Turkiye Klinikleri Journal of Health Sciences

.: ORIGINAL RESEARCH
Investigation of Dysphagia Education and Practice Among the Speech and Language Therapists in Türkiye: A Descriptive Cross-Sectional Study
Türkiye'deki Dil ve Konuşma Terapistleri Arasında Disfaji Eğitimi ve Uygulamasının İncelenmesi: Tanımlayıcı-Kesitsel Bir Araştırma
Hakan GÖLAÇa,b, Önal İNCEBAYb, Fatma ESEN AYDINLIb
aDepartment of Speech and Language Therapy, Gazi University Faculty of Health Sciences, Ankara, Türkiye
bDepartment of Speech and Language Therapy, Hacettepe University Faculty of Health Sciences, Ankara, Türkiye
Turkiye Klinikleri J Health Sci. 2022;7(3):712-25
doi: 10.5336/healthsci.2021-86184
Article Language: EN
Full Text
ABSTRACT
 Objective: Swallowing disorder (dysphagia) is one of the major areas of interest for speech and language therapists (SLT). This study aims to investigate the educational background and practice patterns of Turkish SLTs in the field of dysphagia. Material and Methods: A total of 127 SLTs were included in this descriptive cross-sectional study. An online survey consisting of 45 questions in total was created via 'Google forms' and sent to the SLTs across Türkiye using professional networks and social media. Results: The response rate to the survey was 52.4% (127/242). Among the study population, only 22 (18.2%) participants reported having 4 years or more experience in the profession. Almost 95% of the SLTs indicated that they had at least one theoretical course, and 25.2% reported attending a postgraduate course about dysphagia. Twenty three (18.1%) subjects reported the presence of a dysphagia team in their current facility. History-taking, oral-motor assessment, and cognitive screening were the most frequently used dysphagia assessment modalities and, therapeutic approaches such as oral hygiene, caregiver education and training, and oral motor exercises were the most frequently preferred techniques for dysphagia treatment. Conclusion: Although the SLTs in Türkiye have an adequate level of dysphagia education based on the best practices and standards in the profession, they do not have enough opportunity to practice this knowledge in their facilities. From the outcome of our investigation, it is possible to conclude that increasing SLT employment in medical centers and providing adequate opportunities for comprehensive management can improve dysphagia practice patterns of SLTs in Türkiye.

Keywords: Deglutition disorders; educational measurement; evidence-based practice; professional practice
ÖZET
 Amaç: Yutma bozuklukları, dil ve konuşma terapistlerinin (DKT) çalışma alanı içerisindedir. Bu araştırmanın temel amacı, Türkiye'de çalışan DKT'lerin yutma bozuklukları ile ilgili almış oldukları eğitimleri ve klinik pratikte uygulama yapabilme olanaklarını incelemektir. Gereç ve Yöntemler: Tanımlayıcı-kesitsel desende yapılan bu çalışmaya 127 DKT dâhil edilmiştir. Toplam 45 sorudan oluşan ve 'Google Forms' üzerinden oluşturulan bir anket, profesyonel bağlantılar ve çeşitli sosyal medya platformları üzerinden katılımcılara gönderilmiştir. Bulgular: Anket gönderilen terapistlerin %52,4'ü (127/242) geri dönüş sağlamıştır. Yirmi iki (%18,2) katılımcı alanda 4 yıl ve üzeri deneyim sahibi olduğunu belirtmiştir. DKT'lerin %95'i yutma bozuklukları ile ilgili en az bir ders aldığını belirtirken, %25,2'si mezuniyet sonrası kurs aldığını belirtmiştir. Çalışılan merkezlerin sadece 23'ünde (%18,1) yutma bozuklukları ile ilgili bir ekibinin olduğu bildirilmiştir. DKT'ler arasında hikâye alma, oral motor değerlendirme ve kognitif tarama en çok kullanılan değerlendirme yöntemleri olurken ağız hijyeni, aile eğitimi ve oral motor egzersizler ise en sık kullanılan terapi yaklaşımları olarak belirtilmiştir. Sonuç: Her ne kadar Türkiye'deki DKT'ler mesleki klinik uygulamalar ve standartlar çerçevesinde yeterli düzeyde disfaji eğitimi almış olsalar da, çalıştıkları kurumlarda bu bilgileri uygulama fırsatları yetersizdir. Sonuç olarak, Türkiye'deki DKT'lerin disfaji ile ilgili uygulama fırsatlarını geliştirmek için, kurumlardaki DKT istihdamlarının arttırılması ve terapistlere yutma bozukluklarını kapsamlı yönetebilmeleri için iş yerlerinde yeterli olanakların sunulması gerekmektedir.

Anahtar Kelimeler: Yutma bozuklukları; eğitimsel ölçüm; kanıta dayalı uygulama; profesyonel uygulama
REFERENCES:
  1. Groher ME, Crary MA. Dysphagia: Clinical Management in Adults and Children. 2nd ed. USA: Elsevier Health Sciences; 2016. [Crossref] 
  2. Roden DF, Altman KW. Causes of dysphagia among different age groups: a systematic review of the literature. Otolaryngol Clin North Am. 2013;46(6):965-87. [PubMed] 
  3. Royal College of Speech and Language Therapists. RCSLT Guidance to Meet HCPC Standards. 2016. Erişim tarihi: 28.06.2021 [Link] 
  4. Standing Liaison Committee of European Union Speech and Language Therapists and Logopedists. Professional Profile. 2019. Erişim tarihi: 28.06.2021 [Link] 
  5. The American Speech-Language-Hearing Association. ASHA Practice Policy. 2016. Erişim tarihi: 28.06.2021 [Link] 
  6. Topbas S. A Turkish perspective on communication disorders. Logoped Phoniatr Vocol. 2006;31(2):76-88. [Crossref]  [PubMed] 
  7. Georgieva D, Woźniak T, Topbaş S, Vitaskova K, Vukovic M, Zemva N, et al. Education of speech and language therapists/logopedists in selected Central and Southeastern European countries: challenges and new horizons. Folia Phoniatr Logop. 2014;66(4-5):183-96. [Crossref]  [PubMed] 
  8. Yüksek Öğretim Kurumu. Dil ve Konuşma Terapisi Ulusal Çekirdek Eğitim Programı. 2016. [Link] 
  9. Kamal RM, Ward E, Cornwell P. Dysphagia management practices among speech-language pathologists in Malaysia. Asia Pacific Journal of Speech, Language and Hearing. 2012;15(2):111-28. [Crossref] 
  10. Toğram B, Güneri Y, Yanat Van Zonderen E. Dil ve konuşma terapistlerinin klinik uygulama ve deneyimlerinin incelenmesi [Clinical practice and experiences of speech and language therapists in Turkey summary]. Dil Konuşma ve Yutma Araştırmaları Dergisi. 2019;2(3):315-47. [Link] 
  11. Bengisu S, Gerçek E. Türkiye'de yutma bozuklukları ile ilgili yapılmış lisansüstü tez çalışmalarının incelenmesi [A survey of available graduate theses on swallowing disorders conducted in Turkey summary]. Dil Konuşma ve Yutma Araştırmaları Dergisi. 2019;2(1):77-103. [Link] 
  12. Walshe M, Ryan M, Regan J. Screening for dysphagia: perspectives and practices of speech and language therapists in the republic of Ireland. Folia Phoniatr Logop. 2017;69(5-6):226-38. [Crossref]  [PubMed] 
  13. Mathers-Schmidt BA, Kurlinski M. Dysphagia evaluation practices: inconsistencies in clinical assessment and instrumental examination decision-making. Dysphagia. 2003;18(2):114-25. [Crossref]  [PubMed] 
  14. Blackwell Z, Littlejohns P. A review of the management of dysphagia: a South African perspective. J Neurosci Nurs. 2010;42(2):61-70. [Crossref]  [PubMed] 
  15. Mustaffa Kamal R, Ward EC, Cornwell P, Sharma S. Provision of dysphagia services in a developing nation: Infrastructural challenges. Int J Speech Lang Pathol. 2015;17(6): 594-604. [Crossref]  [PubMed] 
  16. Rangarathnam B, Desai RV. A preliminary survey of dysphagia practice patterns among speech-language pathologists in India. Journal of Indian Speech Language & Hearing Association. 2020;34(2):259-72. [Crossref] 
  17. Pettigrew CM, O'Toole C. Dysphagia evaluation practices of speech and language therapists in Ireland: clinical assessment and instrumental examination decision-making. Dysphagia. 2007;22(3):235-44. [Crossref]  [PubMed] 
  18. Kamal RM, Ward E, Cornwell P. Dysphagia training for speech-language pathologists: implications for clinical practice. Int J Speech Lang Pathol. 2012;14(6):569-76. [Crossref]  [PubMed] 
  19. Daniels SK, McAdam CP, Brailey K, Foundas AL. Clinical assessment of swallowing and prediction of dysphagia severity. American Journal of Speech-Language Pathology. 1997; 6(4):17-24. [Crossref] 
  20. Pu D, Murry T, Wong MCM, Yiu EML, Chan KMK. Indicators of Dysphagia in Aged Care Facilities. J Speech Lang Hear Res. 2017; 60(9):2416-26. [Crossref]  [PubMed] 
  21. van der Zwaluw CS, Valentijn SA, Nieuwenhuis-Mark R, Rasquin SM, van Heugten CM. Cognitive functioning in the acute phase poststroke: a predictor of discharge destination? J Stroke Cerebrovasc Dis. 2011;20(6):549-55. [Crossref]  [PubMed] 
  22. Suiter DM, Leder SB. Clinical utility of the 3-ounce water swallow test. Dysphagia. 2008; 23(3):244-50. [Crossref]  [PubMed] 
  23. Schultheiss C, Nusser-Müller-Busch R, Seidl RO. The semisolid bolus swallow test for clinical diagnosis of oropharyngeal dysphagia: a prospective randomised study. Eur Arch Otorhinolaryngol. 2011;268(12):1837-44. [Crossref]  [PubMed]  [PMC] 
  24. Sørensen RT, Rasmussen RS, Overgaard K, Lerche A, Johansen AM, Lindhardt T. Dysphagia screening and intensified oral hygiene reduce pneumonia after stroke. J Neurosci Nurs. 2013;45(3):139-46. [Crossref]  [PubMed] 
  25. Torres-Arreola Ldel P, Doubova Dubova SV, Hernandez SF, Torres-Valdez LE, Constantino-Casas NP, Garcia-Contreras F, et al. Effectiveness of two rehabilitation strategies provided by nurses for stroke patients in Mexico. J Clin Nurs. 2009;18(21):2993-3002. [Crossref]  [PubMed] 
  26. Elmståhl S, Bülow M, Ekberg O, Petersson M, Tegner H. Treatment of dysphagia improves nutritional conditions in stroke patients. Dysphagia. 1999;14(2):61-6. [Crossref]  [PubMed] 
  27. Denk DM, Swoboda H, Schima W, Eibenberger K. Prognostic factors for swallowing rehabilitation following head and neck cancer surgery. Acta Otolaryngol. 1997;117(5):769-74. [Crossref]  [PubMed] 
  28. Rayner MG, King T, Djalilian HR, Smith S, Levine SC. Resolution of facial stimulation in otosclerotic cochlear implants. Otolaryngol Head Neck Surg. 2003;129(5):475-80. [PubMed] 
  29. Zuercher P, Moret CS, Dziewas R, Schefold JC. Dysphagia in the intensive care unit: epidemiology, mechanisms, and clinical management. Crit Care. 2019;23(1):103. [Crossref]  [PubMed]  [PMC] 
  30. Speyer R, Baijens L, Heijnen M, Zwijnenberg I. Effects of therapy in oropharyngeal dysphagia by speech and language therapists: a systematic review. Dysphagia. 2010;25(1): 40-65. [Crossref]  [PubMed]  [PMC] 
  31. Turkish Association of Speech and Language Pathologist. 2020. Erişim tarihi: 20.08.2021 [Link] 
  32. Rumbach A, Coombes C, Doeltgen S. A survey of australian dysphagia practice patterns. Dysphagia. 2018;33(2):216-26. [Crossref]  [PubMed] 
  33. Steele C, Allen C, Barker J, Buen P, French R, Fedorak A, et al. Aysphagia service delivery by speech-language pathologists in Canada: results of a national survey. Canadian Journal of Speech-Language Pathology and Audiology. 2007;31(4):166-77. [Link] 

.: 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