Nilay Aksoy

To evaluate the efficacy and safety of short-course (≤ 9 days) versus extended-course levetiracetam (LEV) prophylaxis for preventing seizures in seizure-naïve patients following supratentorial tumor resection. A systematic review and meta-analysis were conducted across PubMed, Google Scholar, and the Cochrane Library. Eight studies encompassing nine distinct clinical cohorts (N = 385) were included. Studies were dichotomized into Short-Term (ST: ≤ 9 days) and Extended-Term (ET: > 9 days) groups. Pooled seizure incidence was analyzed using a random-effects model, and a multivariate meta-regression isolated drivers of seizure risk. A temporal crossover analysis mapped medication attrition against marginal prophylactic benefit. The ST group demonstrated a pooled seizure incidence of 2.4% (95% CI: 1.1%-4.6%), significantly below the 12% historical baseline. Conversely, ET cohorts exhibited higher, volatile rates (up to 34.7%), statistically indistinguishable from untreated late-onset benchmarks (20%). Meta-regression identified only treatment duration and tumor type as significant moderators of outcomes (p < 0.05); age, gender, and LEV dosage (1000-3000 mg) had no impact. Safety analysis revealed a day-14 "clinical pivot": early well-tolerated somatic effects transitioned to severe neuropsychiatric toxicity with extended therapy, driving high attrition rate. ST (≤ 9 days) LEV protocol provides maximal prophylactic efficacy with minimal toxicity. Extending prophylaxis beyond this window offers no incremental protection against late-onset seizures but subjects patients to an intolerable neuropsychiatric burden. While prospective control trials are necessary to establish definitive guidelines, our findings indicate that a short term LEV course may offer a highly favorable risk-benefit profile. Extending prophylaxis beyond this timeframe seems to offer minimal additional benefit while markedly elevating the risk of neuropsychiatric toxicity, thereby requiring prudent clinical evaluation.

ÖzGiriş ve Amaç: Bu araştırma, yaşlı bireylerin sağlık hizmetlerine erişiminde karşılaşılan finansal ve fiziksel engelleri çok boyutlu bir çerçevede incelemeyi ve mevcut literatürdeki sınırlılıkları eleştirel bir perspektifle değerlendirmeyi amaçlamaktadır. Küresel ölçekte yaşlanan nüfus, sağlık sistemleri üzerinde artan talep ve maliyet baskısı yaratmakta ve erişim konusunu sağlık politikalarının temel alanlarından biri haline getirmektedir. Gereç ve Yöntem: Söz konusu çalışma, anlatı temelli (narrative) bir derleme olarak tasarlanmıştır. Literatür taraması kapsamında sağlık hizmetlerine erişim, yaşlı sağlığı, finansal engeller ve karşılanmayan sağlık ihtiyacı konularında ulusal ve uluslararası çalışmalar incelenmiştir. Elde edilen bulgular, finansal, fiziksel ve yapısal faktörler çerçevesinde tematik olarak analiz edilmiştir. Bulgular ve Sonuç: Literatür bulguları, yaşlı bireylerin sağlık hizmetlerine erişimde finansal engellerin önemli bir rol oynadığını; ancak bu engellerin çoğu zaman fiziksel ve yapısal faktörlerden bağımsız ele alındığını göstermektedir. Cepten sağlık harcamaları, gelir yetersizliği ve finansal koruma eksiklikleri erişimi sınırlarken; ulaşım güçlükleri, coğrafi uzaklık ve sağlık sisteminin organizasyon yapısı bu engelleri derinleştirmektedir. Sonuç olarak, yaşlı bireylerin sağlık hizmetlerine erişimi tek boyutlu yaklaşımlarla açıklanamayacak kadar karmaşık bir süreçtir. Mevcut derleme, erişim sorununa bütüncül bir perspektif sunarak sağlık politikalarının daha kapsayıcı ve sürdürülebilir şekilde tasarlanmasına katkı sağlamaktadır.Kaynakça:Allin, S., & Masseria, C. (2009). Unmet need as an indicator of health care access. Eurohealth, 15(3), 7–9.Allin, S., Grignon, M., & Le Grand, J. (2010). Subjective unmet need and utilization of health care services in Canada. Social Science & Medicine, 70(3), 465–472. https://doi.org/10.1016/j.socscimed.2009.10.027Alonso, J., Orfila, F., Ruigomez, A., Ferrer, M., & Antó, J. M. (1997). Unmet health care needs and mortality among Spanish elderly. American Journal of Public Health, 87(3), 365–370. https://doi.org/10.2105/AJPH.87.3.365Andersen, R. M. (1995). Revisiting the behavioral model and access to medical care. Journal of Health and Social Behavior, 36(1), 1–10.Ayanian, J. Z., Weissman, J. S., Schneider, E. C., Ginsburg, J. A., & Zaslavsky, A. M. (2000). Unmet health needs of uninsured adults in the United States. JAMA, 284(16), 2061–2069. https://doi.org/10.1001/jama.284.16.2061Beard, J. R., Officer, A., de Carvalho, I. A., ve ark. (2016). The World report on ageing and health. The Lancet, 387(10033), 2145–2154.Braveman, P. A. (2003). Monitoring equity in health and health care. Journal of Health, Population and Nutrition, 21(3), 181–192.Connolly, S., & Wren, M. A. (2017). Unmet healthcare needs in Ireland. Health Policy, 121(4), 434–441.Ensor, T., & Cooper, S. (2004). Overcoming barriers to health service access. Health Policy and Planning, 19(2), 69–79.Gakidou, E. E., Murray, C. J. L., & Frenk, J. (2000). Defining health inequality. Bulletin of the World Health Organization, 78(1), 42–54.Genç, G., & Kurutkan, M. N. (2021). Türkiye’de karşılanmayan sağlık ihtiyacı. SDÜ Sağlık Yönetimi Dergisi, 3(1), 34–51.Gibson, G., Grignon, M., Hurley, J., & Wang, L. (2019). Self-assessed unmet need. Health Economics, 28(6), 727–735.Goddard, M., & Smith, P. (2001). Equity of access to health care services. Social Science & Medicine, 53(9), 1149–1162.Grossman, M. (1972). The demand for health: A theoretical and empirical investigation. Columbia University Press.Gulliford, M., ve ark. (2002). What does access to health care mean? Journal of Health Services Research & Policy, 7(3), 186–188.Herr, M., ve ark. (2014). Unmet health care needs of older people. European Journal of Public Health, 24(5), 808–813.Jung, B., & Ha, I. H. (2021). Reasons for unmet healthcare needs. Health and Quality of Life Outcomes, 19, 1.Kawachi, I., Subramanian, S. V., & Almeida-Filho, N. (2002). Health inequalities glossary. Journal of Epidemiology & Community Health, 56(9), 647–652.Kim, Y. S., ve ark. (2018). Unmet healthcare needs of elderly. BMC Geriatrics, 18, 98.Levesque, J. F., Harris, M. F., & Russell, G. (2013). Patient-centred access. International Journal for Equity in Health, 12(1), 18.

This book is an authoritative guide addressing principles and practices of pharmacology insofar as they concern dentistry. The book covers all the critical aspects of drug prescribing starting with the basics of the importance of rational and evidence-based prescribing practice. Having laid this foundation, it proceeds to discuss the key principles of pharmacokinetics and pharmacodynamics and the processes of drug absorption, distribution, metabolism, and excretion. Key areas that are covered in the publication include some of the most prescribed drugs in dental practice, including analgesics, anti-inflammatories, antibiotics, antimicrobials, local anesthetics, sedatives, anxiolytics, topical agents, and prescription-strength oral hygiene products. The various classes of drugs are discussed in relation to their clinical applications, benefits, and potential side effects. Pediatric and geriatric patients, pregnant and lactating women, as well as those who are medically compromised, have special considerations. In this way, dental professionals will have the necessary background to individualize their prescribing based on the peculiar needs of these special groups of patients. This text also includes information on the pharmacotherapy of periodontal diseases, endodontic infections, oral surgery, and temporomandibular joint disorders. Addressing alternative and adjunctive therapies beyond traditional pharmacotherapies, It covers herbal remedies and integrative pain management approaches as they pertain to their place and function in improving patient outcomes. The authors also look ahead to address the future trends and developments in dental pharmacotherapy, new drug product delivery innovations, and the effect that personalized medicine may have on dental prescribing patterns in the future. The conclusion reiterates continuous education and compliance with guidelines of prescribing as a pathway to absolute currency in the profession. A Comprehensive Manual on Drug Prescribing in Dentistry is an indispensable part of the professional library whether you are a dental student, general practitioner, researcher, or teacher. Such is the rationale for bringing together, in a single manual, evidence-based and practical information that will be useful in delivering safe, effective, and patient-centered dental care.

Background: During pregnancy, the maternal immune system plays a central role in maintaining health and preventing disease. Attaining a healthy daily diet contributes to adequate immune fitness, maintaining health, and preventing disease. This pilot study evaluated the relatively underexplored relationships between the stage of pregnancy, immune fitness and the dietary patterns of pregnant women. Methods: An online survey was conducted among n = 20 pregnant Turkish women. They reported the number of weeks that they were pregnant and completed the single-item Healthy Diet Scale (HDS) to determine to what extent they considered their daily diet to be healthy. Immune fitness was assessed with a single-item scale ranging from 0 (very poor) to 10 (excellent). Spearman’s correlations (including bootstrapping to account for the small sample size) were computed between weeks pregnant, daily diet scores, and immune fitness. Results: A significant negative correlation was found between weeks pregnant and immune fitness ( r = −0.449, p = .047), and a significant negative correlation was also found between weeks pregnant and the percentage of daily diet considered healthy ( r = −0.642, p = .002). A significant positive correlation was found between immune fitness and the percentage of the daily diet considered healthy ( r = 0.622, p = .003). Discussion: With progressing pregnancy, poorer immune fitness and a shift towards a less healthy diet were reported. The data suggest that attaining a healthy diet significantly contributes to maintaining adequate immune fitness, which is of particular importance to pregnant women. Future studies in larger cohorts should confirm these findings.

Introduction: Seasonal influenza is a major cause of illness and death worldwide. Vaccination remains the cornerstone of prevention, with options including trivalent inactivated (TIV), quadrivalent inactivated (QIV), and live-attenuated vaccines. This study aimed to provide a systematic overview of the cost-effectiveness of pediatric influenza vaccination programs, with a particular focus on comparing different vaccine types. Methods: A comprehensive literature search was conducted in PubMed, Web of Science, Scopus, and Cochrane databases for records published between 2013 and 2024. The target population included individuals younger than 18 years. The primary research question was: Which influenza vaccines, trivalent, quadrivalent, or live-attenuated, are more cost-effective, and how does introducing seasonal vaccination for children under 18 influence healthcare costs and health outcomes? Data extraction was performed using a structured Excel spreadsheet. Results: This review included 33 studies that met the inclusion and exclusion criteria. Most studies support the conclusion that vaccinating children is an effective and cost-effective strategy for reducing influenza transmission. Cost-effectiveness varied depending on epidemiological and demographic factors, the type of vaccine used, and age group differences, which were influenced by the analytical perspective and local health and economic conditions. Conclusion: This review confirms that pediatric influenza vaccination is a cost-effective intervention, particularly with quadrivalent vaccines. The optimal choice of vaccine and strategy should be tailored to local population needs and economic conditions to maximize public health benefits.

Background: This study aims to investigate the infection patterns and antibiotic utilization in critically ill patients receiving extracorporeal membrane oxygenation treatment. Methods: Between January 2019 and January 2024, a total of 165 patients (109 males, 56 females; median age: 58 years; range, 48 to 67 years) who were hospitalized for at least 24 h and underwent extracorporeal membrane oxygenation, and received ≥1 antibiotic treatment in the cardiovascular intensive care unit were retrospectively analyzed. Microbiological culture results, pathogen resistance patterns, antibiotics used, and their doses during extracorporeal membrane oxygenation were evaluated based on the literature and the Sanford Antimicrobial Guide database. Results: The median number of days spent on extracorporeal membrane oxygenation was 4 (range, 2 to 7) days. Klebsiella pneumoniae (28.8%) and Acinetobacter baumannii (21.1%) were frequently detected in culture results. The median number and duration of antibiotics were 2 (range, 1 to 3) and 2 (range, 1 to 4) days, respectively. Cephalosporins (39%) and penicillins (30%) were the most commonly used antibiotics. At least one antibiotic dose inappropriateness was detected in 56 (33.9%) patients. A total of 366 antibiotic administrations included 73 (19.9%) dose inappropriateness. Continuous renal replacement therapy, sepsis/septic shock, and extracorporeal membrane oxygenation duration >4 days were identified as risk factors increasing antibiotic inappropriateness (pConclusion: Our study results indicate that patients receiving extracorporeal membrane oxygenation frequently experience antibiotic resistance and the proliferation of Gram-negative bacteria. In our study, antibiotic dosing was inappropriate in approximately one-third of patients receiving extracorporeal membrane oxygenation. Based on these findings, adherence to the literature should be increased while selecting antibiotics and doses for patients.

Introduction: The growing number of people living with, through and beyond cancer poses a new challenge for sustainable survivorship care solutions. Digital health solutions which incorporate various information and communication technologies are reshaping healthcare; offering huge potential to facilitate health promotion, support healthcare efficiencies, improve access to healthcare and positively impact health outcomes. Digital health solutions include websites and mobile applications, health information technologies, telehealth solutions, wearable devices, AI-supported chatbots and other technologically assisted provision of health information, communication and services. The breadth and scope of digital health solutions necessitate a synthesis of evidence on their use in supportive care in cancer. This umbrella review will identify, synthesise, and compare systematic reviews which have evaluated the efficacy or effectiveness of digital solutions for adult cancer survivorship care with a particular focus on surveillance and management of physical effects, psychosocial effects, new cancer/ recurring cancers and supporting health promotion and disease prevention. Methods and analysis: An umbrella review of published systematic reviews will be undertaken to explore the types of digital health solutions used, their efficacy or effectiveness as a form of supportive care, and the barriers and enablers associated with their implementation. The umbrella review will be reported according to the Preferred Reporting Items for Overviews of Reviews (PRIOR) checklist. A search will be conducted across key databases. Records will be assessed independently by two review authors for eligibility against predefined criteria and will undergo two stage title, abstract and full text screening. All systematic reviews that meet the inclusion criteria will be assessed for quality using the AMSTAR 2 checklist with quality assessment and data extraction by two reviewers. The degree of publication overlap of primary studies across the included reviews will also be calculated and a mapping of the evidence will also be presented. Ethics and dissemination: As this research proposes using systematic reviews that are already published, ethical approval is not required. Results from this umbrella review will be published in a peer-reviewed journal where any significant deviations from the protocol will be justified.

Introduction: This systematic review and meta-analysis aimed to analyze the adherence rate for conventional and biological disease-modifying antirheumatic drugs (DMARDs) utilizing different assessment measures.Method: A systematic literature search was performed in four electronic databases, including PubMed, Scopus, Web of Science, and the Cochrane Central Register of Controlled Trials (CENTRAL), covering the time frame from April 1970 to April 2023. Studies that present data on medication adherence among adult patients with rheumatoid arthritis (RA), specifically focusing on DMARDs (conventional or biological), were included in the analysis. The adherence rate for different assessment measures was documented and compared, as well as for conventional and biological DMARDs. A random-effects meta-analysis was performed to assess adherence rates across different adherence assessment measures and drug groups.Results: The search identified 8,480 studies, out of which 66 were finally included in the analysis. The studies included in this meta-analysis had adherence rates ranging from 12 to 98.6%. Adherence rates varied across several adherent measures and calculation methods. Using the subjective assessment measures yielded the outcomes in terms of adherence rate: 64.0% [0.524, 95% CI 0.374–0.675] for interviews and 60.0% [0.611, 95% CI 0.465–0.758] for self-reported measures (e.g., compliance questionnaires on rheumatology CQR-5), p > 0.05. In contrast, the objective measurements indicated a lower adherence rate of 54.4% when using the medication event monitoring system (p > 0.05). The recorded rate of adherence to biological DMARDs was 45.3% [0.573, 95% CI 0.516–0.631], whereas the adherence rate for conventional DMARDs was 51.5% [0.632, 95% CI 0.537–0.727], p > 0.05. In the meta-regression analysis, the covariate “Country of origin” shows a statistically significant (p = 0.003) negative effect with a point estimate of −0.36, SE (0.12), 95% CI, −0.61 to −0.12.Discussion: Despite its seemingly insignificant factors that affect the adherence rate, this meta-analysis reveals variation in adherence rate within the types of studies conducted, the methodology used to measure adherence, and for different antirheumatic drugs. Further research is needed to validate the findings of this meta-analysis before applying them to clinical practice and scientific research. In order to secure high reliability of adherence studies, compliance with available reporting guidelines for medication adherence research is more than advisable.

Previous studies from the Netherlands, Germany, and Argentina revealed that the 2019 coronavirus disease (COVID-19) pandemic and associated lockdown periods had a significant negative impact on the wellbeing and quality of life of students. The negative impact of lockdown periods on health correlates such as immune fitness, alcohol consumption, and mood were reflected in their academic functioning. As both the duration and intensity of lockdown measures differed between countries, it is important to replicate these findings in different countries and cultures. Therefore, the purpose of the current study was to examine the impact of the COVID-19 pandemic on immune fitness, mood, academic functioning, sleep, smoking, alcohol consumption, healthy diet, and quality of life among Turkish students. Turkish students in the age range of 18 to 30 years old were invited to complete an online survey. Data were collected from n = 307 participants and included retrospective assessments for six time periods: (1) BP (before the COVID-19 pandemic, 1 January 2020–10 March 2020), (2) NL1 (the first no lockdown period, 11 March 2020–28 April 2021), (3) the lockdown period (29 April 2021–17 May 2021), (4) NL2 (the second no lockdown period, 18 May 2021–31 December 2021), (5) NL3 (the third no lockdown period, 1 January 2022–December 2022), and (6) for the past month. In this data descriptor article, the content of the survey and the dataset are described.