Person: ARSLANTAŞ, MUSTAFA KEMAL
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ARSLANTAŞ
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MUSTAFA KEMAL
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Publication Open Access Reduction of nosocomial infections in the intensive care unit using an electronic hand hygiene compliance monitoring system(2021-12-01) GÜL, FETHİ; YAKUT, NURHAYAT; BİLGİLİ, BELİZ; KASAPOĞLU, UMUT SABRİ; ARSLANTAŞ, MUSTAFA KEMAL; KEPENEKLİ KADAYİFCİ, EDA; Akkoc G., Soysal A., GÜL F., KEPENEKLİ KADAYİFCİ E., Arslantas M. K., Yakut N., BİLGİLİ B., Demir S. O., Haliloglu M., Kasapoglu U. S., et al.Introduction: Healthcare-associated infection is an important cause of mortality and morbidity worldwide. Well-regulated infection control and hand hygiene are the most effective methods for preventing healthcare-associated infections. This study evaluated and compared conventional hand hygiene observation and an electronic hand-hygiene recording and reminder system for preventing healthcare-associated infections. Methodology: This pre-and post-intervention study, employed an electronic hand-hygiene recording and reminder system for preventing healthcare-associated infections at a tertiary referral center. Healthcare-associated infection surveillance was recorded in an anesthesia and reanimation intensive care unit from April 2016 to August 2016. Hand-hygiene compliance was observed by conventional observation and an electronic recording and reminder system in two consecutive 2-month periods. healthcare-associated infections were calculated as incidence rate ratios. Results: The rate of healthcare-associated infections in the electronic hand-hygiene recording and reminder system period was significantly decreased compared with that in the conventional hand-hygiene observation period (incidence rate ratio = 0.58; 95% confident interval = 0.33-0.98). Additionally, the rate of central line-associated bloodstream infections and the rate of ventilator-associated pneumonia were lower during the electronic hand hygiene recording and reminder system period (incidence rate ratio= 0.41; 95% confident interval = 0.11-1.30 and incidence rate ratio = 0.67; 95% confident interval = 0.30-1.45, respectively). Conclusions: After implementing the electronic hand hygiene recording and reminder system, we observed a significant decrease in healthcare-associated infections and invasive device-associated infections. These results were encouraging and suggested that electronic hand hygiene reminder and recording systems may reduce some types of healthcare-associated infections in healthcare settings.Publication Open Access The effects of pneumoperitoneum and patient position on the perfusion index and pleth variability index during laparoscopic bariatric surgery(MARMARA UNIV, FAC MEDICINE, 2020-03-31) ARSLANTAŞ, MUSTAFA KEMAL; Arslantas, Reyhan; Arslantas, Mustafa Kemal; Tore Altun, Gulbin; Corman Dincer, PelinObjective: Limited data are available on the use of the perfusion index (PI) and the pleth variability index (PVI) during laparoscopic bariatric suigery. We investigated the effects of pneumoperitoneum and the reverse Trendelenburg position on these indices. Materials and Methods: PI, PVI, heart rate (HR), blood pressure, SpO(2) and ventilation parameters were recorded before anaesthesia induction (T0), 5 min after endotracheal intubation (T1), immediately before surgery, after the patient had been in the reverse Trendelenburg position for 5 min (T2), after inflating the abdomen with CO2 in reverse Trendelenburg (T3), after the abdomen had been deflated (T4) and 5 min after extubation (T5). Results: General anaesthesia induced an increase in the PI (P<.001), and a decrease in the PVI (P=.002). The PI and PVI values were not affected during T2 or T3. Pneumoperitoneum caused an increase in mean arterial pressure (MAP) and a decrease in HR. PVI and MAP decreased during 14, but the PI and IHR remained unchanged. PVI, HR and MAP increased during T5. Conclusion: Our data suggest that the reverse Trendelenburg position and pneumoperitoneum did not affect the PI or PVI values, whereas deflation decreased the PVI in morbidly obese patients under general anaesthesia.Publication Open Access Factors affecting the attitudes and opinions of ICU physicians regarding end-of-life decisions for their patients and themselves: A survey study from Turkey(PUBLIC LIBRARY SCIENCE, 2020-05-20) ARSLANTAŞ, MUSTAFA KEMAL; Baykara, Nur; Utku, Tughan; Alparslan, Volkan; Arslantas, Mustafa Kemal; Ersoy, NerminIntroduction 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.Publication Open Access Dental follicle mesenchymal stem cells regulate responses in sepsis(MARMARA UNIV, FAC MEDICINE, 2020-01-31) GÜL, FETHİ; Gul, Fethi; Genc, Deniz; Arslantas, Mustafa Kemal; Zibandeh, Noushin; Topcu, Leyla; Akkoc, Tunc; Cinel, IsmailObjective: Sepsis-induced immune alterations are associated with secondary infections and increased risk of death. The use of mesenchymal stern cells (MSCs) has been described as a novel therapeutic strategy. We evaluated the immunomodulatory effects of human dental follicle (DF-MSCs) on lymphocytes of sepsis and septic shock patients. Materials and Methods: Peripheral blood mononuclear cells (PBMCs) were isolated from venous blood samples of sepsis, septic shock and healthy subjects. PBMCs were co-cultured in the presence and absence of DF-MSCs with or without interferon-gamma (IFN-gamma) for 72 hours. CD4+CD25+FoxP3+regulatory T (Treg) cell frequency, lymphocyte proliferation, cytokine levels and apoptosis were evaluated via flow cytometry. Results: DF-MSCs significantly suppressed proliferation of lymphocytes in sepsis group compared to septic shock group (p<0.005). DP-MSCs remarkably increased Treg ratio in sepsis compared to control group (p<0.05). Reduction of lymphocyte apoptosis in cocultures of DF-MSCs and PBMC was significant in both sepsis and septic shock groups. IFN-gamma stimulation of DF-MSCs ameliorated shift in the T-cell subsets from Th2 to Th1 phenotype in septic shock. Conclusion: Our findings revealed that DEL MSCs have immunoregulatory effects both in sepsis and septic shock, by reducing interleukin-4 (IL-4) and increasing IFN-gamma levels. This immunoreactivity regulation may open new therapeutic approaches for septic shock patients.