Evaluation of Pain During Endotracheal Aspiration in Intensive Care Patients Diagnosed with COVID-19.

BACKGROUND: Endotracheal aspiration, a procedure that is particularly painful for intensive care patients, has received little attention in terms of pain evaluation specifically among intubated patients with COVID-19 in intensive care. AIM: The study aims to assess the level of pain experienced by intubated intensive care patients diagnosed with COVID-19 during an endotracheal aspiration procedure. METHOD: The study population was composed of patients admitted to the COVID-19 intensive care unit of the specified hospital between February and March 2021. Of the 56 patients admitted during that period, 47 were contacted and participated in the study. These 47 intubated and sedated patients were evaluated for 94 different expressions of pain during endotracheal aspiration twice a day before and during the procedure. Data were collected using the patient descriptive information form, the Non-Verbal Pain Scale for adults and data observation record form. RESULTS: In the study, pain behavior was observed in 54.2% (n = 51) of the 94 observations. The patients were found to experience mild pain with an average score of 3.6 ± 1.07 on the Non-Verbal Pain Scale. The mean pain score before the procedure was found to be significantly different from the mean pain score during the procedure (p < .05), with an increase in pain during the procedure. During the procedure, 33.3% (n = 17) of the patients had a 10% decreased SpO2, and 29.4% (n = 15) had an increase in systolic blood pressure (>20), pulse (>20), and respiration (>10). Additionally, 21.5% (n = 11) of the patients experienced severe incompatibility with the ventilator, and 15.68% had muscle tension. CONCLUSIONS: The study findings showed that nonverbal pain scores of sedated and intubated intensive care patients diagnosed with COVID-19 increased during endotracheal aspiration, accompanied by physiologic pain indicators. Effective pain management should be a priority for nurses. It is important to remember that patients with COVID-19 in the intensive care unit may experience pain while sedated and intubated. A holistic approach should be adopted for the evaluation and relief of pain in these patients. Intensive care nurses should consider physiologic and nonverbal behavioral pain indicators when evaluating pain in patients diagnosed with COVID-19.

Validity and Reliability of the Pieper-Zulkowski Pressure Ulcer Knowledge Test for Use in Turkey.

OBJECTIVE: To assess the validity and reliability of the Pieper-Zulkowski Pressure Ulcer Knowledge Test (PZ-PUKT) for use in Turkey. METHODS: This methodological study was carried out at a state hospital from June to November 2022. The authors used the PZ-PUKT and nurse identification form for data collection. They assessed the validity and reliability of the PZ-PUKT for Turkish society by evaluating language validity, content validity index, exploratory factor analysis, confirmatory factor analysis, Cronbach α, Spearman-Brown Split-Half analysis, item-scale correlations, and test-retest correlations. RESULTS: Item-level content validity indices ranged from .778 to 1.000 and the scale-level content validity index was .960. Factor loadings of the Turkish version of the PZ-PUKT ranged between .297 and .671. Cronbach α coefficients for the scale subsections were .838 for wounds, .851 for prevention, and .844 for staging; the Cronbach α coefficient was .936 for the total scale score. CONCLUSIONS: The PZ-PUKT is valid and reliable for use with nurses in Turkey. The authors recommend using the Turkish version of the tool in education and research to assess nurses' pressure injury knowledge.

The Effect of Prolonged Fasting Before Surgery on Pain and Anxiety.

PURPOSE: To investigate the effect of prolonged fasting before surgery on pain and anxiety. DESIGN: This was a descriptive study. METHODS: This study was conducted in a plastic, reconstructive, and esthetic surgery clinic at a university hospital in Bursa, Turkey. A data collection tool was designed to collect data on the sociodemographic characteristics. The Beck Anxiety Scale was used to assess patients' anxiety in the preoperative period and the Visual Analog Scale was used to measure pain levels in the postoperative period. The Statistical Package for Social Sciences was used for data analysis. FINDINGS: A total of 363 patients took part in the study. A majority (91.2%) of the patients who participated in the study were aware of why they were fasting before surgery, and 41.6% of them had been informed about preoperative fasting by the nurse. In addition, 60.9% of patients had thirst, 17.6% had headache, 40.5% were hungry, 62% had dry mouth, 79.6% were restless, and 83.7% were anxious. Most (82.6%) of the patients who participated in the study had a preoperative fasting period of more than 6 hours, 58.4% had a postoperative fasting period of 5 hours or less, and the mean fasting period was 6.82 ± 1.76. The mean score of the Visual Comparison Scale was 5.09 ± 0.31 and the mean score of the Beck Anxiety Scale was 21.86 ± 0.054, and patients with a fasting period of 6 hours or more experienced more pain and anxiety. CONCLUSIONS: This study shows that patients with longer fasting duration experience more pain and anxiety, and patients with more anxiety experience more pain. Based on the results of this study, it is recommended that studies should be done to emphasize the issue and to increase the awareness of health care professionals about pre- and postoperative fasting.

Meeting the Needs of Family Members of Trauma Patients in the Emergency Department.

BACKGROUND: While the needs of family members have previously been studied, the needs of families of trauma patients have received less attention. OBJECTIVE: This study aims to assess the needs of family members of trauma patients in the emergency department. METHODS: This cross-sectional survey study was conducted over 4 months (February-May 2022) with family members of trauma patients admitted to the emergency department of a state hospital in Istanbul, Turkey. The validated Critical Care Family Needs Inventory - Emergency Department survey was administered face-to-face to a convenience sample of consenting family members. RESULTS: A total of 248 family members participated, representing 84 patients. The mean age of the participants was 33 (8.18) years, with a gender distribution of 50% women. On average, 76.5% of the family members' needs were met. The most important needs reported as mean (SD) were as follows: communication, 3.52 (0.68); participation in care, 3.52 (0.68); comfort, 3.36 (0.65); and support needs, 3.21 (0.72). These needs were met to varying degrees: communication 85%, participation in care 81.2%, comfort 75.4%, and support needs 65.2%. CONCLUSION: The study findings indicate that the needs of family members of emergency department trauma patients are not fully met. Families report needing communication the most and comfort the least.

Successful Treatment of Central Nervous System Involvement in Posttransplant EBV-related Lymphoproliferative Disease With Intrathecal Rituximab Therapy.

The posttransplant lymphoproliferative disease is a severe cause of morbidity and mortality following allogeneic hematopoietic stem cell transplantation. Central Nervous System involvement in EBV-related PTLD is rare, and there is no standard treatment recommendation. We present our patient and discuss other previously reported cases of EBV-associated PTLD with CNS involvement.

The Relationship of Evidence-Based Nursing Attitudes of Nurses Working in Surgical Wards With Patient-Centered Care Competencies.

PURPOSE: The aim of this study was to determine the relationship between the evidence-based nursing attitudes of nurses working in surgical wards and their patient-centered care competencies. DESIGN: This was a prospective, correlational, and cross-sectional study. METHODS: The sample for this study included 209 surgical nurses working in the surgical clinics of a research hospital. Data were collected between March and July 2020 using the Nurses' Descriptive Characteristics form, Evidence-Based Attitude Toward Nursing Scale (EATNS) and the patient-centered care competency of the nurses, Patient-Centered Care Competency Scale (PCCS). Descriptive statistics and correlation analysis were conducted to analyze the data. FINDINGS: The mean total EATNS was moderate (53.93 ± 7.18, out of 75), and their approach to patient-centered care behaviors was high (69.46 ± 8.64, out of 85). CONCLUSIONS: We found a medium level of positive correlation and a significant relationship between the attitudes toward evidence-based nursing and patient-centered care competencies of the nurses participating in the study (r = 0.507, P < .05).

Elderly patients and falls: a systematic review and meta-analysis.

OBJECTIVE: The predetermination of the risk for falls in elderly patients, who will have or had a surgery, enables one to carry out the protective/preventive interventions on this matter. The aim of this review was to provide an up-to-date meta-analysis with regard to falls in elderly surgical patients. MATERIALS AND METHODS: The studies, which were carried out on elderly patients between January 2009 and November 2019 and which investigated the risk factors for falls in elderly surgical patients, were screened on the databases of Google Scholar, Pubmed, Ovid, Cinahl through various combinations of keywords, such as "geriatrics", "aged", "surgery", "accidental falls" in English or Turkish, to determine the risk factors for the falls in elderly surgical patients. RESULTS: Meeting the study inclusion criteria, 18 studies were analyzed. Of these studies, three were retrospective, seven descriptive, two case-control, four cross-sectional, and two prospective. The kappa value of the general rate of agreement was found as 0.84. No publication bias found in the studies included (Kendall's tau b = 0.31; p = 0.07) in the meta-analysis based on the values calculated. CONCLUSION: In this meta-analysis, it was determined that the falls in elderly surgical patients were quite a prevalent public health problem, that the presence of chronic diseases and previous history of falls constituted an extremely high risk for the falls in elderly patients, and that the age or the presence of a gait-inhibiting condition did not constitute any risk for the falls in elderly patients.

The effect of comorbidity on mortality in elderly patients undergoing emergency abdominal surgery: a systematic review and metaanalysis

Background/aim: With the increase in the elderly population, the elderly proportion needing emergency surgery is also increasing. Despite medical advances in surgery and anesthesia, negative postoperative outcomes and high mortality rates are still present in elderly patients undergoing emergency surgery. Comorbidities are described as the main determining factors in poor outcomes. In this metaanalysis, it was aimed to investigate the effect of comorbidity on mortality in elderly patients undergoing emergency abdominal surgery. Materials and methods: The studies published between 2010-2019 were scanned from databases of Google Scholar, Cinahl, Pub Med, Medline and Web of Science. Quality criteria proposed by Polit and Beck were used in the evaluation of the included studies. Interrater agreement was calculated by using the Kappa statistic, effect size by using the odds ratio, and heterogeneity among studies by using the Cochran's Q statistics. Kendall's Tau-b coefficient and funnel plot were used to determine publication bias. Results: A total of 9 studies were included in the research. There was a total of 1330 cases in the studies. The total mortality rate was 21% (n = 279), the total rate of having a comorbid factor was 83.6% (n = 1112), and the rate of having a comorbid factor in mortality was 89.2% (n = 249). According to the fixed effects model, the total effect size of comorbid factors on causing mortality was not statistically significant with a value of 1.296 (C.I; 0.84-1.97; P > 0.05). Conclusion: Our study revealed that comorbidity had no significant effect on causing mortality in geriatric patients undergoing emergency abdominal surgery. There are controversial results in the literature, and in order to reach more precise results, studies involving wider groups of patients and further studies examining the specific effect of certain comorbid conditions are needed.

The Effect of Exaggerated Lithotomy Position on Shoulder Pain after Laparoscopic Cholecystectomy.

BACKGROUND: The exaggerated lithotomy position with the expertise of nurses can be successful solution for the patients who have the postoperative shoulder pain after laparoscopic cholecystectomy. AIMS: This study aimed to determine the effect of applying an exaggerated lithotomy positions to patients who had laparoscopic cholecystectomy to relieve shoulder pain. The study was conducted on nonrandomized groups and made as a semiexperimental study with a pretest/post-test control group design. Design, Settings, and Subjects/Participants: The study was conducted on 102 patients who had elective laparoscopic cholecystectomy and agreed to participate in this study after they met the inclusion-exclusion criteria in the general surgery clinic of a training and research hospital in Istanbul between December 12, 2012, and June 30, 2013. METHODS: The pain levels (10 minutes before and after positioning) and peripheral oxygen saturation (SPO2) levels (1 minute, 5 minutes, and 10 minutes before and after positioning-total 6 times) of the patients were measured using a visual analog scale and pulse oximetry, respectively. The pain levels and the analgesic (pethidine hydrochloride and diclofenac sodium) usage of the patients in both the experimental and the control group were compared. RESULTS: The exaggerated lithotomy position appreciably lowered the shoulder pain of the patients in the experimental group (t = 12.663; p = .000 < .001). It also increased peripheral saturation levels of the patients more rapidly compared with those in the control group receiving analgesics (t = 17.693; p = .000 < .005). In addition, it decreased the need to use additional analgesics and opioids (t = 2.14; p = .037). CONCLUSIONS: In this study the exaggerated lithotomy position was found to be fast and effective for relieving shoulder pain after laparoscopic cholecystectomy, decreased the need to use additional analgesics and opioids, and, in conjunction with pain control, also contributed to improvements in respiratory functions.

Molecular Characterization of Cyclamen Species Collected from Different Parts of Turkey by RAPD and SRAP Markers.

The genus Cyclamen (family Myrsinaceae) contains about 20 species, most of which occur in the Mediterranean region. Turkey has critically important Cyclamen genetic resources. Molecular characterization of plant materials collected from different regions of Turkey in which Cyclamen species grow naturally, namely Adana, Antalya, Aydin, Mugla, Izmir, Denizli, Kahramanmaras, Osmaniye, Eskisehir, Trabzon, and Rize provinces, was performed using RAPD and SRAP markers. DNA was successfully amplified by 30 RAPD primers and 14 SRAP primer pairs. Among the 470 bands generated by the RAPD primers, 467 were polymorphic. The number of bands detected by a single primer set ranged from 11 to 22 (average of 15.6). The percentage polymorphism was 99.3 % based on the RAPD data. In the SRAP analysis, a total of 216 bands were generated, showing 100 % polymorphism. The number of bands detected by a single primer set ranged from 9 to 22 (average of 15.4). All data were scored and UPGMA dendrograms were constructed with similar results in both marker systems, i.e., different species from nine provinces of Turkey were separated from each other in the dendrograms with the same species being clustered together.

3D printing of reactive macroporous polymers via thiol-ene chemistry and polymerization-induced phase separation.

Using thiol-ene chemistry, polymerization-induced phase separation, and DLP 3D printing, we present a method for manufacturing reactive macroporous 3D structures. This approach enables the fabrication of structures with tunable physicochemical properties and compressibility. Moreover, it facilitates post-functionalization through thiol-Michael addition reactions, thereby expanding performance and application potential.

Correction: 3D printing of reactive macroporous polymers via thiol-ene chemistry and polymerization-induced phase separation.

Correction for '3D printing of reactive macroporous polymers via thiol-ene chemistry and polymerization-induced phase separation' by Nikolaj K. Mandsberg et al., Chem. Commun., 2024, https://doi.org/10.1039/d4cc00466c.

Relationship between student nurses' self-efficacy and psychomotor skills competence.

This study aimed to determine the general self efficacy levels of students studying for undergraduate degree in nursing and to examine the relationship between skills development and self efficacy. The research was conducted in a descriptive way. The sample consisted of 100 students. Data were collected via the use of a student introduction form, Self-Efficacy Scale (SES) and an intramuscular (i.m.) injection procedure checklist; the forms were filled in by 100% of the nursing students. The mean general self-efficacy score of the students in the study was high. the self-efficacy levels of our students were high, and no correlation was observed between personal characteristics and self-efficacy; therefore, education in injection technique had the same influence on all students' self-efficacy.

Investigation of Effects of Preoperative Readiness on Symptom Management in Patients with Intestinal Stoma: A Systematic Review and Meta-Analysis Study.

OBJECTIVE: This study aims to examine the effect of preoperative readiness on postoperative symptom management in patients with intestinal stoma through systematic review and meta-analysis. METHODS: "Intestinal stoma", "complications" and other related terms were searched regardless of the language of publication in the publications published in the databases until December 29, 2021. RESULT: As a result, 30 studies were found. Two independent reviewers reviewed the studies, and the methodological quality of the included studies was assessed using the Health Evidence™ Quality Assessment Tool. The Comprehensive Meta-Analysis 3 was used to analyze the data. Publication bias, funnel plot, and the effect size were calculated using Cohen's kappa. Preparation for intestinal stoma surgery consisted of two main themes, and postoperative complications/problems consisted of nine sub-themes. The meta-analysis results showed that preoperative readiness had a moderate effect size on postoperative complications (d=0.498, d=0.457). CONCLUSION: It was thus concluded that preoperative practices were significant and effective in postoperative symptom management.

Prevalence of pain in adult population in Türkiye.

vObjectives: The aim of this study is to determine the incidence and characteristics of pain in adults in Türkiye. METHODS: This cross-sectional study was carried out with 1391 participants in 28 provinces spread across seven demographic regions of Türkiye, between February 1 and March 31, 2021. The data were collected through the introductory and pain assessment information form prepared by the researchers and the online Google forms. SPSS 25.0 statistical program was used for data analysis. RESULTS: As a result of the analysis of the data obtained, it was found that the average age of the participants included in the study was 40.83±7.78 years, education level was 70.4% at most, and 80.9% was female at most. It was determined that 58.1% lived in the Marmara region and 41.8% lived in Istanbul, and 41.2% were private sector employees. It was determined that the pain prevalence of adults in Türkiye was 80.84% and 79.07% of them had pain in the last year. It was determined that the region with the most pain was the head and neck region with 37.88%. CONCLUSION: According to the results of the research, the prevalence of adult pain is quite high in Türkiye. Despite the high prevalence of pain, the rate of preference for drug therapy to relieve pain is low and the preference for non-drug treatment methods is high.

Effect of the Educational Intervention on the Balance of Diabetic Foot Amputees: A Randomized Controlled Study.

This study aimed to evaluate the effect of educational intervention on the balance of diabetic foot amputees. There were 2 groups and 60 patients (30 in each group) in the study. The patients were divided into 2 groups using block randomization to provide equal distribution of the minor and major amputations in groups. An education program was prepared in line with Bandura's Social Cognitive Learning theory. Education was administered to the intervention group before the amputation. Three days after the education, the patients' balance was examined using Berg Balance Scale (BBS). There were not any statistically significant differences between the groups regarding the sociodemographic and disease-related characteristics except for marital status (P = .038). The mean BBS scores were 31.4 ± 17.6 for the intervention group and 20.3 ± 17.8 for the control group. We demonstrated that the intervention lowered fall risk after minor (P = .045) but not major amputation (P = .067). We recommend using education for the patients who will undergo amputation and further studies in larger and different populations.

Relationship between the insulin use and stigma in type 2 diabetes mellitus.

AIMS: This study aimed to investigate the relationship between insulin use and stigma in Type 2 Diabetes Mellitus (T2DM). METHODS: The study was carried out in the endocrinology and metabolic disorders outpatient clinic of a state hospital between February and October 2022. The study was carried out with 154 patients, 77 of them were treated with insulin while 77 were treated with peroral antidiabetic drugs (PAD). The patient identification form and Type 2 Diabetes Stigma Assessment Scale (DSAS-2) were used for data collection. The data were analyzed by using IBM SPSS 26.0 software. RESULTS: DSAS-2 total score, treated differently, blame and judgment, and self-stigma subscales were higher in insulin-treated T2DM patients compared to the patients treated with PAD. There was a positive relationship between the number of daily injections and the DSAS-2 total score (r = 0.554). Multiple linear regression showed that type of the treatment, treatment duration, number of daily injections and perceived level of health were the determinants of the DSAS-2 score. CONCLUSIONS: Stigma was high in insulin-treated T2DM patients and as the number of daily injections increased, the level of the perceived stigma increased. We recommend considering the high level of perceived stigma in insulin-treated T2DM patients while preparing nursing investigations.

[The impact of visits on vital signs of the patients in surgical intensive care unit: a pilot study]. / Cerrahi yogun bakim hastalarinda ziyaretin yasam bulgulari üzerine etkisi: Pilot çalisma.

BACKGROUND: This research was conducted to analyze the impact of visiting patients in the intensive care unit on the vital signs of the patients. METHODS: This descriptive study was conducted at the emergency surgical intensive care unit of a university hospital in Istanbul. The sample consisted of 43 patients aged 18 and above, who stayed at the unit for more than 24 hours. Data collection included the demographic features of the patients as well as the information and evaluation form including the vital signs of patients before, during and after visits. Data were measured before, during and after visits. RESULTS: 39.5% (n=17) of the patients were female and 60.5% (n=26) were male. Values before and after visits, respectively, were as follows: Mean fever 36.7±0.81 and 36.8±.94; pulse 97.3±26.4 and 98.4±26.1; mean respiration 23.76±4.55 and 24.30±4.53; systolic pressure 113.4±25.86 and 120.4±21.15; and diastolic pressure 64.81±8 and 67.30±3. CONCLUSION: This study, carried out as a pilot study, found that visiting patients in intensive care units affects the patients; however, this effect does not cause a serious physiological change in the vital signs of the patient.