The Effects of Ginger Kidney Compress on Severity of Pain and Physical Functions of Individuals with Knee Osteoarthritis: A Randomized Controlled Trial
Year 2021,
, 83 - 94, 16.08.2021
Sibel Şentürk
Sultan Taşcı
Abstract
Objective: A randomized controlled study was conducted in order to determine the effect of ginger kidney compress applied to waist region for 30 minutes for seven days on severity of pain and physical functions of individuals with knee osteoarthritis.
Material-Method: This is a randomized controlled trial study. The sample included with 124 patients; 43 ginger kidney compresses, 41 hot compresses, and 40 control groups. The data were collected using Patient Information Form, Visual Analog Scale (VAS) -Pain and WOMAC Osteoarthritis Index. The forms were administered at the beginning (first follow-up) and at the end (7th day, second follow-up) of intervention. The intervention-I group received ginger kidney compress while intervention-II group received hot compress and control group received no intervention.
Results: In the first follow-up, there was no difference between the scores of the groups included in the study (p > 0.05), which were obtained from the VAS-Pain and WOMAC Osteoarthritis Index. In the second follow-up, a significant difference between the scores of the groups obtained from the VAS-Pain and WOMAC Osteoarthritis Indexes (p<0.001) was detected. According to the initial follow-ups, the scores of the individuals in the ginger kidney compress group at the final follow-up decreased significantly from the VAS-Pain and WOMAC Osteoarthritis Index compared to the individuals in the hot compress and the control group ( p<0.001).
Conclusion: It has been determined that the application of ginger kidney compress is more effective than hot compress application and that it decreases the VAS-Pain and WOMAC Osteoarthritis Index scores.
Supporting Institution
This study is associated with the PhD thesis " The Effect of Ginger Kidney Compress Applied to Waist Region upon the Pain Level and Physical Functions of Individuals with Knee Osteoarthritis" This study has been approved and financially supported by the Unit of Scientific Research Projects of Erciyes University
Project Number
Project number: TDK-2013-4218
Thanks
The authors wish to thank Uludag University Medical Faculty biostatistics department academic member Assoc. Dr. Ferhan Elmalı and all the participants for their support and participation in this trial. The responsible researcher would like to thank the officials at the ARCIM Institute located at the Filderklinik Community Hospital in Stuttgart, Germany, and the Ita Wegman Clinic in Basel, Switzerland, where he received ginger kidney compress training. The responsible researcher dedicated this article to Dr. Tessa Therkleson (1950-2016), who has contributed to the shaping of this article and as acted as a reference for overseas education.
References
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- Felson DT, Zhang Y, Hannan MT, Naimark A, Weissman B, Aliabadi P, Levy D. Risk factors for incident radiographic knee osteoarthritis in the elderly: the Framingham Study. Arthritis Rheum. 1997;40:728-733.
- Cooper C, Dennison E, Edwards M, Litwi A. Epidemiology of osteoarthritis. Medicographia. 2013;35:145-151.
- Dillon CF, Rasch EK, Gu Q, Hirsch R. Prevalence of knee osteoarthritis in the United States: arthritis data from the Third National Health and Nutrition Examination Survey 1991-94. J Rheumatol. 2006;33:2271-2279.
- Jordan JM, Helmick CG, Renner JB, Luta G, Dragomir AD, Woodard J, Fang F, Schwartz TA, Abbate LM, Callahan LF, Kalsbeek WD, Hochberg MC. Prevalance of knee symptoms and radiographic and symptomatic knee osteoarthritis in African Americans and Caucasions: the Johston County Osteoarthritis Project. J Rheumatol. 2007;34:172-180.
- Kaçar C, Gilgil E, Urhan S, Arikan V, Dündar U, Oksüz MC. The prevalence of symptomatic knee and distal interphalangeal joint osteoarthritis in the urban population of Antalya, Turkey. Rheumatol InT. 2005;25:201-4.
- Turkish Statistical Institute (TSI) Available from: http://www.tuik.gov.tr/PreTablo.do?alt_id=1095. Accessed: 09.05.2021
- Zhang Y, Jordan JM. Epidemiology of osteoarthritis. Rheum Dis Clin N Am. 2008;34:515-29.
- Bredveld FC. Osteoarthritis - the impact of a serious disease. Rheumatol. 2004;43:4-8.
- Arasıl T, Sarıdoğan M. Fiziksel tıp ve rehabilitasyonda yeni ufuklar- tanıdan tedaviye osteoartrit, Güneş Tıp Kitabevleri, Ankara, 2010, pp. 62-4.
- Karaaslan Y. Osteoartrit, MD Yayıncılık, Ankara, 2000, pp. 36-43.
- Leslie M. Knee osteoarthritis management therapies. Pain Manag Nurs. 2000;1:51-7.
- Zhang W, Nuki G, Moskowitz RW, Abramson S, Altman RD, Arden N. OARSI recommendations for the management of hip and knee osteoarthritis. Osteoarthr Cartil. 2010;18(4):476-499.
- Zhang W, Moskowitz RW, Nuki G, Abramson S, Altman RD, Arden N, Bierma-Zeinstra S, Brandt KD , Croft P, Doherty M, Dougados M, Hochberg M, Hunter DJ, Kwoh K, Lohmander LS , Tugwell P. OARSI recommendations for the management of hip and knee osteoarthritis, Part II: OARSI evidence-based, expert consensus guidelines. Osteoarthr Cartil. 2008;16:137-62.
- Zhang W, Doherty M, Leeb BF, Alekseeva L, Arden NK, Bijlsma JW, Dinçer F, Dziedzic K, Häuselmann HJ, Herrero-Beaumont G, Kaklamanis P, Lohmander S, Maheu E, Martín-Mola E, Pavelka K, Punzi L, Reiter S, Sautner J, Smolen J, Verbruggen G, Zimmermann-Górska I. EULAR evidence based recommendations for the management of hand osteoarthritis: report of a task force of the EULAR Standing Committee for International Clinical Studies Including Therapeutics (ESCISIT). Ann Rheum Dis. 2007;66:377-88.
- Jordan KM, Arden NK, Doherty M, Bannwarth B, Bijlsma JW, Dieppe P, Gunther K, Hauselmann H, Herrero-Beaumont G, Kaklamanis P, Lohmander S, Leeb B, Lequesne M, Mazieres B, Martin-Mola E, Pavelka K, Pendleton A, Punzi L, Serni U, Swoboda B, Verbruggen G, Zimmerman-Gorska I, Dougados M.
- Standing Committee for International Clinical Studies Including Therapeutic Trials ESCISIT: EULAR Recommendations 2003: An evidence based approach to the management of knee osteoarthritis: Report of a Task Force of the Standing Committee for International Clinical Studies Including Therapeutic Trials (ESCISIT). Ann Rheum Dis. 2003;62:1145-55.
- Shengelia R, Parker SJ, Ballin M, George T, Reid MC. Complementary therapies for osteoarthritis: are they effective? Pain Manag Nurs. 2013;14:1-15.
- Ghosh AK, Banerjee S, Mullick HI, Banerjee J. Zingiber officinale: a natural gold. Int J Pharm Bio Sci. 2011;2:283-94.
- Moghaddasi MS, Kashani HH. Ginger (zingiber officinale): a review. J Med Plants Res. 2012;6:4255-8.
- Al-Awwadi NAJ. Potential health benefits and scientific review of ginger. J Pharmacognosy Phytother. 2017;9(7):111-116.
- Singh R, Singh K. Zingiber officinale: a spice with multiple roles. Research Journal of Life Sciences, Bioinformatics, Pharmaceutical and Chemical Sciences. 2019;5(2):113-125.
- Syafitri DM, Levita J, Mutakin M, Diantini A. A review: is ginger (zingiber officinale var. roscoe) potential for future phytomedicine? Indonesian Journal of Applied Sciences. 2018;8(1):1-6.
- Şentürk S. Diz osteoartritinde gelişen ağrıda zencefil böbrek kompres uygulaması, in: M. Başer, S. Taşcı (Eds.), Kanıta dayalı rehberleriyle tamamlayıcı ve destekleyici uygulamalar, Akademisyen Tıp Kitabevi, Ankara, 2015, pp.191-201.
- Therkleson T. A phenomenological study of ginger compress therapy for people with osteoarthritis, Indo-Pacific Journal of Phenomenology. 2010;10:1-10.
- Therkleson T. Ginger and osteoarthritis, in: Q. Chen, (Ed.), Osteoarthritis - diagnosis, treatment and surgery, InTech, China, 2012, pp.157-168.
- International Federation of Anthroposophic Medical Associations (IVAA). Available from: http://www.ivaa.info/home/ Accessed: 7.05.2021.
- Therkleson T. Ginger compress therapy for adults with osteoarthritis. J Adv Nurs. 2010;66:2225-33.
- Therkleson T. Sherwood P. Patients’ experience of the external therapeutic application of ginger by antroposophically trained nurses. Indo-Pacific Journal of Phenomenology. 2004;4:1-11.
- Therkleson T. Topical ginger treatment with a compress or patch for osteoarthritis symptoms, J Holist Nurs. 2014;32:173-82.
- Haghighi M, Khalvat A, Toliat T, Jallaei S. Comparing the effect of ginger (zingiber officinale) extract and ibuprofen on patients with osteoarthritis. Arch Iranian Med. 2005;8(4):267-271.
- Yıldırım N, Ulusoy MF, Bodur H. The effect of heat application on pain, stiffness, physical function and quality of life in patients with knee osteoarthritis. J Clin Nurs. 2010;19:1113-20.
- WHO. Obesity: preventing and managing the global epidemic. report of a WHO consultation. World Health Organ Tech Rep Ser. 2000;894:1-253.
- Price DD, Bush FM, Long S, Harkins SW. A comparison of pain measurement characteristics of mechanical visual analogue and simple numerical rating scales. Pain. 1994;56:217–226.
- Bellamy N. WOMAC: a 20-year experiential review of a patient-centered self-reported health status questionnaire. J Rheumatol. 2002;29(12):2473-6.
- Tüzün EH, Eker L, Aytar A, Daşkapan A, Bayramoğlu M. Acceptability, reliability, validity and responsiveness of the Turkish version of WOMAC Osteoarthritis Index. Osteoarthr Cartil. 2005;13(1):28-33.
- Therkleson T. The experience of receiving ginger compresses in persons with osteoarthritis: a phenomenological study, Edith Cowan University, Western Australia, 2009, PhD Thesis.
- Fingado M. Compresses and other therapeutic applications, a handbook from the Ita wegman clinic. (Translated by: Therkleson T, Therkleson S). Floris Books, 2012, pp. 55-59.
- Therkleson T. Transdermal patch. wipo patent application WO/2012/026829 A1.
- Loeser JD. Bonica’s management of pain. 3nd ed, Lippincot Williams, USA, 2001.
- Kwekkeboom KL, Gretarsdottir E. Systematic review of relaxation interventions for pain. J Nurs Scholarsh. 2006;38:269-277.
- Karagülle Z. Kaplıca tedavisi, balneoterapi, hidroterapi, in: M. Beyazova, Y. Gökçe-Kutsal (Eds), Fizksel tıp ve rehabilitasyon, Güneş Kitabevi, Ankara, 2000, pp.878-908.
- Mazzuca SA, Page MC, Meldrum RS, Brandt KD, Petty-Saphon S. Pilot study of the effects of a heat-retaining knee sleeve on joint pain, stiffness, and function in patients with knee osteoarthritis. Arthritis Rheum. 2004;51:716-721.
- Aciksoz S, Akyuz A, Tunay S. The effect of self-administered superficial local hot and cold application methods on pain, functional status and quality of life in primary knee osteoarthritis patients. J Clin Nurs. 2017;26(23-24):5179-5190.
- Ochiai S, Watanabe A, Oda H, Ikeda H. Effectiveness of thermotherapy using a heat and steam generating sheet for cartilage in knee osteoarthritis. J Phys Ther Sci. 2014;26:281–284.
- Karadag S, Taşci S, Dogan N, Demir H, Kiliç Z. Application of heat and a home exercise program for pain and function levels in patients with knee osteoarthritis: a randomized controlled trial. Int J Nurs Pract. 2019:25(5):e12772.
- Mohamed HG, Mohamed MAF. effect of local heat application on complaints of patients with moderate knee osteoarthritis. Am J Nurs Res. 2019;7(2):148-159.
- Qato DM, Alexander GC, Conti RM, Johnson M, Schumm P, Lindau ST. Use of prescription and over-the-counter medications and dietary supplements among older adults in the United States. JAMA. 2008;300(24):2867-78.
- Chrischilles E, Rubenstein L, Van Gilder R, Voelker M, Wright K, Wallace R. Risk factors for adverse drug events in older adults with mobility limitations in the community setting. J Am Geriatr Soc. 2007;55(1):29-34.
- Ünüvar S, Bayrak H, Aktay G. Evaluation of multiple drug use in the elderly. Genel Medical Journal (Genel Tıp Dergisi) 2019;29(2):55-59.
- Öztürk Z, Uğraş KG. Drug use and polypharmacy in elderly patients. The Journal of Tepecik Education and Research Hospital (Tepecik Eğitim ve Araştırma Hastanesi Dergisi). 2017;27(2):103-108.
Year 2021,
, 83 - 94, 16.08.2021
Sibel Şentürk
Sultan Taşcı
Project Number
Project number: TDK-2013-4218
References
- van Schoor NM, Zambon S, Castell MV, Cooper C, Denkinger M, Dennison EM, Edwards ME, Herbolsheimer F, Maggi S, Sánchez-Martinez M, Pedersen NL, Peter R, Schaap LA, Rijnhart JJM, van der Pas S, Deeg DJ. Impact of clinical osteoarthritis of the hip, knee and hand on selfrated health in six European countries: the European Project on OSteoArthritis. Qual Life Res. 2016;25:1423-1432.
- Castell MV, van der Pas S, Otero A, Siviero P, Dennison E, Denkinger M, Pedersen N, Sánchez-Martinez M, Queipo R, van Schoor N, Zambon S, Edwards M, Peter R, Schaap L, Deeg D. Osteoarthritis and frailty in elderly individuals across six European countries: results from the European project on OSteoArthritis (EPOSA). BMC Musculoskelet Disord. 201516:359.
- Massicotte F. Epidemiology of osteoarthritis, in: J. Martel-Pelletier, J.P. Pelletier (Eds.), Understanding Osteoarthritis from bench to bedside, Research Signpost, India, 2011, pp. 1-26.
- Felson DT, Zhang Y, Hannan MT, Naimark A, Weissman B, Aliabadi P, Levy D. Risk factors for incident radiographic knee osteoarthritis in the elderly: the Framingham Study. Arthritis Rheum. 1997;40:728-733.
- Cooper C, Dennison E, Edwards M, Litwi A. Epidemiology of osteoarthritis. Medicographia. 2013;35:145-151.
- Dillon CF, Rasch EK, Gu Q, Hirsch R. Prevalence of knee osteoarthritis in the United States: arthritis data from the Third National Health and Nutrition Examination Survey 1991-94. J Rheumatol. 2006;33:2271-2279.
- Jordan JM, Helmick CG, Renner JB, Luta G, Dragomir AD, Woodard J, Fang F, Schwartz TA, Abbate LM, Callahan LF, Kalsbeek WD, Hochberg MC. Prevalance of knee symptoms and radiographic and symptomatic knee osteoarthritis in African Americans and Caucasions: the Johston County Osteoarthritis Project. J Rheumatol. 2007;34:172-180.
- Kaçar C, Gilgil E, Urhan S, Arikan V, Dündar U, Oksüz MC. The prevalence of symptomatic knee and distal interphalangeal joint osteoarthritis in the urban population of Antalya, Turkey. Rheumatol InT. 2005;25:201-4.
- Turkish Statistical Institute (TSI) Available from: http://www.tuik.gov.tr/PreTablo.do?alt_id=1095. Accessed: 09.05.2021
- Zhang Y, Jordan JM. Epidemiology of osteoarthritis. Rheum Dis Clin N Am. 2008;34:515-29.
- Bredveld FC. Osteoarthritis - the impact of a serious disease. Rheumatol. 2004;43:4-8.
- Arasıl T, Sarıdoğan M. Fiziksel tıp ve rehabilitasyonda yeni ufuklar- tanıdan tedaviye osteoartrit, Güneş Tıp Kitabevleri, Ankara, 2010, pp. 62-4.
- Karaaslan Y. Osteoartrit, MD Yayıncılık, Ankara, 2000, pp. 36-43.
- Leslie M. Knee osteoarthritis management therapies. Pain Manag Nurs. 2000;1:51-7.
- Zhang W, Nuki G, Moskowitz RW, Abramson S, Altman RD, Arden N. OARSI recommendations for the management of hip and knee osteoarthritis. Osteoarthr Cartil. 2010;18(4):476-499.
- Zhang W, Moskowitz RW, Nuki G, Abramson S, Altman RD, Arden N, Bierma-Zeinstra S, Brandt KD , Croft P, Doherty M, Dougados M, Hochberg M, Hunter DJ, Kwoh K, Lohmander LS , Tugwell P. OARSI recommendations for the management of hip and knee osteoarthritis, Part II: OARSI evidence-based, expert consensus guidelines. Osteoarthr Cartil. 2008;16:137-62.
- Zhang W, Doherty M, Leeb BF, Alekseeva L, Arden NK, Bijlsma JW, Dinçer F, Dziedzic K, Häuselmann HJ, Herrero-Beaumont G, Kaklamanis P, Lohmander S, Maheu E, Martín-Mola E, Pavelka K, Punzi L, Reiter S, Sautner J, Smolen J, Verbruggen G, Zimmermann-Górska I. EULAR evidence based recommendations for the management of hand osteoarthritis: report of a task force of the EULAR Standing Committee for International Clinical Studies Including Therapeutics (ESCISIT). Ann Rheum Dis. 2007;66:377-88.
- Jordan KM, Arden NK, Doherty M, Bannwarth B, Bijlsma JW, Dieppe P, Gunther K, Hauselmann H, Herrero-Beaumont G, Kaklamanis P, Lohmander S, Leeb B, Lequesne M, Mazieres B, Martin-Mola E, Pavelka K, Pendleton A, Punzi L, Serni U, Swoboda B, Verbruggen G, Zimmerman-Gorska I, Dougados M.
- Standing Committee for International Clinical Studies Including Therapeutic Trials ESCISIT: EULAR Recommendations 2003: An evidence based approach to the management of knee osteoarthritis: Report of a Task Force of the Standing Committee for International Clinical Studies Including Therapeutic Trials (ESCISIT). Ann Rheum Dis. 2003;62:1145-55.
- Shengelia R, Parker SJ, Ballin M, George T, Reid MC. Complementary therapies for osteoarthritis: are they effective? Pain Manag Nurs. 2013;14:1-15.
- Ghosh AK, Banerjee S, Mullick HI, Banerjee J. Zingiber officinale: a natural gold. Int J Pharm Bio Sci. 2011;2:283-94.
- Moghaddasi MS, Kashani HH. Ginger (zingiber officinale): a review. J Med Plants Res. 2012;6:4255-8.
- Al-Awwadi NAJ. Potential health benefits and scientific review of ginger. J Pharmacognosy Phytother. 2017;9(7):111-116.
- Singh R, Singh K. Zingiber officinale: a spice with multiple roles. Research Journal of Life Sciences, Bioinformatics, Pharmaceutical and Chemical Sciences. 2019;5(2):113-125.
- Syafitri DM, Levita J, Mutakin M, Diantini A. A review: is ginger (zingiber officinale var. roscoe) potential for future phytomedicine? Indonesian Journal of Applied Sciences. 2018;8(1):1-6.
- Şentürk S. Diz osteoartritinde gelişen ağrıda zencefil böbrek kompres uygulaması, in: M. Başer, S. Taşcı (Eds.), Kanıta dayalı rehberleriyle tamamlayıcı ve destekleyici uygulamalar, Akademisyen Tıp Kitabevi, Ankara, 2015, pp.191-201.
- Therkleson T. A phenomenological study of ginger compress therapy for people with osteoarthritis, Indo-Pacific Journal of Phenomenology. 2010;10:1-10.
- Therkleson T. Ginger and osteoarthritis, in: Q. Chen, (Ed.), Osteoarthritis - diagnosis, treatment and surgery, InTech, China, 2012, pp.157-168.
- International Federation of Anthroposophic Medical Associations (IVAA). Available from: http://www.ivaa.info/home/ Accessed: 7.05.2021.
- Therkleson T. Ginger compress therapy for adults with osteoarthritis. J Adv Nurs. 2010;66:2225-33.
- Therkleson T. Sherwood P. Patients’ experience of the external therapeutic application of ginger by antroposophically trained nurses. Indo-Pacific Journal of Phenomenology. 2004;4:1-11.
- Therkleson T. Topical ginger treatment with a compress or patch for osteoarthritis symptoms, J Holist Nurs. 2014;32:173-82.
- Haghighi M, Khalvat A, Toliat T, Jallaei S. Comparing the effect of ginger (zingiber officinale) extract and ibuprofen on patients with osteoarthritis. Arch Iranian Med. 2005;8(4):267-271.
- Yıldırım N, Ulusoy MF, Bodur H. The effect of heat application on pain, stiffness, physical function and quality of life in patients with knee osteoarthritis. J Clin Nurs. 2010;19:1113-20.
- WHO. Obesity: preventing and managing the global epidemic. report of a WHO consultation. World Health Organ Tech Rep Ser. 2000;894:1-253.
- Price DD, Bush FM, Long S, Harkins SW. A comparison of pain measurement characteristics of mechanical visual analogue and simple numerical rating scales. Pain. 1994;56:217–226.
- Bellamy N. WOMAC: a 20-year experiential review of a patient-centered self-reported health status questionnaire. J Rheumatol. 2002;29(12):2473-6.
- Tüzün EH, Eker L, Aytar A, Daşkapan A, Bayramoğlu M. Acceptability, reliability, validity and responsiveness of the Turkish version of WOMAC Osteoarthritis Index. Osteoarthr Cartil. 2005;13(1):28-33.
- Therkleson T. The experience of receiving ginger compresses in persons with osteoarthritis: a phenomenological study, Edith Cowan University, Western Australia, 2009, PhD Thesis.
- Fingado M. Compresses and other therapeutic applications, a handbook from the Ita wegman clinic. (Translated by: Therkleson T, Therkleson S). Floris Books, 2012, pp. 55-59.
- Therkleson T. Transdermal patch. wipo patent application WO/2012/026829 A1.
- Loeser JD. Bonica’s management of pain. 3nd ed, Lippincot Williams, USA, 2001.
- Kwekkeboom KL, Gretarsdottir E. Systematic review of relaxation interventions for pain. J Nurs Scholarsh. 2006;38:269-277.
- Karagülle Z. Kaplıca tedavisi, balneoterapi, hidroterapi, in: M. Beyazova, Y. Gökçe-Kutsal (Eds), Fizksel tıp ve rehabilitasyon, Güneş Kitabevi, Ankara, 2000, pp.878-908.
- Mazzuca SA, Page MC, Meldrum RS, Brandt KD, Petty-Saphon S. Pilot study of the effects of a heat-retaining knee sleeve on joint pain, stiffness, and function in patients with knee osteoarthritis. Arthritis Rheum. 2004;51:716-721.
- Aciksoz S, Akyuz A, Tunay S. The effect of self-administered superficial local hot and cold application methods on pain, functional status and quality of life in primary knee osteoarthritis patients. J Clin Nurs. 2017;26(23-24):5179-5190.
- Ochiai S, Watanabe A, Oda H, Ikeda H. Effectiveness of thermotherapy using a heat and steam generating sheet for cartilage in knee osteoarthritis. J Phys Ther Sci. 2014;26:281–284.
- Karadag S, Taşci S, Dogan N, Demir H, Kiliç Z. Application of heat and a home exercise program for pain and function levels in patients with knee osteoarthritis: a randomized controlled trial. Int J Nurs Pract. 2019:25(5):e12772.
- Mohamed HG, Mohamed MAF. effect of local heat application on complaints of patients with moderate knee osteoarthritis. Am J Nurs Res. 2019;7(2):148-159.
- Qato DM, Alexander GC, Conti RM, Johnson M, Schumm P, Lindau ST. Use of prescription and over-the-counter medications and dietary supplements among older adults in the United States. JAMA. 2008;300(24):2867-78.
- Chrischilles E, Rubenstein L, Van Gilder R, Voelker M, Wright K, Wallace R. Risk factors for adverse drug events in older adults with mobility limitations in the community setting. J Am Geriatr Soc. 2007;55(1):29-34.
- Ünüvar S, Bayrak H, Aktay G. Evaluation of multiple drug use in the elderly. Genel Medical Journal (Genel Tıp Dergisi) 2019;29(2):55-59.
- Öztürk Z, Uğraş KG. Drug use and polypharmacy in elderly patients. The Journal of Tepecik Education and Research Hospital (Tepecik Eğitim ve Araştırma Hastanesi Dergisi). 2017;27(2):103-108.