INTRODUCTION: Consultation-related delays contribute to emergency department (ED) crowding, especially for internal medicine referrals. The 5C consultation model provides a structured communication framework that may improve consultation efficiency when embedded in digital systems.
METHODS: This single-center quasi-experimental pre-post study was conducted in the ED of a tertiary-care hospital with approximately 450,000 annual visits. Internal medicine consultations requested from yellow-zone observation units were compared before (July 1-10, 2023) and after (July 20-30, 2023) implementation of a structured digital consultation form based on four 5C elements (Contact, Communicate, Core Question, Closing the Loop) following a 40-minute resident training session. The primary outcome was consultation-to-decision time..
RESULTS: Fifty-four emergency medicine residents generated 194 pre-intervention and 141 post-intervention consultations. Median consultation-to-decision time decreased from 65 minutes (IQR 40-112) to 44 minutes (IQR 28-69; p<0.001). Consultation response time and final decision time also decreased significantly (both p<0.001). Total ED LOS remained unchanged (median, 15 hours in both periods; p=0.772). Repeat consultations were less frequent after the combined intervention (p=0.035).
DISCUSSION AND CONCLUSION: The four-component 5C-derived model digital consultation form combined with targeted resident training was associated with shorter consultation-related decision intervals and fewer repeat internal medicine consultations without changing overall ED LOS. These preliminary findings suggest that digitizing structured communication may improve workflow efficiency, though multicenter randomized trials are required to confirm these effects..

INTRODUCTION: Post-viral alopecia is a prevalent sequela of SARS-CoV-2 infection, yet its biochemical correlates remain poorly defined. This study aimed to elucidate the hematological and metabolic parameters associated with hair loss in patients with a history of COVID-19 compared to unexposed controls.
METHODS: This retrospective case-control study included 366 adult outpatients presenting with alopecia (101 with prior SARS-CoV-2 infection; 265 without). Comprehensive clinical and laboratory data, encompassing blood counts, biochemical panels, and thyroid indices, were evaluated. Data were subjected to univariate and multivariable logistic regression models. A stringent Bonferroni correction.
RESULTS: Univariate comparisons revealed significantly elevated serum iron, AST, and MCV levels, alongside altered thyroid profiles in the COVID-19 (+) cohort (p < 0.05). However, following multivariable adjustment for baseline confounders, notably a paradoxically higher chronic comorbidity burden in the control group, the initial significance of these parameters was attenuated. Serum iron remained a robust, strictly hypothesis-generating, associative marker (p < 0.001), whereas TSH showed a marginal trend (p = 0.058).
DISCUSSION AND CONCLUSION: The biochemical footprint of post-COVID-19 hair loss highlights altered iron homeostasis rather than sustained, broad-spectrum systemic inflammation. While our findings are hypothesis-generating rather than mechanically definitive due to the retrospective design, they underscore the clinical utility of targeted metabolic screening in primary care to optimize post-viral alopecia management.

INTRODUCTION: This study aimed to examine pediatric subspecialists' experiences, perceptions, and clinical decision-making processes regarding the vaccination of high-risk children using a qualitative approach, thereby identifying the individual and systemic factors influencing this process.
METHODS: In this qualitative study, semi-structured in-depth interviews were conducted with physicians from different pediatric subspecialties working at a tertiary education and research hospital in Ankara, Türkiye. The interviews were audio-recorded, transcribed, and the data were analyzed using thematic analysis methods.
RESULTS: Seventeen pediatric subspecialists were included in this study. The analysis identified seven main themes: (1) risk group vaccination perception and clinical framework, (2) vaccine prioritization and clinical priorities, (3) clinical decision-making process and uncertainties, (4) institutional structures and systemic functioning, (5) communication with families and vaccine hesitancy, (6) access, reimbursement, and logistical issues, and (7) training needs and development recommendations. Participants defined the risk group as a dynamic and specialty-specific concept and emphasized influenza, pneumococcal, and meningococcal vaccines as vital priorities. Differences between guidelines and patient-based clinical variability create significant uncertainties in decision-making.
DISCUSSION AND CONCLUSION: The results reveal that the vaccination of at-risk children should not be left to individual physician initiative; rather, a structured healthcare system approach is necessary, coordinated by units specializing in preventive healthcare services, such as social pediatrics, and supported by standard algorithms, free access policies, and integrated electronic record systems.

INTRODUCTION: Environmental trace element exposure has been proposed as a modifiable risk factor for type 2 diabetes mellitus (DM), but findings are inconsistent. We examined associations between urinary and blood trace elements and DM, and their sensitivity to model specification.
METHODS: We analysed 1,486 adults aged 20 years or older from the 2013–2014 NHANES cycle. DM was defined by American Diabetes Association criteria. Seventeen urinary and five blood elements were measured by mass spectrometry. Groups were compared using Mann–Whitney U and chi-square tests with Benjamini–Hochberg correction. Log-transformed concentrations were entered into logistic regression models adjusted for age, sex, body mass index, race/ethnicity, socioeconomic position, smoking, hypertension, and kidney disease, fitted with and without complex survey weights. Odds ratios (OR) are reported per interquartile-range increase.
RESULTS: DM prevalence was 13.7%. In adjusted models (n=1,388), urinary arsenous acid was inversely associated with DM (OR 0.55, 95% CI 0.36–0.86, p=0.008); this persisted under the survey design (OR 0.47, 0.30–0.72, p<0.001) and after creatinine adjustment. Urinary cadmium, strongly associated when age was omitted (OR 1.56, 1.17–2.07, p=0.002), showed no association after adjustment for age (OR 0.89, 0.65–1.23, p=0.481). Blood selenium was associated in the unweighted analysis (OR 1.26, p=0.020) but not in the weighted analysis; urinary tin and molybdenum were only associated under the survey design.
DISCUSSION AND CONCLUSION: The cadmium–DM association was fully attributable to age confounding, and arsenous acid showed an inverse rather than positive association. Such associations are highly sensitive to model specification; adequate age adjustment and use of the complex survey design are essential in NHANES-based analyses.

INTRODUCTION: Pediatric emergencies are relatively uncommon in prehospital care, but they may cause considerable stress among healthcare providers because of limited exposure, high perceived clinical risk, and age-specific management requirements. This study aimed to evaluate perceived stress during pediatric patient care among prehospital healthcare providers and to examine its relationship with perceived knowledge, clinical self-confidence, pediatric case exposure, and perceived team support.
METHODS: This cross-sectional questionnaire-based study included prehospital healthcare providers working in Ankara Provincial Emergency Medical Services. The online questionnaire was distributed to 312 eligible providers, and 187 participants were analyzed, yielding a response rate of 59.9%. Data were collected using an anonymous questionnaire covering sociodemographic and professional characteristics and five Likert-type subscales. Internal consistency was assessed using Cronbach’s alpha. Since subscale scores were not normally distributed, Spearman correlation analysis was used to examine relationships between variables.
RESULTS: The mean perceived stress score was 3.19±1.10, indicating a moderate-to-high level of stress. Overall, 48.1% of participants had high perceived stress scores. Perceived stress was negatively correlated with perceived knowledge, clinical self-confidence, and pediatric case exposure. Team support had the highest mean score among the subscales but was not directly correlated with perceived stress. More than half of the participants reported exposure to only 0–5 pediatric cases during the previous year.
DISCUSSION AND CONCLUSION: The mean perceived stress score was 3.19±1.10, indicating a moderate-to-high level of stress. Overall, 48.1% of participants had high perceived stress scores. Perceived stress was negatively correlated with perceived knowledge, clinical self-confidence, and pediatric case exposure. Team support had the highest mean score among the subscales but was not directly correlated with perceived stress. More than half of the participants reported exposure to only 0–5 pediatric cases during the previous year.

INTRODUCTION: This study aimed to evaluate family medicine specialty theses in Türkiye (2015–2024) in terms of institutional contribution, author sex distribution, and topic trends.
METHODS: The Council of Higher Education National Thesis Center (YÖKTEZ) was searched using filters “Family Medicine” (department), “Medical Specialty Thesis” (type), and “Permitted” (access) for 01 Jan 2015–31 Dec 2024. After excluding non-eligible/duplicate/non-accessible records, 4,715 theses were included. Year, institution type (University of Health Sciences (UHS) vs other universities), author sex (inferred from names where possible), and topic categories were assigned using a predefined title-based thematic framework. Chi-square tests were applied; p<0.05 was considered significant.
RESULTS: Overall, 64.2% of theses were authored by females (n=3,024) and 35.8% by males (n=1,691). UHS accounted for 45.8% (n=2,160) and other universities for 54.2% (n=2,555); sex distribution did not differ by institution type (p=0.075). The annual number of theses increased from 115 in 2015 to 767 in 2024 and reached its highest level in 2023 with 839 theses. The UHS share exceeded 50% after 2022, rising from 16.5% in 2015 to 53.0% in 2022, 53.3% in 2023, and 50.2% in 2024. The most common topic was primary care practice (25.9%, n=1,223), followed by attitudes/perceptions/approaches (9.3%, n=440) and infectious diseases (8.2%, n=387). Primary care practice remained the leading topic throughout the study period, although its annual proportion varied significantly from 27.8% in 2015 to 18.9% in 2019 and 29.3% in 2024 (p<0.001). Significant year-by-year changes were observed for primary care practice (p<0.001), infectious diseases (p<0.001), and other clinical topics (p<0.001). Infectious diseases showed a pandemic-period increase, rising from 4.6% in 2020 to 13.7% in 2021 and 13.5% in 2022, before decreasing to 3.8% in 2024. Knowledge/awareness topics increased from 0.9% in 2015 to 5.4% in 2023 and 3.8% in 2024 (p=0.041). Other clinical topics increased from 0% in 2015–2016 to 5.9% in 2024 (p<0.001). Linear regression showed a significant increase in annual thesis production (β=84.92, 95% CI=66.07–103.76, R²=0.931, p<0.001). Infectious disease-related theses were more frequent in the pandemic/post-pandemic period than in the pre-pandemic period (OR=1.56, 95% CI=1.20–2.02, p<0.001).
DISCUSSION AND CONCLUSION: Between 2015 and 2024, family medicine thesis production increased, female authorship remained predominant, UHS contributed increasingly, and topic patterns demonstrated statistically significant, albeit proportionally modest, shifts—particularly during the pandemic period. These findings demonstrate both a quantitative expansion in thesis production and significant temporal changes in institutional and thematic patterns in family medicine specialty theses in Türkiye.

INTRODUCTION: Diabetes Mellitus (DM) is a common non-communicable disease globally. Since children spend a significant amount of time at school, collaboration with school staff is essential for managing both emergencies and long-term complications related to DM. Therefore, assessing the knowledge level of school staff about DM is of great importance. This study aimed to develop a Diabetes Mellitus Knowledge Scale (DM-KS) and to conduct its validity and reliability analysis among teachers.
METHODS: This methodological study was carried out with 379 teachers working under the Altındağ District National Education Directorate during the 2022–2023 academic year. The DM-KS consists of 23 items. Validity was assessed through content validity, item analysis, and exploratory factor analysis (EFA), supported by intergroup differentiation. Reliability was evaluated using Cronbach’s alpha coefficient. Statistical analyses included Mann-Whitney U and Kruskal-Wallis tests.
RESULTS: The DM-KS comprises two subscales: “DM General Information and Symptoms” (11 items) and “DM Treatment and Complication Management” (12 items). Item difficulty indices ranged between 0.37 and 0.84, and discrimination coefficients ranged between 0.40 and 0.91. According to EFA, four items were excluded due to overlapping factors, and the factor loadings of the remaining items ranged from 0.39 to 0.76. The explained variances of subscales 1 and 2 were 38.2% and 41.4%, respectively. Cronbach’s alpha values were 0.84-0.87. Participants who had received training scored significantly higher in both subscales.
DISCUSSION AND CONCLUSION: The DM-KS is a valid and reliable instrument and may be further refined in future studies involving different groups.

INTRODUCTION: This study aimed to evaluate levels of social media addiction and obesity awareness among children aged 10–14, examine their relationship, and identify factors affecting both conditions within a primary care context.
METHODS: : An analytical cross-sectional study was conducted with 228 children aged 10–14 years who attended central secondary schools in a district in Türkiye. Those who agreed to participate in the survey were asked to complete a Personal Information Form to record their socio-demographic characteristics, as well as the Social Media Addiction Scale for Adolescents(SMAS-A) and the Obesity Awareness Scale(OAS). Approval for the study was obtained from the Ankara City Hospital Ethics Committee (approval number: E1-22-2566).
RESULTS: Among the participants, 23.2% were overweight, 10.1% were obese, and the mean daily social media use was 128.88 minutes. Social media addiction levels were low (18.20±7.54), while obesity awareness was high (56.39±7.76). A weak but statistically significant negative correlation was found between social media addiction and obesity awareness. In multivariable linear regression analysis, social media addiction scores remained independently associated with obesity awareness. While no significant association was found between BMI and social media addiction, a weak negative association was observed between BMI and obesity awareness. Regular exercise was significantly associated with both scale scores. A positive significant correlation was detected between daily social media use and addiction scores, whereas a negative significant correlation was found with obesity awareness.
DISCUSSION AND CONCLUSION: School-based and primary care-oriented initiatives that promote physical activity and healthy digital habits may contribute to improving adolescent health, increasing obesity awareness, and preventing problematic social media use.

INTRODUCTION: It is well established that systemic inflammatory responses induced by intermittent hypoxia are associated with disease severity in obstructive sleep apnea syndrome (OSAS). This study aimed to investigate the association between the C-reactive protein–to–albumin ratio (CAR), hematological inflammatory markers, and disease severity in OSAS, and to assess their diagnostic performance for predicting moderate-to-severe OSAS.
METHODS: We included 230 individuals aged 18–65 years who underwent full-night polysomnography in our sleep laboratory between June 2025 and December 2025. Participants were classified as normal, mild, moderate, or severe OSAS according to the apnea–hypopnea index (AHI). Serum C-reactive protein (CRP) and albumin levels were measured in all participants, and CAR, neutrophil-to-lymphocyte ratio (NLR), and systemic immune-inflammation index (SII) were calculated. Independent predictors of moderate-to-severe OSAS were assessed using multivariable logistic regression analyses. The discriminative performance of inflammatory markers was evaluated using receiver operating characteristic (ROC) curve analysis.
RESULTS: As OSAS severity increased, CRP, CAR, NLR, and SII levels showed a significant upward trend, whereas serum albumin levels decreased (all p <0.001). In multivariable analyses, CAR, NLR, and SII were independently associated with the presence of moderate-to-severe OSAS. ROC analysis demonstrated that CAR had the highest diagnostic accuracy for distinguishing moderate-to-severe OSAS.
DISCUSSION AND CONCLUSION: Increasing OSAS severity is associated with a marked elevation in systemic inflammatory burden. CAR may serve as a supportive inflammatory marker for identifying patients with moderate-to-severe OSAS.

INTRODUCTION: To investigate whether hemogram-derived inflammatory indices differ between patients with subclinical hypothyroidism and euthyroid controls and whether these indices are associated with thyroid-stimulating hormone (TSH) levels.
METHODS: In this retrospective cross-sectional study, 300 adults were included: 100 euthyroid individuals and 200 patients with subclinical hypothyroidism. Neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, monocyte-to-lymphocyte ratio, and systemic immune-inflammation index (SII) were calculated from complete blood count parameters. Correlations between TSH and laboratory variables were assessed in each group, and multivariable logistic regression identified variables independently associated with subclinical hypothyroidism.
RESULTS: SII values were significantly higher in the subclinical hypothyroidism group than in the euthyroid group (p=0.047). However, the between-group difference in SII showed a small effect size (Cohen’s d=0.29). In the subclinical hypothyroidism group, TSH was positively correlated with neutrophil count (r=0.201, p=0.045), creatinine (r=0.188, p=0.046), NLR (r=0.310, p=0.002), MLR (r=0.239, p=0.017), and SII (r=0.329, p<0.001). Older age (OR 1.058, 95% CI 1.035–1.082; p<0.001), female sex (OR 1.940, 95% CI 1.125–3.345; p=0.017), and higher body mass index (OR 1.055, 95% CI 1.006–1.107; p=0.048) were independently associated with subclinical hypothyroidism, whereas SII was not (OR 1.001, 95% CI 0.999–1.002; p=0.084).
DISCUSSION AND CONCLUSION: Subclinical hypothyroidism was associated with modestly higher SII values and positive correlations between TSH and selected hemogram-derived inflammatory indices. However, the small effect size of SII and its lack of independent significance after adjustment suggest that SII should be interpreted as a supportive and nonspecific marker of low-grade inflammation rather than an independent indicator of subclinical hypothyroidism.

INTRODUCTION: The adoption of Large Language Models (LLMs) raises concerns about scientific writing integrity, affecting clinical guidelines and patient safety. While studies track AI-generated text in English databases, impacts on bilingual ecosystems remain underexplored. This study investigates the "Linguistic Equalizer" hypothesis by analyzing lexical shifts in TR Dizin, determining if LLMs are primarily utilized for content generation or linguistic refinement.
METHODS: We conducted a longitudinal bibliometric analysis of 591,819 abstracts (2010–2025), divided into "General" and "Medical" datasets. We monitored five LLM marker word groups in English and their Turkish equivalents. We evaluated statistical significance via a large-sample pooled two-proportion test (primary analysis, using risk ratios [RR] with 95% CI), a yearly-aggregate Mann-Whitney U test (secondary/directional), and segmented regression analysis to identify post-2022 trend slopes.
RESULTS: A divergence emerged. In the General Dataset, English markers exhibited a marked increase ("underscore" rose from 0.02% to 1.80% of abstracts; RR=78.73, 95% CI 64.49–96.10), while the Turkish equivalent ("vurgula") showed a more modest, though substantial, increase (RR=2.54, 95% CI 2.47–2.61). In the Medical Dataset, English "underscore" rose more sharply (RR=87.98, 95% CI 62.51–123.84), while Turkish usage showed a moderate increase (RR=2.02, 95% CI 1.90–2.15).
DISCUSSION AND CONCLUSION: The disproportionate rise in English AI markers alongside comparatively stable Turkish vocabulary is consistent with the possibility that researchers utilize LLMs primarily as translation or editing tools. These findings lend empirical support to GenAI's potential role as a 'Linguistic Equalizer,' consistent with strategic adaptation to global publishing pressures rather than content fabrication.

INTRODUCTION: Nutritional risk is common among hospitalized patients, and anticholinergic burden may impair nutritional status. This study aimed to evaluate the association between anticholinergic burden and nutritional risk among adult patients hospitalized in an internal medicine ward.
METHODS: This retrospective cross-sectional study included 1570 internal medicine inpatients. Nutritional risk was assessed using the Nutritional Risk Screening 2002 (NRS-2002), with scores ≥3 indicating high nutritional risk. Anticholinergic burden was calculated using the Anticholinergic Cognitive Burden (ACB) Scale and categorized as no burden, low–moderate burden, and high burden. Binary logistic regression identified factors associated with high nutritional risk.
RESULTS: Among the participants, 51.2% had no anticholinergic burden, 32.3% had low–moderate burden, and 16.5% had high burden. High nutritional risk increased progressively across anticholinergic burden groups, from 47.3% in the no-burden group to 69.2% in the low–moderate burden group and 88.8% in the high-burden group (p<0.001). NRS-2002 scores also increased significantly with increasing anticholinergic burden (2.64±1.81, 3.55±1.82, and 4.25±1.48, respectively; p<0.001). In the adjusted logistic regression model, each one-point increase in ACB score was independently associated with higher odds of high nutritional risk (OR=1.96, 95% CI: 1.71–2.34, p<0.001), after controlling for potential confounders. Lower albumin level was also independently associated with high nutritional risk (OR=0.92; 95% CI: 0.89–0.95; p<0.001).
DISCUSSION AND CONCLUSION: A higher anticholinergic burden was independently associated with higher odds of nutritional risk among internal medicine inpatients. These findings suggest that anticholinergic exposure may be a clinically relevant and modifiable factor in nutritional risk assessment.

INTRODUCTION: In Türkiye, no nationally recognized guideline exists for the management of cough in children. The absence of standardized protocols may lead to heterogeneous clinical approaches. This study aimed to describe the diagnostic and therapeutic practices of physicians working in pediatric practice and their perceived need for a common guideline.
METHODS: A cross-sectional digital survey was administered in Türkiye between June and December 2023 using snowball sampling. The 30-item form covered demographic characteristics, clinical experience, diagnostic approaches, and treatment preferences. Data were analyzed using descriptive statistics, with exploratory Fisher's exact comparisons.
RESULTS: Sixty-eight physicians working in pediatric practice completed the survey. Most participants (85.29%) preferred observation before initiating treatment. Among the 55 respondents who selected exactly three medications, 36 (65.45%) selected antibiotics among their three most frequently used treatments. Definitions of acute and chronic cough varied widely. Although viral infection was the most reported cause of cough (92.65%), 96.92% reported some use of chest radiography, mostly in a small proportion of patients. Only 14.71% perceived that a national guideline on pediatric cough existed, and 85.29% reported needing further education or resources on cough management.
DISCUSSION AND CONCLUSION: This descriptive study documents variability in the self-reported practices of pediatricians and a widely reported need for further guidance, in a setting without a national pediatric cough guideline. These hypothesis-generating findings do not establish that any specific practice is unnecessary or inappropriate. They may nonetheless be informative for other settings lacking such a guideline and support the development of standardized, age-specific guidance.