The effect of cigarette smoking on the fractal organisation of the heartbeat regulating system wa... more The effect of cigarette smoking on the fractal organisation of the heartbeat regulating system was investigated by power spectral analysis. The heart rate variability (HRV) signal was obtained from the consecutive RR intervals of ECG. Power law behaviour of 1/f β type was studied to assess the fractal organisation of the heartbeat. Changes in the ratio of low frequency (PLF) to high frequency power (PHF) were used to assess the state of sympathovagal balance. The following statistical procedures were employed, as appropriate: Student's t-test for unpaired samples to compare mean values and paired ttest to compare changes within groups, and linear regression analysis. Experimental data were reported as means±SD. The differences between mean values were considered significant for p<0.05. In young smokers, the slope of the 1/f β relationship was significantly steeper than in non-smokers. The spectral exponent (β) increased during standing in non-smokers but there was no significant change in smokers. Standing also induced a significant increase in the P LF /P HF ratio in the non-smokers but no significant change was observed in smokers. These results suggest that smoking induces alteration in the fractal behaviour of HRV and disrupts the regulatory mechanisms, which show complex fluctuations and long range power-law correlations of the heartbeat recorded in non-smoking subjects. This alteration may contribute to the higher risk of cardiovascular diseases.
EDA, 1970’li yillara kadar, retikuler sistemin kontrolu altinda bulunan, yaygin ve spesifik olmay... more EDA, 1970’li yillara kadar, retikuler sistemin kontrolu altinda bulunan, yaygin ve spesifik olmayan bir aktivite olarak de erlendirildi inden simetrik oldu u du unulmu ve bu nedenle de tek yanli gozlemler yapilmi tir. Gunumuzde, retikuler duzeyin uzerinde, ipsilateral limbik-hipotalamik kaynak (EDA-1) ile kontralateral premotor-bazal gangliyon kayna inin (EDA2) da EDA’nin ortaya ciki inda rol aldi i ifade edilmektedir (1).
Özet: Çevre; insanların ve diğer canlıların yaşamları boyunca ilişkilerini sürdürdükleri ve karşı... more Özet: Çevre; insanların ve diğer canlıların yaşamları boyunca ilişkilerini sürdürdükleri ve karşılıklı olarak etkileşim içinde bulundukları fiziksel, kimyasal, biyolojik, sosyal, ekonomik ve kültürel bir ortamdır. Çevre kirliliği temel olarak hava, toprak ve su kirliliği şeklinde doğada oluşmakta ve sonuçta insanın da içinde olduğu tüm ekosistemi etkilemektedir. İnsan sağlığını veya çevresel dengeleri bozacak şekilde havanın birleşiminin değişmesi, insan sağlığı için zararlı olan maddelerin havaya karışması hava kirliliğine neden olur. Toprağın verim gücünün düşmesi, toprak özelliklerinin bozulması sonucu toprak kirliliği ortaya çıkar. Toprak kirliliği ise doğada giderilemeyen ve dönüşümü olmayan, insan sağlığını tehdit eden kirliliktir. Sanayi tesislerinden ve yerleşim yerlerinden kaynaklanan atık suların arıtılmadan ortama aktarılması, tarımda kullanılan ilaç ve gübrelerin bilinçsiz şekilde kullanılması yüzeysel ve yer altı sularımızın kirlenmesine neden olmaktadır. Sağlıklı bir yaşamın sürdürülmesi ancak sağlıklı bir çevre ile mümkündür. Bu derlemede hava, toprak ve su kirliliklerinin insan sağlığı üzerindeki etkilerinin incelenmesi amaçlanmıştır.
It is concluded that there are limited number of medical profession attitude scales in literature... more It is concluded that there are limited number of medical profession attitude scales in literature. For this reason, it was aimed to develop a valid and reliable scale based on three-component model of attitudes in this study. Method: This research was carried out among 442 students attending the medical school of a university. The data was obtained using a draft scale consisted of 28 positive items and 40 negative items. A correlation analysis was performed to determine the item discrimination of draft scale items. An explanatory and confirmatory factor analysis was conducted for construct validity and for measurement reliability of draft scale, Cronbach Alpha internal consistency coefficient was used. Findings: A three-factor structure, of which eigenvalue was over 1, explaining 50.11% of the variance was obtained as a result of the analysis on basic components of the research and the Horn's parallel analysis. After the confirmatory factor analysis, the factor structure, which has been modelled in the explanatory factor analysis within the scope of the standard compliance values. In terms of the measurement reliability of the scale, Cronbach Alpha internal consistency coefficient was between .78 and .81. The Medical Profession Attitude Scale is a five-point Likert type scale and consists of 18 items included in the following three factors: (i) Cognitive Attitude, (ii) Affective Attitude and (iii) Behavioural Attitude. Conclusion: The scale, which was developed according to the data obtained in the research, is a valid and reliable data collection tool that can be used in measuring the attitudes of individuals towards the medical profession and it is thought to be used for the studies on the attitudes of the medical profession as well.
Objective: To investigate limb specific differences in cutaneous vascular function in patients (n... more Objective: To investigate limb specific differences in cutaneous vascular function in patients (n=33) with essential hypertension (EHT). Methods: In this observational cross-sectional study, baseline skin blood flow and the response to local heating were measured with a laser Doppler flowmeter (LDF) from the volar region of the forearm and the gaiter area of the foot at supine rest. The fractal analysis, detrended fluctuation analysis (DFA), was used to calculate the correlation properties of skin blood flow, LDF signal. The paired t-test and repeated measures ANOVA were used to determine the response to local heating and compare the scaling exponents of different anatomical locations respectively. Results: We found three linear scaling regions that describe the fractal behavior of LDF signal with their slopes, scaling exponents. For cardiac (α C) and cardio-respiratory (α CR) scaling exponents, thermal hyperemia (T) induced greater change in the leg (α C =1.49±0.26; α CT =1.62±0.20 p<0.01 and α CR =0.84±0.29 α CRT =0.42±0.28 p<0.001) than in forearm (α C =1.28±0.13; α CT =1.33±0.13 p>0.05 and α CR =0.73±0.15; α CRT =0.65±0.018 p<0.05). Local scaling exponents (α L ≈α LT~1) were not significantly different (p>0.05) and, local lines did not shift in parallel with local heating in both extremities. Conclusion: The results of the present study suggest that skin microvascular function is impaired in both extremities in EHT patients. However, myogenic response is not uniform in both extremities and pronounced response to local thermal hyperemia has been observed in the gaiter area compared with the volar region. Further studies are needed to determine if these limb specific microvascular differences is the result of posture-induced structural and functional adaptation.
ABSTRACT In order to evaluate the bilateral asymmetries in evoked electrodermal activity (EDA) an... more ABSTRACT In order to evaluate the bilateral asymmetries in evoked electrodermal activity (EDA) and the use of EDA parameters as indices of relative hemispheric activation, skin resistance level (SRL), skin resistance response (SRR), and the SRR latency (L) were examined in 25 right-handed male subjects. We used bilateral recording with a unilateral stimulation (auditory click/patellar tendon tap) to assess the asymmetries of EDA variables related to the side of stimulation and to handedness. Although no significant asymmetry in C = SRRmax/SRL ratio was found, significant differences in latency were observed. Ipsilateral responses were 100 ms faster than contralateral responses for auditory stimulus, a result that can be explained in terms of contralateral delay of neuronal communication on EDA-l pathway. Response latency to reflex-motor activation was 60-100 ms shorter in the dominant hand, regardless of the stimulation site used. This result indicates that the reaction time of the EDA-2 pathway of the left hemisphere was shorter than the right for right-handed subjects. It is concluded that there is hemispheric asymmetry on EDA-2 pathway and that this asymmetry appears to be dependent on the preferred dexterity. These results have implications for the influence of both central and peripheral factors on EDA laterality and principally on laterality of response amplitude. Further, there is no single cortical mechanism modulating the asymmetries in the latency of this response.
Detrended fluctuation analysis (DFA) of laser Doppler flowmetry (LDF) time series from volar skin... more Detrended fluctuation analysis (DFA) of laser Doppler flowmetry (LDF) time series from volar skin reveals three scaling regions: cardiac, cardio-respiratory and local. Scaling exponents, slopes (α C , α CR and α L) of the straight lines, in these regions indicate correlation properties of LDF signal. Transitions from uncorrelated to positive in cardiac (α C) and positive to negative correlations in the cardio-respiratory (α CR) exponent have been observed for vasodilatation signals in response to local heating. However, positive correlation in local region (α L) did not change with vasodilatation. We studied whether the transitions in scaling exponents are correlated with the increase in peak to peak fluctuation amplitude (A F) of LDF signal. LDF signals were normalized to unity using average values of their pulsatile parts: baseline and saturation signals. If A F of normalized LDF signal is ≥ 0.5, we observed transitions in α C and in α CR but not in α L , in healthy subjects. It is suggested that the transition from positive to negative correlation in α CR with increasing amplitude may be explained by intact arteriolar myogenic activity in healthy young (Y) and middle aged (MA) subjects. In contrast, we did not observe transition in α CR suggesting impaired myogenic activity in patients with essential hypertension (EHT).
The widespread use of cellular phones raises the question of their possible adverse biological ef... more The widespread use of cellular phones raises the question of their possible adverse biological effects, especially on the central nervous system (CNS). Therefore, the authors examined the effect of electromagnetic fields emitted by cellular phones (CPEMFs) on the evoked neuronal activity of CNS relating to generation and representation of electrodermal activity (EDA), an index of sympathetic nervous system activity. EDA (skin resistance response; SRR) latency was lengthened approximately 200 ms with CPEMFs exposure irrespective of the head site next to mobile phone used. Hemispheric asymmetry of EDA-2 pathway, which is represented by shorter SRR latency in the right hand of the right hand responders, was also distorted with CPEMFs. Because the CNS regions including EDA-2 are also involved in tasks of motor timing and time estimation, delayed response in this neuronal network due to CPEMFs exposure may increase the response time of mobile phone users. Therefore, the findings point to the potential risks of mobile phones on the function of CNS and consequently, possible increase in the risk of phone-related driving hazards.
Dünya Tıp Eğitimi Federasyonu tıp eğitiminin amacını, tüm insanların sağlıklı yaşamalarını sağlam... more Dünya Tıp Eğitimi Federasyonu tıp eğitiminin amacını, tüm insanların sağlıklı yaşamalarını sağlamak için iyi hekim yetiştirmek olarak tanımlar. Tıp eğitimi, insan sağlığına yönelik bilgi, beceri ve tutumların kazandırıldığı, teorik ile pratik derslerin verildiği ve hasta başı stajların yapıldığı bir eğitimdir. Aynı zamanda tıp dünyasında ortaya çıkan yeni gelişmelerin izlenmesinin gerekliliği nedeniyle dinamik bir yapıya sahiptir. Toplumun gereksinimleri, öncelikleri, sağlık sorunları değiştikçe tıp eğitimi de buna ayak uydurmak zorundadır. Bu nedenle tıp eğitimi sürekli değişim ve gelişim içerisindedir. Bu değişim sürecinin devam etmesi, tıp fakültelerinin sürekli gelişim ve yeniliklere açık olması, problem çözebilen, sorgulayan, araştıran, yaşam boyu öğrenmeyi öğrenen, gelişime açık, ekip paylaşımını ve iletişim becerileri kazanmış, toplumun gereksinimlerine yanıt verebilen hekimlerin yetiştirilmesi açısından önem taşımaktadır. Bu derleme makalesinin amacı tıp eğitiminin gelişimi ...
EDA, 1970’li yıllara kadar, retiküler sistemin kontrolü altında bulunan, yaygın ve spesifik olmay... more EDA, 1970’li yıllara kadar, retiküler sistemin kontrolü altında bulunan, yaygın ve spesifik olmayan bir aktivite olarak de erlendirildi inden simetrik oldu u dü ünülmü ve bu nedenle de tek yanlı gözlemler yapılmı tır. Günümüzde, retiküler düzeyin üzerinde, ipsilateral limbik-hipotalamik kaynak (EDA-1) ile kontralateral premotor-bazal gangliyon kayna ının (EDA2) da EDA’nın ortaya çıkı ında rol aldı ı ifade edilmektedir (1).
Turkiye Klinikleri Journal of Medical Sciences, 2013
Önde gelen hemodinamik risk faktörlerinden biri olan kan akımının pulslu doğasını, esansiyel hipe... more Önde gelen hemodinamik risk faktörlerinden biri olan kan akımının pulslu doğasını, esansiyel hipertansiyonlu (EHT) hastalarda, deri kan dolaşımında araştırmak. G Ge er re eç ç v ve e Y Yö ön nt te em ml le er r: : Çalışmaya esansiyel hipertansiyonlu (EHT) 33 hasta ile sağlıklı 25 genç ve sağlıklı orta yaşlı 34 kişi gönüllü olarak katıldı. Kan akımı, kişiler yatar pozisyonda iken, bazal koşullarda ve lokal ısısal uyaran (42°C) uygulanırken, ön kolun volar bölgesinden bir laser Doppler (LD) akış ölçer ile kayıtlandı. Deri kan akımının merkezi (pulslu) ve lokal kontrol mekanizmalarının güç spektrumlarını (PSD) hesaplamak için LD sinyallerinin hızlı Fourier dönüşümleri kullanıldı. Güç spektrumu eğrilerinin integralleri 1'e normalize edildi ve merkezi (0,145-16 Hz) ile lokal (0,005-0,145 Hz) bölgelerin integralleri üç grup arasında karşılaştırıldı. B Bu ul lg gu ul la ar r: : Sağlıklı genç grupta, merkezi (I M) ve lokal (I L) bileşenlerin güç spektrumları birbirlerine eşit ve I L~ I M = 0,5 olacak şekilde aralarında anlamlı bir fark yoktu (p=0,335). Bu denge lokal ısısal uyaranın oluşturduğu vazodilatasyonla bozuldu ve I M~ 0,8, IL~ 0,2 oldu. Bununla birlikte, orta yaşlı kontrol grubunda ve EHT grubunda merkezi güç her zaman baskındı (IM~ 0,8) ve bazal koşullar altında bile denge yoktu (p<0,001). Orta yaşlı kontrol grubunda ısısal uyarana yanıt gözlenirken EHT grubunda anlamlı bir yanıt yoktu. S So on nu uç ç: : Bazal LD sinyalinin pulslu olma özelliğinin artması (bazal PSD fonksiyonundaki merkez/lokal dengesizliği) ve bu özelliğin vazodilatör uyaranlarla değişebilirliği mikro/makro-vasküler yapıların sağlığını belirlemede bir gösterge olarak kullanılabilir. A An na ah ht ta ar r K Ke el li im me el le er r: : Forier analizi; lazer Doppler flovmetri; hipertansiyon A AB BS ST TR RA AC CT T O Ob bj je ec ct ti iv ve e: : To investigate the leading hemodynamic risk factor, pulsatile nature of blood flow, in the cutaneous circulation in patients with essential hypertension (EHT). M Ma at te er ri ia al l a an nd d M Me et th ho od ds s: : Thirty three patients with EHT and 59 normotensive healthy young (n=25) and middle aged (n=34) subjects, participated voluntarily in this study. Skin blood flow was measured with a laser Doppler flowmeter (LDF) from volar region of the forearm when the subject is at rest in supine position under basal conditions, and during local thermal hyperemia (42°C). Fast Fourier transformation of LDF signal was used to calculate the power spectral density (PSD) of control mechanisms of central (pulsatile) and local skin blood flow. The integral of PSD curve was normalized to 1 and the integrals of local (0.005-0.145 Hz) and central (0.145-16 Hz) regions were compared among three groups. R Re es su ul lt ts s: : The integral of central (I M) and local (I L) components were not significantly different (p=0.335 and I L~ I M =0.5) in healthy young subjects for baseline LDF signal. This equilibrium was not maintained, I M~ 0.8 and I L~ 0.2, during vasodilatation in response to thermal hyperemia. However, central power (I M~ 0.8) was dominant in EHT patients and in middle aged subjects even for the baseline LDF signal (p<0.001). There was significant response with thermal hyperemia in middle aged healthy subjects but not in EHT patients. C Co on nc cl lu us si io on n: : The increase in the pulsatility of baseline LDF signal (central/local imbalance in baseline PSD function) and its variability with a vasodilator stimulus can be used as an index for determining the micro/macro-vascular health.
The widespread use of cellular phones raises the question of their possible adverse biological ef... more The widespread use of cellular phones raises the question of their possible adverse biological effects, especially on the central nervous system (CNS). Therefore, the authors examined the effect of electromagnetic fields emitted by cellular phones (CPEMFs) on the evoked neuronal activity of CNS relating to generation and representation of electrodermal activity (EDA), an index of sympathetic nervous system activity. EDA (skin resistance response; SRR) latency was lengthened approximately 200 ms with CPEMFs exposure irrespective of the head site next to mobile phone used. Hemispheric asymmetry of EDA-2 pathway, which is represented by shorter SRR latency in the right hand of the right hand responders, was also distorted with CPEMFs. Because the CNS regions including EDA-2 are also involved in tasks of motor timing and time estimation, delayed response in this neuronal network due to CPEMFs exposure may increase the response time of mobile phone users. Therefore, the findings point to the potential risks of mobile phones on the function of CNS and consequently, possible increase in the risk of phone-related driving hazards.
Detrended fluctuation analysis (DFA) of laser Doppler flowmetry (LDF) time series from volar skin... more Detrended fluctuation analysis (DFA) of laser Doppler flowmetry (LDF) time series from volar skin reveals three scaling regions: cardiac, cardio-respiratory and local. Scaling exponents, slopes (αC, αCR and αL) of the straight lines, in these regions indicate correlation properties of LDF signal. Transitions from uncorrelated to positive in cardiac (αC) and positive to negative correlations in the cardio-respiratory (αCR) exponent have been observed for vasodilatation signals in response to local heating. However, positive correlation in local region (αL) did not change with vasodilatation. We studied whether the transitions in scaling exponents are correlated with the increase in peak to peak fluctuation amplitude (AF) of LDF signal. LDF signals were normalized to unity using average values of their pulsatile parts: baseline and saturation signals. If AF of normalized LDF signal is ≥0.5, we observed transitions in αC and in αCR but not in αL, in healthy subjects. It is suggested th...
The relative contribution of vasodilating factors to the control of blood flow in the forearm cut... more The relative contribution of vasodilating factors to the control of blood flow in the forearm cutaneous microcirculation is not well defined. Therefore, a mathematical transformation is introduced to decompose the superimposed signal and to investigate the involved mechanisms separately. Transdermal iontophoresis was used for the delivery of acetylcholine (ACh) or sodium nitroprusside (SNP) into the forearm, and cutaneous perfusion was measured using a laser Doppler flowmeter (LDF). The curve fitting procedure used in this study indicates that the LDF signal in response to ACh iontophoresis can be described by the superposition of two independent hyperbolic response curves. Obviously, each component of LDF signal indicates the existence of a separate mechanism, with corresponding rate constant k, latency T, and the saturation level F max. Blockade of C-fiber function (axon reflex) with topical anesthesia removes one of the two components of this response and allows the precise quantification of its contribution. SNP-evoked response also has two components, but their parameters were different from those of ACh. Therefore, ACh and SNP cause vasodilation in the skin microcirculation through different pathways. These findings have implications for clinical studies that use the iontophoresis technique for assessing vascular function and comparing responses to ACh and SNP to evaluate endothelial dysfunction.
The full diagnostic potential of the fractal complexity measure, α, of detrended fluctuation anal... more The full diagnostic potential of the fractal complexity measure, α, of detrended fluctuation analysis (DFA) has not been realized yet. To reveal the impaired mechanisms in the blood flow regulation in patients with essential hypertension (EHT), we studied the laser Doppler flowmetry (LDF) time series by applying DFA. Forearm microvascular blood flow was measured by LDF during supine rest. After a 15 min baseline recording, microvascular response to thermal hyperemia was measured over 30 min. We found three distinct scaling regions; corresponding to the integration of local mechanisms, cardiac effect on local blood flow, and the coupling of extrinsic factors (cardiac and respiratory) to local blood flow by myogenic mechanism. In the control group, local scaling exponent, α L = 0.96 ± 0.08, did not change but cardiac scaling exponent, α C = 1.53 ± 0.05, for baseline signal was increased to α CT = 1.73 ± 0.10 and cardio-respiratory scaling exponent, α CR = 0.73 ± 0.19, was decreased to α CRT = 0.24 ± 0.06 during vasodilatation in response to local heating. However, we found significantly different scaling exponents, α LT b 1, α CT ≥ α C b 1.5 and α CR ≈ α-CRT N 0.5 in patients with EHT. Our findings suggest that the local regulatory and the cushioning peripheral vascular functions are impaired in patients with EHT, and vascular/microvascular pathology can be evaluated by applying DFA to LDF signal.
Anadolu Kardiyoloji Dergisi/The Anatolian Journal of Cardiology, 2013
Objective: To investigate limb specific differences in cutaneous vascular function in patients (n... more Objective: To investigate limb specific differences in cutaneous vascular function in patients (n=33) with essential hypertension (EHT). Methods: In this observational cross-sectional study, baseline skin blood flow and the response to local heating were measured with a laser Doppler flowmeter (LDF) from the volar region of the forearm and the gaiter area of the foot at supine rest. The fractal analysis, detrended fluctuation analysis (DFA), was used to calculate the correlation properties of skin blood flow, LDF signal. The paired t-test and repeated measures ANOVA were used to determine the response to local heating and compare the scaling exponents of different anatomical locations respectively. Results: We found three linear scaling regions that describe the fractal behavior of LDF signal with their slopes, scaling exponents. For cardiac (α C) and cardio-respiratory (α CR) scaling exponents, thermal hyperemia (T) induced greater change in the leg (α C =1.49±0.26; α CT =1.62±0.20 p<0.01 and α CR =0.84±0.29 α CRT =0.42±0.28 p<0.001) than in forearm (α C =1.28±0.13; α CT =1.33±0.13 p>0.05 and α CR =0.73±0.15; α CRT =0.65±0.018 p<0.05). Local scaling exponents (α L ≈α LT~1) were not significantly different (p>0.05) and, local lines did not shift in parallel with local heating in both extremities. Conclusion: The results of the present study suggest that skin microvascular function is impaired in both extremities in EHT patients. However, myogenic response is not uniform in both extremities and pronounced response to local thermal hyperemia has been observed in the gaiter area compared with the volar region. Further studies are needed to determine if these limb specific microvascular differences is the result of posture-induced structural and functional adaptation.
Tıp Fakültesi öğrencilerinin tıp eğiticisi kavramına ilişkin algılarında çeşitli faktörler etkili... more Tıp Fakültesi öğrencilerinin tıp eğiticisi kavramına ilişkin algılarında çeşitli faktörler etkilidir. Bunlardan en önemlisi öğrenim gördükleri fakültedeki tıp eğiticileridir. Bu bağlamda, araştırmada öğrencilerin bilişsel yapılarında yer alan "ideal tıp eğiticisi" niteliklerinin belirlenmesi ve bu niteliklere göre ideal tıp eğiticisi modellemesi amaçlanmıştır. Gereç ve Yöntem: Karma yöntemlerden keşfedici desenle tasarlanan araştırmada, İç Anadolu Bölgesi"ndeki bir devlet üniversitesi tıp fakültesinde farklı sınıf seviyelerinde öğrenim gören 217 öğrenci çalışma grubunu oluşturmuştur. Araştırma verileri yapılandırılmış görüşme tekniklerinden "dağarçık ağı" tekniği kullanılarak elde edilmiştir. Verilerin analizinde içerik analizi ve ağ benzerlik formülü kullanılmıştır. Bulgular: Bulgular, ideal tıp eğiticisi niteliklerini temsil eden 1.627 adet geçerli bilişsel kurgunun (sadece olumlu nitelikler) olduğunu; bu kurguların 24 alt ve beş ana kategoride sınıflandırılabileceğini göstermiştir. En fazla tekrarlanan ilk üç bilişsel kurgu sınıf yönetimi becerisi, sevecenlik ve ölçme-değerlendirme becerisidir. Bilişsel kurguların sınıflandırıldığı ana kategoriler ise pedagojik yetkinlik, bireysel olgunluk, iletişim becerisi, yenilikçi ruh/uyarılım ve diğer özelliklerdir. Sonuç: Sonuçlar tıp eğiticisi niteliğinin sadece birkaç nitelikle değil bir bütün olarak açıklanmasını gerektiğini ortaya çıkarmıştır. Bu nitelikler pedagoji bilgisinden alan (tıp) bilgisine; nezaketlilikten ve samimiyete uzanan çizgide çeşitlilik göstermektedir. Araştırmada elde edilen niteliklere göre oluşturulan "Çembersel Tıp Eğiticisi Modeli" altı bileşen ve her bir bileşenin birbirleriyle ilişkili 24 yapıdan oluşmaktadır. Her bir bileşen ise kendi içinde yapılara ayrılmaktadır. Modelde tıp eğiticisinin olmazsa olmaz en önemli iki temel niteliği "Pedagojik Yetkinlik" ve Bireysel Olgunluk"tur. Oluşturulan çembersel model tıp eğiticisini bir bütün olarak değerlendirmeye olanak vermekte olup bütün bileşen ve yapılar, tıp eğiticisi niteliklerini sistematik bir ilişki örüntüsüyle açıklamakta kullanılabilmektedir.
The effect of cigarette smoking on the fractal organisation of the heartbeat regulating system wa... more The effect of cigarette smoking on the fractal organisation of the heartbeat regulating system was investigated by power spectral analysis. The heart rate variability (HRV) signal was obtained from the consecutive RR intervals of ECG. Power law behaviour of 1/f β type was studied to assess the fractal organisation of the heartbeat. Changes in the ratio of low frequency (PLF) to high frequency power (PHF) were used to assess the state of sympathovagal balance. The following statistical procedures were employed, as appropriate: Student's t-test for unpaired samples to compare mean values and paired ttest to compare changes within groups, and linear regression analysis. Experimental data were reported as means±SD. The differences between mean values were considered significant for p<0.05. In young smokers, the slope of the 1/f β relationship was significantly steeper than in non-smokers. The spectral exponent (β) increased during standing in non-smokers but there was no significant change in smokers. Standing also induced a significant increase in the P LF /P HF ratio in the non-smokers but no significant change was observed in smokers. These results suggest that smoking induces alteration in the fractal behaviour of HRV and disrupts the regulatory mechanisms, which show complex fluctuations and long range power-law correlations of the heartbeat recorded in non-smoking subjects. This alteration may contribute to the higher risk of cardiovascular diseases.
EDA, 1970’li yillara kadar, retikuler sistemin kontrolu altinda bulunan, yaygin ve spesifik olmay... more EDA, 1970’li yillara kadar, retikuler sistemin kontrolu altinda bulunan, yaygin ve spesifik olmayan bir aktivite olarak de erlendirildi inden simetrik oldu u du unulmu ve bu nedenle de tek yanli gozlemler yapilmi tir. Gunumuzde, retikuler duzeyin uzerinde, ipsilateral limbik-hipotalamik kaynak (EDA-1) ile kontralateral premotor-bazal gangliyon kayna inin (EDA2) da EDA’nin ortaya ciki inda rol aldi i ifade edilmektedir (1).
Özet: Çevre; insanların ve diğer canlıların yaşamları boyunca ilişkilerini sürdürdükleri ve karşı... more Özet: Çevre; insanların ve diğer canlıların yaşamları boyunca ilişkilerini sürdürdükleri ve karşılıklı olarak etkileşim içinde bulundukları fiziksel, kimyasal, biyolojik, sosyal, ekonomik ve kültürel bir ortamdır. Çevre kirliliği temel olarak hava, toprak ve su kirliliği şeklinde doğada oluşmakta ve sonuçta insanın da içinde olduğu tüm ekosistemi etkilemektedir. İnsan sağlığını veya çevresel dengeleri bozacak şekilde havanın birleşiminin değişmesi, insan sağlığı için zararlı olan maddelerin havaya karışması hava kirliliğine neden olur. Toprağın verim gücünün düşmesi, toprak özelliklerinin bozulması sonucu toprak kirliliği ortaya çıkar. Toprak kirliliği ise doğada giderilemeyen ve dönüşümü olmayan, insan sağlığını tehdit eden kirliliktir. Sanayi tesislerinden ve yerleşim yerlerinden kaynaklanan atık suların arıtılmadan ortama aktarılması, tarımda kullanılan ilaç ve gübrelerin bilinçsiz şekilde kullanılması yüzeysel ve yer altı sularımızın kirlenmesine neden olmaktadır. Sağlıklı bir yaşamın sürdürülmesi ancak sağlıklı bir çevre ile mümkündür. Bu derlemede hava, toprak ve su kirliliklerinin insan sağlığı üzerindeki etkilerinin incelenmesi amaçlanmıştır.
It is concluded that there are limited number of medical profession attitude scales in literature... more It is concluded that there are limited number of medical profession attitude scales in literature. For this reason, it was aimed to develop a valid and reliable scale based on three-component model of attitudes in this study. Method: This research was carried out among 442 students attending the medical school of a university. The data was obtained using a draft scale consisted of 28 positive items and 40 negative items. A correlation analysis was performed to determine the item discrimination of draft scale items. An explanatory and confirmatory factor analysis was conducted for construct validity and for measurement reliability of draft scale, Cronbach Alpha internal consistency coefficient was used. Findings: A three-factor structure, of which eigenvalue was over 1, explaining 50.11% of the variance was obtained as a result of the analysis on basic components of the research and the Horn's parallel analysis. After the confirmatory factor analysis, the factor structure, which has been modelled in the explanatory factor analysis within the scope of the standard compliance values. In terms of the measurement reliability of the scale, Cronbach Alpha internal consistency coefficient was between .78 and .81. The Medical Profession Attitude Scale is a five-point Likert type scale and consists of 18 items included in the following three factors: (i) Cognitive Attitude, (ii) Affective Attitude and (iii) Behavioural Attitude. Conclusion: The scale, which was developed according to the data obtained in the research, is a valid and reliable data collection tool that can be used in measuring the attitudes of individuals towards the medical profession and it is thought to be used for the studies on the attitudes of the medical profession as well.
Objective: To investigate limb specific differences in cutaneous vascular function in patients (n... more Objective: To investigate limb specific differences in cutaneous vascular function in patients (n=33) with essential hypertension (EHT). Methods: In this observational cross-sectional study, baseline skin blood flow and the response to local heating were measured with a laser Doppler flowmeter (LDF) from the volar region of the forearm and the gaiter area of the foot at supine rest. The fractal analysis, detrended fluctuation analysis (DFA), was used to calculate the correlation properties of skin blood flow, LDF signal. The paired t-test and repeated measures ANOVA were used to determine the response to local heating and compare the scaling exponents of different anatomical locations respectively. Results: We found three linear scaling regions that describe the fractal behavior of LDF signal with their slopes, scaling exponents. For cardiac (α C) and cardio-respiratory (α CR) scaling exponents, thermal hyperemia (T) induced greater change in the leg (α C =1.49±0.26; α CT =1.62±0.20 p<0.01 and α CR =0.84±0.29 α CRT =0.42±0.28 p<0.001) than in forearm (α C =1.28±0.13; α CT =1.33±0.13 p>0.05 and α CR =0.73±0.15; α CRT =0.65±0.018 p<0.05). Local scaling exponents (α L ≈α LT~1) were not significantly different (p>0.05) and, local lines did not shift in parallel with local heating in both extremities. Conclusion: The results of the present study suggest that skin microvascular function is impaired in both extremities in EHT patients. However, myogenic response is not uniform in both extremities and pronounced response to local thermal hyperemia has been observed in the gaiter area compared with the volar region. Further studies are needed to determine if these limb specific microvascular differences is the result of posture-induced structural and functional adaptation.
ABSTRACT In order to evaluate the bilateral asymmetries in evoked electrodermal activity (EDA) an... more ABSTRACT In order to evaluate the bilateral asymmetries in evoked electrodermal activity (EDA) and the use of EDA parameters as indices of relative hemispheric activation, skin resistance level (SRL), skin resistance response (SRR), and the SRR latency (L) were examined in 25 right-handed male subjects. We used bilateral recording with a unilateral stimulation (auditory click/patellar tendon tap) to assess the asymmetries of EDA variables related to the side of stimulation and to handedness. Although no significant asymmetry in C = SRRmax/SRL ratio was found, significant differences in latency were observed. Ipsilateral responses were 100 ms faster than contralateral responses for auditory stimulus, a result that can be explained in terms of contralateral delay of neuronal communication on EDA-l pathway. Response latency to reflex-motor activation was 60-100 ms shorter in the dominant hand, regardless of the stimulation site used. This result indicates that the reaction time of the EDA-2 pathway of the left hemisphere was shorter than the right for right-handed subjects. It is concluded that there is hemispheric asymmetry on EDA-2 pathway and that this asymmetry appears to be dependent on the preferred dexterity. These results have implications for the influence of both central and peripheral factors on EDA laterality and principally on laterality of response amplitude. Further, there is no single cortical mechanism modulating the asymmetries in the latency of this response.
Detrended fluctuation analysis (DFA) of laser Doppler flowmetry (LDF) time series from volar skin... more Detrended fluctuation analysis (DFA) of laser Doppler flowmetry (LDF) time series from volar skin reveals three scaling regions: cardiac, cardio-respiratory and local. Scaling exponents, slopes (α C , α CR and α L) of the straight lines, in these regions indicate correlation properties of LDF signal. Transitions from uncorrelated to positive in cardiac (α C) and positive to negative correlations in the cardio-respiratory (α CR) exponent have been observed for vasodilatation signals in response to local heating. However, positive correlation in local region (α L) did not change with vasodilatation. We studied whether the transitions in scaling exponents are correlated with the increase in peak to peak fluctuation amplitude (A F) of LDF signal. LDF signals were normalized to unity using average values of their pulsatile parts: baseline and saturation signals. If A F of normalized LDF signal is ≥ 0.5, we observed transitions in α C and in α CR but not in α L , in healthy subjects. It is suggested that the transition from positive to negative correlation in α CR with increasing amplitude may be explained by intact arteriolar myogenic activity in healthy young (Y) and middle aged (MA) subjects. In contrast, we did not observe transition in α CR suggesting impaired myogenic activity in patients with essential hypertension (EHT).
The widespread use of cellular phones raises the question of their possible adverse biological ef... more The widespread use of cellular phones raises the question of their possible adverse biological effects, especially on the central nervous system (CNS). Therefore, the authors examined the effect of electromagnetic fields emitted by cellular phones (CPEMFs) on the evoked neuronal activity of CNS relating to generation and representation of electrodermal activity (EDA), an index of sympathetic nervous system activity. EDA (skin resistance response; SRR) latency was lengthened approximately 200 ms with CPEMFs exposure irrespective of the head site next to mobile phone used. Hemispheric asymmetry of EDA-2 pathway, which is represented by shorter SRR latency in the right hand of the right hand responders, was also distorted with CPEMFs. Because the CNS regions including EDA-2 are also involved in tasks of motor timing and time estimation, delayed response in this neuronal network due to CPEMFs exposure may increase the response time of mobile phone users. Therefore, the findings point to the potential risks of mobile phones on the function of CNS and consequently, possible increase in the risk of phone-related driving hazards.
Dünya Tıp Eğitimi Federasyonu tıp eğitiminin amacını, tüm insanların sağlıklı yaşamalarını sağlam... more Dünya Tıp Eğitimi Federasyonu tıp eğitiminin amacını, tüm insanların sağlıklı yaşamalarını sağlamak için iyi hekim yetiştirmek olarak tanımlar. Tıp eğitimi, insan sağlığına yönelik bilgi, beceri ve tutumların kazandırıldığı, teorik ile pratik derslerin verildiği ve hasta başı stajların yapıldığı bir eğitimdir. Aynı zamanda tıp dünyasında ortaya çıkan yeni gelişmelerin izlenmesinin gerekliliği nedeniyle dinamik bir yapıya sahiptir. Toplumun gereksinimleri, öncelikleri, sağlık sorunları değiştikçe tıp eğitimi de buna ayak uydurmak zorundadır. Bu nedenle tıp eğitimi sürekli değişim ve gelişim içerisindedir. Bu değişim sürecinin devam etmesi, tıp fakültelerinin sürekli gelişim ve yeniliklere açık olması, problem çözebilen, sorgulayan, araştıran, yaşam boyu öğrenmeyi öğrenen, gelişime açık, ekip paylaşımını ve iletişim becerileri kazanmış, toplumun gereksinimlerine yanıt verebilen hekimlerin yetiştirilmesi açısından önem taşımaktadır. Bu derleme makalesinin amacı tıp eğitiminin gelişimi ...
EDA, 1970’li yıllara kadar, retiküler sistemin kontrolü altında bulunan, yaygın ve spesifik olmay... more EDA, 1970’li yıllara kadar, retiküler sistemin kontrolü altında bulunan, yaygın ve spesifik olmayan bir aktivite olarak de erlendirildi inden simetrik oldu u dü ünülmü ve bu nedenle de tek yanlı gözlemler yapılmı tır. Günümüzde, retiküler düzeyin üzerinde, ipsilateral limbik-hipotalamik kaynak (EDA-1) ile kontralateral premotor-bazal gangliyon kayna ının (EDA2) da EDA’nın ortaya çıkı ında rol aldı ı ifade edilmektedir (1).
Turkiye Klinikleri Journal of Medical Sciences, 2013
Önde gelen hemodinamik risk faktörlerinden biri olan kan akımının pulslu doğasını, esansiyel hipe... more Önde gelen hemodinamik risk faktörlerinden biri olan kan akımının pulslu doğasını, esansiyel hipertansiyonlu (EHT) hastalarda, deri kan dolaşımında araştırmak. G Ge er re eç ç v ve e Y Yö ön nt te em ml le er r: : Çalışmaya esansiyel hipertansiyonlu (EHT) 33 hasta ile sağlıklı 25 genç ve sağlıklı orta yaşlı 34 kişi gönüllü olarak katıldı. Kan akımı, kişiler yatar pozisyonda iken, bazal koşullarda ve lokal ısısal uyaran (42°C) uygulanırken, ön kolun volar bölgesinden bir laser Doppler (LD) akış ölçer ile kayıtlandı. Deri kan akımının merkezi (pulslu) ve lokal kontrol mekanizmalarının güç spektrumlarını (PSD) hesaplamak için LD sinyallerinin hızlı Fourier dönüşümleri kullanıldı. Güç spektrumu eğrilerinin integralleri 1'e normalize edildi ve merkezi (0,145-16 Hz) ile lokal (0,005-0,145 Hz) bölgelerin integralleri üç grup arasında karşılaştırıldı. B Bu ul lg gu ul la ar r: : Sağlıklı genç grupta, merkezi (I M) ve lokal (I L) bileşenlerin güç spektrumları birbirlerine eşit ve I L~ I M = 0,5 olacak şekilde aralarında anlamlı bir fark yoktu (p=0,335). Bu denge lokal ısısal uyaranın oluşturduğu vazodilatasyonla bozuldu ve I M~ 0,8, IL~ 0,2 oldu. Bununla birlikte, orta yaşlı kontrol grubunda ve EHT grubunda merkezi güç her zaman baskındı (IM~ 0,8) ve bazal koşullar altında bile denge yoktu (p<0,001). Orta yaşlı kontrol grubunda ısısal uyarana yanıt gözlenirken EHT grubunda anlamlı bir yanıt yoktu. S So on nu uç ç: : Bazal LD sinyalinin pulslu olma özelliğinin artması (bazal PSD fonksiyonundaki merkez/lokal dengesizliği) ve bu özelliğin vazodilatör uyaranlarla değişebilirliği mikro/makro-vasküler yapıların sağlığını belirlemede bir gösterge olarak kullanılabilir. A An na ah ht ta ar r K Ke el li im me el le er r: : Forier analizi; lazer Doppler flovmetri; hipertansiyon A AB BS ST TR RA AC CT T O Ob bj je ec ct ti iv ve e: : To investigate the leading hemodynamic risk factor, pulsatile nature of blood flow, in the cutaneous circulation in patients with essential hypertension (EHT). M Ma at te er ri ia al l a an nd d M Me et th ho od ds s: : Thirty three patients with EHT and 59 normotensive healthy young (n=25) and middle aged (n=34) subjects, participated voluntarily in this study. Skin blood flow was measured with a laser Doppler flowmeter (LDF) from volar region of the forearm when the subject is at rest in supine position under basal conditions, and during local thermal hyperemia (42°C). Fast Fourier transformation of LDF signal was used to calculate the power spectral density (PSD) of control mechanisms of central (pulsatile) and local skin blood flow. The integral of PSD curve was normalized to 1 and the integrals of local (0.005-0.145 Hz) and central (0.145-16 Hz) regions were compared among three groups. R Re es su ul lt ts s: : The integral of central (I M) and local (I L) components were not significantly different (p=0.335 and I L~ I M =0.5) in healthy young subjects for baseline LDF signal. This equilibrium was not maintained, I M~ 0.8 and I L~ 0.2, during vasodilatation in response to thermal hyperemia. However, central power (I M~ 0.8) was dominant in EHT patients and in middle aged subjects even for the baseline LDF signal (p<0.001). There was significant response with thermal hyperemia in middle aged healthy subjects but not in EHT patients. C Co on nc cl lu us si io on n: : The increase in the pulsatility of baseline LDF signal (central/local imbalance in baseline PSD function) and its variability with a vasodilator stimulus can be used as an index for determining the micro/macro-vascular health.
The widespread use of cellular phones raises the question of their possible adverse biological ef... more The widespread use of cellular phones raises the question of their possible adverse biological effects, especially on the central nervous system (CNS). Therefore, the authors examined the effect of electromagnetic fields emitted by cellular phones (CPEMFs) on the evoked neuronal activity of CNS relating to generation and representation of electrodermal activity (EDA), an index of sympathetic nervous system activity. EDA (skin resistance response; SRR) latency was lengthened approximately 200 ms with CPEMFs exposure irrespective of the head site next to mobile phone used. Hemispheric asymmetry of EDA-2 pathway, which is represented by shorter SRR latency in the right hand of the right hand responders, was also distorted with CPEMFs. Because the CNS regions including EDA-2 are also involved in tasks of motor timing and time estimation, delayed response in this neuronal network due to CPEMFs exposure may increase the response time of mobile phone users. Therefore, the findings point to the potential risks of mobile phones on the function of CNS and consequently, possible increase in the risk of phone-related driving hazards.
Detrended fluctuation analysis (DFA) of laser Doppler flowmetry (LDF) time series from volar skin... more Detrended fluctuation analysis (DFA) of laser Doppler flowmetry (LDF) time series from volar skin reveals three scaling regions: cardiac, cardio-respiratory and local. Scaling exponents, slopes (αC, αCR and αL) of the straight lines, in these regions indicate correlation properties of LDF signal. Transitions from uncorrelated to positive in cardiac (αC) and positive to negative correlations in the cardio-respiratory (αCR) exponent have been observed for vasodilatation signals in response to local heating. However, positive correlation in local region (αL) did not change with vasodilatation. We studied whether the transitions in scaling exponents are correlated with the increase in peak to peak fluctuation amplitude (AF) of LDF signal. LDF signals were normalized to unity using average values of their pulsatile parts: baseline and saturation signals. If AF of normalized LDF signal is ≥0.5, we observed transitions in αC and in αCR but not in αL, in healthy subjects. It is suggested th...
The relative contribution of vasodilating factors to the control of blood flow in the forearm cut... more The relative contribution of vasodilating factors to the control of blood flow in the forearm cutaneous microcirculation is not well defined. Therefore, a mathematical transformation is introduced to decompose the superimposed signal and to investigate the involved mechanisms separately. Transdermal iontophoresis was used for the delivery of acetylcholine (ACh) or sodium nitroprusside (SNP) into the forearm, and cutaneous perfusion was measured using a laser Doppler flowmeter (LDF). The curve fitting procedure used in this study indicates that the LDF signal in response to ACh iontophoresis can be described by the superposition of two independent hyperbolic response curves. Obviously, each component of LDF signal indicates the existence of a separate mechanism, with corresponding rate constant k, latency T, and the saturation level F max. Blockade of C-fiber function (axon reflex) with topical anesthesia removes one of the two components of this response and allows the precise quantification of its contribution. SNP-evoked response also has two components, but their parameters were different from those of ACh. Therefore, ACh and SNP cause vasodilation in the skin microcirculation through different pathways. These findings have implications for clinical studies that use the iontophoresis technique for assessing vascular function and comparing responses to ACh and SNP to evaluate endothelial dysfunction.
The full diagnostic potential of the fractal complexity measure, α, of detrended fluctuation anal... more The full diagnostic potential of the fractal complexity measure, α, of detrended fluctuation analysis (DFA) has not been realized yet. To reveal the impaired mechanisms in the blood flow regulation in patients with essential hypertension (EHT), we studied the laser Doppler flowmetry (LDF) time series by applying DFA. Forearm microvascular blood flow was measured by LDF during supine rest. After a 15 min baseline recording, microvascular response to thermal hyperemia was measured over 30 min. We found three distinct scaling regions; corresponding to the integration of local mechanisms, cardiac effect on local blood flow, and the coupling of extrinsic factors (cardiac and respiratory) to local blood flow by myogenic mechanism. In the control group, local scaling exponent, α L = 0.96 ± 0.08, did not change but cardiac scaling exponent, α C = 1.53 ± 0.05, for baseline signal was increased to α CT = 1.73 ± 0.10 and cardio-respiratory scaling exponent, α CR = 0.73 ± 0.19, was decreased to α CRT = 0.24 ± 0.06 during vasodilatation in response to local heating. However, we found significantly different scaling exponents, α LT b 1, α CT ≥ α C b 1.5 and α CR ≈ α-CRT N 0.5 in patients with EHT. Our findings suggest that the local regulatory and the cushioning peripheral vascular functions are impaired in patients with EHT, and vascular/microvascular pathology can be evaluated by applying DFA to LDF signal.
Anadolu Kardiyoloji Dergisi/The Anatolian Journal of Cardiology, 2013
Objective: To investigate limb specific differences in cutaneous vascular function in patients (n... more Objective: To investigate limb specific differences in cutaneous vascular function in patients (n=33) with essential hypertension (EHT). Methods: In this observational cross-sectional study, baseline skin blood flow and the response to local heating were measured with a laser Doppler flowmeter (LDF) from the volar region of the forearm and the gaiter area of the foot at supine rest. The fractal analysis, detrended fluctuation analysis (DFA), was used to calculate the correlation properties of skin blood flow, LDF signal. The paired t-test and repeated measures ANOVA were used to determine the response to local heating and compare the scaling exponents of different anatomical locations respectively. Results: We found three linear scaling regions that describe the fractal behavior of LDF signal with their slopes, scaling exponents. For cardiac (α C) and cardio-respiratory (α CR) scaling exponents, thermal hyperemia (T) induced greater change in the leg (α C =1.49±0.26; α CT =1.62±0.20 p<0.01 and α CR =0.84±0.29 α CRT =0.42±0.28 p<0.001) than in forearm (α C =1.28±0.13; α CT =1.33±0.13 p>0.05 and α CR =0.73±0.15; α CRT =0.65±0.018 p<0.05). Local scaling exponents (α L ≈α LT~1) were not significantly different (p>0.05) and, local lines did not shift in parallel with local heating in both extremities. Conclusion: The results of the present study suggest that skin microvascular function is impaired in both extremities in EHT patients. However, myogenic response is not uniform in both extremities and pronounced response to local thermal hyperemia has been observed in the gaiter area compared with the volar region. Further studies are needed to determine if these limb specific microvascular differences is the result of posture-induced structural and functional adaptation.
Tıp Fakültesi öğrencilerinin tıp eğiticisi kavramına ilişkin algılarında çeşitli faktörler etkili... more Tıp Fakültesi öğrencilerinin tıp eğiticisi kavramına ilişkin algılarında çeşitli faktörler etkilidir. Bunlardan en önemlisi öğrenim gördükleri fakültedeki tıp eğiticileridir. Bu bağlamda, araştırmada öğrencilerin bilişsel yapılarında yer alan "ideal tıp eğiticisi" niteliklerinin belirlenmesi ve bu niteliklere göre ideal tıp eğiticisi modellemesi amaçlanmıştır. Gereç ve Yöntem: Karma yöntemlerden keşfedici desenle tasarlanan araştırmada, İç Anadolu Bölgesi"ndeki bir devlet üniversitesi tıp fakültesinde farklı sınıf seviyelerinde öğrenim gören 217 öğrenci çalışma grubunu oluşturmuştur. Araştırma verileri yapılandırılmış görüşme tekniklerinden "dağarçık ağı" tekniği kullanılarak elde edilmiştir. Verilerin analizinde içerik analizi ve ağ benzerlik formülü kullanılmıştır. Bulgular: Bulgular, ideal tıp eğiticisi niteliklerini temsil eden 1.627 adet geçerli bilişsel kurgunun (sadece olumlu nitelikler) olduğunu; bu kurguların 24 alt ve beş ana kategoride sınıflandırılabileceğini göstermiştir. En fazla tekrarlanan ilk üç bilişsel kurgu sınıf yönetimi becerisi, sevecenlik ve ölçme-değerlendirme becerisidir. Bilişsel kurguların sınıflandırıldığı ana kategoriler ise pedagojik yetkinlik, bireysel olgunluk, iletişim becerisi, yenilikçi ruh/uyarılım ve diğer özelliklerdir. Sonuç: Sonuçlar tıp eğiticisi niteliğinin sadece birkaç nitelikle değil bir bütün olarak açıklanmasını gerektiğini ortaya çıkarmıştır. Bu nitelikler pedagoji bilgisinden alan (tıp) bilgisine; nezaketlilikten ve samimiyete uzanan çizgide çeşitlilik göstermektedir. Araştırmada elde edilen niteliklere göre oluşturulan "Çembersel Tıp Eğiticisi Modeli" altı bileşen ve her bir bileşenin birbirleriyle ilişkili 24 yapıdan oluşmaktadır. Her bir bileşen ise kendi içinde yapılara ayrılmaktadır. Modelde tıp eğiticisinin olmazsa olmaz en önemli iki temel niteliği "Pedagojik Yetkinlik" ve Bireysel Olgunluk"tur. Oluşturulan çembersel model tıp eğiticisini bir bütün olarak değerlendirmeye olanak vermekte olup bütün bileşen ve yapılar, tıp eğiticisi niteliklerini sistematik bir ilişki örüntüsüyle açıklamakta kullanılabilmektedir.
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