Deneysel sepsis modelinde oksidan-antioksidan sistem ve akciğer histopatolojisi üzerine okterotidin doza bağımlı etkileri
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2006
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info:eu-repo/semantics/openAccess
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Acil Tıp alanında çalışan doktorların medikolegal endişeler, tükenmişlik, anksiyete durumları ve iş tatmini düzeylerinin yaş, cinsiyet, çalışma süresi, görev ünvanı ve çalışılan kuruma göre olası farklılıklarını ortaya koymak amacıyla yapılmıştır. Gereç ve Yöntemler Araştırma evrenini Türkiye' deki acil tıp kliniklerinde görev ünvanı pratisyen, asistan, uzman hekim ve öğretim üyesi olan doktorlar oluşturdu. Araştırma Eylül 2018- Ocak 2019 tarihleri arasında gerçekleştirildi. Verilerin toplanması için anketle bilgi toplama tekniği kullanıldı. Anketi tamamen dolduran toplam 141 Hekim çalışma popülasyonuna dâhil edildi. Anket kişisel bilgi formu, medikolegal endişeler anketi, Maslach Tükenmişlik Ölçeği, Durumluk- Süreklilik Anksiyete Ölçeği, Minnesota İş Doyum Ölçeği olmak üzere 5 ayrı bölümden oluşuyordu. Kişisel Bilgi Formu'nda hekimlerin; yaş, cinsiyet, çalışma süresi, görev ünvanı, çalışılan kurum konusunda bilgiler soruldu. Hekimler tarafından medikolegal endişeleri değerlendirmek için 29 sorudan oluşan "Medikolegal Endişeler Anketi" dolduruldu. Tükenmişlik düzeyini belirlemek için, Maslach tarafından geliştirilen Maslach Tükenmişlik Ölçeği (MTÖ), anksiyete düzeyini ölçmek için Durumluk-Süreklilik Anksiyete Ölçeği (STAI), iş tatminini ölçmek için Minnesota İş Doyum Ölçeği' nin kısa formu kullanıldı. Ayrıca çalışma populasyonu cinsiyet, çalışılan kurum, görev unvanı, yaş ve çalışılan hizmet süresi ortalamasına göre alt gruplara ayrıldı. Alt grup analizleri bu gruplar arasında yapıldı. Bu çalışma da değerlendirilen medikolegal endişeler anketi ile acil tıp hekimlerin malpraktis konusunda oldukça endişeli olduğu, komplikasyon- malpraktis ayrımının yapılamadığına inandıkları, onam formlarının ve yapılan tıbbi malpraktis sigortasının onları sorumluluktan kurtarmadığını, medikolegal endişeler ile çoğunlukla fazladan tetkik ve konsültasyon istediklerini, hastalara uygulamaları daha detaylı açıkladıkları, kayıtlar ve onam formlarının alınmasına daha çok özen gösterdikleri, dava riski ve mobbing uygulamasına maruz kaldıklarını, hekimlerin büyük oranda yurtdışına göç, mesleği bırakma veya değiştirme düşüncesinde olduklarını, yaptıkları uygulamalar ve tedaviler için güvende hissetmediklerini ortaya koymaktadır. Aynı zamanda bu cevaplara rağmen hastayla ilgili takip, tedavi planlaması, yatış ve sevk gibi konularda gerekli olan prosedürleri gerektiği gibi uyguladıklarını göstermektedir. Ayrıca STAI anksiyete ölçeğinin durumluk anksiyete ve sürekli anksiyete skorları düşük/ orta derece anksiyete varlığı, Minnesota İş Tatmini Ölçeği' ne göre dışsal iş tatminin düşük olduğu, Maslach "duygusal tükenmişlik" oranı yüksek derecede; Maslach "duyarsızlaşma" oranı orta derecede, Maslach "kişisel başarı hissinde azalma" duygusunun orta derecede olduğu saptandı. Bu skorların cinsiyet ve çalışılan kurum ile farklılık göstermediği belirlendi. Özellikle Maslach tükenmişlik parametrelerinin görev unvanı, yaş ve çalışılan görev yılı ile ilişkili olduğu, yaşı genç olan ve daha az tecrübeli olan asistan ve pratisyen hekimlerde, tükenmişliğin daha yüksek olduğu tespit edildi. Ayrıca duygusal tükenme, duyarsızlaşma, durumluk ve sürekli anksiyetenin artması ile genel, içsel ve dışsal iş tatmininin anlamlı düzeyde azaldığı tespit edildi. Sonuçlar Elde ettiğimiz sonuçlar nedeniyle gerekli hukuksal değişiklikler yapılarak ülkemiz acil tıp doktorlarının çalışma ve nöbet saatlerinin hekimleri yıpratmayacak şekilde düzenlenmesi, yeterli hekim sayısı ile hizmet verilmesi, yapılan işe karşılık uygun ücret verilmesi, hekimler üzerindeki mobbing uygulaması ve dava riskinin azaltılması, hastane öncesinde etkin triaj ile hasta yükünün azaltılabilmesi, acil bakım ve müdahale ihtiyacı olmayan hastaların acile yönlendirilmesinin engellenmesi ile medikolegal endişelerin azalabileceği, tükenmişlik ve anksiyetenin azalarak, iş doyumunun artacağı kanaatindeyiz. Ayrıca bu çalışmada elde edilen sonuçların bulgularının hem Türkiye' de hem de diğer ülkelerde daha önce yapılan çalışmalarla uyuşmasına rağmen, aynı zamanda oldukça farklı sonuçların olduğu gözlemlenmiştir. Bu nedenle, bu çalışmadan elde edilen bulgular, konuyla ilgili önceki çalışmalardan elde edilen çeşitli sonuçlar ışığında değerlendirilmelidir. Bu nedenle, burada incelenen ilişkileri daha iyi anlamak için ek çalışmalara ihtiyaç olduğu kanaatindeyiz.
This research was made to present possible differences in medicolegal concerns, burnout, anxiety conditions and job satisfaction levels of doctors working in Emergency Medicine, considering age, gender, institution, title and duration of employment. Material and Methods Doctors working in emergency medicine departments in Turkey with general practitioner, assistant, specialist and assistant professor titles constituted the population of the study. The research was made between September 2018 and January 2019. Data was gathered through questionnaire. A total of 141 doctors who completed the questionnaire were included in the study. The questionnaire included five different sections as personal data form, medicolegal concerns questionnaire, Maslach Burnout Inventory, State-Trait Anxiety Inventory and Minnesota Job Satisfaction Scale. Age, gender, institution, title and duration of employment of the doctors were questioned through Personal Data Form. Doctors filled in "Medicolegal Concerns Questionnaire" including 29 questions to evaluate medicolegal concerns. Maslach Burnout Inventory (MBI) of Maslach to determine burnout level, State-Trait Anxiety Inventory (STAI) to measure anxiety level and short form of Minnesota Job Satisfaction Scale to measure job satisfaction were used. The study population was also divided into sub groups based on gender, institution, title and duration of employment and age. Sub group analyses were made among these groups. Results Medicolegal concerns questionnaire evaluated in this study showed that emergency medicine doctors are quite concerned about malpractice, believed there was no distinction in complication - malpractice, consent forms and medical malpractice insurance didn't take away their responsibilities, they generally demanded extra examinations and consultations due to medicolegal concerns, explained the applications to the patients in more detail, cared more about taking on interventions and consent forms, were exposed to mobbing, most of them thought about immigrating or leaving or changing their profession, didn't feel safe about the applications and treatments they make and applied the required procedures on patient follow-up, treatment planning, hospitalization and transfer as they should despite these answers they provided. It was also detected that STAI anxiety scale, state anxiety and trait anxiety scores showed presence of low/average degree of anxiety, external job satisfaction was low based on Minnesota Job Satisfaction Scale, Maslach "emotional exhaustion" ratio was high, Maslach "desensitization" ratio and Maslach "reduced sense of personal accomplishemnt" were average. No difference was detected in these scores based on gender and the institution of employment. It was detected that especially Maslach burnout parameters were related to age, title and duration of employment and burnout was higher in residents and general practitioners who are younger and have less experience. A significant decrease was also detected in general, inner and external job satisfaction with the increase in emotional exhaustion, desensitization and state and trait anxiety levels. Conclusions Due to the conclusions we acquired, through the required legal changes, we think that medicolegal concerns may decrease by arranging the working and shift hours of emergency medicine doctors in our country so that they wouldn't have burn out problem, providing service with adequate number of doctors, giving suitable salary for the work done, decreasing the risk of mobbing and legal action on doctors, decreasing the patient load through an active prehospital triage and preventing the emergency department referral of patients not requiring emergency care and intervention and we also think that job satisfaction would increase by decreasing burn-out and anxiety. It was also observed that, although the findings of this study are in line with previous studies made both in Turkey and other countries, there were also quite different results. So, the findings acquired from this study should be evaluated in the light of different results acquired from previous studies on the subject. Thus, we think that additional studies are required to better understand the connections examined here.
This research was made to present possible differences in medicolegal concerns, burnout, anxiety conditions and job satisfaction levels of doctors working in Emergency Medicine, considering age, gender, institution, title and duration of employment. Material and Methods Doctors working in emergency medicine departments in Turkey with general practitioner, assistant, specialist and assistant professor titles constituted the population of the study. The research was made between September 2018 and January 2019. Data was gathered through questionnaire. A total of 141 doctors who completed the questionnaire were included in the study. The questionnaire included five different sections as personal data form, medicolegal concerns questionnaire, Maslach Burnout Inventory, State-Trait Anxiety Inventory and Minnesota Job Satisfaction Scale. Age, gender, institution, title and duration of employment of the doctors were questioned through Personal Data Form. Doctors filled in "Medicolegal Concerns Questionnaire" including 29 questions to evaluate medicolegal concerns. Maslach Burnout Inventory (MBI) of Maslach to determine burnout level, State-Trait Anxiety Inventory (STAI) to measure anxiety level and short form of Minnesota Job Satisfaction Scale to measure job satisfaction were used. The study population was also divided into sub groups based on gender, institution, title and duration of employment and age. Sub group analyses were made among these groups. Results Medicolegal concerns questionnaire evaluated in this study showed that emergency medicine doctors are quite concerned about malpractice, believed there was no distinction in complication - malpractice, consent forms and medical malpractice insurance didn't take away their responsibilities, they generally demanded extra examinations and consultations due to medicolegal concerns, explained the applications to the patients in more detail, cared more about taking on interventions and consent forms, were exposed to mobbing, most of them thought about immigrating or leaving or changing their profession, didn't feel safe about the applications and treatments they make and applied the required procedures on patient follow-up, treatment planning, hospitalization and transfer as they should despite these answers they provided. It was also detected that STAI anxiety scale, state anxiety and trait anxiety scores showed presence of low/average degree of anxiety, external job satisfaction was low based on Minnesota Job Satisfaction Scale, Maslach "emotional exhaustion" ratio was high, Maslach "desensitization" ratio and Maslach "reduced sense of personal accomplishemnt" were average. No difference was detected in these scores based on gender and the institution of employment. It was detected that especially Maslach burnout parameters were related to age, title and duration of employment and burnout was higher in residents and general practitioners who are younger and have less experience. A significant decrease was also detected in general, inner and external job satisfaction with the increase in emotional exhaustion, desensitization and state and trait anxiety levels. Conclusions Due to the conclusions we acquired, through the required legal changes, we think that medicolegal concerns may decrease by arranging the working and shift hours of emergency medicine doctors in our country so that they wouldn't have burn out problem, providing service with adequate number of doctors, giving suitable salary for the work done, decreasing the risk of mobbing and legal action on doctors, decreasing the patient load through an active prehospital triage and preventing the emergency department referral of patients not requiring emergency care and intervention and we also think that job satisfaction would increase by decreasing burn-out and anxiety. It was also observed that, although the findings of this study are in line with previous studies made both in Turkey and other countries, there were also quite different results. So, the findings acquired from this study should be evaluated in the light of different results acquired from previous studies on the subject. Thus, we think that additional studies are required to better understand the connections examined here.
Açıklama
Anahtar Kelimeler
Anahtar Kelimeler: Medikolegal Endişeler, Tükenmişlik, Anksiyete, İş tatmini, Acil Tıp, Keywords: Medicolegal Concerns, Burnout, Anxiety, Job satisfaction, Emergency Medicine, Medikolegal Endişeler, Medicolegal Concerns, Tükenmişlik, Anksiyete, Anxiety, İş tatmini, Acil Tıp, Emergency Medicine, Job satisfaction, Burnout
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Künye
Sönmez, L. Ö. (2006). Deneysel sepsis modelinde oksidan-antioksidan sistem ve akciğer histopatolojisi üzerine okterotidin doza bağımlı etkileri. (Yayınlanmamış tıpta uzmanlık tezi) Necmettin Erbakan Üniversitesi, Meram Tıp Fakültesi Dahili Tıp Bilimleri Acil Tıp Anabilim Dalı, Konya.
