Senaryoya Dayalı Bir Sanal Hasta Programının Hekimlerin Diyabetik Ayak Enfeksiyonu ve Komplike İntraabdominal Enfeksiyon için Mevcut Kılavuzlara Uyumlarını Artırmaya Yönelik Kullanımı

Yıl 2019, , 240 - 261, 30.09.2019

Oguz Karabay , Mehmet Gurlek

https://doi.org/10.26453/otjhs.471652

Öz

Diyabetik ayak enfeksiyonu (DAE) ve komplike
intraabdominal enfeksiyon (KIE) hedefli sanal bir hasta programına katılım
sağlayan hekimlerin tanı ve tedavi pratiklerinin değerlendirilmesi
amaçlanmıştır. Bu çalışma DAE (n=210) ve KIE (n=42) hedefli sanal bir hasta
programına katılım sağlayan 252 hekim ile gönüllülük esasına göre yürütüldü.
Hekimlerin bilgisayar grafik teknolojileri temelinde geliştirilen program
dahilinde yaptıkları aşamalı hasta değerlendirilmesi verileri (hasta özellikleri,
hastalık özellikleri, fizik muayene, laboratuvar ve
radyolojik bulgular) kaydedildi. KIE Olgu Senaryosunda, tanı; hekimlerin
%75,0’i tarafından doğrulanırken, cerrahi 
girişim ve seftriakson +
metronidazol (37,6%) veya ertapenem (34,1%) en sık yapılan tedavi seçimi idi.
DAE Olgu Senaryosunda tanı, hekimlerin %98,0’i
tarafından doğrulanırken, hekimlerin %71,0’i en sık ertapenem (%55,0) olmak
üzere antibiyotik tedavisi başlanmasını  uygun buldu. Sonuç olarak, bulgularımız
“senaryoya dayalı” sanal hasta programlarının sağladığı hızlı ve güncel geri
bildirim ve öğrenim çıktılarının bireysel takibi yoluyla hekimlerin KIE ve DAE
klinik karar alma becerilerinin gelişimine katkıda bulunabileceğini
göstermektedir. Dolayısıyla, bulgularımız hekimlerin KIE için tedavi
uygulamalarının özellikle ampirik antibiyotik seçimi konusunda, DAE tanı ve
tedavi uygulamalarının ise enfeksiyon riskinin daha dikkatli değerlendirilerek
daha uygun ampirik antibiyotik tedavi seçimi yapılması açısından
iyileştirilmesi gerektiğine işaret etmektedir. 

Anahtar Kelimeler

Komplike intraabdominal enfeksiyon, diyabetik ayak enfeksiyonu, tanı, tedavi uygulamaları, senaryoya dayalı sanal hasta programı

A Scenario-Based Virtual Patient Program To İmprove Adherence To Guidelines for Diabetic Foot İnfection and Complicated İntra-Abdominal İnfection among Physicians

Öz

In the study it was aimed to evaluate diagnostic and practice patterns of
physicians who participated for scenario-based virtual patient programs on
complicated intra-abdominal infection (IAI) and diabetic foot infection (DFI). This study was
conducted with 252 physicians who participated on a voluntary basis in two
scenario-based virtual patient programs relating to complicated IAI (n=210) and
DFI (n=42) which provide data on stepwise evaluation of patient (patient
characteristics, disease characteristics, physical examination, laboratory and
radiological findings) as requested by the physician and were developed using
computer graphics technology. For IAI Case Scenario, the diagnosis was confirmed by 75.0% of physicians, while   surgical intervention with ceftriaxone +
metronidazole (37.6%) or with ertapenem (34.1%) was the most commonly selected
treatment modalities. For DFI Case Scenario, the diagnosis was confirmed by
98.0% of physicians, and 71.0% of physicians considered initiation of
antibiotic treatment and mostly with ertapenem (55.0%). In conclusion, our findings revealed that use of “scenario-based”
virtual patient programs provided rapid and up-to-date feedback and
self-monitoring of learning outcomes to improve clinical reasoning skills of
physicians on IAI and DFI. Accordingly, our findings indicate practice pattern
of physicians for complicated IAI should be improved in terms of more
appropriate selection of empirical antibiotherapy, while diagnostic and
practice patterns for DFI should also be improved in terms of more careful
assessment of risk factors for infection and appropriate selection of empirical
antibiotherapy.

Anahtar Kelimeler

Intraabdominal enfeksiyon, diyabetik ayak enfeksiyonu, tanı, tedavi uygulamaları, senaryoya dayalı sanal hasta programı

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