Journal of Traditional Medical Complementary Therapies

.: REVIEW
Kronik Obstrüktif Akciğer Hastalığında Farkındalık Temelli Müdahalelerin Etkileri: Sistematik Derleme ve Metaanaliz
Effects of Mindfulness-Based Interventions in Chronic Obstructive Pulmonary Disease: A Systematic Review and Meta-analysis
Aylin HELVACIa, Zehra GÖK METİNa
aHacettepe Üniversitesi Hemşirelik Fakültesi, İç Hastalıkları ABD, Ankara, TÜRKİYE
J Tradit Complem Med. 2021;4(1):77-90
doi: 10.5336/jtracom.2020-74906
Article Language: TR
Full Text
ÖZET
 Bu sistematik derleme ve metaanaliz, kronik obstrüktif akciğer hastalığı (KOAH) olan bireylerde farkındalık temelli müdahalelerin klinik ve sağlıkla ilgili sonuçlar üzerindeki etkilerini değerlendirmeyi amaçlamıştır. Araştırma kapsamında ScienceDirect, PubMed, Medline, CINAHL ve ULAKBİM veri tabanları taranmış ve 2010 ve 2019 yılları arasında yayımlanmış olan 13 randomize kontrollü araştırma makalesi bu metaanalize dâhil edilmiştir. Makalelerin metodolojik kalitesini değerlendirmek için Jadad Ölçeği; yanlılık riskini değerlendirmek için ise Cochrane Yanlılık Değerlendirme Aracı kullanılmıştır. 'STATA' istatistiksel paket programıyla analizler gerçekleştirilmiştir. Araştırmaların örneklem büyüklüğü 30 ile 96 hasta arasında değişmektedir. Araştırmadaki tüm hastaların yaş ortalaması 64,6±7,3 olup, %68,45'i erkektir. Farkındalık temelli müdahalelerin sonucunda hastaların KOAH Değerlendirme Testi [standartlaştırılmış ortalama farkı (standardised mean difference 'SMD')=-0,46, %95 güven aralığı (GA): - 0,77 ile -0,16] ve St. George Solunum Anketi (SMD=-0,63, %95 GA: -0,87 ile-0,38) puanlarında anlamlı gelişme olduğu belirlenmiştir. Ancak Hastane Anksiyete Depresyon Skalası puanları açısından müdahale ve kontrol grupları arasındaki farkın istatistiksel açıdan anlamlı olmadığı belirlenmemiştir (SMD=-0,21, %95 GA: -0,45 ile 0,03). Bu metaanaliz, KOAH tanılı hastalara uygulanan farkındalık temelli müdahalelerin hastaların sağlık durumu, fiziksel kapasitesi ve yaşam kalitesi üzerine olumlu etkilerinin olduğunu ortaya çıkarmıştır. Türkiye'de KOAH hastalarına uygulanan farkındalık temelli çalışmaların çok sınırlı olduğu, meditasyon ve yoga gibi müdahalelerin hastalar üzerine etkilerini değerlendiren çalışmalara gereksinim olduğu belirlenmiştir. Farkındalık temelli uygulamaların etkilerini araştıracak ileri klinik çalışmaların iyi kalitede yapılandırılması ve KOAH'lı bireylerde sık görülen yorgunluk ve uyku problemlerini hedef alması önerilmektedir.

Anahtar Kelimeler: Farkındalık; hemşirelik; pulmoner hastalık, kronik obstrüktif; meta-analiz
ABSTRACT
 This systematic review and meta-analysis aimed to assess the effects of mindfulness-based interventions on clinical and health-related outcomes in individuals with Chronic Obstructive Pulmonary Disease (COPD). ScienceDirect, PubMed, Medline, CINAHL, and ULAKBİM databases were searched and 13 randomized controlled studies published between January 2010 and December 2019 were included in this meta-analysis. The Jadad Scale for assessing methodological quality and the Cochrane bias assessment tool for evaluating the risk of bias of articles were used. The analysis was performed by using the Stata Statistical Software. The sample size of the studies ranged between 30 and 96 patients. The mean age of all patients was 64.6±7.3 years and 68.45% of patients were males. The COPD Assessment Test [standardised mean difference (SMD)=-0.46, 95% confidence interval (CI): -0.77 ile -0.16] and the St. George Respiratory Questionnaire (SMD=-0.63, 95% CI: -0.87 ile -0.38) scores of patients significantly improved following mindfulness-based interventions. However, there was no significant difference in Hospital Anxiety Depression Scale scores between groups (SMD=-0.21, 95% CI: -0.45 ile 0.03). This meta-analysis revealed that mindfulness-based practices applied to patients with COPD had positive effects on the health status, physical capacity and quality of life of patients. There is a need for studies evaluating the effects of mindfulness-based practices such as meditation and yoga on COPD patients in Turkey. Future studies should structure with high methodological quality, and examine also the effects of mindfulness-based practices on other frequently observed COPD symptoms such as fatigue, and sleep problems.

Keywords: Awareness; nursing; pulmonary disease, chronic obstructive; meta-analysis
REFERENCES:
  1. Global Initiative for Chronic Obstructive Lund Disease. Global strategy for the diagnosis, management and prevention of chronic obstructive pulmonary disease report 2020. [Link] 
  2. Eisner MD, Anthonisen N, Coultas D, Kuenzli N, Perez-Padilla R, Postma D, et al; Committee on Nonsmoking COPD, Environmental and Occupational Health Assembly. An official American Thoracic Society public policy statement: Novel risk factors and the global burden of chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2010;182(5):693-718. [Crossref]  [PubMed] 
  3. Grigsby M, Siddharthan T, Chowdhury MA, Siddiquee A, Rubinstein A, Sobrino E, et al. Socioeconomic status and COPD among low-and middle-income countries. Int J Chron Obstruct Pulmon Dis. 2016;11:2497-507. [Crossref]  [PubMed]  [PMC] 
  4. Gan WQ, FitzGerald JM, Carlsten C, Sadatsafavi M, Brauer M. Associations of ambient air pollution with chronic obstructive pulmonary disease hospitalization and mortality. Am J Respir Crit Care Med. 2013;187(7):721-7. [Crossref]  [PubMed] 
  5. Mannino DM, Buist AS. Global burden of COPD: risk factors, prevalence, and future trends. Lancet. 2007;370(9589):765-73. [Crossref]  [PubMed] 
  6. World Health Organization. Global Status Report on Noncommunicable Diseases 2014. Geneva: WHO Press;2014.
  7. Türkiye istatistik Kurumu [Internet]. ©www.tuik.gov.tr. Ölüm istatistikleri 2017. available from: [Link]  Erişim tarihi: 13 Mart 2020
  8. Christensen VL, Holm AM, Cooper B, Paul SM, Miaskowski C, Rustøen T. Differences in symptom burden among patients with moderate, severe, or very severe chronic obstructive pulmonary disease. J Pain Symptom Manage. 2016;51(5):849-59. [Crossref]  [PubMed] 
  9. Ding B, Small M, Bergström G, Holmgren U. COPD symptom burden: impact on health care resource utilization, and work and activity impairment. Int J Chron Obstruct Pulmon Dis. 2017;12:677-89. [Crossref]  [PubMed]  [PMC] 
  10. Marvel J, Yu TC, Wood R, Higgins VS, Make BJ. Health status of patients with chronic obstructive pulmonary disease by symptom level. Chronic Obstr Pulm Dis. 2016;3(3):643-52. [Crossref]  [PubMed]  [PMC] 
  11. Kentson M, Tödt K, Skargren E, Jakobsson P, Ernerudh J, Unosson M, et al. Factors associated with experience of fatigue, and functional limitations due to fatigue in patients with stable COPD. Ther Adv Respir Dis. 2016;10(5):410-24. [Crossref]  [PubMed]  [PMC] 
  12. Pumar MI, Gray CR, Walsh JR, Yang IA, Rolls TA, Ward DL. Anxiety and depression-Important psychological comorbidities of COPD. J Thorac Dis. 2014;6(11):1615-31. [PubMed]  [PMC] 
  13. Miravitlles M, Worth H, Soler Catalu-a JJ, Price D, De Benedetto F, Roche N, et al. Observational study to characterise 24-hour COPD symptoms and their relationship with patient-reported outcomes: results from the ASSESS study. Respir Res. 2014;15(1):122. [Crossref]  [PubMed]  [PMC] 
  14. Martinez Rivera C, Costan Galicia J, Alcázar Navarrete B, Garcia-Polo C, Ruiz Iturriaga LA, Herrejón A, et al. Factors associated with depression in COPD: a multicenter study. Lung. 2016;194(3):335-43. [Crossref]  [PubMed] 
  15. Köberich S, Lohrmann C, Dassen T. Care dependency in patients with chronic obstructive pulmonary disease and heart failure-a secondary data analysis of German prevalence studies. Scand J Caring Sci. 2014;28(4):665-74. [Crossref]  [PubMed] 
  16. Minakata Y, Morishita Y, Ichikawa T, Akamatsu K, Hirano T, Nakanishi M, et al. Effects of pharmacologic treatment based on airflow limitation and breathlessness on daily physical activity in patients with chronic obstructive pulmonary disease. Int J Chron Obstruct Pulmon Dis. 2015;10:1275-82. [Crossref]  [PubMed]  [PMC] 
  17. Bourbeau J, Casan P, Tognella S, Haidl P, Texereau JB, Kessler R. An international randomized study of a home-based self-management program for severe COPD: the COMET. Int J Chron Obstruct Pulmon Dis. 2016;11:1447-51. [Crossref]  [PubMed]  [PMC] 
  18. Charikiopoulou M, Nikolaidis PT, Knechtle B, Rosemann T, Rapti A, Trakada G. Subjective and objective outcomes in patients with COPD after pulmonary rehabilitation-the impact of comorbidities. Front Physiol. 2019;10:286. [Crossref]  [PubMed]  [PMC] 
  19. Perkins-Porras L, Riaz M, Okekunle A, Zhelezna S, Chakravorty I, Ussher M. Feasibility study to assess the effect of a brief mindfulness intervention for patients with chronic obstructive pulmonary disease: A randomized controlled trial. Chron Respir Dis. 2018;15(4):400-10. [Crossref]  [PubMed]  [PMC] 
  20. Ludwig DS, Kabat-Zinn J. Mindfulness in medicine. JAMA. 2008;300(11):1350-2. [Crossref]  [PubMed] 
  21. Creswell JD. Mindfulness interventions. Annu Rev Psychol. 2017;68:491-516. [Crossref]  [PubMed] 
  22. Kabat-Zinn J. Mindfulness-based interventions in context: past, present, and future. Clinical Psychology: Science and Practice. 2003;10(2):144-56. [Crossref] 
  23. Connelly JE. Narrative possibilities: using mindfulness in clinical practice. Perspect Biol Med. 2005;48(1):84-94. [Crossref]  [PubMed] 
  24. Greeson JM, Chin GR. Mindfulness and physical disease: a concise review. Curr Opin Psychol. 2019;28:204-10. [Crossref]  [PubMed]  [PMC] 
  25. Norman J, Fu M, Ekman I, Björck L, Falk K. Effects of a mindfulness-based intervention on symptoms and signs in chronic heart failure: A feasibility study. Eur J Cardiovasc Nurs. 2018;17(1):54-65. [Crossref]  [PubMed]  [PMC] 
  26. Koo MH. Mindfulness-Based Cognitive Ther-apy for Depressed Diabetic Patients. The journal of Korean Diabetes.2017;18(3):189-92. [Crossref] 
  27. Seyedi Chegeni P, Gholami M, Azargoon A, Hossein Pour AH, Birjandi M, Norollahi H. The effect of progressive muscle relaxation on the management of fatigue and quality of sleep in patients with chronic obstructive pulmonary disease: A randomized controlled clinical trial. Complement Ther Clin Pract. 2018;31:64-70. [Crossref]  [PubMed] 
  28. Farver-Vestergaard I, O'Toole MS, O'Connor M, Løkke A, Bendstrup E, Basdeo SA, et al. Mindfulness-based cognitive therapy in COPD: a cluster randomised controlled trial. Eur Respir J. 2018;51(2):1702082. [Crossref]  [PubMed] 
  29. Ranjita R, Hankey A, Nagendra HR, Mohanty S. Yoga-based pulmonary rehabilitation for the management of dyspnea in coal miners with chronic obstructive pulmonary disease: A randomized controlled trial. J Ayurveda Integr Med. 2016;7(3):158-66. [Crossref]  [PubMed]  [PMC] 
  30. Thokchom SK, Gulati K, Ray A, Menon BK, Rajkumar. Effects of yogic intervention on pulmonary functions and health status in patients of COPD and the possible mechanisms. Complement Ther Clin Pract. 2018;33:20-6. [Crossref]  [PubMed] 
  31. Chan RR, Giardino N, Larson JL. A pilot study: mindfulness meditation intervention in COPD. Int J Chron Obstruct Pulmon Dis. 2015;10:445-54. [Crossref]  [PubMed]  [PMC] 
  32. Horuz D, Kurcer MA, Erdoğan Z. The effect of music therapy on anxiety and various physical findings in patients with COPD in a pulmonology service. Holist Nurs Pract. 2017;31(6):378-83. [Crossref]  [PubMed] 
  33. Burns PB, Rohrich RJ, Chung KC. The levels of evidence and their role in evidence-based medicine. Plast Reconstr Surg. 2011;128(1):305-10. [Crossref] 
  34. Clark HD, Wells GA, Huët C, McAlister FA, Salmi LR, Fergusson D, et al. Assessing the quality of randomized trials: reliability of the Jadad scale. Control Clin Trials. 1999;20(5):448-52. [Crossref]  [PubMed] 
  35. Higgins JP, Altman DG, Gøtzsche PC, Jüni P, Moher D, Oxman AD, et al; Cochrane Bias Methods Group; Cochrane Statistical Methods Group. The cochrane collaboration's tool for assessing risk of bias in randomised trials. BMJ. 2011;343:d5928. [Crossref]  [PubMed]  [PMC] 
  36. Yudhawati R, Rasjid Hs M. Effect of yoga on FEV1, 6-minute walk distance (6-MWD) and quality of life in patients with COPD group B. Adv Respir Med. 2019;87(5):261-8. [Crossref]  [PubMed] 
  37. Kaminsky DA, Guntupalli KK, Lippmann J, Burns SM, Brock MA, Skelly J, et al. Effect of yoga breathing (Pranayama) on exercise tolerance in patients with chronic obstructive pulmonary disease: a randomized, controlled trial. J Altern Complement Med. 2017;23(9):696-704. [Crossref]  [PubMed]  [PMC] 
  38. Yilmaz CK, Kapucu S. The effect of progressive relaxation exercises on fatigue and sleep quality in individuals with COPD. Holist Nurs Pract. 2017;31(6):369-77. [Crossref]  [PubMed] 
  39. Canga B, Azoulay R, Raskin J, Loewy J. AIR: Advances in respiration-music therapy in the treatment of chronic pulmonary disease. Respir Med. 2015;109(12):1532-9. [Crossref]  [PubMed] 
  40. Reychler G, Mottart F, Boland M, Wasterlain E, Pieters T, Caty G, et al. Influence of ambient music on perceived exertion during a pulmonary rehabilitation session: a randomized crossover study. Respir Care. 2015;60(5):711-7. [Crossref]  [PubMed] 
  41. Gupta A, Gupta R, Sood S, Arkham M. Pranayam for treatment of chronic obstructive pulmonary disease: results from a randomized, controlled trial. Integr Med (Encinitas). 2014;13(1):26-31. [PubMed]  [PMC] 
  42. Karanicolas PJ, Farrokhyar F, Bhandari M. Practical tips for surgical research: blinding: who, what, when, why, how? Can J Surg. 2010;53(5):345-8. [PubMed]  [PMC] 
  43. Liu XC, Pan L, Hu Q, Dong WP, Yan JH, Dong L. Effects of yoga training in patients with chronic obstructive pulmonary disease: a systematic review and meta-analysis. J Thorac Dis. 2014;6(6):795-802. [PubMed]  [PMC] 
  44. Chan RR, Larson JL. Meditation Interventions for chronic disease populations: a systematic review. J Holist Nurs. 2015;33(4):351-65. [Crossref]  [PubMed] 
  45. Li C, Liu Y, Ji Y, Xie L, Hou Z. Efficacy of yoga training in chronic obstructive pulmonary disease patients: A systematic review and meta-analysis. Complement Ther Clin Pract. 2018;30:33-7. [Crossref]  [PubMed] 
  46. Field T. Yoga clinical research review. Complement Ther Clin Pract. 2011;17(1):1-8. [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