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SUMMARY OBJECTIVE: Osteoporosis is a prevalent but often overlooked condition in hemiplegic patients that increases the risk of fracture. The aim of this study was to evaluate osteoporosis knowledge and awareness levels and determine associated factors in adult hemiplegic individuals. METHODS: A cross-sectional study was conducted with 88 hemiplegic participants (45 males, 43 females) in a tertiary rehabilitation clinic. Demographic and clinical data were documented. Cognitive function was assessed using the Mini-Mental State Examination, while osteoporosis knowledge was evaluated through the 31-item Osteoporosis Awareness Scale in addition to a structured question ("Have you ever heard of osteoporosis?"). Statistical analyses included independent t-tests, one-way analysis of variance with Tukey post-hoc testing, Pearson correlations, and multiple linear regression (significance: p<0.05). RESULTS: The mean Osteoporosis Awareness Scale score was 72.55±32.29 (range: 32–124). Seventy-two (81.8%) participants reported having heard of osteoporosis. In univariate analysis, Osteoporosis Awareness Scale scores were higher in females (76.58±33.81 vs. 68.73±30.52, p=0.036), postmenopausal women (78.92±33.45 vs. 58.40±26.31, p=0.042), those with higher education levels (p<0.001), and individuals with better cognitive function (p<0.001). Multiple linear regression confirmed that education level (p<0.001) and Mini-Mental State Examination score (p=0.002) were significant independent predictors of Osteoporosis Awareness Scale scores. Gender (p=0.052) and menopausal status (p=0.087) were not significant in the multivariate model. CONCLUSION: Education level and cognitive function were significant independent predictors of osteoporosis knowledge in hemiplegic patients. Gender and menopausal status were not significant after adjustment for education and cognitive function. These findings highlight the need for targeted educational strategies in rehabilitation settings, particularly for patients with lower educational backgrounds and cognitive impairment.

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SUMMARY OBJECTIVE: The aim of this study was to investigate the effects of the Emotional Freedom Technique on depressive and menopausal symptoms among postmenopausal women. METHODS: The study sample consisted of 70 postmenopausal women (Emotional Freedom Technique group: 34; control group: 36). Participants in the intervention group received Emotional Freedom Technique at least once daily for 8 weeks. The control group received only routine care. Data were collected using a personal information form, the Menopause Rating Scale and the Beck Depression Inventory. All assessments were conducted before and after the intervention. Analyses were conducted using G*Power and Statistical Package for the Social Sciences 25. RESULTS: Emotional Freedom Technique significantly reduced the Beck Depression Inventory scores (p<0.001), as well as Menopause Rating Scale total (p<0.001) and subdimension scores: somatic (p<0.001) and psychological (p<0.001), and urogenital (p=0.005). Following the intervention, Beck Depression Inventory score decreased by 62.8%, Menopause Rating Scale total score by 46.3%, somatic subscale score by 52.1%, psychological subscale score by 45.0%, and urogenital subscale score by 20.4%. CONCLUSION: Emotional Freedom Technique shows promise as a potential adjunctive intervention, but further blinded, controlled trials are needed. The Emotional Freedom Technique was effective in reducing depression and menopausal symptoms among postmenopausal women after 8 weeks of daily practice. It is suggested that its use alongside standard care may help alleviate depressive and menopausal symptoms.

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SUMMARY OBJECTIVE: Artificial intelligence-driven conversational models are increasingly used for patient education, yet whether information patients find clear and satisfying also meets expert accuracy standards remains unclear. The aim of this study was to compare patient and physician evaluations of ChatGPT-5 and DeepSeek V3.1 responses to questions on Hashimoto's thyroiditis. METHODS: In a cross-sectional, double-blind, within-participant study, twenty standardized, endocrinologist-developed questions across six domains were submitted to both models in October 2025. Seventeen adults with confirmed Hashimoto's thyroiditis (mean age 47.6±13.5 years; 88.2% female; 64.7% bachelor's degree or higher) rated each blinded response for clarity and satisfaction on 10-point Likert scales and selected a preferred response. Two endocrinologists also rated responses blindly; with only two physicians, their ratings were summarized descriptively. Paired t-tests with Holm correction compared ratings, and preference was analyzed with mixed-effects logistic regression. RESULTS: Patients rated ChatGPT-5 higher than DeepSeek V3.1 for clarity (9.15±0.70 vs. 8.41±1.14; Holm-adjusted p=0.005; Cohen's d_z=0.87) and satisfaction (8.93±0.94 vs. 8.19±1.37; Holm-adjusted p=0.005; d_z=0.85), and preferred ChatGPT-5 in 68.8% of selections (odds ratio 2.20; 95%CI 1.75–2.77; p<0.001). In exploratory analyses, this advantage was concentrated among higher-education participants and was undetectable in the small lower-education subgroup (n=6). Owing to the small physician sample (n=2) and low inter-rater agreement (κ=0.12; accuracy intraclass correlation coefficient=0.48), physician accuracy ratings (5.90 and 5.70/10) are exploratory and do not support a robust patient–physician comparison. CONCLUSION: Patients preferred ChatGPT-5 for clarity and satisfaction, though this advantage may not extend to lower-health-literacy populations; high patient satisfaction should not be taken as a proxy for clinical accuracy. Physician-supervised deployment and language-specific validation are recommended for responsible integration of artificial intelligence into patient education.

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SUMMARY OBJECTIVE: The aim of this study was to evaluate the knowledge, attitudes, and vaccination practices of family physicians in Muğla, Turkey, regarding rotavirus infection and vaccination. METHODS: This descriptive cross-sectional study included family medicine residents and family physicians working in primary care settings in Muğla. Data were analyzed using Kruskal-Wallis, Mann-Whitney U, and Pearson chi-square tests. A p<0.05 was considered statistically significant. RESULTS: Among the participants, 88.6% recommended at least one vaccine not included in the national immunization schedule, with rotavirus vaccine being the most frequently recommended (91.9%). Rotavirus vaccine knowledge scores were significantly associated with age and the recommendation of vaccines not included in the national immunization schedule (p<0.001). Physicians who had vaccinated their own children had significantly higher knowledge scores (p=0.011). CONCLUSION: Although family physicians demonstrated adequate general knowledge of rotavirus infection, vaccine-related knowledge was insufficient. Knowledge level appears to play a key role in shaping vaccination attitudes and behaviors, highlighting the need for targeted continuing medical education.

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SUMMARY OBJECTIVE: The objective of this study was to identify the frequency and severity of diabetic ketoacidosis in the diagnosis of type 1 diabetes mellitus in the pre-, during-, and post-COVID-19 pandemic periods at a state-reference pediatric center. METHODS: Observational, cross-sectional period study, including medical records of patients diagnosed with type 1 diabetes mellitus from 2018 to 2024. The association between the diagnosis period and the presence of diabetic ketoacidosis was assessed using odds ratios with 95%CIs. The association between the diagnosis period and the need for intensive care unit admission, symptom duration, and previous incorrect diagnoses was assessed using Fisher's exact test. Temporal trends in diabetic ketoacidosis severity were assessed using the Cochran-Armitage trend test. p<0.05 were considered significant. RESULTS: Of the 184 type 1 diabetes mellitus cases, 55.4% presented with diabetic ketoacidosis at diagnosis. Patients diagnosed during the pandemic had a higher chance of developing diabetic ketoacidosis compared to the pre-pandemic period (OR 3.17; 95%CI 1.52–6.64; p=0.002) and the post-pandemic period (OR 2.90; 95%CI 1.37–6.16; p=0.005). There was no significant association between the diagnosis period and the occurrence of previous incorrect diagnoses, between the diagnosis period and the time of symptom progression, and intensive care unit admission. Regarding the severity of diabetic ketoacidosis, no significant temporal trend was identified (p>0.05). CONCLUSION: An association was observed between the pandemic period and the occurrence of diabetic ketoacidosis, without inference of causality. There are no significant differences in the proportion of severe diabetic ketoacidosis during the pandemic period.

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SUMMARY OBJECTIVE: Older adults increasingly use artificial intelligence-based tools to obtain health information. Although artificial intelligence chatbots such as ChatGPT may enhance access, the quality, readability, and patient safety of fall-prevention information remain uncertain. This study aimed to evaluate the quality, readability, and patient safety implications of ChatGPT-generated responses to common questions about fall risk and home safety in older adults. METHODS: Ten frequently asked fall-related questions were submitted to ChatGPT (version 5.2). Responses were independently assessed by a multidisciplinary panel including physiotherapists, a geriatrician, a physical medicine and rehabilitation physician, an occupational therapist, and an orthopedic specialist. Quality was evaluated using the Mika classification. Readability was measured with the Flesch-Kincaid Grade Level. Interrater reliability was analyzed using a two-way random-effects intraclass correlation coefficient model with absolute agreement (intraclass correlation coefficient [2,k]). RESULTS: Three responses were rated as "excellent," while seven responses were rated as "satisfactory requiring minimal clarification." No response received a rating corresponding to "moderately satisfactory" or "unsatisfactory." The mean Flesch-Kincaid Grade Level was 8.4 (range 4.3–11.9). Five responses exceeded the readability levels commonly recommended for patient education materials. Interrater reliability demonstrated fair agreement (intraclass correlation coefficient [2,k]=0.72; 95%CI 0.64–0.80). CONCLUSION: While ChatGPT provided generally acceptable clinical information, variability in readability and expert ratings raises patient safety concerns. AI-generated health content should be reviewed and tailored to older adults’ health literacy needs before clinical use.

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SUMMARY OBJECTIVE: Genetic susceptibility is increasingly recognized in cardiac arrhythmias. human leukocyte antigen-DQ2 and human leukocyte antigen-DQ8 alleles are established markers of immune-genetic dysregulation and chronic inflammation. This study investigated the association between human leukocyte antigen-DQ2/DQ8 positivity and incident atrial fibrillation in patients with heart failure with reduced ejection fraction. METHODS: This study was based on a prospectively followed cohort; the present retrospective analysis evaluated 50 heart failure with reduced ejection fraction patients (left ventricular ejection fraction <40%) and 50 age- and sex-matched controls. Participants were screened for human leukocyte antigen-DQ2/DQ8 alleles. All subjects were in sinus rhythm at baseline and followed for 24 months for the primary endpoint of incident atrial fibrillation. RESULTS: Incident atrial fibrillation occurred in 16% (n=8) of the heart failure with reduced ejection fraction group and 2% (n=1) of the control group. Among heart failure with reduced ejection fraction patients, human leukocyte antigen-positive status (positivity for DQ2 and/or DQ8) was found in 20 patients. Interestingly, all eight incident atrial fibrillation cases in the heart failure with reduced ejection fraction group occurred within the human leukocyte antigen-positive subgroup (40 vs. 0% in human leukocyte antigen-negative heart failure with reduced ejection fraction, p=0.031). human leukocyte antigen-positive heart failure with reduced ejection fraction patients exhibited a significantly higher atrial fibrillation risk compared to human leukocyte antigen-positive controls (p=0.0069), suggesting that structural heart disease and genetic predisposition synergistically increase arrhythmic risk. CONCLUSION: Human leukocyte antigen-DQ2/DQ8 positivity is significantly associated with incident atrial fibrillation in heart failure with reduced ejection fraction patients. These findings suggest human leukocyte antigen-related immune-genetic susceptibility contributes to atrial electrical vulnerability, positioning human leukocyte antigen typing as a potential novel biomarker for arrhythmic risk stratification in heart failure.

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SUMMARY OBJECTIVE: The objective of this study is to evaluate the demographic and clinical characteristics of cases consulted with the ear, nose, and throat department in a tertiary hospital, the consultation indications, and independent factors associated with the need for procedural intervention. METHODS: This retrospective single-center study included patients undergoing ear, nose, and throat consultation. Demographics, consultation characteristics, indications, imaging, procedures, and hospitalization were recorded. Procedural intervention rates and independent factors associated with intervention requirements were also examined. RESULTS: Consultations for 1,366 patients were analyzed. The great majority of consultations (76.5%) originated from the emergency department, and procedural interventions were performed in approximately half the cases (48.8%). The most common reasons for consultation were suspected foreign bodies (n=248, 18.2%), nasal fracture (n=231, 16.9%), and epistaxis (n=132, 9.7%). The highest procedural intervention requirements were in the soft tissue trauma group (n=118; 90.7%) and in the epistaxis (87.9%) and nasal fracture (78.3%) cases. Consultation indication was the strongest independent predictor. Epistaxis, trauma-related consultations, and suspected foreign bodies were significantly associated with the need for procedural intervention. CONCLUSION: Consultation indication was the main determinant of intervention. Epistaxis, trauma-related conditions, and suspected foreign bodies were significantly independently associated with intervention requirements. Early identification of these high-risk indications may assist in the optimization of ear, nose, and throat emergency resource planning and consultation triage.

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SUMMARY OBJECTIVE: The aim of this study was to examine the relationship between smartphone distraction and clinical decision-making among nurses. METHODS: This descriptive, cross-sectional study was conducted with 140 nurses working in a state hospital in a provincial center in the Mediterranean region of Turkey between 12 and 31 December 2024. Data were collected using the “Descriptive Information Form,” “Smartphone Distraction Scale,” and “Clinical Decision-Making in Nursing Scale.” RESULTS: A statistically significant weak negative correlation was observed between Smartphone Distraction Scale and Clinical Decision-Making in Nursing Scale scores (p<0.05). In addition, professional experience duration showed a weak positive relationship with Clinical Decision-Making in Nursing Scale scores (p<0.001). CONCLUSION: In this study, higher levels of smartphone distraction were associated with lower levels of clinical decision-making among nurses. In addition, longer professional experience was associated with higher levels of clinical decision-making.

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SUMMARY OBJECTIVE: This case-control study aims to investigate the relationship between low pregnancy-associated plasma protein-A levels and serum urotensin-II concentrations between the 11th and 14th weeks of pregnancy. METHODS: This study was conducted between October 2024 and October 2025 at the perinatology outpatient clinic of a Training and Research Hospital in Istanbul. A total of 84 women were consecutively included and divided into case and control groups based on pregnancy-associated plasma protein-A results. Written consent and a descriptive form were obtained. Combined screening tests were performed, and blood samples were collected for urotensin-II measurement. RESULTS: No significant difference was observed between the case and control groups in terms of urotensin-II concentration. A statistically significant positive correlation was found between pregnancy-associated plasma protein-A levels and urotensin-II concentrations. Each 1 mIU/mL increase in pregnancy-associated plasma protein-A concentration was associated with an approximate 36.45 ng/mL increase in urotensin-II concentration. CONCLUSION: In this study, no significant association was demonstrated between pregnancy-associated plasma protein-A levels and urotensin-II levels in case and control groups; however, a correlation was identified between pregnancy-associated plasma protein-A levels and urotensin-II concentrations.

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SUMMARY OBJECTIVE: We conducted this study to examine the attitudes and metaphorical perceptions of violence against women among midwifery students. METHODS: This Convergent Mixed-Methods study involved 383 midwifery students enrolled in a health sciences department during the 2024–2025 academic year. Data were collected using the Student Information Form, the Scale of Attitude Toward Violence Against Women, and the Metaphor Identification Form on Violence Against Women. RESULTS: Of the midwifery students, 21.5% reported exposure to at least one form of violence, with emotional and verbal violence being the most commonly reported. A substantial proportion of midwifery students remained silent when exposed to violence. The total mean attitude score for violence against women was 27.32±6.46, indicating non-traditional and non-myth-supporting attitudes. The metaphor analysis yielded eight overarching themes. CONCLUSION: The findings suggest that midwifery students hold contemporary and critical attitudes toward violence against women; however, their help-seeking behaviors remain limited due to sociocultural barriers. The metaphors produced reflect a deep understanding of the destructive, cyclical, and structurally oppressive nature of violence. Overall, our findings demonstrate that midwifery students possess a multidimensional and detailed understanding of violence against women; however, persistent barriers to help-seeking behavior indicate that sociocultural norms remain powerful.

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SUMMARY OBJECTIVE: The aim of this study was to evaluate the responses generated by ChatGPT-5, Gemini, and Grok to the “six most frequently asked patient questions” on cryptorchidism published by the European Association of Urology, assessing them in terms of quality, understandability, actionability, and readability. METHODS: ChatGPT-5, Gemini, and Grok were asked these six frequently asked questions listed on the European Association of Urology patient information page on cryptorchidism. The quality of the responses was evaluated using the Quality Assessment Tool for Patient Health Information instrument, understandability and actionability were assessed using Patient Education Materials Assessment Tool scores, and readability was measured with the Coleman-Liau Index. All evaluations were performed by four urologists. RESULTS: Among the three artificial intelligence-based large language models, Gemini achieved the highest mean Quality Assessment Tool for Patient Health Information and Patient Education Materials Assessment Tool for Printable Materials scores. Kruskal-Wallis analysis demonstrated a statistically significant difference in Quality Assessment Tool for Patient Health Information scores among the groups (p=0.005); pairwise comparisons revealed that Gemini scored significantly higher than ChatGPT-5 (p=0.001). No significant differences were observed among the models for Patient Education Materials Assessment Tool—Understandability Section or Patient Education Materials Assessment Tool—Actionability Section scores (p>0.05). In the readability analysis, Grok had the highest Coleman-Liau Index value (Coleman-Liau Index=14.68), and all models produced texts requiring a university-level reading ability. Although the Gemini model achieved higher overall quality scores, all artificial intelligence-based large language models provided good-quality but difficult-to-read information. CONCLUSION: The responses generated by all three models demonstrated high levels of understandability and strong actionability. We anticipate that future, more advanced versions of artificial intelligence-based large language models will further improve these outcomes and contribute positively to the existing literature.

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SUMMARY OBJECTIVE: The aim of this study was to assess the effects of preexisting hypothyroidism on the course of coronavirus disease 2019 and on delivery and fetal outcomes in pregnant women with coronavirus disease 2019. METHODS: Two groups of pregnant women with coronavirus disease 2019 were included, that is, those with no comorbid condition and those with preexisting hypothyroidism as the sole comorbid condition. We assessed the course of coronavirus disease 2019 and delivery and fetal outcomes in the two groups. RESULTS: Of 167 participants, 143 had no preexisting comorbidity, and 24 had hypothyroidism as the sole comorbid condition. Patients with hypothyroidism had significantly higher incidences of severe coronavirus disease 2019 and the following coronavirus disease 2019 symptoms: shortness of breath, loss of sense of smell and/or taste, and tachypnea. Hospital (length of stay, intensive care unit admission and stay, mortality), delivery (normal vaginal delivery, cesarean section, and emergency cesarean section), and fetal (preterm, birth weight, 1- and 5-min Appearance, Pulse, Grimace, Activity, and Respiration scores, stillbirth) outcomes were similar in the two groups. The outcomes were also similar in patients with severe coronavirus disease 2019, though those with hypothyroidism had shorter hospital stay and intensive care unit stay and lower rates of intensive care unit admission, mortality, emergency cesarean section, preterm delivery, and low birth weight newborns. CONCLUSION: Our results suggest that preexisting hypothyroidism has adverse impacts on the severity of coronavirus disease 2019 and its symptoms. Considering severe coronavirus disease 2019 cases, seemingly favorable hospital, delivery, and fetal outcomes on the part of hypothyroidism may be worth further research.

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SUMMARY OBJECTIVE: Benign paroxysmal positional vertigo is the most common peripheral vestibular disorder. It can recur despite successful maneuvers. While various risk factors for recurrence have been investigated, these remain controversial. The aim of this study was to identify potential risk factors for benign paroxysmal positional vertigo recurrence and contribute to the development of preventive treatment strategies. METHODS: The study involved 301 patients who presented to our clinic with dizziness and were diagnosed with benign paroxysmal positional vertigo between December 2019 and May 2022. Two groups, with and without benign paroxysmal positional vertigo recurrence, were compared in terms of age, gender, hypertension, diabetes mellitus, hyperlipidemia, cardiovascular disease, asthma, hypothyroidism, magnesium deficiency, vitamin D deficiency, vitamin B12 deficiency, and iron deficiency to investigate the effects of these factors on recurrence. RESULTS: Recurrence was observed in 38 (12.6%) of the 301 patients. No age or gender difference was determined between the groups. Univariate analysis showed that hypertension (55.3 vs. 29.3%; p=0.003), vitamin B12 deficiency (21.1 vs. 6.5%; p=0.007), hyperlipidemia (26.3 vs. 5.7%; p<0.001), and asthma (15.8 vs. 5.7%; p=0.035) were more common in patients with recurrence. Multivariate logistic regression analysis identified only hyperlipidemia as a risk factor, raising the risk of recurrence approximately 3.7-fold (OR 3.71; 95%CI 1.36–10.13; p=0.011). CONCLUSION: Consideration of underlying comorbidities and systemic factors, effective management of existing comorbidities, and individualized treatment strategies are crucial in order to reduce benign paroxysmal positional vertigo recurrence rates and improve patients’ quality of life.

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SUMMARY OBJECTIVE: The aim of this study was to evaluate neurological outcomes and mortality in polytrauma patients with severe traumatic brain injury who were included in a massive transfusion protocol compared to those who were not. METHODS: Retrospective analysis of adult traffic accident with blunt head trauma and severe traumatic brain injury between 2013 and 2018. Inclusion criteria: Glasgow Coma Scale score≤8, Abbreviated Injury Scale score≥3, Injury Severity Score≥16. Patients were divided into two groups: those who received massive transfusion protocol (massive transfusion protocol group) and those who did not (No massive transfusion protocol group). Data collected included demographics, accident type, severity scores, serum lactate, and base excess. Neurological outcomes were assessed using the modified Rankin Scale. Mortality and hospital length of stay were recorded. RESULTS: 77 patients met the inclusion criteria (massive transfusion protocol group: n=26 [33.8%]; No massive transfusion protocol group: n=51 [66.2%]). Most patients were young males involved in motorcycle accidents. Trauma scores, lactate, and base excess were similar between groups. The mean modified Rankin Scale score at discharge was lower in the massive transfusion protocol group (massive transfusion protocol: 4.65 vs. No massive transfusion protocol: 5.41; p=0.0313), indicating better neurological outcomes. Among surviving patients, the distribution of non-fatal modified Rankin Scale categories was similar between groups. Mortality (modified Rankin Scale 6) was significantly lower in the massive transfusion protocol group (57.7%) compared to the No massive transfusion protocol group (80.4%; p=0.007). Hospital length of stay in days was similar in both groups. CONCLUSION: Inclusion in a massive transfusion protocol was associated with improved neurological outcomes and lower mortality in polytrauma patients with severe traumatic brain injury.

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SUMMARY OBJECTIVE: The objective of this study is to evaluate the effects of bromelain on serum endocannabinoid levels and oxidative stress markers in a rat model of surgically induced endometriosis. METHODS: A total of 24 female Wistar albino rats were randomly assigned to three groups (n=8 each): Sham, endometriosis, and endometriosis treated with bromelain (endometriosis+B). Endometriosis was induced by autotransplantation of uterine tissue. Bromelain (20 mg/kg/day) was administered orally for 15 consecutive days. Serum levels of 2-arachidonoylglycerol, anandamide, superoxide dismutase, glutathione, and malondialdehyde were measured using ELISA. Statistical analysis was performed using one-way analysis of variance followed by Tukey's post hoc test. RESULTS: Induction of endometriosis significantly reduced serum 2-arachidonoylglycerol, anandamide, superoxide dismutase, and glutathione levels while increasing malondialdehyde concentrations compared with the Sham group (p<0.05). Bromelain treatment significantly improved most endocannabinoid and oxidative stress parameters compared with the untreated endometriosis group (p<0.05). CONCLUSION: Bromelain ameliorated endocannabinoid deficiency and oxidative stress in experimental endometriosis. These findings suggest that bromelain may represent a promising non-hormonal therapeutic candidate targeting interconnected inflammatory and redox pathways in endometriosis.

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SUMMARY OBJECTIVE: Antiseizure medications used during pregnancy may exert teratogenic effects on the developing fetus, with risks varying according to drug type, dosage, and exposure timing. While older agents such as carbamazepine are associated with known risks, newer agents including lamotrigine and levetiracetam have demonstrated more favorable safety profiles. This study aimed to evaluate pregnancy outcomes, major congenital malformation rates, and seizure frequency in pregnant women with epilepsy exposed to carbamazepine, lamotrigine, or levetiracetam as monotherapy or polytherapy, compared with an untreated control group. METHODS: This retrospective observational study included pregnant women with epilepsy who were categorized into antiseizure medication-exposed (monotherapy or polytherapy) and non-exposed groups. Clinical data, including seizure history, medication type and dosage, pregnancy outcomes, and neonatal findings, were collected. major congenital malformations were identified according to European Surveillance of Congenital Anomalies criteria. RESULTS: A total of 307 pregnancies were analyzed, resulting in 276 live births. major congenital malformation rates were 6.1% for carbamazepine, 1.7% for levetiracetam, and 3.6% for lamotrigine monotherapy. Polytherapy outcomes varied by combination, with relatively low risks observed in levetiracetam-containing regimens. Seizure frequency remained unchanged in most cases (69.6%), increased in 21%, and decreased in 9.4% of pregnancies. Preconception seizure presence significantly increased the risk of seizures during pregnancy. CONCLUSION: Levetiracetam and lamotrigine demonstrate favorable safety profiles, whereas carbamazepine carries a moderate teratogenic risk. Polytherapy risk is combination-dependent, and preconception seizure control is a key predictor of seizure outcomes during pregnancy.

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SUMMARY OBJECTIVE: The aim of this study was to examine the effect of an Environment-Based Education Program applied to adolescents on their pro-environmental behavior and ecological footprint awareness. METHODS: This research, conducted in a quasi-experimental design with a pre-test-post-test control group in non-randomized samples, was carried out with 10th-grade students attending a vocational high school in the Central Anatolia region of Turkey. The study included 52 students in the intervention group and 52 students in the control group. The Environment-Based Education Program, consisting of three weeks and three sessions, was applied to the students in the intervention group. Data were collected using a Personal Information Form, the Pro-Environmental Behavior Scale, and the Ecological Footprint Awareness Scale. Chi-square, dependent samples t-test, and independent samples t-test were used in the analysis of the data. RESULTS: After the applied Environment-Based Education Program, it was found that the mean total scores on the Pro-Environmental Behavior Scale of the intervention group increased in the post-test compared to the pre-test, and the difference was statistically significant (p<0.001). No significant difference was found between the intervention and control groups in ecological footprint awareness scores (p>0.05). CONCLUSION: The Environment-Based Education Program applied to adolescents was found to increase their pro-environmental behaviors. In light of these results, environmental education programs should be organized periodically for adolescents, and school visits should be planned by public health nurses.

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SUMMARY OBJECTIVE: Venous thromboembolism prophylaxis remains a complex and controversial issue in orthopedic practice, with persistent variability in recommendations even among experts. With the growing use of online platforms and artificial intelligence, the aim of this study was to evaluate the quality and clinical adequacy of artificial intelligence-generated recommendations regarding venous thromboembolism. METHODS: Thirty-three guideline-based questions derived from International Consensus Meeting, National Institute for Health and Care Excellence, American College of Chest Physicians, and American Academy of Orthopaedic Surgeons recommendations were independently submitted to ChatGPT (Generative Pre-trained Transformer [GPT]-4.0) by two orthopedic surgeons, resulting in 66 generated responses for analysis. Responses were assessed using the DISCERN instrument, Journal of the American Medical Association benchmark criteria, and a novel clinically oriented scale, the Thromboembolism Digital Knowledge Level. Inter-rater reliability was evaluated using intraclass correlation coefficients. RESULTS: According to DISCERN, 62.1% of responses were classified as good quality, whereas Thromboembolism Digital Knowledge Level evaluation demonstrated that only 45.45% of responses were clinically adequate, with no responses classified as excellent. The same responses were systematically categorized into higher quality levels by DISCERN compared to Thromboembolism Digital Knowledge Level. All scoring systems demonstrated excellent inter-rater reliability (Intraclass Correlation Coefficient range: 0.897–0.961). Although differences between scoring systems were statistically significant, the effect size was moderate (r=0.39). Strong correlations were observed between evaluators across all scales (p<0.001). CONCLUSION: ChatGPT-generated responses demonstrated good structural quality but limited clinical adequacy for thromboembolic prophylaxis after arthroplasty. These findings suggest that artificial intelligence systems should be used cautiously and may not be sufficient as standalone clinical decision-support tools.