Hospital classroom experiences of hospitalized school-age pediatric oncology patients: A qualitative study.

PURPOSE: In this study, it was aimed to examine the hospital classroom experiences of school-age children who received treatment and care at a pediatric oncology-hematology clinic in Turkey. METHODS: The study was conducted using the in-depth interview method with the participation of 17 children who were hospitalized in the pediatric oncology-hematology clinic of a research and training hospital in the Ankara province of Turkey. The data were collected using a "Semi-Structured Interview Form". The interviews started with the question "How do you perform the assignments given by your teacher while you are hospitalized?", and the interviews were recorded as audio with the consent of the children and their parents. RESULTS: As a result of the interviews, three main themes, (1) Learning, (2) Maintaining normalcy, and (3) Expectations, and 9 subthemes (teacher, continuation of learning, learning through play, feeling good, continuation of routines, peer interaction, communication with the school-teacher, basic sport activity, and tablet/internet access) were generated from the data. CONCLUSIONS: Hospital classrooms had a significant role in increasing the children's adaptation to hospital conditions and ensuring the continuation of school/learning. PRACTICE IMPLICATIONS: Pediatric nurses can refer children with long and repeated hospitalizations (e.g., pediatric oncology patients and children with chronic diseases) to hospital classrooms. Thus, children can adapt more easily to the procedures performed in the hospital.

Development of a Sensitive Method for Cadmium Determination in Fish Tissue and Drinking Water Samples by FAAS Using SQT In Situ Atom Trapping.

A sensitive and robust trap method was developed for the determination of cadmium (Cd) by using a slotted quartz tube. Using this method at a sample suction rate of 7.4 mL/min for 4.0 min collection, a 1467-fold increase in sensitivity was obtained compared to the flame atomic absorption spectrometry method. Under the optimized conditions, a limit of detection of 0.075 ng mL-1 was obtained for the trap method. The interference effects of hydride-forming elements, transition metals, and some anions on the Cd signal were investigated. The developed method was evaluated by analyzing "Sewage Sludge-industrial origin (BCR no: 146R)", "NIST SRM 1640a Trace elements in natural water", and "DOLT: 5 Dogfish Liver". There was a good agreement between the certified and found values at the 95% confidence level. This method was applied successfully for the determination of Cd in drinking water and some fish tissue samples (liver, muscle, and gill) obtained from Mugla province.

Bioaccumulation and health risk assessment of heavy metals in European eels taken from Lakes Köycegiz (Turkey) and Võrtsjärv (Estonia).

Monitoring heavy metal contaminants in fish is important for the assessment of environmental quality as well as food safety. In this study, European eel samples were collected from Lake Köycegiz and Lake Võrtsjärv in 2017 and 2018. The concentrations of Mn, Cd, Zn, Pb, and Cu metals were measured by using GF-AAS in four selected tissues of eel, including liver, gill, skin, and muscle in both lakes. The pollution index (Pi, MPI) values were calculated for both lakes and the health risk for consumers was assessed for both adults and children in Turkey and Estonia. The estimated weekly intake (EWI), hazard index (HI), and lifetime cancer risk values (CRs) for the metals were calculated for both lakes. According to the results of this study, a significant difference was determined between the metal concentrations (especially Cu, Cd, and Pb) in the tissues of the eel samples taken from the two lakes. These results show that besides the pollution levels in the aquatic environment, physiological needs and metabolic activities in different habitats have a significant effect on metal accumulation in eels. In addition, HI was found to be < 1 for both adult and child consumers in both lakes, which indicates that consumers would not experience non-carcinogenic health effects. However, the values of CR for Pb and Cd were found negligible in Lake Köycegiz, while the CR value for Pb was found to be very close to the danger limits in Lake Võrtsjärv.

Evaluation of the metal concentrations of wild mushroom species with their health risk assessments.

The ability of mushrooms to accumulate heavy metals has increased concerns over their toxic effects on human health in recent years. The aim of this study was to determine the metal contents (Zn, Fe, Co, Mn, Cu, Pb, Ni, and Cd), daily intake of metal (DIM) and health risk index (HRI) values of nineteen different mushroom species (edible, inedible, and poisonous) collected from Uzungol, Trabzon (Turkey). Although the area where mushrooms were collected has the status of "Natural Park," there has been an excessive human settlement in recent years. Elemental analyses have shown that Fe, Mn, Cu, Zn, Co, Cd, Pb, and Ni concentrations in mushrooms were in the following ranges: 49.0-1713.0, 3.0-425.0, 3.0-154.0, 16.0-134.0, 0.17-1.79, 0.28-7.88, 0.07-5.68, and 0.24-6.82 mg/kg dry weight, respectively. As a result of DIM analysis, while it was determined that the daily consumption of Hygrophorus pudorinus, Meripilus giganteus, and Sarcodon imbricatus was safe for all the metals examined, HRI analysis showed that only M. giganteus and S. imbricatus can be consumed safely. The content of Cd was found to be above the legal limits determined by the competent authorities. According to Pearson correlation analysis, the correlations between Fe-Pb, Cu-Zn, Cd-Co, Pb-Co, Cd-Fe, Co-Fe, Cd-Pb, and Fe-Mn pairs were statistically significant (p < 0.01). Although the data obtained from this study did not provide clear data on environmental pollution in the area where the samples were collected, it was concluded that the competent authorities should take measures regarding possible environmental pollution at this location.

Effect of Gastrostomy Tube Feeding Education on Parents of Children with Gastrostomy.

BACKGROUND: Success in long-term enteral feeding is, in part, dependent on careful selection of the appropriate enteral access device and placement technique together with proper maintenance and care. This study was conducted to evaluate the effect of education on satisfaction with gastrostomy tube feeding, quality of life, caregiver burden, and anxiety. METHODS: A quasi-experimental, pretest and posttest research design without a control group was used. A total 78 mothers were included in the study. The child and parent data form, Zarit Caregiver Burden Scale, Satisfaction Questionnaire with Gastrostomy Feeding (SAGA-8), State-Trait Anxiety Inventory (STAI), 36-Item Short-Form quality-of-life scale (SF-36), complication control form, and the gastrostomy care skill assessment checklist were used. RESULTS: There was a significant decrease in participants' burden as caregivers (anxiety, P < .001) and a significant increase in positive outcomes in caregivers' satisfaction with gastrostomy feeding and in the physical component summary and mental component summary scores (P < .05). Posteducation, the mean score of subdimensions showed increases (P < .05). CONCLUSION: The intervention increased positive outcomes and decreased negative outcomes for caregivers during the first 3 months postgastrostomy placement.

Miliary tuberculosis: Epidemiologicaland clinical analysis of large-case series from moderate to low tuberculosis endemic Country.

The aim of this study was to determine the clinical features, and outcome of the patients with miliary tuberculosis (TB).We retrospectively evaluated 263 patients (142 male, 121 female, mean age: 44 years, range: 16-89 years) with miliary TB. Criteria for the diagnosis of miliary TB were at least one of the followings in the presence of clinical presentation suggestive of miliary TB such as prolonged fever, night sweats, anorexia, weight loss: radiologic criterion and pathological criterion and/or microbiological criterion; pathological criterion and/or microbiological criterion.The miliary pattern was seen in 88% of the patients. Predisposing factors were found in 41% of the patients. Most frequent clinical features and laboratory findings were fever (100%), fatigue (91%), anorexia (85%), weight loss (66%), hepatomegaly (20%), splenomegaly (19%), choroid tubercules (8%), anemia (86%), pancytopenia (12%), and accelerated erythrocyte sedimentation rate (89%). Tuberculin skin test was positive in 29% of cases. Fifty percent of the patients met the criteria for fever of unknown origin. Acid-fast bacilli were demonstrated in 41% of patients (81/195), and cultures for Mycobacterium tuberculosis were positive in 51% (148/292) of tested specimens (predominantly sputum, CSF, and bronchial lavage). Blood cultures were positive in 20% (19/97). Granulomas in tissue samples of liver, lung, and bone marrow were present in 100% (21/21), 95% (18/19), and 82% (23/28), respectively. A total of 223 patients (85%) were given a quadruple anti-TB treatment. Forty-four (17%) patients died within 1 year after diagnosis established. Age, serum albumin, presence of military pattern, presence of mental changes, and hemoglobin concentration were found as independent predictors of mortality. Fever resolved within first 21 days in the majority (90%) of the cases.Miliary infiltrates on chest X-ray should raise the possibility of miliary TB especially in countries where TB is endemic. Although biopsy of the lungs and liver may have higher yield rate of organ involvement histopathologicaly, less invasive procedures including a bone marrow biopsy and blood cultures should be preferred owing to low complication rates.

Epidemiological profile of naive HIV-1/AIDS patients in Istanbul: the largest case series from Turkey.

The aim of the study was to report the epidemiological profile of HIV-1 positive patients from, Istanbul, Turkey, which has one of the lowest HIV-1/AIDS prevalences in Europe. The patients were followed by ACTHIV-IST group which was established by the Infectious Diseases Departments of five teaching hospitals (three university hospitals and two public hospitals) in Istanbul, Turkey. The HIV-1 positive patients were added to the standard patient files in all of the centers; these files were then transferred to the ACTHIV-IST database in the Internet. A total of 829 naiv-untreated HIV-1 positive patients were chosen from the database. The number of male patients was 700 (84.4%) and the mean age of the patients was 37 years (range, 17-79). In our study group 348 (42%) of the patients were married and 318 (38.7%) of the patients were single. The probable route of transmission was heterosexual intercourse in 437 (52.7%) patients and homosexual intercourse in 256 (30.9%) patients. In 519 (62.6%) patients the diagnose was made due to a screening test and in 241 (29.1%) patients, the diagnose was made due to an HIV-related/non-related disease. The mean CD4+ T cell number in 788 of the patients was 357.8/mm(3) (±271.1), and the median viral load in 698 of the patients was 100,000 copies/mL (20-9,790,000). In Turkey, the number of HIV-1 positive patients is still low and to diagnose with a screening test is the most common way of diagnostic route.

Observational study comparing long-term safety and efficacy of Deferasirox with Desferrioxamine therapy in chelation-naïve children with transfusional iron overload.

OBJECTIVES: An observational study was conducted to explore postmarketing safety and efficacy of Deferasirox (DFX) in comparison with conventional Desferrioxamine (DFO) in chelation-naïve children with transfusional iron overload. METHODS: Transfusion-dependent children (aged ≤ 5 yr) who had serum ferritin above 1000 µg/L and had been prescribed either first-line DFX or DFO for at least 12 months to maintain serum ferritin between 500 and 1000 µg/L were included. Initial DFX dose was 20 mg/kg/d for 7 d a week, and DFO dose was 25-35 mg/kg/d subcutaneously, given for 5 d a week. Dose adjustments were based on serum ferritin changes and safety markers. The primary efficacy endpoint was change in serum ferritin from baseline. The effect of transfusional iron loading rate (ILR) and different doses of chelators on serum ferritin was also assessed. RESULTS: A total of 111 patients were observed for a median of 2.29 yr on DFX (n = 71) and 2.75 yr on DFO (n = 40). Absolute change in serum ferritin from baseline to the last available observation was not significant with DFX (91 µg/L, P = 0.5) but significantly higher with DFO (385 µg/L, P < 0.005). ILR and DFX doses had a major impact on serum ferritin changes in DFX cohort. The height- and weight-standard deviation scores did not differ significantly in both cohorts during the study. Fluctuations in liver enzymes and non-progressive increase in serum creatinine were the most common adverse events (DFX; 9.8%, 18.0% and DFO; 5.0%, 7.5%, respectively). CONCLUSION: DFX is well tolerable and at least as effective as DFO to maintain safe serum ferritin levels and normal growth progression in chelation-naïve children.

Myocardial iron loading in patients with thalassemia major in Turkey and the potential role of splenectomy in myocardial siderosis.

Iron-induced cardiac disease is the leading cause of death in thalassemia major (TM). Splenectomy is performed in TM to reduce transfusion requirements and iron intake. Prevalence of myocardial siderosis and its relationship with splenectomy in 146 patients with TM were investigated. The patients with myocardial siderosis (T2*<20 ms) accounted for 42% of the cohort. Splenectomized patients had a higher incidence of myocardial siderosis (48%) compared with those having intact spleen (28%) and significantly higher myocardial iron content. Higher myocardial iron content in splenectomized patients may deserve special attention for the role of spleen in iron regulation.

[Analysis of the knowledge and practices of health care workers in Emergency Departments regarding the protection and preservation of evidence in forensic cases]. / Acil servislerde çalisan saglik bakim personelinin adli olgularda delillerin korunmasi ve saklanmasina yönelik bilgi ve uygulamalarinin incelenmesi.

BACKGROUND: The frequency of violent incidents is increasing. This increase has made the role of Emergency Department (ED) staff more important in the collection, recording, protection, and storage of the evidence until the arrival of the responsible people concerned with the issue. Therefore, this study was designed to analyze the knowledge and practices of the nursing staff working in the EDs with respect to the protection and preservation of the evidence in forensic cases. METHODS: This research, which was designed to be descriptive, was conducted with 44 health care workers in the hospitals with Emergency Departments in the center of Bolu province between October 2008 and January 2009. RESULTS: It was observed that 90.9% of the health care workers encountered forensic cases, 65.9% of them had not attended any training on forensic cases, and 22.7% of them did not use care when removing and storing the clothes of the patient. It was considered that 90.9% of the health care workers duly carry out their duties and responsibilities in forensic cases; however, 18.2% of them do not have sufficient knowledge or practical experience in the preservation and protection of evidence in forensic cases. CONCLUSION: It was observed that most health care workers do not have sufficient knowledge or practical experience in the preservation and protection of evidence in forensic cases.