Publications by authors named "Tuğhan Utku"

6 Publications

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Human factors and ergonomics to improve performance in intensive care units during the COVID-19 pandemic.

Anaesthesiol Intensive Ther 2021 May 19. Epub 2021 May 19.

International Fluid Academy, Lovenjoel, Belgium.

The COVID-19 pandemic has tested the very elements of human factors and ergonomics (HFE) to their maximum. HFE is an established scientific discipline that studies the interrelationship between humans, equipment, and the work environment. HFE includes situation awareness, decision making, communication, team working, leadership, managing stress, and coping with fatigue, empathy, and resilience. The main objective of HF is to optimise the interaction of humans with their work environment and technical equipment in order to maximise patient safety and efficiency of care. This paper reviews the importance of HFE in helping intensivists and all the multidisciplinary ICU teams to deliver high-quality care to patients in crisis situations.
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http://dx.doi.org/10.5114/ait.2021.105760DOI Listing
May 2021

Factors affecting the attitudes and opinions of ICU physicians regarding end-of-life decisions for their patients and themselves: A survey study from Turkey.

PLoS One 2020 20;15(5):e0232743. Epub 2020 May 20.

Department of Medical History and Ethics, School of Medicine, Kocaeli University, Kocaeli, Turkey.

Introduction: Turkey is constitutionally secular with a Muslim majority. There is no legal basis for limiting life-support at the end-of-life (EOL) in Turkey. We aimed to investigate the opinions and attitudes of intensive care unit (ICU) physicians regarding EOL decisions, for both their patients and themselves, and to evaluate if the physicians' demographic and professional variables predicted the attitudes of physicians toward EOL decisions.

Methods: An online survey was distributed to national critical care societies' members. Physicians' opinions were sought concerning legalization of EOL decisions for terminally ill patients or by patient-request regardless of prognosis. Participants physicians' views on who should make EOL decisions and when they should occur were determined. Participants were also asked if they would prefer cardiopulmonary resuscitation (CPR) and/or intubation/mechanical ventilation (MV) personally if they had terminal cancer.

Results: A total of 613 physicians responded. Religious beliefs had no effect on the physicians' acceptance of do-not-resuscitate (DNR) / do-not-intubate (DNI) orders for terminally ill patients, but atheism, was found to be an independent predictor of approval of DNR/DNI in cases of patient request (p<0.05). While medical experience (≥6 years in the ICU) was the independent predictor for the physicians' approval of DNI decisions on patient demand, the volume of terminal patients in ICUs (between 10-50% per year) where they worked was an independent predictor of physicians' approval of DNI for terminal patients. When asked to choose personal options in an EOL scenario (including full code, only DNR, only DNI, both DNR and DNI, and undecided), younger physicians (30-39 years) were more likely to prefer the "only DNR" option compared with physicians aged 40-49 years (p<0.05) for themselves and age 30-39 was an independent predictor of individual preference for "only DNR" at the hypothetical EOL. Physicians from an ICU with <10% terminally ill patients were less likely to prefer "DNR" or "DNR and DNI" options for themselves at EOL compared with physicians who worked in ICUs with a higher (>50%) terminally ill patient ratio (p<0.05).

Conclusion: Most ICU physicians did not want legalization of DNR and DNI orders, based solely on patient request. Even if EOL decision-making were legal in Turkey, this attitude may conflict with patient autonomy. The proportion of terminally ill patients in the ICU appears to affect physicians' attitudes to EOL decisions, both for their patients and by personal preference, an association which has not been previously reported.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0232743PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7239490PMC
July 2020

Knowledge and Attitude Toward Brain Death and Organ Donation Among Anesthesiology and Reanimation Professionals.

Transplant Proc 2019 Sep;51(7):2163-2166

Department of Anaesthesiology and Reanimation, Yeditepe Medical Faculty, Istanbul, Turkey.

Purpose: We aimed to establish the basic data for the improvement of the weak points by determining the knowledge and attitude of professionals in anesthesiology and reanimation or/and intensive care, who are 50% responsible for the diagnosis of brain death.

Methods: After the approval of the ethics committee, questionnaires were sent to participants. The data were collected electronically. The questionnaire consists of 89 questions.

Results: A total of 564 (22.56%) completed questionnaires were returned. The sex distribution of the respondents was 207 (36.7%) female and 357 (63.3%) male; the mean age was 37 (SD, 7) years. Among participants, 87.2% reported needing ancillary testing for the diagnosis of brain death. Nevertheless, the rate of those who never needed ancillary testing was high among the participants who were specialized and working in hospitals covered by Erzurum RCC (31.2% and 26.7%, respectively) (P < .05). A total of 55.3% of respondents reported considering brain death and 41.9% reported considering circulatory arrest at the time of death. Participants' religious beliefs are not against to organ donation (93.4%). However, the percentage of respondents who thought that families refuse organ donation because of their religion was 84.1%. Suggestions for increasing organ transplants from deceased donors include education (54.1%), religious support (21.4%), use of media resources (25%), government support and legislative changes (10.1% and 7.6%, respectively), and education of health workers (9.4%).

Conclusion: The most important way to solve this problem is to give adequate education to main stakeholders. This is the most effective method to improve the public's behavior.
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http://dx.doi.org/10.1016/j.transproceed.2019.01.168DOI Listing
September 2019

Sedation Practices and Preferences of Turkish Intensive Care Physicians: A National Survey.

Turk J Anaesthesiol Reanim 2019 Jun 24;47(3):220-227. Epub 2019 Feb 24.

Department of Anaesthesiology and Reanimation, İstanbul University-Cerrahpaşa, Cerrahpaşa School of Medicine, İstanbul, Turkey.

Objective: Sedation is one of the most common practices applied in the intensive care units (ICUs), and the management of sedation, analgesia and delirium is a quality measure in the ICUs. Several guidelines on sedation had been published, and many surveys investigated the practices of sedation in the ICUs, but knowledge on the sedation practices in Turkey is lacking. The aim of the present study was to provide baseline knowledge on the sedation practices and preferences of Turkish intensive care physicians and to establish some points to be improved.

Methods: An electronic survey form consisting of 34 questions was generated and posted to email addresses. The survey included questions about demographics and practices on sedation, analgesia, neuromuscular blockage and delirium.

Results: Of 1700 email addresses, 429 (25.0%) were returned. Sedation was practised by 98.0% of the respondents, and mechanical ventilation was indicated as the primary indication (94.0%) for sedation. The presence of a written sedation protocol was 37.0%. For drug choices for sedation, midazolam was the most preferred agent (90.0%). With regard to pain questions, the most commonly used evaluation tool was Visual Analogue Scale (69.0%), and the most preferred drug was tramadol. Nearly half of the participants routinely evaluated delirium and used the confusion assessment method in the ICU.

Conclusion: The results of this survey have indicated some areas to be improved, and a national guideline should be prepared taking pain, agitation and delirium in focus. ClinicalTrials.gov ID: NCT03488069.
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http://dx.doi.org/10.5152/TJAR.2019.49799DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6537960PMC
June 2019

Perioperative Temperature Monitoring and Patient Warming: A Survey Study.

Turk J Anaesthesiol Reanim 2013 Oct 1;41(5):149-55. Epub 2013 Oct 1.

Department of Anaesthesiology and Reanimation, Cerrahpaşa Faculty of Medicine, İstanbul University, İstanbul, Turkey.

Objective: Hypothermia is defined as the decrease of core body temperature under 36°C. Hypothermia is observed at a rate of 50-90% in the perioperative period. In our study, we aimed to measure the perception of hypothermia in our country, to evaluate the measures taken by physicians to intercept hypothermia, to determine the frequency and the methods used to monitor body temperature and the techniques used in warming the patients. Another aim was to develop a guideline for preventing perioperative hypothermia.

Methods: The questionnaire consisted of 26 multiple-choice questions. The time needed to answer the questions was 8-10 minutes.

Results: Of the 1380 individuals, 312 (22.6%) answered the questions in the questionnaire. Of these, 148 (47.4%) declared they were working in university hospitals, 80 (25.6%) in training and research hospitals, 51 (16.4%) in government hospitals and 33 (10.6%) in various private hospitals. Of the 312 individuals, 134 (42.9%) were specialists, 107 (34.3%) were resident physicians, 71 (22.8%) were academics. In addition, 212 (67.9%) reported working in operating rooms, 49 (15.7%) in intensive care units and 42 (13.5%) both in operating rooms and intensive care units. In the answers, there was variation among the hospital types in applications of body temperature monitoring and warming the patient. Another finding was that the individuals had different approaches to the concepts on perioperative hypothermia and its consequences.

Conclusion: The perceptions of physicians and the allied health personnel in government and private hospitals should be enhanced by informing them about the passive and active heating systems to prevent hypothermia. Although the situation in university and training and research hospitals seems to be better, defects are still observed in practice. Preparation of a national guideline for prevention of perioperative hypothermia is needed.
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http://dx.doi.org/10.5152/TJAR.2013.63DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4894089PMC
October 2013

Chediak-Higashi syndrome in the intensive care unit.

Paediatr Anaesth 2004 Aug;14(8):685-8

Department of Anaesthesiology, Cerrahpasa Medical School, Istanbul University, Sadi Sun ICU, Istanbul, Turkey.

Chediak-Higashi Syndrome is a rare autosomal recessive disease characterized by recurrent infections, giant cytoplasmic granules and oculocutaneous albinism. We describe the clinical and laboratory findings of a patient with Chediak-Higashi syndrome who was diagnosed and treated in the intensive care unit because of bleeding tendency after surgery.
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http://dx.doi.org/10.1111/j.1460-9592.2004.01257.xDOI Listing
August 2004