Birinci basamak için Beck depresyon tarama ölçeği’nin Türkçe çeviriminin geçerlik ve güvenirliği
(2005)
Dealing with uncertainty in general practice: an essential skill for the general practitioner
(2011)
Many patients attending general practice do not have an obvious diagnosis at presentation. Skills to deal with uncertainty are particularly important in general practice as undifferentiated and unorganized problems are a common challenge for general practitioners (GPs). This paper describes the management of uncertainty as an essential skill which should be included in educational programmes for both trainee and established GPs. Philosophers, psychologists and sociologists use different approaches to the conceptualisation of managing uncertainty. The literature on dealing with uncertainty focuses largely on identifying relevant evidence and decision making. Existing models of the consultation should be improved in order to understand consultations involving uncertainty. An alternative approach focusing on shared decision making and understanding the consultation from the patient’s perspective is suggested. A good doctor–patient relationship is vital, creating trust and mutual respect, developed over time with good communication skills. Evidence-based medicine should be used, including discussion of probabilities where available. Trainers need to be aware of their own use of heuristics as they act as role models for trainees. Expression of feelings by trainees should be encouraged and acknowledged by trainers as a useful tool in dealing with uncertainty. Skills to deal with uncertainty should be regarded as quality improvement tools and included in educational programmes involving both trainee and established GPs.
Amaç: Depresyon tüm toplumu özellikle de kad›nlar› etkileyen ve birinci basamakta s›k karfl›lafl›lan temel sa¤l›k sorunlar›ndan biridir. Yayg›nl›¤›, tedavisinin uzun sürmesi ve tekrarlama riski nedeniyle uzun süre yak›n takip gereklidir. Depresyon kronik hastal›k olarak kabul edilmesine karfl›n ülkemizde, birinci basamakta uzun dönem seyri ile ilgili çal›flma yap›lmam›flt›r. Bu çal›flmada poliklini¤imizde depresyon tan›s›yla tedavi edilen hastalar›n flimdiki durumunu görmek ve yap›lan tedavinin uzun dönem etkinli¤ini de¤erlendirmek amaçlanm›flt›r.
Yöntem: Poliklini¤imizde depresyon tan›s› alm›fl 78 hastadan ulafl›labilen 45 hasta çal›flmaya davet edildi ve 28’i (%62.2) kabul etti (grup 1). Kontrol grubu oluflturmak üzere poliklinik hasta kay›tlar›ndan rasgele örneklem yoluyla seçilen 250 kifliden 166’s› (%66.4) çal›flmaya kat›ld› (grup 2). Bunlardan daha önce depresyon geçirmemifl olan 130 kifli grup 2, daha önce depresyon geçiren ve baflka yerde tedavi gören 36 kifli ise grup 3 olarak incelendi. Her üç gruba da Beck Depresyon Envanteri uyguland›. Kontrol grubundan 10 kifli öyküsünde depresyon olmaks›z›n Beck Depresyon Envanterinden 17 puandan fazla ald›klar›ndan çal›flmadan ç›kar›ld›lar. Veriler SPSS Program›nda de¤erlendirildi.
Bulgular: Toplam 184 kat›l›mc›n›n yafl ortalamas› 45.9±13.3 y›l, kad›nlar›n oran› %91.8 (n=169), evlilerin oran› %85.8 (n=158) idi. Grup 1’de ilk tan› ald›ktan sonra geçen ortalama süre 24.3±8.0 ay idi. Grup 1’in Beck depresyon puanlar› grup 3’den daha düflük olmakla birlikte her üç grup aras›nda ista- tistiksel olarak anlaml› bir fark yoktu (p>0.05). Aral›ks›z ilaç kullanma süreleri ve düzenli ilaç kullan›m› yönünden grup 1 ve grup 3 benzerdi. Halen tedavi alanlar ve almayanlar ayr›ca karfl›laflt›r›ld›¤›nda da Beck puanlar› farkl› de¤ildi. En s›k kul- lan›lan antidepresanlar tianeptin, sertralin ve amitriptilindi.
Bununla birlikte grup 1 grup 3’den daha az anksiyolitik ve antipsikotik kullanm›flt›.
Sonuç: Elde etti¤imiz sonuçlar, gelecekte depresyonun birinci basamaktaki baflar›l› tedavisinin bir iflareti olarak kabul edilebilir. Birinci basamakta etkili flekilde takip ve tedavisinin yap›lmas› depresyonla savaflta baflar›y› kolaylaflt›racakt›r.
Anahtar sözcükler: Depresyon, birinci basamak, bak›m, tedavi, aile hekimli¤i
Objectives: We investigated the effect of some hypothetical factors (nutrition, health indicators, risk behaviors, personal characteristics, and family indicators) on academic achievement using Logistic Regression (LR) and the Chi-squared Automatic Interaction Detection (CHAID) method.
Study Design: Participants were 873 secondary school or high school students selected randomly from a total of 12,150 students after stratification according to school populations in Edirne, in 2003.
Results: The sensitivity, positive predictivity, and specificity rates were 61.19%, 67.70%, and 74.25% for CHAID, and 50.00%, 64.29%, and 75.69% for LR, respectively. Father's educational level was the most important factor in the CHAID method. Smoking status, time reserved for homework, and nutrition were the other important factors predicting low school performance according to the CHAID method.
Conclusion: The classification tree algorithm can be used in risk analysis and target segmentation for academic achievement management. Our results may contribute to developing guidelines for those involved in secondary school and high school education.
