Turkiye Klinikleri Journal of Nursing Sciences

.: ORIGINAL RESEARCH
The Effect of Virtual Reality Application on Pain and Anxiety During Chest Tube Removal Following Open Heart Surgery: Randomized Controlled Study
Açık Kalp Ameliyatı Olan Hastalarda Göğüs Tüpü Çıkarılması Sırasında Uygulanan Sanal Gerçekliğin Ağrı ve Anksiyete Üzerine Etkisi: Randomize Kontrollü Çalışma
Nilgün ÖZBAŞa , Yasin ÇAKMAKb , Sameh ALAGHAc
aYozgat Bozok University Akdağmadeni School of Health, Department of Nursing, Division of Surgical Diseases Nursing, Yozgat, Türkiye
bYozgat Bozok University Akdağmadeni School of Health, Department of Nursing, Yozgat, Türkiye
cYozgat Bozok University Faculty of Medicine, Department of Cardiovascular Surgery, Yozgat, Türkiye
Turkiye Klinikleri J Nurs Sci. 2024;16(3):640-8
doi: 10.5336/nurses.2023-101151
Article Language: EN
Full Text
ABSTRACT
 Objective: Chest tube removal is a painful medical procedure following cardiac surgery. This study aimed to examine the effect of virtual reality (VR) application on pain and anxiety during chest tube removal in patients undergoing open-heart surgery. Material and Methods: In this parallel-group, randomized controlled study, a total of 40 participants were randomly assigned to intervention (n=20) and control (n=20) groups. 360-degree VR videos with nature and landscape scenes and relaxing background music were shown to the intervention group using VR glasses. Data were collected using a Patient Information Form, visual analog scale (VAS), Trait Anxiety Inventory, and Profile of Mood States Tension-Anxiety Subscale (POMS-TA). Descriptive statistics, independent samples t-test, chi-square tests, mixed design analysis of variance, and Bonferroni correction were used for data analysis. Results: VAS, POMS-TA Subscale, systolic and diastolic blood pressure, pulse, and respiratory scores measured immediately after chest tube removal (T1), 10 minutes later (T2), and one hour later (T3) were found to be lower in the intervention group compared to the control group (p<0.05). The number of patients using analgesics during and after chest tube removal was lower in the intervention group (p<0.05). Conclusion: VR application reduced pain and anxiety levels during chest tube removal and improved vital signs. Additionally, VR reduced the use of analgesics during and after the procedure. In this context, VR applications can be recommended as an effective attention diversion method during chest tube removal.

Keywords: Virtual reality; chest tube; pain; anxiety; nursing
ÖZET
 Amaç: Kalp ameliyatı sonrası göğüs tüpü çıkarılması, ağrılı tıbbi işlemlerden biridir. Bu çalışma, açık kalp ameliyatı geçiren hastalarda göğüs tüpü çıkarılması sırasında sanal gerçeklik (SG) uygulamasının ağrı ve anksiyete üzerindeki etkisini incelemek amacıyla yapılmıştır. Gereç ve Yöntemler: Bu paralel gruplu, randomize kontrollü çalışmada toplam 40 katılımcı rastgele olarak müdahale (n=20) ve kontrol (n=20) gruplarına atanmıştır. Müdahale grubuna SG gözlükleri kullanılarak doğa ve manzara sahneleri ve rahatlatıcı fon müziği içeren 360 derece VR videolar izletilmiştir. Veriler; Hasta Bilgi Formu, Görsel Kıyaslama Ölçeği (GKÖ), Sürekli Anksiyete Ölçeği ve Duygu Durum Profili Gerginlik & Anksiyete Alt Ölçeği (DDP-GAAÖ) kullanılarak toplanmıştır. Verilerin değerlendirilmesinde tanımlayıcı istatistikler, bağımsız örneklerde t-testi, ki-kare testleri, karma desen varyans analizi ve ve Bonferroni düzeltmesi kullanılmıştır. Bulgular: Göğüs tüpü çıkarılmasından hemen sonra (T1), 10 dk sonra (T2) ve 1 saat sonra (T3) ölçülen GKÖ, DDP-GAAÖ, sistolik ve diyastolik kan basıncı, nabız ve solunum skorları, müdahale grubunda kontrol grubuna göre daha düşük bulunmuştur (p<0,05). Göğüs tüpü çıkarılması sırasında ve sonrasında analjezik kullanan hastaların sayısı müdahale grubunda daha düşüktü (p<0,05). Sonuç: SG uygulaması, göğüs tüpü çıkarılması sırasında ağrı ve anksiyete düzeylerini azaltmış ve temel yaşamsal bulguları iyileştirmiştir. Ayrıca SG, işlem sırasında ve sonrasında analjezi kullanımını azaltmıştır. Bu bağlamda, SG uygulamaları göğüs tüpü çıkarılması sırasında etkili bir dikkat dağıtma yöntemi olarak önerilebilir.

Anahtar Kelimeler: Sanal gerçeklik; göğüs tüpü; ağrı; anksiyete; hemşirelik
REFERENCES:
  1. Hardin S, Kaplow R. Cardiac Surgery Essentials for Critical Care Nursing. 3rd ed. Burlington MA: Jones & Bartlett Learning; 2020.
  2. Jarrah MI, Hweidi IM, Al-Dolat SA, Alhawatmeh HN, Al-Obeisat SM, Hweidi LI, et al. The effect of slow deep breathing relaxation exercise on pain levels during and post chest tube removal after coronary artery bypass graft surgery. Int J Nurs Sci. 2022;9(2):155-61. [Crossref]  [PubMed]  [PMC] 
  3. Malik V, Kiran U, Chauhan S, Makhija N. Transcutaneous nerve stimulation for pain relief during chest tube removal following cardiac surgery. J Anaesthesiol Clin Pharmacol. 2018;34(2):216-20. [Crossref]  [PubMed]  [PMC] 
  4. Sajedi-Monfared Z, Rooddehghan Z, Haghani H, Bakhshandeh AR, Monfared LS. Cold therapy and respiratory relaxation exercise on pain and anxiety related to chest tube removal: a clinical trial. Iran J Nurs Midwifery Res. 2021;26(1):54-9. [Crossref]  [PubMed]  [PMC] 
  5. Hasanzadeh F, Kashouk NM, Amini S, Asili J, Emami SA, Vashani HB, et al. The effect of cold application and lavender oil inhalation in cardiac surgery patients undergoing chest tube removal. EXCLI J. 2016;15:64-74. [PubMed]  [PMC] 
  6. Yarahmadi S, Mohammadi N, Ardalan A, Najafizadeh H, Gholami M. The combined effects of cold therapy and music therapy on pain following chest tube removal among patients with cardiac bypass surgery. Complement Ther Clin Pract. 2018;31:71-5. [Crossref]  [PubMed] 
  7. McGovern C, Cowan R, Appleton R, Miles B. Pain, agitation and delirium in the intensive care unit. Anaesthesia and Intensive Care Med. 2018;19(12):634-40. [Crossref] 
  8. Hendricks TM, Gutierrez CN, Stulak JM, Dearani JA, Miller JD. The use of virtual reality to reduce preoperative anxiety in first-time sternotomy patients: a randomized controlled pilot trial. Mayo Clin Proc. 2020;95(6):1148-57. [Crossref]  [PubMed] 
  9. Kızılcık Özkan Z, Gökçe Işıklı A, Yanık F. The effect of virtual reality glasses on reducing pain during chest tube removal. J Clin Med Kaz. 2023;20(4):38-42. [Crossref] 
  10. Huang Q, Lin J, Han R, Peng C, Huang A. Using virtual reality exposure therapy in pain management: a systematic review and meta-analysis of randomized controlled trials. Value Health. 2022;25(2):288-301. [Crossref]  [PubMed] 
  11. Ding L, Hua H, Zhu H, Zhu S, Lu J, Zhao K, et al. Effects of virtual reality on relieving postoperative pain in surgical patients: a systematic review and meta-analysis. Int J Surg. 2020;82:87-94. [Crossref]  [PubMed] 
  12. Ioannou A, Papastavrou E, Avraamides MN, Charalambous A. Virtual reality and symptoms management of anxiety, depression, fatigue, and pain: a systematic review. SAGE Open Nurs. 2020;6:2377960820936163. [Crossref]  [PubMed]  [PMC] 
  13. Mallari B, Spaeth EK, Goh H, Boyd BS. Virtual reality as an analgesic for acute and chronic pain in adults: a systematic review and meta-analysis. J Pain Res. 2019;12:2053-85. [Crossref]  [PubMed]  [PMC] 
  14. Laghlam D, Naudin C, Coroyer L, Aidan V, Malvy J, Rahoual G, et al. Virtual reality vs. Kalinox® for management of pain in intensive care unit after cardiac surgery: a randomized study. Ann Intensive Care. 2021;11(1):74. [Crossref]  [PubMed]  [PMC] 
  15. Furness PJ, Phelan I, Babiker NT, Fehily O, Lindley SA, Thompson AR. Reducing pain during wound dressings in burn care using virtual reality: a study of perceived impact and usability with patients and nurses. J Burn Care Res. 2019;40(6):878-85. [Crossref]  [PubMed] 
  16. Gerçeker GÖ, Binay Ş, Bilsin E, Kahraman A, Yılmaz HB. Effects of virtual reality and external cold and vibration on pain in 7- to 12-year-old children during phlebotomy: a randomized controlled trial. J Perianesth Nurs. 2018;33(6):981-9. [Crossref]  [PubMed] 
  17. Teeley AM, Soltani M, Wiechman SA, Jensen MP, Sharar SR, Patterson DR. Virtual reality hypnosis pain control in the treatment of multiple fractures: a case series. Am J Clin Hypn. 2012;54(3):184-94. [Crossref]  [PubMed] 
  18. Karaman D, Taşdemir N. The effect of using virtual reality during breast biopsy on pain and anxiety: a randomized controlled trial. J Perianesth Nurs. 2021;36(6):702-5. [Crossref]  [PubMed] 
  19. Georgescu R, Fodor LA, Dobrean A, Cristea IA. Psychological interventions using virtual reality for pain associated with medical procedures: a systematic review and meta-analysis. Psychol Med. 2020;50(11):1795-807. [Crossref]  [PubMed] 
  20. Carl E, Stein AT, Levihn-Coon A, Pogue JR, Rothbaum B, Emmelkamp P, Asmundson GJG, et al. Virtual reality exposure therapy for anxiety and related disorders: a meta-analysis of randomized controlled trials. J Anxiety Disord. 2019;61:27-36. [Crossref]  [PubMed] 
  21. Menekli T, Yaprak B, Doğan R. The effect of virtual reality distraction intervention on pain, anxiety, and vital signs of oncology patients undergoing port catheter implantation: a randomized controlled study. Pain Manag Nurs. 2022;23(5):585-90. [Crossref]  [PubMed] 
  22. Eti Aslan F. Ameliyat Sonrası Ağrı Değerlendirmesinde Görsel Kıyaslama Ölçeğiyle Basit Tanımlayıcı Ölçeğin duyarlık ve seçiciliği [Sensitivity and Selectivity of Visual Analogue Scale and Simple Descriptive Scale in postoperative pain assessment]. Journal of Intensive Care Nursing. 2004;8(1):1-6. [Link] 
  23. Öner N, Le Compte A. Durumluk Sürekli Kaygı Envanteri El Kitabı. 1. Baskı. İstanbul: Boğaziçi Üniversitesi Yayınları; 1983.
  24. Ağargün MY, Özcan Ç, Kıran ÜK. POMS (Mizaç durumları profili): geçerlik ve güvenirlik çalışması. 39.Ulusal Psikiyatri Kongresi. Antalya: Türkiye Psikiyatri Derneği; 2003. p.557-9.
  25. Mosso-Vázquez JL, Gao K, Wiederhold BK, Wiederhold MD. Virtual reality for pain management in cardiac surgery. Cyberpsychol Behav Soc Netw. 2014;17(6):371-8. [Crossref]  [PubMed]  [PMC] 
  26. Cacau Lde A, Oliveira GU, Maynard LG, Araújo Filho AA, Silva WM Jr, Cerqueria Neto ML, et al. The use of the virtual reality as intervention tool in the postoperative of cardiac surgery. Rev Bras Cir Cardiovasc. 2013;28(2):281-9. [Crossref]  [PubMed] 
  27. Lima HJ, Souza RDSP, Santos ASMSE, Borges DL, Guimaraes ARF, Ferreira GVDBA, et al. Virtual reality on pulmonary function and functional independence after coronary artery bypass grafting: clinical trial. Am J Cardiovasc Dis. 2020;10(4):499-505. [PubMed]  [PMC] 
  28. Smith V, Warty RR, Sursas JA, Payne O, Nair A, Krishnan S, et al. The effectiveness of virtual reality in managing acute pain and anxiety for medical inpatients: systematic review. J Med Internet Res. 2020;22(11):e17980. [Crossref]  [PubMed]  [PMC] 
  29. Dreesmann NJ, Su H, Thompson HJ. A systematic review of virtual reality therapeutics for acute pain management. Pain Manag Nurs. 2022;23(5):672-81. [Crossref]  [PubMed]  [PMC] 
  30. Goudman L, Jansen J, Billot M, Vets N, De Smedt A, Roulaud M, et al. virtual reality applications in chronic pain management: systematic review and meta-analysis. JMIR Serious Games. 2022;10(2):e34402. [Crossref]  [PubMed]  [PMC] 
  31. Candela L, Ventimiglia E, Corrales M, Sierra Del Rio A, Villa L, Goumas IK, et al. The use of a virtual reality device (HypnoVR) during extracorporeal shockwave lithotripsy for treatment of urinary stones: initial results of a clinical protocol. Urology. 2023;175:13-7. [Crossref]  [PubMed] 
  32. Theingi S, Leopold I, Ola T, Cohen GS, Maresky HS. Virtual reality as a non-pharmacological adjunct to reduce the use of analgesics in hospitals. J Cogn Enhanc. 2022;6(1):108-13. [Crossref]  [PubMed]  [PMC] 
  33. Barry KS, Nimma SR, Spaulding AC, Wilke BK, Torp KD, Ledford CK. Perioperative outcomes of immersive virtual reality as adjunct anesthesia in primary total hip and knee arthroplasty. Arthroplast Today. 2022;18:84-8. [Crossref]  [PubMed]  [PMC] 
  34. McSherry T, Atterbury M, Gartner S, Helmold E, Searles DM, Schulman C. Randomized, crossover study of immersive virtual reality to decrease opioid use during painful wound care procedures in adults. J Burn Care Res. 2018;39(2):278-85. [Crossref]  [PubMed] 
  35. Sahin G, Basak T. The effects of intraoperative progressive muscle relaxation and virtual reality application on anxiety, vital signs, and satisfaction: a randomized controlled trial. J Perianesth Nurs. 2020;35(3):269-76. [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