Hitit Üniversitesi Kurumsal Akademik Arşivi
DSpace@Hitit, Hitit Üniversitesi tarafından doğrudan ve dolaylı olarak yayınlanan; kitap, makale, tez, bildiri, rapor, araştırma verisi gibi tüm akademik kaynakları uluslararası standartlarda dijital ortamda depolar, Üniversitenin akademik performansını izlemeye aracılık eder, kaynakları uzun süreli saklar ve telif haklarına uygun olarak Açık Erişime sunar.
Güncel Gönderiler
Laparoskopik kolesistektomi uygulanan hastalara ultrasonografi eşliğinde yapılan subkostal transversus abdominis plan bloğu ile rekto-interkostal fasiyal plan bloğunun postoperatif analjezik etkinliklerinin karşılaştırılması
(Hitit Üniversitesi, 2025) Kitaplı, İbrahim; Kayır, Selçuk
Aim: Severe postoperative pain is observed in patients following laparoscopic cholecystectomy. Currently, peripheral nerve blocks, which are a part of multimodal analgesia, are widely used in postoperative pain management. This study investigated the effects of subcostal transversus abdominis plane nerve block (STAP), recto-intercostal fascial plane block (RIFPB) on postoperative NRS scores and tramadol consumption.
Material and method: This study was designed as a prospective, randomized, double-blind trial. Seventy-two patients scheduled for laparoscopic cholecystectomy were included in the study. One group received a bilateral STAP block (group S, n=35), while the other group received a bilateral recto-intercostal fascial plan block (RIFPB) (group R, n=35). For the peripheral nerve blocks, STAP was administered with 20 mL of 0.25% bupivacaine per side, RIFPB with 20 mL of 0.25% bupivacaine per side. These blocks were performed after the surgery but before the termination of general anesthesia. The postoperative NRS scores and tramadol consumption were compared between the groups.
Results: The groups were similar in terms of ASA scores and demographic characteristics. The rates of dermatomal involvement at the midclavicular line at T5 and T10 in the 2nd postoperative hour were found to be statistically significantly different between the groups (P=0.01 and P=0.044, respectively). Additionally, a statistically significant difference was observed between the groups in terms of T6–T9 dermatomal involvement at the midaxillary line at both the 2nd and 24th postoperative hours (P<.001). A statistically significant difference was also found between the groups regarding the time to mobilization (P=0.005). Furthermore, postoperative nausea and vomiting scores at hour 0 differed significantly between the groups (P=0.046).
Conclusion: In laparoscopic cholecystectomy procedures, both the STAP block and the RIFPB are effective in postoperative pain management. RIFPB may provide more effective analgesia compared to the STAP block alone, as it also targets the lateral cutaneous branches of the abdominal nerves in addition to those innervated by the STAP block.
Kronik böbrek hastalığı olanlarda serum proprotein konvertaz subtilisin/ keksin tip 9 düzeyinin endotel disfonksiyonu ve subklinik ateroskleroz ile ilişkisi
(Hitit Üniversitesi, 2025) Avcı, Ahmet; Eser, Barış
Objective: This study aims to investigate the relationship between serum PCSK9 values and subclinical atherosclerosis and endothelial dysfunction in patients with chronic kidney disease.
Materials and methods: A total of 127 participants over the age of 20 those receiving hemodialysis (HD) (n=30), those receiving continuous peritoneal dialysis (PD) (n=36), stage 3-4 CKD (n=31), and non-CKD control group (n=30) participants] were included in this clinical cross-sectional study. Flow-mediated dilatation (FMD) for ED, endothelial deceleration time (EDT) for left ventricular diastolic dysfunction (LVDD), and carotid intima media thickness (CIMT) for subclinical atherosclerosis were measured by echocardiography. Blood samples were taken for simultaneous PCSK9 measurements.
Results: Of the 122 participants who participated in the study, 30 (24.5%) were in the control group, 31 (25.4) in the stage 3-4 CKD patient group, 31 (25.4) in the peritoneal dialysis group, and 30 (24.5%) in the hemodialysis patient group. Although no significant difference was found between the study groups in FMD BASE and FMD HYPEREMIA; FMD ratio was found to be significant (P values, respectively; 0.552; 0.435; 0.001). A significant difference was found between the CIMT groups (both 0<.001). E/e', one of the parameters indicating LVDD was found to be significantly different (P:0.009).
Conclusion: There was a statistically significant difference in endothelial dysfunction and subclinical atherosclerosis in chronic kidney disease patients compared to the healthy group. However, no significant difference was found in PCSK9 correlation.
Keywords: Proprotein convertase subtilisin/kexin type 9, chronic kidney disease, endothelial dysfunction, subclinical atherosclerosis
İzole hipertansiyon hastalarında nondipper kalp hızı varlığının ventriküler aritmiler ile ilişkisi
(Hitit Üniversitesi, 2025) Sarıhan, Abdullah; Bekar, Lütfü
Objective: In healthy individuals, the increase in parasympathetic tone during nighttime leads to a decrease in heart rate. When this decrease does not occur or happens minimally, it is an indicator of increased sympathetic activity. This condition could be an important mechanism that may increase the susceptibility to ventricular arrhythmias, especially in hypertensive individuals. The aim of this study is to compare the frequency of ventricular arrhythmias and other clinical parameters between cases with and without a heart rate decrease during the night in isolated hypertensive patients monitored by a rhythm Holter. Materials and Methods: A total of 229 isolated hypertensive patients (mean age 58.2±12.5 years, 89 (38.9%) male) who underwent transthoracic echocardiography, rhythm Holter, and amulatory blood pressure monitoring and applied to the Department of Cardiology at Hitit University Faculty of Medicine in the last 12 months up until March 2025 were included in this study. The cases included in the study were divided into two groups based on their nighttime heart rate decrease in the rhythm Holter: the 'dipper' group, with a decrease of 10% or more, and the 'non-dipper' group, with a decrease of less than 10%. The primary comparisons were made between these two groups. Then, according to the Lown classification, patients in the low Lown class (Lown 0) were compared with those in the high Lown class (Lown 1-4), and the same comparisons were repeated between these two groups. Parameters that were significantly different between the Lown class 0 and Lown class 1-4 groups were included in multivariate analysis, aiming to identify independent and significant parameters that may influence the development of cardiac arrhythmias in isolated hypertensive patients. Results: In Holter rhythm analyses, 170 patients (mean age 57.8±12.2 years, 66 [38.8%] male) with a nocturnal heart rate decrease of ≥10% were classified as the dipper group, while 59 patients (mean age 59.3±13.4 years, 23 [29%] male) with a decrease of <10% were classified as the non-dipper group. There was no significant difference between the dipper and non-dipper groups in terms of baseline demographic parameters, laboratory values, or medications used. When transthoracic echocardiographic parameters were compared between the two groups, interventricular septal thickness (11.9±1.6 vs. 11.3±1.4 mm; p=0.005), posterior wall thickness (11.7±1.6 vs. 11.3±1.6 mm; p=0.047), left ventricular (LV) mass (193.8±47.1 vs. 174.7±48.6 g; p=0.009), LV mass index (103.9±26.2 vs. 95.3±28.2 g/m²;VIII p=0.040), presence of LV hypertrophy (78% vs. 60.6%; p=0.016), and presence of concentric hypertrophy (55.9% vs. 37.6%; p=0.014) were significantly higher in patients with non-dipper heart rate compared to those with dipper heart rate. When Holter rhythm parameters were compared between the two groups, both the number of ventricular extrasystoles (1039 [8– 1600] vs. 120 [0–321] beats; p<0.001) and the number of atrial premature beats (451 [3– 1366] vs. 129 [0–445] beats; p<0.001) were found to be significantly higher in the non-dipper heart rate group. Comparing the Lown classification between the two groups, arrhythmia frequency was observed to be higher in patients with non-dipper heart rate (p<0.001). Based on Lown classification, 139 patients (mean age 57.2±13.4 years, 58 [41.7%] male) were categorized in Lown class 0, and 90 patients (mean age 59.8±10.8 years, 31 [34.4%] male) in Lown class 1–4. No significant differences were observed between these groups in terms of baseline demographic characteristics, laboratory findings, or medications used. However, echocardiographic parameters such as interventricular septal thickness (11.8±1.6 vs. 11.3±1.5 mm; p=0.005), posterior wall thickness (11.7±1.6 vs. 11.2±1.6 mm; p=0.011), LV mass (187.8±47.2 vs. 174.3±49.3 g; p=0.040), LV mass index (102.8±26.2 vs. 94.1±28.6 g/m²; p=0.021), presence of LV hypertrophy (73.3% vs. 59.7%; p=0.036), and presence of concentric hypertrophy (52.2% vs. 36%; p=0.015) were significantly higher in patients in the Lown class 1–4 group compared to the Lown class 0 group. Additionally, 24-hour average systolic blood pressure (p=0.015), daytime average systolic blood pressure (p=0.014), and nighttime average systolic blood pressure (p=0.011) were significantly higher in the Lown class 1–4 group among ambulatory blood pressure monitoring parameters. When rhythm Holter parameters were compared between these two groups, both the number of ventricular extrasystoles (908 [122–2509] vs. 0 [0] beats; p<0.001) and the number of atrial premature beats (671 [122–1863] vs. 52 [0–360] beats; p<0.001) were found to be significantly higher in the Lown class 1–4 group. Furthermore, non-dipper heart rate status was more frequently observed in the Lown class 1–4 group (89.9% vs. 50%; p<0.001). In correlation analysis, a weak but statistically significant negative correlation was detected between percentage change in heart rate and both LV mass (r= -0.256; p=0.018) and LV mass index (r= -0.243; p=0.031). In multivariate analysis, the presence of concentric hypertrophy (Relative Risk: 2.879; 95% Confidence Interval: 1.843–9.829; p=0.041) and a nocturnal heart rate decrease of less than 10% (Relative Risk: 9.616; 95% Confidence Interval: 4.563–20.261; p=0.001) were identified as independent predictive parameters for the development of cardiac arrhythmias.
Hizmet kalitesi algı düzeyi ve marka değeri ilişkisinde kurumsal marka imajının aracılık etkisinin belirlenmesi: PTT kurumuna yönelik bir saha araştırması
(Hitit Üniversitesi, 2025) Kavukçu, Merve; Yoldaş, Muhammed Asıf
The brand value of an institution directly affects not only the financial performance of the institution but also its sustainability, competitive power and image in the long term. In recent years, it has become important to increase the brand image and value by providing quality service by meeting the demands of the customers correctly. Corporate brand image, service quality and brand value feed each other in three different cycles. High service quality creates a positive corporate brand image, which increases the brand value. As the brand value increases, the company's reputation is strengthened and the opportunity to invest in service quality increases. If institutions can manage these three elements in a harmonious way, they achieve sustainable success. In this context, the purpose of the study is to investigate the mediating effect of the perceived corporate brand image between the service quality level and brand value of PTT (Postal and Telegraph Organization) Inc., which has a deep-rooted history of 184 years, a large number of branches and a wide range of services. In order to achieve the purpose of the study, a survey was conducted online on social media tools with 409 people using the snowball sampling method and the data was obtained. The data was transferred from Excel to the SPSS (22) program and the averages of the questions were taken. Validity and reliability analyses of the data were conducted in the Amos (24) program. Explanatory and confirmatory factor analysis were conducted to test the suitability of the research for the structural equation model path analysis. Three of the survey questions were removed from the analysis because their values were not consistent. First, a model was created between service quality and brand value based on Baron and Kenny's causal steps approach and path analysis was conducted. As a result of the analysis, H3: 'Service quality level has a positive effect on brand value' hypothesis was accepted. After the verified Model 1, the 2nd Model, which also included the mediation effect of the corporate brand image, was analyzed. As a result of the analysis, the goodness of fit values were good. H1: Service quality level has a positive effect on perceived corporate brand image. H2: Perceived corporate brand image has a positive effect on brand value. H4: Perceived corporate brand image has a mediation effect on the effect of service quality level on brand value. All hypotheses were accepted. In addition, the indirect, direct and total effects between service quality, corporate brand image and brand value variables were examined. Service quality directly affects the corporate brand image, and the corporate brand image directly affects the brand value. In the high value of the service quality level indirectly affecting the brand value, there is a mediating effect of the corporate brand image. The corporate brand image contributes positively to the two variables and a partial mediating effect is found. In line with all the analysis results, some suggestions were made to the PTT institution and researchers. It is assumed that significant contributions will be made to the literature by analyzing brand value, service quality and corporate brand image together.
Aile hekimliğinde malpraktis korkusu ve defansif tıp uygulamaları
(Hitit Üniversitesi, 2025) Eldemir, İsa; (İren) Akbıyık, Derya
Aim: Malpractice lawsuits are increasing worldwide. Physicians are also developing defensive behaviors to avoid making medical errors and to protect themselves from these lawsuits. This study aims to compare the malpractice fears and defensive medical attitudes of family physicians in light of current demographic data, to reduce these fears of physicians, to prevent defensive medical practices that we do not want to occur, and to contribute to health policies.
Materials and Methods: In this study, demographic data form, fear of malpractice scale and defensive medicine practices attitude scale were sent digitally to 186 contracted family physicians working in Çorum province between 01.07.2024 and 30.09.2024. Physicians who approved to participate in the study were asked to fill out the data sets via Google Forms.
Results: The sample was formed by 168 (90.3%) of the 186 physicians constituting the study universe. 72% of the participants were aged 40 and over, 71% were male, and 80,4% were general practitioner family physicians. A high level of fear of malpractice was detected in 80,36% of the participants. As the fear of malpractice increases, positive defensive medicine and negative defensive medicine scores increase. As the physician's age, length of time in the profession, and length of time working at the family health center increase, the fear of malpractice, positive defensive medicine, and negative defensive medicine scores decrease. If the physician has malpractice lawsuit experience in his/her close circle or if a complaint is made, the fear of malpractice and defensive medicine scores increase. The defensive medicine attitude knowledge level of male physicians was found to be significantly higher than that of female physicians. The defensive medicine knowledge levels of physicians who follow up patients on the disease management platform and who have lawsuit experience due to malpractice or defensive medicine attitude against themselves or their close circle were found to be higher.
Conclusions: As a result of this study, a widespread and high level of fear of malpractice was found among all family physicians. When the literature is examined, it
is seen that this fear has increased over the years. It was observed that a high level of fear triggers defensive medical attitudes, and among these attitudes, detailed record keeping and more detailed explanations to patients, which have the lowest cost to the health system, are the highest. On the other hand, it was determined that physicians are greatly affected by malpractice news in the media and hesitate to make decisions based solely on their own clinical experiences.
