Turkiye Klinikleri Journal of Nursing Sciences

.: ORIGINAL RESEARCH
Kemoterapi Tedavisi Alan Çocuklarda Oral Mukozitin Yaşam Kalitesine Etkisi: Tanımlayıcı Araştırma
Effects of Oral Mucositis on the Quality of Life of Children Receiving Chemotherapy: Descriptive Study
Azime HACIOĞLU GÜVENa , Hatice BAL YILMAZb
aPamukkale Üniversitesi Sağlık Bilimleri Fakültesi, Çocuk Sağlığı ve Hastalıkları Hemşireliği ABD, Denizli, Türkiye
bEge Üniversitesi Hemşirelik Fakültesi, Çocuk Sağlığı ve Hastalıkları Hemşireliği ABD, İzmir, Türkiye
Turkiye Klinikleri J Nurs Sci. 2023;15(2):349-56
doi: 10.5336/nurses.2022-94621
Article Language: TR
Full Text
ÖZET
 Amaç: Bu araştırma, pediatrik hematoloji-onkoloji kliniklerinde kemoterapi tedavisi alan çocuklarda oral mukozitin (OM) yaşam kalitesine etkisini incelemek amacı ile gerçekleştirilmiştir. Gereç ve Yöntemler: Tanımlayıcı ve kesitsel tipteki bu araştırmanın örneklemini kemoterapi tedavisi alan 58 çocuk oluşturmuştur. Verilerin toplanmasında ''Çocuk ve Ebeveyn Bilgi Formu'', ''Dünya Sağlık Örgütü Mukozit Değerlendirme İndeksi'', ''Uluslararası Çocuk Mukozit Değerlendirme Ölçeği [Children's International Mucositis Evaluation Scale (ChIMES)]'' ve ''7-12 Yaş Pediatrik Onkoloji Hastaları Yaşam Kalitesi Ölçeği Çocuk Formu'' kullanılmıştır. Verilerin analizinde; tanımlayıcı istatistiksel yöntemler, Spearman korelasyon analizi, bağımsız örneklem t-testi ve ANOVA analizi kullanılmıştır. Bulgular: Kemoterapi tedavisi öncesi (0. gün) çocukların tamamının (%100) mukozit derecesi, 0 derece olarak tanımlanmıştır. Kemoterapi tedavisinden 10 gün sonra çocuklarda farklı derecelerde mukozit görülmüştür. Kemoterapi tedavisi alan çocuklarda gelişen OM ile yaşam kalitesi arasında istatistiksel olarak anlamlı bir fark olduğu bulunmuştur (p<0,01). Çocukların Dünya Sağlık Örgütü Mukozit Değerlendirme İndeksine göre mukozit derecesi arttıkça ChIMES'e göre ağrı puan ortalamalarının yükseldiği saptanmıştır. Çocukların mukozit derecesi ile ağrı puan ortalamaları (r=0,948**, p<0,01) ve yaşam kalitesi puan ortalamaları (r=0,614**, p<0,01) arasında pozitif yönde çok güçlü düzeyde ilişki bulunmuştur. Sonuç: Çocuklarda mukozit derecesinin artması ile ağrı puanlarının arttığı ve bunlara paralel olarak yaşam kalitesinin de azaldığı görülmüştür. Kemoterapi tedavisi alan çocuklarda yaşam kalitesinin artırılması için ağız içinin her gün değerlendirilmesi ve mukozit gelişme durumunun değerlendirilerek, çocuklarda mukozit gelişiminin mümkün olduğunca azaltılması ve mukozite bağlı ağrının azaltılmasına ilişkin önlemlerin erken dönemde alınması önerilir.

Anahtar Kelimeler: Mukozit; çocuk; kemoterapi; yaşam kalitesi; hemşirelik
ABSTRACT
 Objective: This study was conducted to investigate the effect of oral mucositis on the quality of life in children receiving chemotherapy treatment in pediatric hematology-oncology clinics. Material and Methods: The sample of this descriptive and cross-sectional study consisted of 58 children who had been receiving chemotherapy treatment. A ''Child and Parent Information Form,'' the ''World Health Organization Mucositis Classification Index,'' the ''Children's International Mucositis Evaluation Scale (ChIMES),'' and the ''Scale for Quality of Life in Pediatric Oncology Patients Aged 7-12 Child'' were used to collect study data. Descriptive statical methods, independent sample t-test, Spearman correlation analysis, ANOVA analysis were used to evaluate the data. Results: The grade of mucositis in all children (100%) before chemotherapy treatment (day 0) was defined as grade 0. Ten days after chemotherapy treatment, it was determined that the children had varying grades mucositis. It was found that there was a statistically significant difference between oral mucositis developing in children receiving chemotherapy and their quality of life (p<0.01). It was determined that as the grade of children's mucositis increased according to the World Health Organization Mucositis Assessment Index, their mean pain scores increased according to ChIMES, as well. A very strong positive correlation was found between the degree of mucositis and the mean scores of pain (r=0.948**, p<0.01) and mean scores of quality of life (r=0.614**, p<0.01) of the children. Conclusion: It was found that as the severity of mucositis in children increased, their pain scores increased, and their quality of life decreased in parallel to it. To increase the quality of life in children receiving chemotherapy, it is recommended to evaluate the oral cavity every day, reduce the development of mucositis as much as possible, and take measures to relieve the mucositis-induced pain in the early period.

Keywords: Mucositis; child; chemotherapy; quality of life; nursing
REFERENCES:
  1. Kutluk T. Çocukluk çağı kanserlerinin epidemiyolojisi [Epidemiology of childhood cancersI]. İÜ Cerrahpaşa Tıp Fakültesi Sürekli Tıp Eğitimi Etkinlikleri. 2006;49:11-5. [Link] 
  2. TÜİK [İnternet]. [Erişim tarihi: Şubat, 2023]. İstatistiklerle Çocuk, Türkiye İstatistik Kurumu. Erişim linki: [Link] 
  3. Törüner E, Büyükgönenç L. Çocukluk çağı kanserleri. Çocuk Sağlığı Temel Hemşirelik Yaklaşımları. 1. Baskı. Ankara: Gökçe Ofset; 2012. p.836-9.
  4. Yavuz B, Yılmaz HB, Karaman N. Kanserli çocuklarda uluslararası çocuk mukozit değerlendirme ölçeği Türkçe formunun geçerlilik güvenilirlik çalışması [A study of reliability and validity for the Turkish version of children's international mucositisis evaluation scale for children with cancer]. Turk J Oncol. 2011;26(4):157-62. [Link] 
  5. Ribeiro ILA, Limeira RRT, Dias de Castro R, Ferreti Bonan PR, Valença AMG. Oral mucositis in pediatric patients in treatment for acute lymphoblastic leukemia. Int J Environ Res Public Health. 2017;14(12):1468. [Crossref]  [PubMed]  [PMC] 
  6. Sevinir B, Demirkaya M. Kemoterapi ve hedefe yönelik tedaviler [Chemotherapy and targeted therapies]. Kanser Gündemi Derg. 2016;4(1-2):55-9. [Link] 
  7. Andersen C, Adamsen L, Moeller T, Midtgaard J, Quist M, Tveteraas A, et al. The effect of a multidimensional exercise programme on symptoms and side-effects in cancer patients undergoing chemotherapy--the use of semi-structured diaries. Eur J Oncol Nurs. 2006;10(4):247-62. [Crossref]  [PubMed] 
  8. Taş F, Başbakkal Z. Kemoterapi alan çocukların yaşadıkları semptomlar ve ebeveynlerinin semptom kontrolüne yönelik uygulamaları [Symptoms expe- rienced by children who received chemotherapy and parental applications to- wards symptom management]. Ege Pediatri Bülteni. 2009;16:33-44. (Erişim tarihi Şubat, 2023). [Link] 
  9. Ünal Çubukçu N, Çınar S. Kemoterapi alan kanserli hastalarda oral mukozitler önlenebilir mi? [Can oral mucositis be prevented in patients receiving chemotherapy?] Clinical and Experimental Health Sciences. 2014;2(4):155-63. [Link] 
  10. El Bousaadani A, Eljahd L, Abada R, Rouadi S, Roubal M, Mahtar M. Actualités de la prévention et du traitement des mucites orales chez les enfants cancéreux: recommandations pratiques [Prevention and treatment of mucositis in children with oral cancers: Practical recommendations]. Cancer Radiother. 2016;20(3):226-30. French. [Crossref]  [PubMed] 
  11. McCulloch R, Hemsley J, Kelly P. Symptom management during chemoterapy. Pediatr Child Health 2014;24(4):166-71. [Crossref] 
  12. Çıtlak K, Kapucu S. Kemoterapi alan hastalarda görülen oral mukozitin önlemesi ve tedavisinde güncel yaklaşımlar: kanıta dayalı uygulamalar [Current approaches to oral mucositis prevention and treatment in patients receiving chemotherapy: evidencebased practices]. Hacettepe Üniversitesi Hemşirelik Fakültesi Dergisi. 2015;2(1):70-7. [Link] 
  13. Eiser C, Morse R. Quality-of-life measures in chronic diseases of childhood. Health Technol Assess. 2001;5(4):1-157. [Crossref]  [PubMed] 
  14. Altundağ B, Karaçam E, Aydoğan Y, Okyay Ö, Bedriye AK, Alpteker H. Lösemili çocuklara yönelik uygulanan psikososyal desteğin etkileri [Effects of psychosocial support provided for children with leukemia]. Kastamonu Education Journal. 2016;24(5):2549-60. [Link] 
  15. Attinà G, Romano A, Maurizi P, D'Amuri S, Mastrangelo S, Capozza MA, et al. Management of oral mucositis in children with malignant solid tumors. Front Oncol. 2021;11:599243. [Crossref]  [PubMed]  [PMC] 
  16. Cheng KK, Molassiotis A, Chang AM. An oral care protocol intervention to prevent chemotherapy-induced oral mucositis in paediatric cancer patients: a pilot study. Eur J Oncol Nurs. 2002;6(2):66-73. [Crossref]  [PubMed] 
  17. Çakır G, Altay N, Kılıçarslan Törüner E. Kemoterapi alan pediatrik onkoloji hastalarında oral mukozit yönetimi: kanıt temelli uygulamaların değerlendirilmesi [Management of oral mucositis in pediatric oncology patients receiving chemotherapy: evaluation of evidence-based practices]. Hacettepe Üniversitesi Hemşirelik Fakültesi Dergisi. 2022;9(2):225-32. [Crossref] 
  18. Yıldız Kabak V, İpek F, Ünal Ş, Atasavun Uysal S, Düger T. Akut lenfoblastik lösemili çocuklarda motor fonksiyonlar ile yaşam kalitesi ve günlük yaşam aktiviteleri arasındaki ilişkinin araştırılması [Investigation of the association between motor functions with quality of life and daily living activities in children with acute lymphoblastic leukemia]. Celal Bayar Üniversitesi Sağlık Bilimleri Enstitüsü Dergisi. 2021;8(3):426-30. [Crossref] 
  19. Kalaycı E. Çocuk onkoloji-hematoloji polikliniğinde tedavi gören 8-12 yaş çocuklarda yaşam kalitesi ve etkileyen faktörlerin belirlenmesi [Yüksek lisans tezi]. Nevşehir: Nevşehir Hacı Bektaş Veli Üniversitesi; 2019. (Erişim Tarihi: Şubat, 2023) [Link] 
  20. Dolu S. Kemoterapi tedavisi alan hastalarda tat alma değişikliğinin yaşam kalitesine etkisinin incelenmesi [Yüksek lisans tezi]. Malatya: Malatya İnönü Üniversitesi; 2021. (Erişim Tarihi: Şubat, 2023) [Link] 
  21. Kilavun N. Kanserli çocuklarda yaşam kalitesi ve uyku kalitesini etkileyen fak- törlerin incelenmesi [Yüksek lisans tezi]. Manisa: Manisa Celal Bayar Üniver- sitesi; 2019. (Erişim Tarihi: Şubat, 2023). [Link] 
  22. Cheng KK, Lee V, Li CH, Yuen HL, Epstein JB. Oral mucositis in pediatric and adolescent patients undergoing chemotherapy: the impact of symptoms on quality of life. Support Care Cancer. 2012;20(10):2335-42. [Crossref]  [PubMed] 
  23. Hendrawati S, Nurhidayah I, Mediani HS, Mardhiyah A, Maryam NNA. Mucositis effect on quality of life of hospitalized children with cancer who received chemotherapy. Jurnal Keperawatan Padjadjaran. 2019;7(1):29-37. [Crossref] 
  24. Tomlinson D, Gibson F, Treister N, Baggott C, Judd P, Hendershot E, et al. Refinement of the Children's International Mucositis Evaluation Scale (ChIMES): child and parent perspectives on understandability, content validity and acceptability. Eur J Oncol Nurs. 2010;14(1):29-41. [Crossref]  [PubMed] 
  25. Kudubes AA, Bektas M. Developing a scale for quality of life in pediatric oncology patients aged 7-12--children and parent forms. Asian Pac J Cancer Prev. 2015;16(2):523-9. [Crossref]  [PubMed] 
  26. Kin-Fong Cheng K, Ka Tsui Yuen J. A pilot study of chlorhexidine and benzydamine oral rinses for the prevention and treatment of irradiation mucositis in patients with head and neck cancer. Cancer Nurs. 2006;29(5):423-30. [Crossref]  [PubMed] 
  27. Tao Z, Gao J, Qian L, Huang Y, Zhou Y, Yang L, et al. Factors associated with acute oral mucosal reaction induced by radiotherapy in head and neck squamous cell carcinoma: A retrospective single-center experience. Medicine (Baltimore). 2017;96(50):e8446. [Crossref]  [PubMed]  [PMC] 
  28. Şahin Ş, Karaman S. Kanserli çocuklarda nötropeni ve oral enfeksiyonlar [Neutropenia and oral infections in children with cancer]. Çocuk Dergisi. 2021;21(2):203-6. [Crossref] 
  29. Sonis ST. Mucositis: The impact, biology and therapeutic opportunities of oral mucositis. Oral Oncol. 2009;45(12):1015-20. [Crossref]  [PubMed] 
  30. Bahar A, Ovayolu Ö, Ovayolu N. Onkoloji hastalarında sık karşılaşılan semptomlar ve hemşirelik yönetimi [Common symptoms of oncology patients and nursing management]. ERÜ Sağlık Bilimleri Fakültesi Dergisi. 2019;6(1):42-58. [Link] 
  31. Cheng KK, Leung SF, Liang RH, Tai JW, Yeung RM, Thompson DR. Severe oral mucositis associated with cancer therapy: impact on oral functional status and quality of life. Support Care Cancer. 2010;18(11):1477-85. [Crossref]  [PubMed] 
  32. Zincircioğlu G. Hematolojik hastalıklarda ağız sağlığı durum değerlendirilmesi: kesitsel çalışma [Doktora tezi]. Ankara: Ankara üniversitesi; 2011. (Erişim Tarihi: Şubat, 2023). [Link] 
  33. Gautam AP, Fernandes DJ, Vidyasagar MS, Maiya AG, Vadhiraja BM. Low level laser therapy for concurrent chemoradiotherapy induced oral mucositis in head and neck cancer patients - a triple blinded randomized controlled trial. Radiother Oncol. 2012;104(3):349-54. [Crossref]  [PubMed] 
  34. Öztürk Ş, Şen H, Akyüz C, Gökmen Özel H. Yatarak kemoterapi alan pediatrik onkoloji hastalarında oral mukozit gelişiminin beslenmeye etkisi [Influence of oral mucositis on nutrition of pediatric oncology patients receiving chemotherapy]. Beslenme ve Diyet Dergisi. 2018;46(2):125-35. [Crossref] 
  35. Russell KM, Hudson M, Long A, Phipps S. Assessment of health-related quality of life in children with cancer: consistency and agreement between parent and child reports. Cancer. 2006;106(10):2267-74. [Crossref]  [PubMed] 

.: 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