Turkiye Klinikleri Journal of Nursing Sciences

.: REVIEW
Acil Servis Hemşiresinde Bilgi ve Farkındalık Gerektiren Bir Durum: Geriatrik Sendromların Değerlendirilmesi
A Case Requiring Information and Awareness in Emergency Nursing: Evaluation of Geriatric Syndromes
Gönül DÜZGÜNa, Derya ÇINARb, Aynur TÜREYENc
aSağlık Bilimleri Üniversitesi Tepecik Eğitim ve Araştırma Hastanesi, Palyatif Bakım Kliniği, İzmir, TÜRKİYE
bİzmir Bakırçay Üniversitesi Sağlık Bilimleri Fakültesi, Hemşirelik Bölümü, İzmir, TÜRKİYE
cEge Üniversitesi Hemşirelik Fakültesi, İç Hastalıkları Hemşireliği ABD, İzmir, TÜRKİYE
Turkiye Klinikleri J Nurs Sci. 2020;12(2):280-90
doi: 10.5336/nurses.2019-70057
Article Language: TR
Full Text
ÖZET
 Yaşlı nüfusun artmasıyla birlikte acil hizmetlere gereksinim de artmaktadır. Acil serviste geriatrik hastalar; diğer hastalardan daha kompleks sorunlara sahip olması, daha kırılgan olması ve daha uzun süre izlem gerektirmesi açısından önemlidir. Geriatrik sendrom; yaşlı hastalarda sık görülen, çoğunlukla atipik semptomlarla kendini gösteren ve hastalık tanımı ile tam olarak açıklanamayan, yaşam kalitesini olumsuz etkileyerek morbidite ve mortaliteyi artırabilen klinik durumları ve semptomları ifade etmektedir. Geriatrik sendromlar başlığı altında malnütrisyon, sarkopeni, deliryum, düşme, inkontinans, polifarmasi, osteoporoz ve basınç yarası gibi birçok klinik durum tanımlanmaktadır. Bu çalışmanın amacı; acil serviste çalışan hemşirelerin, acil servislere başvuran geriatrik yaş grubundaki hastalarda; geriatrik sendrom sıklığını tanımaları, fark etmeleri ve değerlendirmeleri için sıklıkla acile başvuru nedeni olan geriatrik sendromlarla ilgili farkındalık oluşturmaktır. Özetle, acil servis hemşiresi, geriatrik hastaların sıklıkla karşılaşabilecekleri düşme, deliryum, inkontinans, bası yaraları gibi durumların saptanması ve fark edilmesinde önemli bir noktada yer almaktadır. Hemşirelerin, acil serviste izlenen geriatrik hastaların sadece acil servis ortamında bulunması nedeni ile bile, gelişebilecek olası riskler açısından daha dikkatli olması ile geriatrik hastalarda daha kaliteli bakım sonuçları elde edilebilir.

Anahtar Kelimeler: Geriatrik hasta; acil servis; geriatrik sendrom
ABSTRACT
 With the increase in the elderly population, the need for emergency services also increases. Geriatric patients in the emergency room are important in terms of having more complex problems than other patients, being more fragile and requiring longer follow-up. Geriatric syndrome refers to the clinical conditions and symptoms that are common in elderly patients, mostly manifested by atypical symptoms and which cannot be fully explained by the definition of the disease, which can negatively affect the quality of life and increase morbidity and mortality. Many clinical conditions such as malnutrition, sarcopenia, delirium, fall, incontinence, polypharmacy, osteoporosis and pressure wound are defined under the title of geriatric syndromes. The purpose of this review is for the nurses working in the emergency department, in the geriatric age group who applied to the emergency departments; is to raise awareness about geriatric syndromes, which are often the reason for emergency referral, in order to recognize and evaluate the frequency of geriatric syndrome. In summary, the emergency nurse takes an important place in detecting and noticing conditions such as falls, delirium, incontinence, pressure sores that geriatric patients may frequently encounter. By monitoring the geriatric patients in the emergency room and carefully observing the possible health risks only because of staying in the emergency room, better care results can be obtained in geriatric patients.

Keywords: Geriatric patient; emergency department; geriatric syndrome
REFERENCES:
  1. Çığşar G, Akkuş Y, Elnare G, Öztürk EE, Palas MB. [Etiology of emergency department admission of the elderly: a retrospective studyin Kars]. Turkish Journal of Geriatrics. 2016;19(1):19-26.
  2. Flood M, Phillips KD. Creativity in older adults: a plethora of possibilities. Issues Ment Health Nurs. 2007;28(4):389-411. [Crossref]  [PubMed] 
  3. Ünsal A, Çevik AA, Metintaş S, Arslantaş D, İnan OÇ. [Emergency department visits by elder patients]. Turkish Journal of Geriatrics. 2003;6(3):83-8.
  4. Ciccone A, Allegra JR, Cochrane DG, Cody RP, Roche LM. Age-related differences in diagnoses within the elderly population. Am J Emerg Med. 1998;16(1):43-8. [Crossref] 
  5. Durukan P, Çevik Y, Yıldız M. [Evaluation of the elderly patients with abdominal pain in the emergency department]. Turkish Journal of Geriatrics. 2005;8(3):111-4.
  6. Varışlı B, Doğan FS, Yiğitbaş MR. [Examination of Geriatric Patients Who Presented to the Emergency Department in Terms of Clinical, Demographic and Cost]. Anatolian Journal of Emergency Medicine. 2018;1(2):18-24.
  7. Köse A, Köse B, Öncü MR, Tuğrul F. [Admission appropriateness and profile of the patients attended to a state hospital emergency department]. Gaziantep Med J. 2011;17(2):57-62. [Crossref] 
  8. Edirne T, Edirne Y, Atmaca B, Keskin S. [Characteristics of emergency department patients of the 100th year university medical school]. Van Medical Journal. 2008;15(4):107-11.
  9. Özşaker E, Korkmaz F, Dölek M. [Analyzing individual characteristics and admission causes of elderly patients to emergency departments]. Turkish Journal of Geriatrics. 2011;14(2):128-34.
  10. Özdemir L, Koçoğlu G, Sümer H, Nur N, Polat H, Aker A, et al. [Frequency of some chronic diseases and risk factors among the elderly people in Sivas, Turkey]. C.Ü. Tıp Fakültesi Dergisi. 2005;27(3):89-94.
  11. Çakır-Dolu İ, Bilgili N. [Drug use practices and determination of drug knowledge levels in a group of elderly individuals living in Ankara]. TAF Prev Med Bull. 2010;9(1):37-44.
  12. Doğan A, Köse-Dönmez B, Nakipoğlu G, Özgirgin N. [The complication and comorbid medical diseases of geriatric stroke patients]. Turkish Journal of Geriatrics. 2009;12(3):118-23.
  13. Akça-Demir AS, Emre U, Ünal A, Acıman E, Akça F. [Comorbid diseases and drug usage among geriatric patients presenting with neurological problems at the emergency department]. Turkish Journal of Geriatrics. 2012;15(2):151-5.
  14. Yıldız S, Bilgili N. [Evaluating individual characteristics and applications of elderly patients presented to emergency service]. Gazi University Journal of Health Sciences. 2016:1(1):15-31.
  15. Tokem Y, Karadakovan A. [Examining the effects of individualized drug education program on drug management in elderly individuals]. Sağlık ve Toplum. 2004;14(3):79-87.
  16. Kekeç Z, Koç F, Büyük S. [Review of geriatric patients hospitalization in emergency department]. JAEM. 2009;8(3):21-4.
  17. Mc Craig LF. National hospital ambulatory medical care survey: 2000 emergency department summary. Washington, DC: National Center for Health Statistics, Centers for Disease Control and Prevention, US Department of Health and Human Services; 2002.
  18. Downing A, Wilson R. Older people's use of accident and emergency services. Age Ageing. 2005;34(1):24-30. [Crossref]  [PubMed] 
  19. Kaldırım U, Eroğlu M, Durusu M, Yıldırım AO, Tuncer SK, Eyi YE, et al. The evaluation of mental status of elderly patients presenting to emergency services and the comparison between the last diagnosis and their complaints. Bulletin of Clinical Psychopharmacology. 2015;25(1):2-8. [Crossref] 
  20. Kılınç AS, Çatak B, Badıllıoğlu O, Sütlü S, Dikme Ö, Aydın O, et al. [Causes and consequences of the admission to the emergency department in elderly]. SDÜ Tıp Fak Derg. 2012;19(4):139-43.
  21. Cigolle CT, Langa KM, Kabeto MU, Tian Z, Blaum CS. Geriatric conditions and disability: the health and retirement study. Ann Intern Med. 2007;147(3):156-64. [Crossref]  [PubMed] 
  22. Inouye SK, Studenski S, Tinetti ME, Kuchel GA. Geriatric syndromes: clinical, research, and policy implications of a core geriatric concept. J Am Geriatr Soc. 2007;55(5):780-91. [Crossref]  [PubMed]  [PMC] 
  23. Topinková E. Aging, disability and frailty. Ann Nutr Metab. 2008;52 Suppl 1:6- 11. [Crossref]  [PubMed] 
  24. Younis K, Ahmad S, Badpa A. Malnutrition: Causes and strategies. Journal of Food Processing and Technology. 2015;6(4):1-8.
  25. Seiler WO. Clinical pictures of malnutrition in ill elderly subject. Nutrition. 2001;17(6):496-8. [Crossref] 
  26. Sayhan MB, Oğuz S, Ümit H, Sayhan ES, Eralp MO, Akdur G, et al. Evaluation of risk factors and clinical characteristics of elderly patients with acute upper gastrointestinal hemorrhage. Tr J Emerg Med. 2012;12(4): 157-62. [Crossref] 
  27. Saka B, Özkulluk H. [Evaluation of the nutritional status and relationship of malnutrition with other geriatric syndromes in elderly patients who admitted to the internal medicine outpatient clinic]. Gülhane Journal of Medicine. 2008;50(3):151-7.
  28. Nalbur İH, Sayhan MB, Oğuz S, Sayhan ES, Hüseyin S. [Nutritional situation assessment of 65 years old patient who applicate to emergency department]. J Clin Anal Med. 2014;5(3):293-8.
  29. Vivanti AP, McDonald CK, Palmer MA, Sinnott M. Malnutrition associated with increased risk of frail mechanical falls among older people presentingto an emergency department. Emerg Med Australas. 2009;21(5):386-94. [Crossref]  [PubMed] 
  30. Cruz-Jentoft AJ, Baeyens JP, Bauer JM, Boirie Y, Cederholm T, Landi F, et al. Sarcopenia: European consensus on definition and diagnosis: report of the European Working Group on sarcopenia in older people. Age Ageing. 2010;39(4):412-23. [Crossref]  [PubMed]  [PMC] 
  31. Janssen I, Baumgartner RN, Ross R, Rosenberg IH, Roubenoff R. Skeletal muscle cutpoints associated with elevated physical disability risk in older men and women. Am J Epidemiol. 2004;159(4):413-21. [Crossref]  [PubMed] 
  32. Morley JE. Sarcopenia: diagnosis and treatment. J Nutr Health Aging. 2008;12(7):452-6. [Crossref]  [PubMed] 
  33. Thomas DR. Loss of skeletal musclemass in aging: examining the relationship of starvation, sarcopenia and cachexia. Clin Nutr. 2007;26(4):389-99. [Crossref]  [PubMed] 
  34. Onur E, Cimilli C. [A new approach to the treatment of deliryum: atypical antipsychotics]. Turk Psikiyatri Derg. 2005;16(3):216-24.
  35. Alexander E. Deliryum in the intensive care unit: medications as risk factors. Crit Care Nurse. 2009;29(1):85-7. [Crossref]  [PubMed] 
  36. Dedeli Ö, Akyol A. [Intensive care unit syndrome]. Yoğun Bakım Hemşireliği Dergisi. 2005;9(1-2):20-7.
  37. Kuşçu MK, Topçuoğlu V, Altunel Ö, Bez Y. [Clinical presentations and follow up outcomes of the delirium patients]. Anatolian Journal of Psychiatry. 2004;5(1):16-21.
  38. Yaşayacak A, Eker F. [Determining delirium and risk factors of patients in cardiovascular surgery intensive care unit]. Türk Göğüs Kalp Damar Cerrahisi Dergisi. 2012;20(2):265-74. [Crossref] 
  39. Kaya E, Sönmez S, Barlas F. [Delirium]. Okmeydanı Tıp Dergisi. 2013;29(Ek Sayı 2):70-4. [Crossref] 
  40. Bogardus ST, Desai MM, Williams CS, Leo-Summer L, Acampora D, Inouye SK. The effects of a targeted multicompanent deliryum intervention on postdischarge outcomes for hospitalized older adults. Am J Med. 2003;114(5):383-90. [Crossref] 
  41. Han JH, Schnelle J, Ely W. Deliryum and the elderly in the emergency department setting. Touch brifing 2008 web site. [Internet] Available from: http://www.touchbriefings.com/ pdf/3195/ely.pdf.
  42. Agostini JV, Inouye SK. Delirium. In: Hazzard WR, Blass JP, Halter JB, Ouslander JG, Tinetti M, eds. Principles of Geriatric Medicine & Gerontology. 5th ed. New York, NY: McGraw-Hill; 2003. p.1503-15.
  43. Atilla ÖD, Sezik S, Dağar S, Akkaya A, Aksay E. [Delirium in older emergency department patientsis associated with increased in- hospital mortality]. Turkish Journal of Geriatrics. 2014;17(1):57-62.
  44. Wilber ST, Gerson LW. A research agenda for geriatric emergency medicine. Acad Emerg Med. 2003;10(3):251-60. [Crossref]  [PubMed] 
  45. Inouye SK, van Dyck CH, Alessi CA, Balkin S, Siegal AP, et al. Clarifying confusion: the confusion assessment method. A new method for detection of deliryum. Ann Intern Med. 1990;113(12):941-8. [Crossref]  [PubMed] 
  46. Han JH, Zimmerman BA, Cutler N, Schnelle J, Morandi A, Dittus RS, et al. Delirium in older emergency department patients: recognition, risk, factors, and psychomotor subtypes. Acad Emerg Med. 2009;16(3):193-200. [Crossref]  [PubMed]  [PMC] 
  47. Eyigör S. [Approach to falls]. Ege Journal of Medicine. 2012;51(Ek Sayı/Suppl):43-51.
  48. Ganz DA, Bao Y, Shekelle PG, Rubenstein LZ. Will my patient fall? JAMA. 2007;297(1):77-86. [Crossref]  [PubMed] 
  49. Rubenstein LZ, Josephson KR. The epidemiology of falls and syncope. Clin Geriatr Med. 2002;18(2):141-58. [Crossref] 
  50. Guideline for the Management of Falls in Older Patients. https://www.rcem.ac.uk/docs/Local%20Guidelines_Audit%20Guidelines%20Protocols/12f.%20Falls%20in%20older%20patients%20(Russells%20Hall%20Hospital,%202012).pdfDate of access 03.05.2017.
  51. World Health Organisation. Falls. www.who.int.violence_injury_prevention/other_injury/falls/en/index. html Date of access 03.05.2017.
  52. Global Report on Falls Prevention in Older Age. WHO Library Cataloguing in Publication Data https://www.who.int/ageing/publications/Falls_prevention7March.pdf Date of access 03.05.2017
  53. İçme F, Becel S, Ahmedalı A, Avcı A, Akoğlu H, Satar S. [The use of trauma scoring systems in elderly patients who are admitted to the emergency department due to falls]. Turkish Journal of Geriatrics. 2014;17(2):138-42.
  54. RCP Report 2011: 'Falling Standards, Broken Promises: Report of the National audit of Falls and Bone Health in older People 2010'. https://www.rcplondon.ac.uk/projects/outputs/falling-standards-broken-promises-report-national-audit-falls-and-bone-health Date of access 03.05.2017.
  55. Abrams P, Cardozo L, Fall M, Griffiths D, Roise P, Kerrebroeck P, et al. The standardisation of terminology in lower urinary tract function: report from the standardisation sub-committee of the International Continence Society. Urology. 2003;61(1):37-49. [Crossref] 
  56. Park WH. Urinary incontinence and physician's attitude. J Korean Med Sci. 2013;28(11):1559-60. [Crossref]  [PubMed]  [PMC] 
  57. Theodore M, Johnson II, Ouslander JG. Urinary incontinence. In: Halter JB, Ouslander JG, Tinetti M, Studenski S, High KP, Asthana S, eds. Informa Hazzard's Geriatric Medicine and Gerontology. 6th ed. New York: McGraw Hill Professional; 2009. p.717-30.
  58. Akın S. [Urinary incontinence in the elderly]. Kontinans ve Nöroüroloji Bülteni. 2015;2:49-54.
  59. Güler H. [Approach to the geriatric patients with musculoskeletal system diseases]. Turkiye Klinikleri J Int Med Sci. 2005;1(27):16-21.
  60. Kılınç AS, Çatak B, Badıllıoğlu O, Sütlü S, Dikme Ö, Aydın O, et al. [Evaluation of reasons and results of elderly applied to the emergency department]. Medical Journal of Suleyman Demirel University. 2012;19(4).
  61. Gökçe KY. [Old age and women's health]. Akın A, editör. Toplumsal Cinsiyet, Sağlık ve Kadın. HÜKSAM Yayını. Ankara: Hacettepe Üniversitesi Hastaneleri Basımevi; p.191-208.
  62. Çelik Ö, Bayındır A, Tuncer Ö. [Vertebral failure fracture in a geriatric patient: case report]. Prusias Medical Journal. 2016;1(1):44-7.
  63. Halil M. [Management of geriatric syndromes: urinary incontinanca, falls, pressure sores]. İç Hastalıkları Dergisi. http://ichastaliklaridergisi.org/managete/fu_folder/2007-01/html/2007-14-1-045-054.htm (Erişim tarihi: 28.05.2017).
  64. Linjakumpu T, Hartikainen S, Klaukka T, Veijola J, Kivelä SL, Isoaho R. Use of medications and polypharmacy are increasing among the elderly. J Clin Epidemiol. 2002;55(8):809-17. [Crossref] 
  65. Koh Y, Kutty FB, Li SC. Drug-related problems in hospitalized patients on polypharmacy: the influence of age and gender. Ther Clin Risk Manag. 2005;1(1):39-48. [Crossref]  [PubMed]  [PMC] 
  66. Lund BC, Carnahan RM, Egge JA, Chrischilles EA, Kaboli PJ. In appropriate prescribing predicts adverse drug events in older adults. Ann Pharmacother. 2010;44(6):957-63. [Crossref]  [PubMed] 
  67. Spinewine A, Schmader KE, Barber N, Hughes C, Lapane KL, Swine C, et al. Appropriate prescribing in elderly people: how well can it be measured and optimised? Lancet. 2007;370(9582):173-84. [Crossref] 
  68. Veehof LJG, Meyboom-de Jong B, Haaijer-Raskamp FM. Polypharmacy in the elderly-a literatüre review. Eur J Gen Pract. 2000;6(3):98-106. [Crossref] 
  69. Jyrkkä J, Enlund H, Korhonen MJ, Sulkava R, Hartikainen S. Polypharmacy status as an indicator of mortality in an elderly population. Drugs Aging. 2009;26(12):1039-48. [Crossref]  [PubMed] 
  70. Gurwitz JH. Polypharmacy: a new paradigm for quality drug therapy in the elderly? Arch Intern Med. 2004;164(18):1957-9. [Crossref]  [PubMed] 
  71. Hilmer SN, Gnjidic D. The effects of polypharmacy in older adults. Clin Pharmacol Ther. 2009;85(1):86-8. [Crossref]  [PubMed] 
  72. Steinman MA, Landefeld CS, Rosenthal GE, Berthenthal D, Sen S, Kaboli PJ. Polypharmacy and prescribing quality in older people. J Am Geriatr Soc. 2006;5(10):1516-2. [Crossref]  [PubMed] 
  73. Loğoğlu A, Ayrık C, Köse A, Bozkurt S, Demir F, Narcı H, et al. [Analysis of non-traumatic elderly patient presentations to the emergency department]. Türkiye Acil Tıp Dergisi. 2013;13(4):171-9. [Crossref] 
  74. Lim KH, Yap KB. The prescribing pattern of outpatient polyclinic doctors. Singapore Med J. 1999;40(6):416-9.
  75. Kunt MM. [Emergency problems in old age.] Birinci Basamak İçin Temel Geriatri. 1. Baskı. Ankara: Algı Tanıtım; 2012. p.66-73.
  76. Aydos TR. [The principles of rational drug use in old age.] Birinci Basamak İçin Temel Geriatri. 1. Baskı. Ankara: Algı Tanıtım; 2012. p.57-65.
  77. Keskinler MV, Tufan F, Oğuz A. [Geriatric syndromes]. Okmeydanı Tıp Dergisi. 2013;29(Ek Sayı 2):41-8. [Crossref] 
  78. Kurtuluş Z, Pınar R. [Relation between albumin levels and pressure sore in high-risk patients defined with Braden's risk assessment tool]. C.Ü. Hemşirelik Yüksek Okulu Dergisi. 2003;7(2):1-10.
  79. Oğuz O. [Decubitis ulcers]. Beğer T, editör. Geriatrik Hasta ve Sorunları. İstanbul: Cerrahpaşa Tıp Fakültesi Sürekli Tıp Eğitimi Yayınları; 1998. p.147-51.

.: Up To Date

.: Process List

Login

 Forgot your password?

 New Registration  

Contact

Ortadoğu Reklam Tanıtım Yayıncılık Turizm Eğitim İnşaat Sanayi ve Ticaret A.Ş.

.: Address

Turkocagi Caddesi No:30 06520 Balgat / ANKARA
Phone: +90 312 286 56 56
Fax: +90 312 220 04 70
E-mail: info@turkiyeklinikleri.com

.: Manuscript Editing Department

Phone: +90 312 286 56 56/ 2
E-mail: yaziisleri@turkiyeklinikleri.com

.: English Language Redaction

Phone: +90 312 286 56 56/ 145
E-mail: tkyayindestek@turkiyeklinikleri.com

.: Marketing Sales-Project Department

Phone: +90 312 286 56 56/ 142
E-mail: reklam@turkiyeklinikleri.com

.: Subscription and Public Relations Department

Phone: +90 312 286 56 56/ 118
E-mail: abone@turkiyeklinikleri.com

.: Customer Services

Phone: +90 312 286 56 56/ 118
E-mail: satisdestek@turkiyeklinikleri.com

1. TERMS OF USE

1.1. To use the web pages with http://www.turkiyeklinikleri.com domain name or the websites reached through the sub domain names attached to the domain name (They will be collectively referred as "SITE"), please read the conditions below. If you do not accept these terms, please cease to use the "SITE." "SITE" owner reserves the right to change the information on the website, forms, contents, the "SITE," "SITE" terms of use anytime they want.

1.2. The owner of the "SITE" is Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. (From now on it is going to be referred as "Turkiye Klinikleri", shortly) and it resides at Turkocagi cad. No:30, 06520 Balgat Ankara. The services in the "SITE" are provided by "Turkiye Klinikleri."

1.3. Anyone accessing the "SITE" with or without a fee whether they are a natural person or a legal identity is considered to agree these terms of use. In this contract hereby, "Turkiye Klinikleri" may change the stated terms anytime. These changes will be published in the "SITE" periodically and they will be valid when they are published. Any natural person or legal identity benefiting from and reaching to the "SITE" are considered to be agreed to any change on hereby contract terms done by "Turkiye Klinikleri."

1.4. The "Terms of Use" hereby is published in the website with the last change on March 30th 2014 and the "SITE" is activated by enabling the access to everyone. The "Terms of Use" hereby is also a part of the any "USER Contract" was and/or will be done with the users using "Turkiye Klinikleri" services with or without a fee an inseparable.

2. DEFINITIONS

2.1. "SITE": A website offering different kind of services and context with a certain frame determined by "Turkiye Klinikleri" and it is accessible on-line on http://www.turkiyeklinikleri.com domain name and/or subdomains connected to the domain name.

2.2. USER: A natural person or a legal identity accessing to the "SITE" through online settings.

2.3. LINK: A link enabling to access to another website through the "SITE", the files, the context or through another website to the "SITE", the files and the context.

2.4. CONTEXT: Any visual, literary and auditory images published in the "Turkiye Klinikleri", "SITE" and/or any website or any accessible information, file, picture, number/figures, price, etc.

2.5. "USER CONTRACT": An electronically signed contract between a natural or a legal identity benefiting from special services "Turkiye Klinikleri" will provide and "Turkiye Klinikleri".

3. SCOPE OF THE SERVICES

3.1. "Turkiye Klinikleri" is completely free to determine the scope and quality of the services via the "SITE".

3.2. To benefit the services of "Turkiye Klinikleri" "SITE", the "USER" must deliver the features that will be specified by "Turkiye Klinikleri". "Turkiye Klinikleri" may change this necessity any time single-sided.

3.3. Not for a limited number, the services "Turkiye Klinikleri" will provide through the "SITE" for a certain price or for free are;

- Providing scientific articles, books and informative publications for health industry.

- Providing structural, statistical and editorial support to article preparation stage for scientific journals.

4. GENERAL PROVISIONS

4.1. "Turkiye Klinikleri" is completely free to determine which of the services and contents provided in the "SITE" will be charged.

4.2. People benefiting from the services provided by "Turkiye Klinikleri" and using the website can use the "SITE" only according to the law and only for personal reasons. Users have the criminal and civil liability for every process and action they take in the "SITE". Every USER agrees, declares and undertakes that they will not proceed by any function or action infringement of rights of "Turkiye Klinikleri"s and/or other third parties', they are the exclusive right holder on usage, processing, storage, made public and revealing any written, visual or auditory information reported to Turkiye Klinikleri" and/or "SITE" to the third parties. "USER" agrees and undertakes that s/he will not duplicate, copy, distribute, process, the pictures, text, visual and auditory images, video clips, files, databases, catalogs and lists within the "SITE", s/he will not be using these actions or with other ways to compete with "Turkiye Klinikleri", directly or indirectly.

4.3. The services provided and the context published within the "SITE" by third parties is not under the responsibility of "Turkiye Klinikleri", institutions collaborated with "Turkiye Klinikleri", "Turkiye Klinikleri" employee and directors, "Turkiye Klinikleri" authorized salespeople. Commitment to accuracy and legality of the published information, context, visual and auditory images provided by any third party are under the full responsibility of the third party. "Turkiye Klinikleri" does not promise and guarantee the safety, accuracy and legality of the services and context provided by a third party.

4.4. "USER"s cannot act against "Turkiye Klinikleri", other "USER"s and third parties by using the "SITE". "Turkiye Klinikleri" has no direct and/or indirect responsibility for any damage a third party suffered or will suffer regarding "USER"s actions on the "SITE" against the rules of the hereby "Terms of Use" and the law.

4.5. "USER"s accept and undertake that the information and context they provided to the "SITE" are accurate and legal. "Turkiye Klinikleri" is not liable and responsible for promising and guaranteeing the verification of the information and context transmitted to "Turkiye Klinikleri" by the "USER"s, or uploaded, changed and provided through the "SITE" by them and whether these information are safe, accurate and legal.

4.6. "USER"s agree and undertake that they will not perform any action leading to unfair competition, weakening the personal and commercial credit of "Turkiye Klinikleri" and a third party,  encroaching and attacking on personal rights within the "SITE" in accordance with the Turkish Commercial Code Law.

4.7. "Turkiye Klinikleri" reserves the right to change the services and the context within the "SITE"  anytime. "Turkiye Klinikleri" may use this right without any notification and timelessly. "USER"s have to make the changes and/or corrections "Turkiye Klinikleri" required immediately. Any changes and/or corrections that are required by "Turkiye Klinikleri", may be made by "Turkiye Klinikleri" when needed. Any harm, criminal and civil liability resulted or will result from changes and/or corrections required by "Turkiye Klinikleri" and were not made on time by the "USER"s belongs completely to the users.

4.8. "Turkiye Klinikleri" may give links through the "SITE" to other websites and/or "CONTEXT"s and/or folders that are outside of their control and owned and run by third parties. These links are provided for ease of reference only and do not hold qualification for support the respective web SITE or the admin or declaration or guarantee for the information inside. "Turkiye Klinikleri" does not hold any responsibility over the web-sites connected through the links on the "SITE", folders and context, the services or products on the websites provided through these links or their context.

4.9. "Turkiye Klinikleri" may use the information provided to them by the "USERS" through the "SITE" in line with the terms of the "PRIVACY POLICY" and "USER CONTRACT". It may process the information or classify and save them on a database. "Turkiye Klinikleri" may also use the USER's or visitor's identity, address, e-mail address, phone number, IP number, which sections of the "SITE" they visited, domain type, browser type, date and time information to provide statistical evaluation and customized services.

5. PROPRIETARY RIGHTS

5.1. The information accessed through this "SITE" or provided by the users legally and all the elements (including but not limited to design, text, image, html code and other codes) of the "SITE" (all of them will be called as studies tied to "Turkiye Klinikleri"s copyrights) belongs to "Turkiye Klinikleri". Users do not have the right to resell, process, share, distribute, display or give someone permission to access or to use the "Turkiye Klinikleri" services, "Turkiye Klinikleri" information and the products under copyright protection by "Turkiye Klinikleri". Within hereby "Terms of Use" unless explicitly permitted by "Turkiye Klinikleri" nobody can reproduce, process, distribute or produce or prepare any study from those under "Turkiye Klinikleri" copyright protection.

5.2. Within hereby "Terms of Use", "Turkiye Klinikleri" reserves the rights for "Turkiye Klinikleri" services, "Turkiye Klinikleri" information, the products associated with "Turkiye Klinikleri" copyrights, "Turkiye Klinikleri" trademarks, "Turkiye Klinikleri" trade looks or its all rights for other entity and information it has through this website unless it is explicitly authorized by "Turkiye Klinikleri".

6. CHANGES IN THE TERMS OF USE

"Turkiye Klinikleri" in its sole discretion may change the hereby "Terms of Use" anytime announcing within the "SITE". The changed terms of the hereby "Terms of Use" will become valid when they are announced. Hereby "Terms of Use" cannot be changed by unilateral declarations of users.

7. FORCE MAJEURE

"Turkiye Klinikleri" is not responsible for executing late or never of this hereby "Terms of Use", privacy policy and "USER Contract" in any situation legally taken into account as force majeure. Being late or failure of performance or non-defaulting of this and similar cases like this will not be the case from the viewpoint of "Turkiye Klinikleri", and "Turkiye Klinikleri" will not have any damage liability for these situations. "Force majeure" term will be regarded as outside of the concerned party's reasonable control and any situation that "Turkiye Klinikleri" cannot prevent even though it shows due diligence. Also, force majeure situations include but not limited to natural disasters, rebellion, war, strike, communication problems, infrastructure and internet failure, power cut and bad weather conditions.

8. LAW AND AUTHORISATION TO FOLLOW

Turkish Law will be applied in practicing, interpreting the hereby "Terms of Use" and managing the emerging legal relationships within this "Terms of Use" in case of finding element of foreignness, except for the rules of Turkish conflict of laws. Ankara Courts and Enforcement Offices are entitled in any controversy happened or may happen due to hereby contract.

9. CLOSING AND AGREEMENT

Hereby "Terms of Use" come into force when announced in the "SITE" by "Turkiye Klinikleri". The users are regarded to agree to hereby contract terms by using the "SITE". "Turkiye Klinikleri" may change the contract terms and the changes will be come into force by specifying the version number and the date of change on time it is published in the "SITE".

 

30.03.2014

Privacy Policy

We recommend you to read the terms of use below before you visit our website. In case you agree these terms, following our rules will be to your favor. Please read our Terms of Use thoroughly.

www.turkiyeklinikleri.com website belongs to Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. and is designed in order to inform physicians in the field of health

www.turkiyeklinikleri.com cannot reach to user’s identity, address, service providers or other information. The users may send this information to the website through forms if they would like to. However, www.turkiyeklinikleri.com may collect your hardware and software information. The information consists of your IP address, browser type, operating system, domain name, access time, and related websites. www.turkiyeklinikleri.com cannot sell the provided user information (your name, e-mail address, home and work address, phone number) to the third parties, publish it publicly, or keep it in the website. Gathered information has a directing feature to be a source for the website’s visitor profile, reporting and promotion of the services.

www.turkiyeklinikleri.com uses the taken information:

-To enhance, improve and maintain the quality of the website

-To generate visitor’s profile and statistical data

-To determine the tendency of the visitors on using our website

-To send print publications/correspondences

-To send press releases or notifications through e-mail

-To generate a list for an event or competition

By using www.turkiyeklinikleri.com you are considered to agree that;

-Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. cannot be hold responsible for any user’s illegal and immoral behavior,

-Terms of use may change from time to time,

-It is not responsible for other websites’ contents it cannot control or the harms they may cause although it uses the connection they provided.

Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. may block the website to users in the following events:

-Information with wrong, incomplete, deceiving or immoral expressions is recorded to the website,

-Proclamation, advertisement, announcement, libelous expressions are used against natural person or legal identity,

-During various attacks to the website,

-Disruption of the website because of a virus.

Written, visual and audible materials of the website, including the code and the software are under protection by legal legislation.

Without the written consent of Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. the information on the website cannot be downloaded, changed, reproduced, copied, republished, posted or distributed.

All rights of the software and the design of the website belong to Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc.

Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. will be pleased to hear your comments about our terms of use. Please share the subjects you think may enrich our website or if there is any problem regarding our website.

info@turkiyeklinikleri.com