with short stature showing systemic clinical findings. GH therapy is effective for improvement of short stature especially in the first two years of treatment. Further studies are needed for optimisation of GH therapy and evaluation of final height data in NS patients.
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AIM: To report patient and procedure-related factors affecting the angiographic and clinical outcome in patients treated with the Silk device. MATERIAL and METHODS: All patients with intracranial aneurysms in whom treatment was attempted with the Silk flow diverter by our neurovascular team between October 2010 and November 2013 were included consecutively. The data was analyzed by an independent stroke neurologist not involved in the treatment of the patients. RESULTS: A total of 96 patients (64 female) with ages range from 3 to 78 were included in this study. We found that 54 of the patients were asymptomatic and 42 of them symptomatic, while 21 had a prior history of subarachnoid hemorrhage (SAH). Mean aneurysm size was 10.2 mm (range 2 to 40 mm). 2 patients died due to consequences of SAH. 3 patients developed visual decline on the follow-up, 2 of these were procedure-related. Symptomatic thromboembolic events were noted in 7 cases. Patients with aneurysms smaller than 13 mm had significantly less complications and higher occlusion rates. The complication rate was significantly high in patients admitted with symptoms. Adjunctive coiling had no impact on outcome. CONCLUSION: Safety and efficacy of flow diversion in this series was closely related to aneurysm size and presenting symptoms. A size cut-off for safety and efficacy has not been reported before and will be useful not only for future studies but also for patient counseling in daily practice. The futility of adjunctive coiling in this series calls for reappraisal of the current recommendations for this specific device.
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Amaç: Bu çalışmada ileri yaşta kalp ameliyatı geçiren hastalarda ameliyat sırası bakım, anestezi yönetimi, kısa dönem mortalite-morbidite verileri araştırıldı. Çalışma planı: Şubat 2007 - Şubat 2009 tarihleri arasında kardiyovasküler cerrahi kliniğimizde ameliyat geçirmiş olan 120 hastanın (70 hasta 65-79 yaş arası; 50 hasta ≥80 yaş) klinik dosyaları retrospektif olarak incelendi. Hastalar, grup 1 (65-79 yaş arası) ve grup 2 (80 yaş ve üstü) olarak iki gruba ayrıldı. Bulgular: Cinsiyet, ASA (American Society of Anesthesiologists) skoru ve ameliyat öncesi eşlik eden hastalıklar açısından iki grup arasında fark bulunmadı. Grup 1’de bir, grup 2’de ise sekiz hasta acil şartlarda ameliyata alındı. Grup 2’de Euroskor değerleri anlamlı derecede daha yüksek idi (p<0.001). Ameliyat sonrası komplikasyonlar, hastanede kalış ve taburculuk şekli açısından iki grup arasında herhangi bir fark görülmedi. Grup 2’de yedi hastada mortalite gelişirken, grup 1’de yalnızce üç hastada mortalite gelişti. Sonuç: İleri yaştaki kalp hastalarında ameliyat sonrası komplikasyon riski, yoğun bakım ünitesinde kalış süresi, hastane kalış süresi ve mortalite oranı yüksek bulunmakla birlikte, bu grupta elde edilen sonuçlar oldukça kabul edilebilir aralıkta idi. Hastaların beklenen yaşam süreleri göz önüne alındığında bu hasta grubunda ameliyat kararının göze alınabilecek bir risk oranı taşıdığı düşünüldü.
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