Turkiye Klinikleri Journal of Nursing Sciences

.: REVIEW
Çocuk Hastalarda Basınç Yaralanması Risk Değerlendirmesi: Geleneksel Derleme
Pressure Injury Risk Assessment in Pediatric Patients: Traditional Review
Ayişe KARADAĞa , Enes ŞİMŞEKb , Remziye SEMERCİb
aKoç Üniversitesi Hemşirelik Fakültesi, Hemşirelik Esasları ABD, İstanbul, Türkiye
bKoç Üniversitesi Hemşirelik Fakültesi, Çocuk Sağlığı ve Hastalıkları Hemşireliği ABD, İstanbul, Türkiye
Turkiye Klinikleri J Nurs Sci. 2024;16(2):582-92
doi: 10.5336/nurses.2023-97160
Article Language: TR
Full Text
ÖZET
 Günümüzde, basınç yaralanmaları ciddi bir sağlık sorunudur. Basınç yaralanmalarının önlenmesine ve tedavisine yönelik klinik uygulama kılavuzlarında çocuklar, basınç yaralanması gelişimi açısından yüksek riskli popülasyon olarak kabul edilmektedir. Çocuklarda basınç yaralanması gelişimini etkileyen risk faktörleri; vücudun anatomik gelişimini tamamlamaması, gestasyonel yaşın küçük olması, hastane yatış süresinin uzaması, beslenme bozukluğu, hemoglobin düzeyinde düşüş, doku perfüzyonunda bozulma, inatçı ateş, inkontinans, sürtünme ve yırtılmaya maruziyet, cerrahi girişim, mobilizasyonda bozulma ve tıbbi araç kullanımıdır. Basınç yaralanmasını önlemede ilk strateji, geçerli ve güvenilir bir risk değerlendirme aracıyla, hastanın sistematik ve periyodik olarak değerlendirilmesidir. Bu sayede, basınç yaralanması gelişme riski yüksek olan hastalar belirlenerek, hemşirelik bakımı risk düzeyine uygun planlanabilir ve basınç yaralanmalarının gelişimi engellenebilir. Çocuk hastalarda, basınç yaralanması risk değerlendirmesi hastaneye yatıştan itibaren başlatılmalı ve taburculuğa kadar düzenli olarak devam etmelidir. Ayrıca mobilite ve duyusal algılamada problemi olan çocuklarda risk değerlendirmesi, her gün en az bir kez yapılmalıdır. Kronik hastalarda, risk skoru değişim göstermiyorsa haftada bir kez risk değerlendirmesi yeterli olacaktır. Ancak hastanın klinik durumunda bir değişiklik olursa, risk değerlendirme sıklığı yeniden planlanmalıdır. Çocuklarda risk değerlendirmesi için birden fazla ölçek mevcuttur ancak bunlar arasında tıbbi araçlara bağlı basınç yaralanmalarını değerlendirmesi, kullanım kolaylığı ve uygulama yaş aralığının geniş olması gibi nedenlerle Braden QD Ölçeği'nin kullanılması önerilmektedir.

Anahtar Kelimeler: Basınç yaralanması; risk faktörleri; risk değerlendirmesi; çocuk; hemşirelik
ABSTRACT
 Globally, pressure injuries are a serious health problem. In clinical practice guidelines for the prevention and treatment of pressure injuries, children are considered a high-risk population for the development of pressure injuries. Risk factors for pressure injury in children are immature anatomical development, small gestational age, prolonged hospitalization, malnutrition, hemoglobin level decrease, impaired tissue perfusion, fever, incontinence, exposure to friction and tearing, surgical intervention, impaired mobilization, and use of medical device. The first strategy for preventing pressure injury is the systematic and periodic evaluation of the patient with a reliable and valid risk assessment tool. Thus, identifying patients at high risk of developing a pressure injury and nursing care planning in accordance with the patient's risk level by nurses ensure minimizing the risk and providing cost-effective health care. In pediatric patients, pressure injury risk assessment should be initiated from hospital admission and continued regularly until discharge. In addition, risk assessment should be performed at least once a day in children with mobility and sensory perception problems. In chronic patients, risk assessment once per week will be sufficient if the risk score does not change. However, if there is a change in the clinical condition, the frequency of the risk assessment should be rescheduled. Although there are more than one risk assessment scales for children, it is recommended to use the Braden QD Scale among other scales due to its features for evaluating medical device-related pressure injuries, ease of use, and wide applicable age range.

Keywords: Pressure injury; risk factors; risk assessment; child; nursing
REFERENCES:
  1. Tayyib N, Coyer F, Lewis PA. A two-arm cluster randomized control trial to determine the effectiveness of a pressure ulcer prevention bundle for critically ill patients. J Nurs Scholarsh. 2015;47(3):237-47. [Crossref]  [PubMed] 
  2. Li Z, Lin F, Thalib L, Chaboyer W. Global prevalence and incidence of pressure injuries in hospitalised adult patients: a systematic review and meta-analysis. Int J Nurs Stud. 2020;105:103546. [Crossref]  [PubMed] 
  3. Zhang H, Ma Y, Wang Q, Zhang X, Han L. Incidence and prevalence of pressure injuries in children patients: a systematic review and meta-analysis. J Tissue Viability. 2022;31(1):142-51. [Crossref]  [PubMed] 
  4. Levy A, Kopplin K, Gefen A. Adjustability and adaptability are critical characteristics of pediatric support surfaces. Adv Wound Care (New Rochelle). 2015;4(10):615-22. [Crossref]  [PubMed]  [PMC] 
  5. McCord S, McElvain V, Sachdeva R, Schwartz P, Jefferson LS. Risk factors associated with pressure ulcers in the pediatric intensive care unit. J Wound Ostomy Continence Nurs. 2004;31(4):179-83. [Crossref]  [PubMed] 
  6. European Pressure Ulcer Advisory Panel, National Pressure Injury Advisory Panel and Pan Pacific Pressure Injury Alliance. Prevention and Treatment of Pressure Ulcers/Injuries: Quick Reference Guide. EPUAP/NPIAP/PPPIA; 2019. [Link] 
  7. Frank G, Walsh KE, Wooton S, Bost J, Dong W, Keller L, et al. Impact of a pressure injury prevention bundle in the solutions for patient safety network. Pediatr Qual Saf. 2017;2(2):e013. [Crossref]  [PubMed]  [PMC] 
  8. Peterson J, Adlard K, Walti BI, Hayakawa J, McClean E, Feidner SC. Clinical nurse specialist collaboration to recognize, prevent, and treat pediatric pressure ulcers. Clin Nurse Spec. 2015;29(5):276-82. [Crossref]  [PubMed] 
  9. Delmore B, Deppisch M, Sylvia C, Luna-Anderson C, Nie AM. Pressure injuries in the pediatric population: a national pressure ulcer advisory panel white paper. Adv Skin Wound Care. 2019;32(9):394-408. [Crossref]  [PubMed] 
  10. Ayello EA, Delmore BA. Risk assessment for pressure injuries. WCET Journal. 2022;42(4):31-7 [Crossref] 
  11. National Pressure Ulcer Advisory Panel, European Pressure Ulcer Advisory Panel and Pan Pacific Pressure Injury Alliance. Prevention and treatment of pressure ulcers: quick reference guide. Osborne Park, Western Australia:Cambridge Media; 2014. [Link] 
  12. Türkiye Cumhuriyeti Sağlık Bakanlığı Sağlık Hizmetleri Genel Müdürlüğü Eğitim ve Seritifikasyon Hizmetleri Daire Başkanlığı. Stoma ve yara bakım hemşireliği sertifikalı eğitim standartları. 2015. Erişim tarihi 11.05.2024 [Link] 
  13. Gefen A, Alves P, Ciprandi G, Coyer F, Milne CT, Ousey K, et al. Device-related pressure ulcers: SECURE prevention. Second edition. J Wound Care. 2022;31(Sup3a):S1-S72. [Crossref]  [PubMed] 
  14. Lund C, Kuller J, Lane A, Lott JW, Raines DA. Neonatal skin care: the scientific basis for practice. Neonatal Netw. 1999;28(3):241-54. [Crossref]  [PubMed] 
  15. Törüner Kılıçarslan E, Büyükgönenç LA, Altay N. Çocuklarda basınç ülserleri [Pressure ulcers in children]. Dokuz Eylül Üniversitesi Hemşirelik Yüksekokulu Elektronik Dergisi. 2011;4(1):2-6. [Link] 
  16. Özgen R. Çocuklarda basınç yarası prevalansı ve risk faktörlerinin belirlenmesi [Yüksek lisans tezi]. İstanbul: Acıbadem Üniversitesi; 2015. [Erişim tarihi: 07 Mart 2024]. Erişim linki: [Link] 
  17. García-Molina P, Balaguer López E, Verdú J, Nolasco A, García Fernández FP. Cross-cultural adaptation, reliability and validity of the Spanish version of the Neonatal Skin Risk Assessment Scale. J Nurs Manag. 2018;26(6):744-56. [Crossref]  [PubMed] 
  18. Telofski LS, Morello AP 3rd, Mack Correa MC, Stamatas GN. The infant skin barrier: can we preserve, protect, and enhance the barrier? Dermatol Res Pract. 2012;2012:198789. [Crossref]  [PubMed]  [PMC] 
  19. Visscher MO, Adam R, Brink S, Odio M. Newborn infant skin: physiology, development, and care. Clin Dermatol. 2015;33(3):271-80. [Crossref]  [PubMed] 
  20. Blume-Peytavi U, Hauser M, Stamatas GN, Pathirana D, Garcia Bartels N. Skin care practices for newborns and infants: review of the clinical evidence for best practices. Pediatr Dermatol. 2012;29(1):1-14. [Crossref]  [PubMed] 
  21. Fox MD. Wound care in the neonatal intensive care unit. Neonatal Netw. 2011;30(5):291-303. [Crossref]  [PubMed] 
  22. Widiati E, Nurhaeni N, Gayatri D. Medical-device related pressure injuries to children in the intensive care unit. Compr Child Adolesc Nurs. 2017;40(sup1):69-77. [Crossref]  [PubMed] 
  23. Taylor SL, Sen S, Greenhalgh DG, Lawless M, Curri T, Palmieri TL. A competing risk analysis for hospital length of stay in patients with burns. JAMA Surg. 2015;150(5):450-6. [Crossref]  [PubMed]  [PMC] 
  24. Eberlein-Gonska M, Petzold T, Helaß G, Albrecht DM, Schmitt J. The incidence and determinants of decubitus ulcers in hospital care: an analysis of routine quality management data at a university hospital. Dtsch Arztebl Int. 2013;110(33-34):550-6. [PubMed]  [PMC] 
  25. Baranoski S, Ayello EA, Tomic-Canic M, Levine J. Skin: an essential organ. Wound Care Essentials: Practice Principles. 3rd ed. Philadelphia: Lippincott Williams & Wilkins; 2012. p.173-5.
  26. White JV, Guenter P, Jensen G, Malone A, Schofield M; Academy Malnutrition Work Group; A.S.P.E.N. Malnutrition Task Force; A.S.P.E.N. Board of Directors. Consensus statement: Academy of Nutrition and Dietetics and American Society for Parenteral and Enteral Nutrition: characteristics recommended for the identification and documentation of adult malnutrition (undernutrition). JPEN J Parenter Enteral Nutr. 2012;36(3):275-83. [Crossref]  [PubMed] 
  27. Fogerty MD, Abumrad NN, Nanney L, Arbogast PG, Poulose B, Barbul A. Risk factors for pressure ulcers in acute care hospitals. Wound Repair Regen. 2008;16(1):11-8. [Crossref]  [PubMed] 
  28. Bryant R, Nix D. Acute and Chronic Wounds: Current Management Concepts. 5th ed. Elsevier Health Sciences; 2015.
  29. Theaker C, Mannan M, Ives N, Soni N. Risk factors for pressure sores in the critically ill. Anaesthesia. 2000;55(3):221-4. [Crossref]  [PubMed] 
  30. Willock J, Baharestani MM, Anthony D. The development of the Glamorgan paediatric pressure ulcer risk assessment scale. J Wound Care. 2009;18(1):17-21. [Crossref]  [PubMed] 
  31. International Review. Pressure Ulcer Prevention: Pressure, Shear, Friction and Microclimate in Context: A Consensus Document. London: Wounds International; 2010. [Link] 
  32. Brienza DM, Geyer MJ. Using support surfaces to manage tissue integrity. Adv Skin Wound Care. 2005;18(3):151-7. [Crossref]  [PubMed] 
  33. Mayrovitz HN, Sims N. Biophysical effects of water and synthetic urine on skin. Adv Skin Wound Care. 2001;14(6):302-8. [Crossref]  [PubMed] 
  34. Kim S, Ward E, Dicianno BE, Clayton GH, Sawin KJ, Beierwaltes P, et al; National Spina Bifida Patient Registry. Factors associated with pressure ulcers in individuals with spina bifida. Arch Phys Med Rehabil. 2015;96(8):1435-41.e1. [Crossref]  [PubMed]  [PMC] 
  35. Baharestani MM, Ratliff CR. Pressure ulcers in neonates and children: an NPUAP white paper. Adv Skin Wound Care. 2007;20(4):208, 210, 212, 214, 216, 218-20. [Crossref]  [PubMed] 
  36. Tanrıkulu F, Dikmen Y. Yoğun bakım hastalarında basınç yaraları: risk faktörleri ve önlemler [Pressure ulcers in intensive care patients: risk factors and precautions]. J of Human Rhythm. 2017;3(4):177-82. [Link] 
  37. Cooper KL. Evidence-based prevention of pressure ulcers in the intensive care unit. Crit Care Nurse. 2013;33(6):57-66. [Crossref]  [PubMed] 
  38. Garvin G. Wound and skin care for the PICU. Crit Care Nurs Q. 1997;20(1):62-71. [Crossref]  [PubMed] 
  39. Eberhardt TD, de Lima SBS, de Avila Soares RS, Silveira LBTD, Rossarola Pozzebon B, Reis CR, et al. Prevention of pressure injury in the operating room: Heels operating room pressure injury trial. Int Wound J. 2021;18(3):359-66. [Crossref]  [PubMed]  [PMC] 
  40. Karadag M, Gümüskaya N. The incidence of pressure ulcers in surgical patients: a sample hospital in Turkey. J Clin Nurs. 2006;15(4):413-21. [Crossref]  [PubMed] 
  41. Joseph J, McLaughlin D, Darian V, Hayes L, Siddiqui A. Alternating pressure overlay for prevention of intraoperative pressure injury. J Wound Ostomy Continence Nurs. 2019;46(1):13-7. [Crossref]  [PubMed] 
  42. Mervis JS, Phillips TJ. Pressure ulcers: pathophysiology, epidemiology, risk factors, and presentation. J Am Acad Dermatol. 2019;81(4):881-90. [Crossref]  [PubMed] 
  43. Ali NA, O'Brien JM Jr, Hoffmann SP, Phillips G, Garland A, Finley JC, et al; Midwest Critical Care Consortium. Acquired weakness, handgrip strength, and mortality in critically ill patients. Am J Respir Crit Care Med. 2008;178(3):261-8. [Crossref]  [PubMed] 
  44. Gruther W, Benesch T, Zorn C, Paternostro-Sluga T, Quittan M, Fialka-Moser V, et al. Muscle wasting in intensive care patients: ultrasound observation of the M. quadriceps femoris muscle layer. J Rehabil Med. 2008;40(3):185-9. [Crossref]  [PubMed] 
  45. Parry SM, El-Ansary D, Cartwright MS, Sarwal A, Berney S, Koopman R, et al. Ultrasonography in the intensive care setting can be used to detect changes in the quality and quantity of muscle and is related to muscle strength and function. J Crit Care. 2015;30(5):1151.e9-14. [Crossref]  [PubMed] 
  46. Cameron S, Ball I, Cepinskas G, Choong K, Doherty TJ, Ellis CG, et al. Early mobilization in the critical care unit: a review of adult and pediatric literature. J Crit Care. 2015;30(4):664-72. [Crossref]  [PubMed] 
  47. Curley MAQ, Hasbani NR, Quigley SM, Stellar JJ, Pasek TA, Shelley SS, et al. Predicting pressure injury risk in pediatric patients: the Braden QD Scale. J Pediatr. 2018;192:189-95.e2. [Crossref]  [PubMed] 
  48. Rowe AD, McCarty K, Huett A. Implementation of a nurse driven pathway to reduce incidence of hospital acquired pressure injuries in the pediatric intensive care setting. J Pediatr Nurs. 2018;41:104-9. [Crossref]  [PubMed] 
  49. Murray JS, Noonan C, Quigley S, Curley MA. Medical device-related hospital-acquired pressure ulcers in children: an integrative review. J Pediatr Nurs. 2013;28(6):585-95. [Crossref]  [PubMed] 
  50. Visscher M, King A, Nie AM, Schaffer P, Taylor T, Pruitt D, et al. A quality-improvement collaborative project to reduce pressure ulcers in PICUs. Pediatrics. 2013;131(6):e1950-60. [Crossref]  [PubMed]  [PMC] 
  51. Avşar P, Karadağ A. Waterlow Basınç Ülseri Risk Değerlendirme Ölçeği'nin Türkçeye uyarlanması, geçerlik-güvenirlik çalışması [Turkish adaptation and validity reliability study of the Waterlow Pressure Ulcer Risk Assessment Scale]. J Hacettepe Univ Fac Nurs. 2016;3(3):1-15. [Link] 
  52. Mallah Z, Nassar N, Kurdahi Badr L. The effectiveness of a pressure ulcer intervention program on the prevalence of hospital acquired pressure ulcers: controlled before and after study. Appl Nurs Res. 2015;28(2):106-13. [Crossref]  [PubMed] 
  53. Defloor T, Grypdonck MF. Pressure ulcers: validation of two risk assessment scales. J Clin Nurs. 2005;14(3):373-82. [Crossref]  [PubMed] 
  54. Ayello EA, Braden B. How and why to do pressure ulcer risk assessment. Adv Skin Wound Care. 2002;15(3):125-31; quiz 132-33. [Crossref]  [PubMed] 
  55. Waterlow J. From costly treatment to cost-effective prevention: using Waterlow. Br J Community Nurs. 2005;10(9):S25-6, S28, S30. [Crossref]  [PubMed] 
  56. O'Tuathail C, Taqi R. Evaluation of three commonly used pressure ulcer risk assessment scales. Br J Nurs. 2011;20(6):S27-8, S30, S32 Passim. [Crossref]  [PubMed] 
  57. Charalambous C, Koulori A, Vasilopoulos A, Roupa Z. Evaluation of the Validity and Reliability of the Waterlow Pressure Ulcer Risk Assessment Scale. Med Arch. 2018;72(2):141-4. [Crossref]  [PubMed]  [PMC] 
  58. Huffines B, Logsdon MC. The Neonatal Skin Risk Assessment Scale for predicting skin breakdown in neonates. Issues Compr Pediatr Nurs. 1997;20(2):103-14. [Crossref]  [PubMed] 
  59. Saçar Ç, Öztürk C, Bektaş M. Glamorgan pediatrik Basınç Ülseri Risk Tanılama Ölçeği Türkçe formunun psikometrik özellikleri [The psychometric properties of the Turkish form of the Galmorgan Pediatric Pressure Ulcer Risk Assessment Scale]. Yoğun Bakım Hemş Derg. 2013;17(2):45-51. [Link] 
  60. Broom M, Dunk AM, E Mohamed AL. Predicting neonatal skin injury: the first step to reducing skin injuries in neonates. Health Serv Insights. 2019;12:1178632919845630. [Crossref]  [PubMed]  [PMC] 
  61. Bergstrom N, Demuth PJ, Braden BJ. A clinical trial of the Braden Scale for Predicting Pressure Sore Risk. Nurs Clin North Am. 1987;22(2):417-28. [Crossref]  [PubMed] 
  62. Oğuz S. Braden Ölçeği ile hastaların risklerinin belirlenmesi ve planlı hemşirelik bakımının bası yaralarının önlenmesindeki etkinliğinin saptanması [Yüksek lisans tezi]. İstanbul: Marmara Üniversitesi; 1997. [Erişim tarihi: 07 Mart 2024]. Erişim linki: [Link] 
  63. Oğuz S, Olgun N. Braden Ölçeği ile hastaların risklerinin belirlenmesi ve planlı hemşirelik bakımının bası yaralarının önlenmesindeki etkinliğinin saptanması [Predicting the pressure sore risk with Braden Scale and determining the effectiveness of predetermined nursing preventing of pressure sore]. Nurs Forum. 1998;1(3)131-5. [Link] 
  64. Braden B, Bergstrom N. A conceptual schema for the study of the etiology of pressure sores. Rehabil Nurs. 1987;12(1):8-12. [Crossref]  [PubMed] 
  65. Huang C, Ma Y, Wang C, Jiang M, Yuet Foon L, Lv L, et al. Predictive validity of the braden scale for pressure injury risk assessment in adults: A systematic review and meta-analysis. Nurs Open. 2021;8(5):2194-207. [Crossref]  [PubMed]  [PMC] 
  66. Curley MA, Razmus IS, Roberts KE, Wypij D. Predicting pressure ulcer risk in pediatric patients: the Braden Q Scale. Nurs Res. 2003;52(1):22-33. [Crossref]  [PubMed] 
  67. Güneş NB, Kılıçarslan Törüner E. Çocuk hastalarda Braden Q Basınç Ülseri Değerlendirme Ölçeği'nin Türkçe geçerlilik ve güvenirliği [Turkish validity and reliability of the Braden Q Scale for predicting pressure ulcer risk in children]. Anadolu Hemş Sağ Bil Derg. 2014;17(1):6-14. [Link] 
  68. Liao Y, Gao G, Mo L. Predictive accuracy of the Braden Q Scale in risk assessment for paediatric pressure ulcer: a meta-analysis. Int J Nurs Sci. 2018;5(4):419-26. [Crossref]  [PubMed]  [PMC] 
  69. Puspitasari JD, Nurhaeni N, Waluyanti FT. Testing of Braden QD Scale for predicting pressure ulcer risk in the Pediatric Intensive Care Unit. Pediatr Rep. 2020;12(Suppl 1):8694. [Crossref]  [PubMed]  [PMC] 

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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