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Öğe Accessibility to Healthcare and Risk of Polypharmacy on Chronically ill Patients(Coll Physicians & Surgeons Pakistan, 2019) Ersoy, Suleyman; Engin, Velittin SelcukObjective: To investigate the rates of polypharmacy (PP) and its relations with accessibility to health services in chronic patients in a primary care setting. Study Design: A cross-sectional study. Place and Duration of Study: Melekhatun Family Health Center, Istanbul, Turkey, from January 2014 to January 2017. Methodology: Chronically ill older adults were enrolled in the study. Patients were seen either at home or at health centre. Threshold for PP was five medications daily. Chi-square tests were applied for group comparisons of PP. Continuous variables were examined by Student's t-test. Logistic regressions followed. Results: Study population (n= 707) consisted of 442 female (62.5%) and 265 male (37.5%) subjects. Mean age was 73.6 +/- 7.1 years. Mean number of medicine used per day was 4.7 +/- 3.5. Polypharmacy rate was 32.8%. Although the number of chronic diseases, that at home patients had, was significantly higher, outpatients had 1.92 times higher risk for PP. Similarly, risk for PP was found 2.57-fold higher in insured patients. Conclusion: Univariate results of this study suggests that accessibility to health services also increases PP risk, in addition to known risk factors such as female gender, depression and chronic diseases. Same results draw our attention to the risk of inadequate treatment in those who lack health insurance. Longitudinal studies in larger scale are needed for further assessment of these relationships.Öğe Effectiveness of STOPP/START criteria in primary prevention of polypharmacy and under-treatment in older patients(Elsevier, 2022) Pala, Emin; Ersoy, Suleyman; Engin, Velittin Selcuk; Benli, Ali RamazanAim of the study. - STOPP/START criteria appear to be a useful tool to curb inappropriate prescribing (IP), which encompasses errors of both, over and under-treatment. This study aimed to find out whether application of STOPP/START reduces the IP effectively in primary care. Methods. - This prospective cross-sectional study was conducted in two family health centers (FHCs) in Istanbul. All older adults who applied to FHCs between 01-07-2018 and 01-072020 were enrolled. The potential inappropriate medications (PIMs) and potential prescription omissions (PPOs) were identified according to STOPP/START version 2 criteria. Mean drug consumptions before and after STOPP/START were compared using Student's t-test. Results. - Among 1023 participants there were 626 females and 397 males. The mean age was 73.33 +/- 7.30 years. The number of the patients seen at FHCs was 657 (64.2%) while 366 (35.8%) of them were visited at home. Of the patients, 383 (37.8) were 75 years old or older and 631 (62.2%) of them were under 75. Overall number of drugs consumed per patient was 5.49 +/- 3.93 while it was 6.01 +/- 3.71 and 4.55 +/- 4.138 for outpatients and home patients respectively (p < 0.001). By application of STOPP criteria, among the 5616 medications consumed by the overall patients, 881(%15.6) of them were found to be potentially inappropriate. 424 (41.4%) patients were using at least one PIM. This ratio was 354 (53.8%) in outpatients and 70 (19%) in home patients. START criteria identified 380 (%7.4) PPOs. There were 246 (24.0%) patients at least with one PPO; 155 (42.3%) of whom were home patients and 91 (13.8%) were outpatients. Regarding the age groups; PIM ratio was 35.5% in patients under 75 and 52.1% over 75 whereas PPO ratio was 22.5% under 75 and 26.8% over 75. Conclusion. - This study supports the data reporting the effectiveness of STOPP/START criteriain primary care units in implementing appropriate prescription criteria. (C) 2021 Societe francaise de pharmacologie et de therapeutique. Published by Elsevier MassonSAS. All rights reserved.Öğe Investigation of wet cupping therapy's effect on oxidative stress based on biochemical parameters(Elsevier Science Inc, 2019) Ersoy, Suleyman; Altinoz, Eyup; Benli, Ali Ramazan; Erdemli, Mehmet Erman; Aksungur, Zeynep; Bag, Harika Gozukara; Engin, Velittin SelcukIntroduction: Wet cupping therapy is one of the main applications which has been used in the Unani medicine system. Current literature explaining how this traditional treatment method works is still limited. The aim of this study was to investigate whether wet cupping therapy could affect reactive oxygen species and antioxidant levels. Methods: This was a single arm pre and posttest intervention study conducted in Karabuk University Teaching and Research Hospital (KUTRH) between 1st January and 1st May 2018. Twenty-four participants were included. Wet Cupping Therapy was applied to all individuals once every month for three months. Venous blood samples were collected before the first (Venousl) and after the last application (Venous 2) and cupping blood samples were collected during the first and last applications. Malondialdehyde (MAD) and total oxidant status (TOS) which both indicate oxidation; glutathione (GSH), superoxide dismutase (SOD), total antioxidant status (TAS), catalase (CAT) activities that indicate antioxidant effect, and protein levels were measured on the obtained serums. Results: The highest MDA and TOS levels and the lowest TAS, GSH, SOD and CAT levels were found in initial cupping blood. Significant improvement was observed in second cupping blood for these parameters when compared to initial values. We also found that MDA and TOS levels, as well as TAS, GSH, SOD and CAT levels, all changed favorably in the Venous 2 blood sample compared to the Venous 1 (p < 0.001). Conclusion: Wet cupping therapy seems a promising method for increasing antioxidant levels and curbing oxidative stress.Öğe Risk factors for polypharmacy in older adults in a primary care setting: a cross-sectional study(Dove Medical Press Ltd, 2018) Ersoy, Suleyman; Engin, Velittin SelcukPurpose: Polypharmacy (PP) is a clinical challenge in older adults. Therefore, assessment of daily drug consumption (DDC) and its relationships is important. First-line health services have a crucial role in monitoring and prevenfmg PP. In this study, we aimed to assess DDC and investigate the risk factors for higher DDC among older adults in a pi-Unary care setting. Patients and methods: A total of 1,000 patients aged 65 years who visited Melek Ilatun Family Practice Center between December I, 2014, and August 1, 2017, were enrolled in the study. All patients were seen either at the center or in their homes, and informed consent was obtained. Comprehensive geriatric assessment was performed for each subject. Data were analyzed using SPSS software (version 17). The daily number of medicines that each patient used (DDC) regardless of whether they were prescribed was the dependent variable. Relationships between DDC and other continuous variables were examined using Pearson's correlation. For between-group comparisons of DDC, Student's i-tests were performed. Results: Univariate tests showed relationships between DDC and various demographic and clinical parameters. The variables that remained significant at the last step of a stepwise linear regression analysis were metabolic syndrome, chronic NM, incontinence, increased serum creatinine level, increased Geriatric Depression Scale scores, reported gastric disturbances, and neutrophil lymphocyte ratio. Conclusion: Along With certain chronic conditions, depressive symptoms and an inflammatory marker (neutrophillymphocyte ratio) significantly and independently related to higher DDC. Longitudinal and larger studies are ceded to further explore the multifaceted relationships of PP.Öğe Statistical concerns about the study: Risk factors for polypharmacy in older adults in a primary care setting: a cross-sectional study reply(Dove Medical Press Ltd, 2018) Ersoy, Suleyman; Engin, Velittin Selcuk[No abstract available]
