Tıp Fakültesi Son Sınıf Öğrencilerinin Anafilaksi Bilgi Düzeyleri

Abstract

Anafilaksi ani gelişen ve hayatı tehdit edebilen bir aşırı duyarlılık reaksiyonudur. Erken tanı ve adrenalinin erken uygulanması mortaliteyi azaltmaktadır. Bu çalışmada tıp eğitiminin son yılında bulunan öğrencilerin anafilaksi hakkındaki bilgi düzeylerinin ölçülmesi amaçlanmıştır. Anket formu; anafilaksi etiyolojisi, tanısı, tedavisi ve korunma yöntemleri ile ilgili 14 sorudan oluşturuldu. Çevrimiçi anket formu tıp fakültesi son sınıfta bulunan 354 öğrenciye internet aracılığıyla gönderildi. Anket formu gönderilen öğrencilerin %44,9’u (n=159) çalışmaya katıldı. Öğrencilerin kız erkek oranı 1,4 (93/66) ve ortalama yaşları 24,8 ±1,5 yıl (ortanca: 25 yıl, en az: 23, en çok: 33) idi. Öğrencilerin aldıkları toplam puanları yüz üzerinden skorlandığında ortalama skor 71,7±12,9’du (ortanca: 71,4, en az: 35,7, en çok: 92,9). Kadın öğrencilerin ortanca skorları (ortanca: 78,6, en az: 35,7, en çok: 92,9), erkek öğrencilerden (ortanca: 71,4, en az: 35,7, en çok: 92,9) anlamlı olarak yüksekti (p=0,011). Adrenalin otoenjektör uygulamasıyla ilgili eğitim aldığını ifade eden öğrencilerin ortanca skorları (ortanca: 78,6, en az: 35,7, en çok: 92,9), almadıklarını ifade edenlerden (ortanca: 71,4, en az: 35,7, en çok: 92,9) anlamlı olarak yüksekti (p<0,001). Genel olarak bakıldığında çalışmamıza katılan öğrencilerin çoğunun; anafilaksi tanısı, risk faktörleri ve tedavisi hakkındaki bilgi düzeylerinin yeterli düzeyde olduğu gözlenmiştir. Mezuniyet sonrası anafilaksi eğitimlerinin tekrarlanması mevcut durumun daha iyi hale getirilmesine ve korunmasına katkı sağlayacaktır.

Keywords

• anafilaksi
• tıp fakültesi öğrencisi
• adrenalin

Knowledge Levels of Final Year Medical School Students about Anaphylaxis

Abstract

Anaphylaxis is an acute and life-threatening hypersensitivity reaction. Early diagnosis of anaphylaxis and administration of adrenaline reduces the risk of death. We aimed to measure the knowledge levels of students in the last year of medical education about the etiology, diagnosis, treatment, and prevention methods of anaphylaxis. The questionnaire form was composed of 14 questions about the etiology, diagnosis, treatment and prevention methods of anaphylaxis. An online questionnaire was sent to 354 students in the final year of medical faculty via the internet. 44.9% of the students (n=159) whose questionnaire was sent participated in the study. The female to male ratio of students was 1.4 (93/66) and the mean age was 24.8 ± 1.5 years (median 25 years, minimum: 23, maximum: 33). The mean score of participants was 71.7 ± 12.9 (median: 71.4, minimum: 35.7, maximum: 92.9). The median scores of female students (median: 78.6, minimum: 35.7, maximum: 92.9) was significantly higher than male students (median: 71.4, minimum: 35.7, maximum: 92.9) (p = 0.011). The median scores of the students who stated that they were trained in adrenaline auto-injector application (median: 78.6, minimum: 35.7, maximum: 92.9) were found significantly higher than those who were not trained (median: 71.4, minimum: 35.7, maximum: 92.9) (p <0.001). It was observed that the most of students in the final year of medical faculty who participated in our study have sufficient information about the diagnosis, risk factors, and treatment of anaphylaxis. Repeating anaphylaxis training after graduation will contribute to improving and maintaining the current situation.

Keywords

• anaphylaxis
• medical school students
• adrenaline

References

1. Lieberman P, Camargo CA Jr, Bohlke K, et al. Epidemiology of anaphylaxis: findings of the American College of Allergy, Asthma and Immunology Epidemiology of Anaphylaxis Working Group. Ann Allergy Asthma Immunol 2006;97:596-602.
2. Tejedor Alonso MA, Moro Moro M, Mugica Garcia MV, et al. Incidence of anaphylaxis in the city of Alcorcon (Spain): A population-based study. Clin Exp Allergy 2012; 42:578-589
3. de Silva IL, Mehr SS, Tey D, et al. Paediatric anaphylaxis: a 5-year retrospective review. Allergy 2008;63:1071-6
4. Turner PJ, Gowland MH, Sharma V, et al. Increase in anaphylaxis-related hospitalizations but no increase in fatalities: an analysis of United Kingdom national anaphylaxis data, 1992- 2012. J Allergy Clin Immunol 2015;135:956
5. Orhan F, Canitez Y, Bakirtas A, et al. Anaphylaxis in Turkish children: a multi-centre, retrospective, case study. Clin Exp Allergy 2011;41:1767-76
6. Sheikh A, Shehata YA, Brown SG, et al. Adrenaline for the treatment of anaphylaxis: cochrane systematic review. Allergy 2009; 64:204
7. Simons FE. Emergency treatment of anaphylaxis. BMJ 2008; 336:1141
8. Baccioglu A, Ucar EY. Level of knowledge about anaphylaxis among health care providers. Tuberk Toraks 2013;61:140‑6.

9. Jose R, Clesham GJ. Survey of the use of epinephrine (adrenaline) for anaphylaxis by junior hospital doctors. Postgrad Med J 2007;83:610‑1.
10. Droste J, Narayan N. Hospital doctors’ knowledge of adrenaline (epinephrine) administration in anaphylaxis in adults is deficient. Resuscitation 2010;81:1057‑8.
11. Mezuniyet Öncesi Tıp Eğitimi Ulusal Çekirdek Eğitim Programı 2020 https://tip.uludag.edu.tr/sites/default/files/egitim-programlari/cep-2020.pdf
12. Gupta RS, Springston EE, Kim JS, Smith B, Pongracic JA, Wang X, Holl J. Food allergy knowledge, attitudes, and beliefs of primary care physicians. Pediatrics. 2010 ;125(1):126-32.
13. Drupad HS, Nagabushan H. Level of knowledge about anaphylaxis and its management among health care providers. Indian J Crit Care Med. 2015;19(7):412-5.
14. Erkoçoğlu M, Civelek E, Azkur D, et al. Knowledge and attitudes of primary care physicians regarding food allergy and anaphylaxis in Turkey. Allergol Immunopathol (Madr) 2013;41:292-7.
15. Haymore BR, Carr WW, Frank WT. Anaphylaxis and epinephrine prescribing patterns in a military hospital: underutilization of the intramuscular route. Allergy Asthma Proc 2005;26:361–5.
16. Muraro A, Werfel T, Hoffmann-Sommergruber K, et al; EAACI Food Allergy and Anaphylaxis Guidelines Group. EAACI food allergy and anaphylaxis guidelines: diagnosis and management of food allergy. Allergy.2014;69(8):1008-25.
17. Simons FE, Ardusso LR, Bilò MB, et al. World Allergy Organization. World allergy organization guidelines for the assessment and management of anaphylaxis. World Allergy Organ J. 2011;4(2):13-37
18. Orhan F, Cıvelek E, Şahıner ÜM, ve ark. Anafilaksi: Türk Ulusal Rehberi 2018. Asthma Allergy Immunol 2018;16:1-62.
19. Özkars MY, Anaflaksiye Aile Hekimlerinin Gözünden Bakış, JCP2019;17:(1):34-44
20. Munblit D, Treneva M, Korsunskiy I, et al. A national survey of Russian physicians' knowledge of diagnosis and management of food induced anaphylaxis. BMJ Open. 2017; 7(7):e015901.
21. Krugman SD, Chiaramonte DR, Matsui EC. Diagnosis and management of food-induced anaphylaxis: a national survey of pediatricians. Pediatrics 2006;118:554–60.
22. Prince BT, Mikhail I, Stukus DR. Underuse of epinephrine for the treatment of anaphylaxis: missed opportunities. J Asthma Allergy. 2018;20;11:143-151.
23. Bernstein DI, Wanner M, Borish L, et al. Twelve-year survey of fatal reactions to allergen injections and skin testing: 1990–2001. J Allergy Clin Immunol 2004;113:1129–13.
24. Gompels LL, Bethune C, Johnston SL, et al. Proposed use of adrenaline (epinephrine) in anaphylaxis and related conditions: a study of senior house officers starting accident and emergency posts. Postgrad Med J 2002;78:416–8.
25. Thain S, Rubython J. Treatment of anaphylaxis in adults: results of a survey of doctors at Dunedin Hospital, New Zealand. N Z Med J 2007;120:1–8.
26. Gokmirza P, Beken B, Future doctors and anaphylaxis: What do they know? What should we do?, Annals of Medical Research, 2019;26(10):2340-5
27. Grabenhenrich LB, Dolle S, Moneret-Vautrin A, et al. Anaphylaxis in children and adolescents: The European Anaphylaxis Registry. J Allergy Clin Immunol 2016;137:1128-37.
28. Oropeza AR, Bindslev-Jensen C, Broesby-Olsen S, et al. Patterns of anaphylaxis after diagnostic workup: A follow-up study of 226 patients with suspected anaphylaxis. Allergy ,2017;72(12):1944-52
29. Simons FER, Ebisawa M, Sánchez-Borges M, et al. 2015 update of the evidence base: World Allergy Organization anaphylaxis guidelines. World Allergy Organ J. 2015;8(1)
30. Lieberman P, Nicklas RA, Randolph C, et al. Anaphylaxis-a practice parameter update 2015. Ann Allergy Asthma Immunol. 2015;115(5):341–84
31. Sidhu N, Jones S, Perry T, et al. Evaluation of anaphylaxis management in a pediatric emergency department. Pediatr Emerg Care. 2016;32(8):508–13
32. Gelincik A, Demirtürk M, Yılmaz E, et al. Anaphylaxis in a tertiary adult allergy clinic: a retrospective review of 516 patients. Ann Allergy Asthma Immunol. 2013;110(2):96–100
33. Campbell RL, Luke A, Weaver AL, et al. Prescriptions for self-injectable epinephrine and follow-up referral in emergency department patients presenting with anaphylaxis. Ann Allergy Asthma Immunol. 2008;101(6):631–6
34. Benjamin T Prince, Irene Mikhail, David R Stukus, Underuse of epinephrine for the treatment of anaphylaxis: missed opportunities J Asthma Allergy. 2018;11:143–51
35. Russell WS, Farrar JR, Nowak R, et al. Evaluating the management of anaphylaxis in US emergency departments: Guidelines vs. practice. World J Emerg Med. 2013;4(2):98–106
36. Çetinkaya F, et al, Pediatricians’ knowledge about recent advances in anaphylaxis treatment in İstanbul, Turkey, The Turkish Journal of Pediatrics 2009; 51:19-21
37. Arga M, Bakirtas A, Turktas I, et al. Do pediatricians and the pediatric residents know how to use adrenalin autoinjector? Asthma Allergy Immunol 2009;7:26-31
38. Calvani M, Cardinale F, Martelli A, et al. Italian and members Members of the Italian Society of Pediatric Allergy and Immunology (SIAIP) Anaphylaxis’ Study Group. Risk factors for severe pediatric food anaphylaxis in Italy. Pediatr Allergy Immunol 2011;22:813-9
39. González-Pérez A, Aponte Z, Vidaurre CF, Rodríguez LA. Anaphylaxis epidemiology in patients with and patients without asthma: a United Kingdom database review. J Allergy Clin Immunol. 2010;125(5):1098-104
40. Marques ML, Gouveia J, Cunha I M, et al. Anaphylaxis in pediatric age: an overview. Nascer e Crescer - Bırth And Growth Medıcal Journal, 2020;29(2):92-100.