Turkiye Klinikleri Journal of Gerontology

.: REVIEW
Symptom Management in Geriatric Hematologic Malignancy Patients: Traditional Review
Geriatrik Hematolojik Maligniteli Hastalarda Semptom Yönetimi: Geleneksel Derleme
Nurhan DOĞANa
aAmasya University Faculty of Health Sciences, Department of Medical Nursing, Amasya, Türkiye
Turkiye Klinikleri J Gerontol. 2023;2(2):69-80
doi: 10.5336/jgeront.2024-102254
Article Language: EN
Full Text
ABSTRACT
 The proportion of the older adult population is increasing all over the world. One of the conditions frequently encountered with aging is hematological malignancies. In hematological malignancies, there are many symptoms related to cancer and its treatment, and when the decrease in physical functions in old age is added to this situation, symptom management becomes difficult. Symptoms are frequently seen in individuals, pain, anxiety, nausea and vomiting, and dyspnea. However, geriatric syndromes such as malnutrition, delirium, frailty and falls are also seen. In geriatric individuals, complex symptoms such as dermatologic problems, peripheral neuropathy, fatigue, loss of muscle tone and financial toxicity, which have been taken into consideration more in recent years, are known to negatively affect quality of life and are difficult to manage. In individuals with geriatric hematological malignancies, a geriatric evaluation with a holistic and multidisciplinary approach will be more effective in terms of symptom management. In symptom management of geriatric individuals, it is important to provide a holistic approach in team collaboration with individualized care and treatment methods. The issue of incorporating evidence-based practices into care and treatment is another issue that needs to be addressed. As a result of the literature review, it was determined that more studies are needed on symptom management of geriatric individuals in order to reveal the importance of the subject. This review aims to improve care by providing information about common symptoms and management of these symptoms in geriatric individuals with hematological malignancies. The article was compiled by examining current literature.

Keywords: Hematologic cancer; nursing care; symptom management; older adult
ÖZET
 Tüm dünyada yaşlı nüfusun oranı giderek artmaktadır. Yaşlanmayla birlikte sıklıkla karşılaşılan durumlardan biri de hematolojik malignitelerdir. Hematolojik malignitelerde kansere ve tedavisine bağlı pek çok semptom vardır ve bu duruma yaşlılıkta fiziksel fonksiyonlardaki azalma da eklenince semptom yönetimi zorlaşmaktadır. Bireylerde sıklıkla görülen semptomlar; ağrı, anksiyete, bulantı, kusma ve dispnedir. Bununla birlikte malnütrisyon, deliryum, kırılganlık ve düşmeler gibi geriatrik sendromlar da görülmektedir. Geriatrik bireylerde, dermatolojik problemler, periferal nöropati, yorgunluk, kas tonus kaybı ve son yıllarda daha çok dikkate alınmaya başlanan finansal toksisite gibi kompleks semptomların yaşam kalitesini olumsuz etkilediği ve yönetiminin zor olduğu bilinmektedir. Geriatrik hematolojik malignitesi olan bireylerde öncelikle bütüncül ve multidisipliner bir yaklaşımla geriatrik değerlendirmenin yapılması, semptom yönetimi açısından daha etkili olacaktır. Geriatrik bireylerin semptom yönetiminde ise bireyselleştirilmiş bakım ve tedavi yöntemleri ile ekip iş birliğinde bütüncül yaklaşımın sağlanması önemlidir. Kanıta dayalı uygulamaların bakım ve tedaviye katılması konusu ise ele alınması gereken bir başka konudur. Yapılan literatür incelemesi soncunda konunun önemini ortaya koymak için geriatrik bireylerin semptom yönetimi konusunda daha fazla çalışmaya ihtiyaç duyulduğu saptanmıştır. Bu derleme, hematolojik maligniteli geriatrik bireylerde sık görülen semptomlar ve bu semptomların yönetimi hakkında bilgi vererek bakımın iyileştirilmesini amaçlamaktadır. Makale güncel literatür incelenerek derlenmiştir.

Anahtar Kelimeler: Hematolojik kanser; hemşirelik bakımı; semptom yönetimi; yaşlı birey
REFERENCES:
  1. Bumanlag IM, Jaoude JA, Rooney MK, Taniguchi CM, Ludmir EB. Exclusion of older adults from cancer clinical trials: review of the literature and future recommendations. Semin Radiat Oncol. 2022;32(2):125-34. [Crossref]  [PubMed]  [PMC] 
  2. Mishkin GE, Denicoff AM, Best AF, Little RF. Update on enrollment of older adults onto national cancer institute national clinical trials network trials. J Natl Cancer Inst Monogr. 2022;2022(60):111-6. [Crossref]  [PubMed]  [PMC] 
  3. Feliu J, Heredia-Soto V, Gironés R, Jiménez-Munarriz B, Saldaña J, Guillén-Ponce C, et al. Management of the toxicity of chemotherapy and targeted therapies in elderly cancer patients. Clin Transl Oncol. 2020;22(4):457-67. [Crossref]  [PubMed] 
  4. Rosko AE, Cordoba R, Abel G, Artz A, Loh KP, Klepin HD. Advances in management for older adults with hematologic malignancies. J Clin Oncol. 2021;39(19):2102-14. [Crossref]  [PubMed]  [PMC] 
  5. Terpos E, Mikhael J, Hajek R, Chari A, Zweegman S, Lee HC, et al. Management of patients with multiple myeloma beyond the clinical-trial setting: understanding the balance between efficacy, safety and tolerability, and quality of life. Blood Cancer J. 2021;11(2):40. [Crossref]  [PubMed]  [PMC] 
  6. Ninomiya K, Inoue D, Sugimoto K, Tanaka C, Murofushi K, Okuyama T, et al. Significance of the comprehensive geriatric assessment in the administration of chemotherapy to older adults with cancer: Recommendations by the Japanese Geriatric Oncology Guideline Committee. J Geriatr Oncol. 2023;14(5):101485. [Crossref]  [PubMed] 
  7. Nathwani N, Kurtin SE, Lipe B, Mohile SG, Catamero DD, Wujcik D, et al. Integrating touchscreen-based geriatric assessment and frailty screening for adults with multiple myeloma to drive personalized treatment decisions. JCO Oncol Pract. 2020;16(1):e92-e99. [Crossref]  [PubMed] 
  8. Briand M, Gerard S, Gauthier M, Garric M, Steinmeyer Z, Balardy L. Impact of therapeutic management and geriatric evaluation on patient of eighty years and older with diffuse large B-cell lymphoma on survival: a systematic review. Eur J Haematol. 2022;108(1):3-17. [Crossref]  [PubMed] 
  9. Uğur Ö. Geriatrik palyatif bakım ve hemşirelik yaklaşımı [Geriatric palliative care and nursing approach]. Abant Tıp Dergisi. 2022;11(1):112-22. [Link] 
  10. Özel V, Alphan E. Yetişkin hematolojik kanserli hastaların malnütrisyon düzeylerinin farklı tarama araçları ile değerlendirilmesi [Evaluation of malnutrition levels of patients with adult hematological cancer with different screening tools]. Sağlık ve Yaşam Bilimleri Dergisi. 2019;1(1):21-9. [Crossref] 
  11. Drury A, O'Brien A, O'Connell L, Cosgrave S, Hannan M, Smyth C, et al. Setting a patient-driven agenda for cancer research priorities in geriatric oncology: a qualitative study. Semin Oncol Nurs. 2023;39(4):151463. [Crossref]  [PubMed]  [PMC] 
  12. Neter E, Brainin E. Association between health literacy, ehealth literacy, and health outcomes among patients with long-term conditions. European Psychologist. 2019;24(1):68-81. [Crossref] 
  13. Hachem GE, Rocha FO, Pepersack T, Jounblat Y, Drowart A, Lago LD. Advances in pain management for older patients with cancer. Ecancermedicalscience. 2019;13:980. [Crossref]  [PubMed]  [PMC] 
  14. World Health Organization. WHO Guidelines for the Pharmacological and Radiotherapeutic Management of Cancer Pain in Adults and Adolescents. Geneva: World Health Organization; 2018. [Link] 
  15. Miró Ò, Gil V, Martín-Sánchez FJ, Herrero-Puente P, Jacob J, Mebazaa A, et al; ICA-SEMES Research Group(∗). Morphine use in the ED and outcomes of patients with acute heart failure: a propensity score-matching analysis based on the EAHFE registry. Chest. 2017;152(4):821-32. [PubMed] 
  16. Agewall S. Morphine in acute heart failure. J Thorac Dis. 2017;9(7):1851-4. [Crossref]  [PubMed]  [PMC] 
  17. Ding T, Wang X, Fu A, Xu L, Lin J. Anxiety and depression predict unfavorable survival in acute myeloid leukemia patients. Medicine (Baltimore). 2019;98(43):e17314. [Crossref]  [PubMed]  [PMC] 
  18. Meier C, Taubenheim S, Lordick F, Mehnert-Theuerkauf A, Götze H. Depression and anxiety in older patients with hematological cancer (70+) - Geriatric, social, cancer- and treatment-related associations. J Geriatr Oncol. 2020;11(5):828-35. [Crossref]  [PubMed] 
  19. Gökalp K, Ekinci M. Effect of music therapy on anxiety and sleep quality of geriatric haematological oncology patients. Turkish Journal of Geriatrics. 2020;23(4):546-54. [Crossref] 
  20. Lu G, Jia R, Liang D, Yu J, Wu Z, Chen C. Effects of music therapy on anxiety: a meta-analysis of randomized controlled trials. Psychiatry Res. 2021;304:114137. [Crossref]  [PubMed] 
  21. Navari RM, Pywell CM, Le-Rademacher JG, White P, Dodge AB, Albany C, et al. Olanzapine for the treatment of advanced cancer-related chronic nausea and/or vomiting: a randomized pilot trial. JAMA Oncol. 2020;6(6):895-9. [Crossref]  [PubMed]  [PMC] 
  22. Navari RM. Managing Nausea and Vomiting in Patients With Cancer: What Works. Oncology (Williston Park). 2018;32(3):121-5, 131, 136. [PubMed] 
  23. Bajpai J, Kapu V, Rath S, Kumar S, Sekar A, Patil P, et al. Low-dose versus standard-dose olanzapine with triple antiemetic therapy for prevention of highly emetogenic chemotherapy-induced nausea and vomiting in patients with solid tumours: a single-centre, open-label, non-inferiority, randomised, controlled, phase 3 trial. Lancet Oncol. 2024;25(2):246-54. [Crossref]  [PubMed] 
  24. Norman K, Haß U, Pirlich M. Malnutrition in older adults-recent advances and remaining challenges. Nutrients. 2021;13(8):2764. [Crossref]  [PubMed]  [PMC] 
  25. Correa-Pérez A, Abraha I, Cherubini A, Collinson A, Dardevet D, de Groot LCPGM, et al. Efficacy of non-pharmacological interventions to treat malnutrition in older persons: A systematic review and meta-analysis. The SENATOR project ONTOP series and MaNuEL knowledge hub project. Ageing Res Rev. 2019;49:27-48. [Crossref]  [PubMed] 
  26. Zemel RA. Pharmacologic and non-pharmacologic dyspnea management in advanced cancer patients. Am J Hosp Palliat Care. 2022;39(7):847-55. [Crossref]  [PubMed] 
  27. Papadopoulou SK. Sarcopenia: a contemporary health problem among older adult populations. Nutrients. 2020;12(5):1293. [Crossref]  [PubMed]  [PMC] 
  28. Nagano A, Wakabayashi H, Maeda K, Kokura Y, Miyazaki S, Mori T, et al. Respiratory sarcopenia and sarcopenic respiratory disability: concepts, diagnosis, and treatment. J Nutr Health Aging. 2021;25(4):507-15. [Crossref]  [PubMed]  [PMC] 
  29. Iglseder B, Frühwald T, Jagsch C. Delirium in geriatric patients. Wien Med Wochenschr. 2022;172(5-6):114-21. [Crossref]  [PubMed]  [PMC] 
  30. Erbay Ö, Kelebek Girgin N. Deliryumun değerlendirilmesinde sık kullanılan ölçüm araçlarının incelenmesi [Investigation of frequently used measurement tools for evaluation of delirium]. Uludağ Üniversitesi Tıp Fakültesi Dergisi. 2020;46(1):113-21. [Crossref] 
  31. Karadaş C, Özdemir L. Nursing responsibilities and non-pharmacological approaches in delirium management. Journal of Psychiatric Nursing. 2019;10(2). [Crossref] 
  32. Lin RJ, Hilden PD, Elko TA, Dahi PB, Shahrokni A, Jakubowski AA, et al. Burden and impact of multifactorial geriatric syndromes in allogeneic hematopoietic cell transplantation for older adults. Blood Adv. 2019;3(1):12-20. [Crossref]  [PubMed]  [PMC] 
  33. Kıymaç Sarı M, Durna Z. Geriatrik sendromlar ve bakım [Geriatric syndromes and care]. ERÜ Sağlık Bilimleri Fakültesi Dergisi. 2022;9(1):39-46. [Link] 
  34. Zhang Q, Liu Y, Li D, Jia Y, Zhang W, Chen B, et al. Exercise intervention for the risk of falls in older adults: a protocol for systematic review and meta-analysis. Medicine (Baltimore). 2021;100(5):e24548. [Crossref]  [PubMed]  [PMC] 
  35. Sherrington C, Fairhall N, Kwok W, Wallbank G, Tiedemann A, Michaleff ZA, et al. Evidence on physical activity and falls prevention for people aged 65+ years: systematic review to inform the WHO guidelines on physical activity and sedentary behaviour. Int J Behav Nutr Phys Act. 2020;17(1):144. [Crossref]  [PubMed]  [PMC] 
  36. Feliu J, Heredia-Soto V, Gironés R, Jiménez-Munarriz B, Saldaña J, Guillén-Ponce C, et al. Can we avoid the toxicity of chemotherapy in elderly cancer patients? Crit Rev Oncol Hematol. 2018;131:16-23. [Crossref]  [PubMed] 
  37. Cordoba R, Eyre TA, Klepin HD, Wildes TM, Goede V. A comprehensive approach to therapy of haematological malignancies in older patients. Lancet Haematol. 2021;8(11):e840-e52. [Crossref]  [PubMed] 
  38. Antoine-Pepeljugoski C, Braunstein MJ. Management of newly diagnosed elderly multiple myeloma patients. Curr Oncol Rep. 2019;21(7):64. [Crossref]  [PubMed] 
  39. Choi JY, Kim KI. Assessing frailty using comprehensive geriatric assessment in older patients with hematologic malignancy. Blood Res. 2022;57(S1):1-5. [Crossref]  [PubMed]  [PMC] 
  40. Aksoy Sarac G, Emeksiz MAC, Acar O, Nazlican E, Tanacan E, et al. Retrospective analysis of dermatological diseases in geriatric patients during dermatology outpatient department visits. Dermatol Pract Concept. 2022;12(3):e2022145. [Crossref]  [PubMed]  [PMC] 
  41. Barton-Burke M, Ciccolini K, Mekas M, Burke S. Dermatologic reactions to targeted therapy: a focus on epidermal growth factor receptor inhibitors and nursing care. Nurs Clin North Am. 2017;52(1):83-113. [Crossref]  [PubMed]  [PMC] 
  42. Beech J, Germetaki T, Judge M, Paton N, Collins J, Garbutt A, et al. Management and grading of EGFR inhibitor-induced cutaneous toxicity. Future Oncol. 2018;14(24):2531-41. [Crossref]  [PubMed] 
  43. Bouche P. Neuropathy of the elderly. Rev Neurol (Paris). 2020;176(9):733-8. [Crossref]  [PubMed] 
  44. Yan M, Li Y, Zeng H, Zhao X, Wu H, Qian W, Guo X. The effect of rat nerve growth factor combined with vitamin B on peripheral neuropathy in multiple myeloma patients. Hematology. 2020;25(1):264-9. [Crossref]  [PubMed] 
  45. Yasuda H, Hoshino Y, Ando J, Miyachi M, Osawa M, Hattori N, et al. Vitamin B6 deficiency polyneuropathy and dermatitis. Am J Med. 2023;136(1):e10-e11. [Crossref]  [PubMed] 
  46. Hofer F, Koinig KA, Nagl L, Borjan B, Stauder R. Fatigue at baseline is associated with geriatric impairments and represents an adverse prognostic factor in older patients with a hematological malignancy. Ann Hematol. 2018;97(11):2235-43. [Crossref]  [PubMed]  [PMC] 
  47. Cheng D, Wang X, Hu J, Dai LL, Lv Y, Feng H, et al. Effect of tai chi and resistance training on cancer-related fatigue and quality of life in middle-aged and elderly cancer patients. Chin J Integr Med. 2021;27(4):265-72. [Crossref]  [PubMed] 
  48. Özdemir Ü, Taşcı S. Yorgunluk yaşayan kanserli bireylerde bütünleşik sağlık uygulaması: akupres [Integrated health implementation in cancer individuals suffering from fatigue: acupressure]. Journal of Health Sciences. 2017;26(3):253-6. [Link] 
  49. Özdemir Ü, Taşcı S. Acupressure for cancer-related fatigue in elderly cancer patients: a randomized controlled study. Altern Ther Health Med. 2023;29(4):57-65. [PubMed] 
  50. Ishii S, Hirota K, Nakano J. Muscle mass, cachexia, and health-related quality of life in patients with hematologic malignancies. In: Morishita S, Inoue J, Nakano J, eds. Physical Therapy and Research in Patients with Cancer. 1st ed. Singapore: Springer; 2023. p.93-110. [Crossref] 
  51. Liu MA, DuMontier C, Murillo A, Hshieh TT, Bean JF, Soiffer RJ, et al. Gait speed, grip strength, and clinical outcomes in older patients with hematologic malignancies. Blood. 2019;134(4):374-82. [Crossref]  [PubMed]  [PMC] 
  52. Duggal NA, Pollock RD, Lazarus NR, Harridge S, Lord JM. Major features of immunesenescence, including reduced thymic output, are ameliorated by high levels of physical activity in adulthood. Aging Cell. 2018;17(2):e12750. [Crossref]  [PubMed]  [PMC] 
  53. LaVoy EC, Bollard CM, Hanley PJ, Blaney JW, O'Connor DP, Bosch JA, et al. A single bout of dynamic exercise enhances the expansion of MAGE-A4 and PRAME-specific cytotoxic T-cells from healthy adults. Exerc Immunol Rev. 2015;21:144-53. [PubMed] 
  54. Sitlinger A, Brander DM, Bartlett DB. Impact of exercise on the immune system and outcomes in hematologic malignancies. Blood Adv. 2020;4(8):1801-11. [Crossref]  [PubMed]  [PMC] 
  55. Ürek D, Uğurluoğlu Ö. Finansal toksisite: kanser bakımında yeni bir yan etki [Financial toxicity: a new side effect in cancer care]. 2021;24(3):651-80. [Link] 
  56. McNulty J, Khera N. Financial Hardship--an Unwanted Consequence of Cancer Treatment. Curr Hematol Malig Rep. 2015;10(3):205-12. [Crossref]  [PubMed] 
  57. Gordon LG, Merollini KM, Lowe A, Chan RJ. Financial toxicity-what it is and how to measure it. Cancer Forum. 2017;41(2):30-35. [Link] 
  58. Gengenbach L, Reinhardt H, Ihorst G, Ajayi S, Dold SM, Köhler M, et al. Navigating the changing multiple myeloma treatment landscape: clinical practice patterns of MM patients treated in- and outside German DSMM study group trials. Leuk Lymphoma. 2018;59(11):2692-9. [Crossref]  [PubMed] 
  59. Schumacher M, Hieke S, Ihorst G, Engelhardt M. Dynamic prediction: a challenge for biostatisticians, but greatly needed by patients, physicians and the public. Biom J. 2020;62(3):822-35. [Crossref]  [PubMed] 
  60. Bian C, Ye B, Hoonakker A, Mihailidis A. Attitudes and perspectives of older adults on technologies for assessing frailty in home settings: a focus group study. BMC Geriatr. 2021;21(1):298. [Crossref]  [PubMed]  [PMC] 
  61. Schreurs K, Quan-Haase A, Martin K. Problematizing the digital literacy paradox in the context of older adults' ICT use: Aging, media discourse, and self-determination. Canadian Journal of Communication. 2017;42(2):359-77. [Crossref] 
  62. Chirico A, Lucidi F, De Laurentiis M, Milanese C, Napoli A, Giordano A. Virtual reality in health system: beyond entertainment. A mini-review on the efficacy of VR during cancer treatment. J Cell Physiol. 2016;231(2):275-87. [Crossref]  [PubMed] 
  63. Glennon C, McElroy SF, Connelly LM, Mische Lawson L, Bretches AM, Gard AR, et al. Use of virtual reality to distract from pain and anxiety. Oncol Nurs Forum. 2018;45(4):545-52. [Crossref]  [PubMed] 
  64. Gambhir S, Narkeesh A, Arunmozhi R. Role of the virtual reality in cognitive rehabilitation: a review. International Journal of Therapies and Rehabilitation Research. 2017;6(2):125. [Crossref] 
  65. Indovina P, Barone D, Gallo L, Chirico A, De Pietro G, Giordano A. Virtual reality as a distraction intervention to relieve pain and distress during medical procedures: a comprehensive literature review. Clin J Pain. 2018;34(9):858-77. [Crossref]  [PubMed] 
  66. Zeng Y, Zhang JE, Cheng ASK, Cheng H, Wefel JS. Meta-analysis of the efficacy of virtual reality-based interventions in cancer-related symptom management. Integr Cancer Ther. 2019;18:1534735419871108. [Crossref]  [PubMed]  [PMC] 
  67. Kocaoğlu Y. Hareket hastalığı ve sanal ortam [Motion sickness and virtual environment]. Beden Eğitimi ve Spor Bilimleri Dergisi. 2022;16(1):22-39. [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