Medical Device-Related Pressure injuries in adult intensive care units.

AIM AND OBJECTIVE: This study was conducted to examine the development, characteristics, and risk factors of medical device-related pressure injury (MDRPI) in intensive care units (ICU). BACKGROUND: The number of individuals admitted to ICU increased in the last years all over the world. In parallel with this need, the frequency of the use of life-support and therapeutic medical devices in the ICU also increases. This situation may lead to the development of MDRPI in the ICU and an increase in its prevalence. METHOD: The study, which was conducted observationally, prospectively and descriptively, included 302 patients who were hospitalised in an ICU within a year. The study was reported according to the STROBE Declaration. RESULTS: It was observed that MDRPI developed in 27.2% of the patients. It was found that MDRPI developed the most in the nose (26.8%) and mouth (15.9%) regions of the patients. It was determined that MDRPI was diagnosed in 28% of the patients within 3-5 days. It was determined that mostly orthopaedic devices (plaster, cervical collar, splint) (62.5%), fasteners (57.1%), non-invasive ventilation/oxygen masks (51.2%) caused the development of MDRPI. It was found that the number of medical devices used was higher, and the number of hospitalisation days in the ICU was also higher, and these factors explained 28.3% of the total variance in the development of MDRPI. CONCLUSION: It was determined that MDRPI developed in approximately one of four patients in the ICU and that the numbers of medical devices and hospitalisation days were important determinant risk factors. RELEVANCE TO CLINICAL PRACTICE: The high rate of development of MDRPI is worrying in terms of nursing care quality. It is recommended that nurses recognise risk factors in order to prevent the development of MDRPI, evaluate the suitability, necessity, and safety of the devices to be used is located.

Telemedicine as a Motivational Tool to Optimize Metabolic Control in Patients with Diabetes in Turkey: A Prospective, Randomized, Controlled TeleDiab Trial.

Introduction: Telemedicine is a follow-up system that can improve the quality of management and cost-effectiveness of rapidly increasing diabetes patients. Methods: Two hundred adult patients with diabetes were enrolled in this prospective, randomized study. Consecutive patients were divided equally into two groups. Both groups received routine care visits quarterly. TeleDiab group also sent self-monitoring of blood glucose data and received short message service over the transmission system for 12 months. After the study was completed, all patients continued their routine care visits, and their data were evaluated for another 12 months. Six years after the initial study, patients were contacted by phone during the Covid-19 lockdown, and their status was assessed. Results: At the end of the study, glycemic control, kidney function, and lipid parameters of the TeleDiab group were statistically significantly better than the Usual Care group. There was no significant change in the weights of the patients. It was observed that this state of wellbeing continued both at the end of the second year and during the Covid-19 lockdown. Individuals with type 2 diabetes were found to benefit more from telemedicine. Discussion: It has been beneficial to guide patients with applications such as TeleDiab in diseases such as diabetes that require lifelong follow-up. On the other hand, the importance of telemedicine programs in the management of chronic diseases in the current pandemic conditions has come to the fore even more. Telemedicine is an effective motivational tool to ensure optimal control not only of glycemic but also of kidney and lipid parameters.

Evaluation of a Pressure Injury Prevention Care Bundle in an ICU in Turkey.

OBJECTIVE: To evaluate a pressure injury (PI) prevention care bundle in ICU patients diagnosed with internal diseases. METHODS: The study had a quasi-experimental design and included 98 patients who were diagnosed with internal diseases and hospitalized in the ICU. Patients in the control group (n = 49) received routine clinical care, whereas those in the intervention group (n = 49) received the PI prevention care bundle. Data were collected using a patient information form and the Braden Scale. RESULTS: All patients in the control group and 61.2% of the patients in the intervention group developed PIs. Those in the intervention group who developed PIs did so later on average in comparison with the control group. Patient risk of PI development increased with advanced age, low oxygen saturation, low prealbumin values, and low Braden Scale scores. Fewer PIs developed in the patients in the intervention group despite their longer duration of hospitalization and high glucose levels. CONCLUSIONS: The PI prevention care bundle may help prevent the development of PI.

Spiritual Well-being, Diabetes Burden, Self-management, and Glycemic Control Among Patients with Type 2 Diabetes in Turkey: A Descriptive and Correlational Study.

Spiritual well-being is considered a significant factor in helping to manage chronic diseases and cope with the disease process. This descriptive-correlational study aimed to investigate the relationship between spiritual well-being, diabetes burden, self-management, and among 300 outpatients with type 2 diabetes in Turkey. A significant relationship was found between the diabetes burden and self-management levels and the spiritual well-being of patients with diabetes (p < 0.005). Multiple linear regression analyses found that a high diabetes burden (ß = -0.106) decreased well-being, and high self-management increased well-being (ß = 0.415). Additionally, the results revealed that marital status, household members, performing daily life activities alone, hospitalization due to complications, diabetes burden, self-management, glycemic control, and blood lipid parameters explained 29% of the total variance in the spiritual well-being level. Accordingly, the present study recommended that health professionals should consider spiritual well-being to support disease management with a holistic approach to diabetes patients.

Comparison of the Turkish versions of the Glasgow coma scale and four score used by intensive care nurses for neurological evaluation.

OBJECTIVE: This study aimed to compare the use of the Turkish versions of the Glasgow Coma Scale (GCS) and Full Outline of UnResponsiveness (FOUR) Score by intensive care nurses in neurological evaluation. MATERIALS AND METHODS: This cross-sectional study was conducted between July 2018 and March 2019 with 92 patients in the general intensive care unit (ICU) of the training and research hospital of a private university. Data were collected using nurse and patient information forms, the GCS and the FOUR Score. The patients were evaluated by 27 intensive care nurses. To evaluate interrater reliability of the GCS and FOUR Score, each patient in the study was evaluated using both scales by two nurses who were blinded to each other's responses. RESULTS: Comparison of the patients' mean GCS and FOUR Score values from the two nurses revealed no significant difference in subscale or total scores (p > 0.05). Evaluation of interrater reliability demonstrated very good agreement (κ = 0.935, p < 0.001). There was also very good agreement between the results of the two nurse groups when the patients' total scores were categorised according to the cut-off points for the two instruments (κ = 0.927, p < 0.001). CONCLUSION: This study demonstrated excellent agreement in the Turkish GCS and FOUR Score values, indicating that both scales can be used in neurological evaluation. Both instruments are reliable and easily applied by ICU nurses. RELEVANCE TO CLINICAL PRACTICE: The Turkish versions of the FOUR Score and GCS are both appropriate for use in intensive care units and are reliable tools for use by intensive care unit nurses.

Alexithymia in diabetes patients: its relationship with perceived social support and glycaemic control.

AIM AND OBJECTIVE: This study was conducted to assess whether there is an association between alexithymia in patients with diabetes and the levels of perceived social support and glycaemic control. BACKGROUND: In the literature, whether inadequate perceived social support is a cause or effect of alexithymia has also not been clearly explained. It is stated that it is difficult to determine from where these contradictions arise, and there is a need for more studies on this topic. METHOD: This cross-sectional and correlational study included 537 patients with type I and type 2 diabetes. The data were collected using a Patient Information Form including the patient's HbA1c value that reflected their glycaemic control level, the Toronto Alexithymia Scale and the Multidimensional Scale of Perceived Social Support. The study was reported according to the STROBE Declaration. RESULTS: Among the patients with diabetes, 63.9% showed signs of alexithymia. Alexithymia had a negative relationship with perceived social support and a positive relationship with HbA1c. Additionally, it was determined that the patients who showed signs of alexithymia had lower levels of perceived social support in comparison with those who did not show such signs, whereas the HbA1c levels of the former were also higher than those of the latter. Moreover, it was found that the duration of the disease, HbA1c levels and levels of perceived social support from family and a significant other explained 30% of the total variance in the level of alexithymia. CONCLUSION: Alexithymia was seen prevalently among the patients with diabetes, and it was associated with a reduced level of perceived social support and weak glycaemic control. RELEVANCE TO CLINICAL PRACTICE: It is recommended to provide patients with psychosocial support in the scope of holistic care and include the individuals who provide care for and support the patient in the patient's management of the disease.

Assessment the effect of diabetes education on self-care behaviors and glycemic control in the Turkey Nursing Diabetes Education Evaluating Project (TURNUDEP): a multi-center study.

BACKGROUND: Diabetes education in Turkey is provided by diabetes nurse educators in almost all healthcare organizations. However, the education is not standardized in terms of learning content, duration, and methods. This multi-center study was performed to assess the self-care behaviors and glycemic control following education provided to the patients with type 2 diabetes mellitus by diabetes nurse educators. METHODS: This was a descriptive and cross-sectional study and included 1535 patients admitted to 28 public hospitals for the treatment of type 2 diabetes mellitus. The education was assessed by using a Patient Identification Form and Self-care Scale. RESULTS: The proportion of individuals who received diabetes education within the last year was 78.5%, with 46.7% of them having received it once. Of the patients, 84.8% reported that they received diabetes education individually. It was found that the proportion of individuals who received education about oral antidiabetics (78.5%) and glucose testing at home (78.5%) was higher than the proportion of individuals who received education about exercise (58.8%) and foot care (61.6%). The status of diabetes education, education intervals, and the correlation of the education method with self-care and glycemic control was evaluated. Self-care and glycemic control levels were better among the patients who received diabetes education thrice or more and in patients who received education both individually and in a group (p < 0.05). CONCLUSIONS: Approximately three-quarters of individuals with type 2 diabetes mellitus received education by diabetes nurse educators in Turkey. Diabetes education is positively correlated with self-care and glycemic control levels among patients with type 2 diabetes mellitus. Efforts for generalization and standardized education for all diabetes patients are necessary.

Depression and Religious Coping in Patients with Acute Coronary Syndrome in Turkey.

Psychological health problems such as depression, anxiety and feelings of distress are often seen in patients with acute coronary syndrome (ACS). Religious coping in dealing with psychological health problems is one of the methods commonly used by cardiac patients. This study was conducted to determine the depression levels and religious coping methods of individuals diagnosed with ACS and identify the relationship between their positive or negative religious coping methods and their depression levels. The descriptive and correlational study was conducted with 253 ACS patients. In the study, the depression levels of most patients were low, but 19.8% showed moderate-severe depressive symptoms. It was found that the patients adopted positive religious coping styles on a high level, but there was no significant relationship between positive religious coping and depression levels (p > 0.05). It is recommended that health professionals also closely monitor ACS patients for depressive symptoms after their diagnosis, encouraging patients to use positive religious coping styles to support their well-being and recovery against this life-threatening disease.

The Effect of Religious Coping on Disease Acceptance and Management Among Patients with Diabetes in Turkey.

Religious coping is considered an important factor for assisting with the management of chronic diseases. This study was conducted to determine the relationship between religious coping and disease acceptance and management among patients with diabetes. A total of 504 individuals with type 2 diabetes were included in this descriptive-correlational study. In this study, individuals who did not use their medications regularly, those who did not pay attention to their diet and those who did not exercise regularly had higher levels of positive religious coping. No significant relationship was found between the level of acceptance of illness and religious coping styles among participants with diabetes. However, it was found out that there was a positive relationship between HbA1C levels and the mean score of positive religious coping and positive religious coping accounted for 7% of the total variance in the glycemic control parameter.

Short report: correlates of functional disability with disease activity in elderly patients with rheumatoid arthritis.

Rheumatoid arthritis (RA) prevalence increases with age and old people are special patient population. The recognition of functional disability related to RA could be challenging in elderly patients because aging itself and potential co-morbid disease may also cause functional disability. In this study, we aimed to look at the correlation between disease activity and functional disability in elderly RA patients. Elderly RA patients, ≥65 years old at their routine visits were included in the study. The composite 'disease activity score' in 28 joints (DAS-28) was used to determine disease activity groups. Health assessment questionnaire (HAQ) scores were calculated to describe the functional disability and compared across the disease activity groups. Two hundred and fifty-eight RA patients with the mean age of 71 ± 5 (65-90) and a total disease duration of 8.4 ± 8.5 (.5-50) years were recruited. The proportion of patients with high and moderate disease activity was 70%. HAQ scores were significantly correlated with disease activity (p < .05). Functional disability estimated by HAQ was correlated with disease activity in elderly patients with RA.

Lower Urinary Tract Symptoms in Women With Type 2 Diabetes Mellitus.

PURPOSE: The aim of the study was to compare lower urinary tract symptoms (LUTS) in women with and without type 2 diabetes mellitus (DM). SUBJECTS AND SETTING: The sample was drawn from community-dwelling women in the province of Istanbul who were cared for in the diabetes outpatient clinic of Istanbul Medical School between January and June 2012. Two hundred forty-nine women with DM were compared to 255 women without DM cared for in the obstetrics and gynecology department of the same university hospital. The mean ages of the groups were 55.1 and 53.7 years, respectively. METHODS: Participants completed a questionnaire that queried sociodemographic and clinical characteristics; the Bristol Female Lower Urinary Tract Symptoms-Short Form (BFLUTS-SF) was used to evaluate LUTS. The questionnaire required 10 to 15 minutes to complete; participants completed the questionnaire in a private room of each of the respective outpatient clinics. RESULTS: No statistically significant differences were found when groups (women with and without DM) were compared based on age and cigarette smoking (P > .05). In contrast, BMI scores were significantly higher in the women with DM (P < .001). The cumulative BFLUTS scores and the filling and incontinence symptoms subscale sores (P < .001) were significantly higher in women with DM. No differences were observed in voiding symptoms (P = .347), sexual function (P = .380), and health-related quality of life (P = .142) subscale scores. The prevalence of storage symptoms nocturia, voiding frequency, urge incontinence, stress incontinence, frequency of incontinent episodes were higher among women with DM. In addition, women with DM were more likely to report the need to change clothing because of urinary leakage, effect of incontinence on daily tasks, and overall interference with daily activities of living. CONCLUSIONS: Women with type 2 DM are more likely to experience LUTS as compared to women without DM. Women with type 2 DM should routinely be assessed for LUTS.

Pulmonary artery aneurysms in Behçet's syndrome: a review of the literature with emphasis on geographical differences.

OBJECTIVES: To investigate the frequency of Behçet's syndrome (BS) with pulmonary artery aneurysms (PAA) publications, the most lethal complication of BS, as reported from different countries and to provide a review of diagnostic techniques, treatment approaches and prognosis. METHODS: Countries from each continent with a population of 4 million and over were chosen (n=128). A PubMed search for "BS, PAA and the country name" was conducted and 23 countries with BS and PAA were identified. The full texts of articles (n=91) were analysed for data including gender, age, accompanying vascular findings, diagnostic techniques, treatment modalities and mortality rates. RESULTS: A total of 207 (183 males, 24 females) patients with BS and PAA were reported in 91 articles originating from 23 countries. As expected there was a significant correlation (r=0.88, p<0.001) between the total number of articles about BS (n=4431) and those related to PAA and BS. In a simple linear regression analysis the number of BS and PAA articles from Japan was significantly below the identity line while in Turkey there was a propensity to publish more articles related to PAA than expected. One hundred and sixteen patients (56%) were treated with immunosuppressive therapy. Biologics were used only in 5 patients (2%). Of the 207 patients, 62 (30%) died. CONCLUSIONS: PAA is mostly reported as case reports from countries where BS is common. PAA might be uncommon in Japan. The prognosis of PAA could be getting better.

Does the diabetes of type 2 affect the sexual functions of women?

This study aimed to investigate female sexual dysfunction in patients with type 2 diabetes. Using the Index of Female Sexual Function, the authors compared the sexual function of type 2 diabetic women with that of nondiabetic women. Participants were 76 sexually active women with type 2 diabetes (study group) and 100 sexually active nondiabetic women (control group); all women were 24-47 years of age and had similar backgrounds. The participants with type 2 diabetes were selected from those women who applied to the Diabetes Polyclinic of the Istanbul University. Results were analyzed using chi-square and Student's t test. The prevalence of sexual dysfunction was significantly higher among the study group than in the control group. The authors found that if HbA1c, body mass index, and duration of diabetes increase, the prevalence of sexual dysfunction also increases. The authors of this article conclude that all diabetic patients should be considered to have sexuality, and patients with sexual dysfunction should be referred to appropriate medical centers.

Using mobile phone text messages to improve insulin injection technique and glycaemic control in patients with diabetes mellitus: a multi-centre study in Turkey.

AIM AND OBJECTIVES: To improve the knowledge and skills of diabetic patients on insulin injections using mobile phone short message services and to evaluate the association of this intervention with metabolic outcomes. BACKGROUND: Mobile communication technologies are widely used in Turkey, which maintains a diabetic population of more than 6·5 million. However, there are a limited number of studies using mobile technologies in the challenging and complicated management of diabetes. DESIGN: A one group pretest-posttest design was used in this study. METHODS: The study sample consisted of 221 people with type 1 and type 2 Diabetes Mellitus from eight outpatient clinics in six cities in Turkey. The 'Demographic and diabetes-related information Form' and 'Insulin Injection Technique and Knowledge Form' were used in the initial interview. Subsequently, 12 short messages related to insulin administration were sent to patients twice a week for six months. Each patient's level of knowledge and skills regarding both the insulin injection technique and glycaemic control (glycated haemoglobin A1c) levels were measured at three months and six months during the text messaging period and six months later (12 months total) when text messaging was stopped. RESULTS: The mean age of the patients with diabetes was 39·8 ± 16·2 years (min: 18; max: 75). More than half of the patients were females with a mean duration of diabetes of 11·01 ± 7·22 years (min 1; max: 32). Following the text message reminders, the patients' level of knowledge and skills regarding the insulin injection technique improved at month 3 and 6 (p < 0·05). The patients' A1c levels statistically significantly decreased at the end of month 3, 6 and 12 compared to the baseline values (p < 0·05). The number of insulin injection sites and the frequency of rotation of skin sites for insulin injections also increased. CONCLUSION: This study demonstrated that a short message services-based information and reminder system on insulin injection administration provided to insulin-dependent patients with diabetes by nurses resulted in improved self-administration of insulin and metabolic control. RELEVANCE TO CLINICAL PRACTICE: Today, with the increased use of mobile communication technologies, it is possible for nurses to facilitate diabetes management by using these technologies. We believe that mobile technologies, which are not only easy to use and to follow-up with by healthcare providers, are associated with positive clinical outcomes for patients and should be more commonly used in the daily practice of diabetes management.

Are sample sizes of randomized clinical trials in rheumatoid arthritis too large?

OBJECTIVE: We had the impression that randomized clinical trials (RCTs) frequently over enrolled patients. Thus, we surveyed power calculations in publications of RCTs of biologics in rheumatoid arthritis (RA) to assess over enrollment. METHODS: A PubMed search identified 40 reports of original RCTs testing the efficacy of infliximab, etanercept, adalimumab, abatacept, rituximab and tocilizumab in patients with RA. As a first analysis, based on a two equal arms study with an alpha error of 0·05 and a power of 80% and of 90%, recalculation of the sample size was performed using the primary outcome results. In the second analysis, only those studies with equal number of patients in both arms and also in which all elements of a power calculation were given, were considered. New sample sizes were calculated based on the presented power elements in the related publications. RESULTS: In the first analysis, when we assigned a power of 80% and of 90%, 32 of 40 (80%) studies enrolled more than required number of patients, with a mean 131 ± 147 (SD), and 31 of 40 (78%) studies having had enrolled extra patients, with a mean 121 ± 147 (SD) in their treatment arms, respectively. Eleven studies qualified for the second analysis. There were still more patients with a mean of 48 ± 30 (SD) extra patients enrolled in the treatment arms. CONCLUSION: Most RCTs in RA enrol more patients than needed. This is costly and has the immediate consequence of exposing needless number of patients to potential harm.