A Rare Reason for Severe Hypocalcemia Following Kidney Transplant: Denosumab Treatment.

Deviations of calcium, phosphate, parathyroid hormone, and vitamin D levels are the basis for the diagnosis of calcium-phosphate metabolism disorders. The plasma concentration of the biologically active form known as free calcium is regulated in a harmonious manner by its exchange in the bones and reabsorption by the kidneys. These steps take place under the control of parathyroid hormone and calcitriol. In the process of chronic kidney disease, the kidney cannot synthesize adequate calcitriol, and the resulting hypocalcemia and hyperphosphatemia cause the development of secondary hyperparathyroidism. Osteoporosis is a metabolic bone disease and is essentially the consequence of osteoclastogenesis-induced bone resorption that exceeds bone formation. Osteoporosis is common after kidney transplant. However, hypocalcemia following kidney transplant is rare. The hungry bone syndrome after parathyroidectomy is often responsible for this condition in the pretransplant period. Denosumab is a human monoclonal antibody developed against the receptor activator of nuclear factor kappa-B ligand (known as RANKL). Denosumab exerts an antiresorptive effect on bones by reducing differentiation into osteoclasts. It is an effective treatment option for osteoporosis in the general population. There is insufficient scientific data regarding the use of denosumab in kidney transplant patients. Here, we present the case of a kidney transplant recipient who developed severe hypocalcemia (serum calcium 4.7 mg/dL) after denosumab treatment for osteoporosis.

The Use of Complementary and Alternative Medicine and Quality of Life in Patients With Hip and Knee Osteoarthritis.

The use of complementary and alternative medicine (CAM) practices was common among patients with osteoarthritis (OA) since the patients experienced severe problems. The aim of this study was to determine the prevalence of CAM use and quality of life in pre-arthroplasty patients. This study was designed as a descriptive, consecutive survey of pre-arthroplasty patients due to hip and knee OA. Data were collected by the Personal Information Form, Western Ontario and McMaster Universities (WOMAC) Index, and EQ-5D-5L quality-of-life scale. Logistic regression was used to determine the risk factors of CAM usage; 74.4% of the patients used CAM methods. The most frequently used methods of CAM were biologically based herbal therapies. All patients indicated that they did not disclose CAM methods they used to their physicians. The median EQ-5D-5L index value of the patients was 0.08 and the median WOMAC score was 96.8. Furthermore, patients with right knee OA were found to have a higher risk of using CAM. This study demonstrated that communication between patients and health care professionals is generally poor, and there is an urgent need to develop patient education to minimize the risks and maximize the benefits of using CAM.

Factors Affecting the Thermal Comfort of Perioperative Personnel in the OR.

Thermal comfort is an important component of any work setting and can be difficult to achieve in the complex OR environment. This comparative descriptive study sought to identify factors affecting the thermal comfort of perioperative personnel in the OR (N = 68). Researchers used the American Society of Heating, Refrigerating and Air-Conditioning Engineers Thermal Sensation Scale and researcher-developed surveys to collect data. The mean reported thermal comfort level was -0.44 (standard deviation 1.3), which is within acceptable parameters. Factors affecting thermal comfort were gender, professional role, and wearing additional clothing. Additionally, participants who complained about temperature or ventilation were less likely to report thermal comfort levels in the normal range. Health care facility leaders should consider the comfort needs of perioperative personnel when making purchasing decisions about ventilation systems and surgical clothing; however, they also should consider other factors (eg, surgeon comfort, permeability of protective clothing to blood and other body fluids).

Effects of pre-operative individualized education on anxiety and pain severity in patients following open-heart surgery.

OBJECTIVES: Individualized education is important for preparing patients for the operation both physically and psychologically. This study investigated the effects of pre-operative individualized education for open-heart surgery patients on post-operative anxiety and pain severity. METHODS: This quasi-experimental study was conducted in a university hospital between January and October 2014 and involved 109 patients. Data were collected through a form developed by the authors, the State-Trait Anxiety Inventory (STAI), and the visual analog scale (VAS). Patients underwent STAI 1 day before the operation to identify their sources of anxiety and educational needs, and then individualized education was given accordingly. 1 day after the operation, STAI was used to measure patients' state anxiety level, and VAS was used to measure their pain level. The effect of demographic variables on differences in anxiety and pain was investigated. RESULTS: The average age of the participants was 59.62; 69.7% were male, 92.7% were married, 49.5% graduated from primary school, and the majority (71.6%) had coronary heart disease. The most common sources of anxiety reported the participants included lack of knowledge, being away from family, risk of death, and pain. An analysis of the participants' pre-operative mean scores for state anxiety displayed statistically significant differences (P < 0.05) according to age groups and gender. No significant difference was detected between mean pre- and post-operative state anxiety scores. There was a statistically significant relationship between mean pre- and post-operative state anxiety scores and mean pain scores. CONCLUSIONS: The individualized education is given to patients before surgery was found to have potential effects on their post-operative pain levels.

The attitudes of the undergraduate nursing students towards lesbian women and gay men.

AIMS AND OBJECTIVES: This study was conducted to determine the attitudes of undergraduate nursing students towards lesbian women and gay men. BACKGROUND: Nursing education in Turkey is conducted holistically; in other words, it is an integration of the physical, spiritual, mental and social realms. Students are therefore expected to not express any discrimination due to factors such as religion, language, race and gender. However, some serious problems still exist in terms of the practical applications of that philosophy. DESIGN: This study was descriptive. METHODS: This study included 964 students. The Attitudes towards Lesbian Women and Gay Men scale and a questionnaire were used to learn about the attitudes of undergraduate nursing students regarding gay men and lesbian women. RESULTS: Results of this study have indicated that the attitudes of religiously educated and/or conservative students towards lesbian women and gay men were negative. Female students from families with high incomes and highly educated families attended social activities and read more than other female students. The students with free life choice options expressed very positive attitudes towards gay men. CONCLUSION: The nursing education curriculum should cover information about patients with diverse sexual orientations and their absolute rights for equally optimal healthcare. Strategies to discourage traditional gender role stereotypes and educational and media experiences for better acceptance of sexual minorities need to be developed by educational policy makers. Antidiscrimination policies protecting lesbian women and gay men should be developed by the legislative authorities and then taught to students during their nursing education. Getting familiar with diverse sexual orientations might create awareness among nursing students and reduce their attitudinal and behavioural prejudices and biases. RELEVANCE TO CLINICAL PRACTICE: To provide equal healthcare services for all patients, nurses must have accurate information about lesbian women, gay men and modify their attitude and behaviour accordingly.

The Effects of Workload and Working Conditions on Operating Room Nurses and Technicians.

This study was conducted between August 15 and September 20, 2013, to determine the effects of workload and working conditions on operating room (OR) nurses and technicians. The study sample included 74 OR nurses and technicians working in a private university's six hospitals. The Individual Workload Perception Scale and a questionnaire that collected data on risk and environmental factors were used. The mean age of study participants was 29.3 ± 6.7 years, and 62.2% of the participants were female. More than 90% of the nurses and technicians had experienced spills or splashing of blood or other body fluids; anesthetic gases and radiation had affected 63.5% and 71.6% of nurses and technicians, respectively; 63.5% reported lumbar pain; and 46.6% defined the work environment as very stressful. The average workload scale score was 32.4 ± 6.2 (min = 11, max = 55). OR nurses and technicians are exposed to many occupational risks.

Comparison of sampling methods for urine cultures.

PURPOSE: To compare efficacy and cost of conventional and alternative sampling methods concerning urine cultures. DESIGN AND METHODS: An experimental study with two replications was carried out in a 900-bed university hospital in Ankara, Turkey. The sample was 160 hospitalized female patients, who were asked to give urine specimens, September 10,2000 and September 1,2001. They were patients on urology and obstetrics and gynaecology wards. The authors informed the patients about the study first and then obtained two samples from each patient under their observation. The number of specimens was 320. Statistical methods were descriptive. FINDINGS: The rates of contamination and significant growth, respectively, were 4.4% and 7.5% for the conventional method and 5.6% and 10% for the alternative method. The cost per culture was 2.588.257 TL (2.10 USD) for the conventional method and 57.021 TL (0.05 USD) for the alternative method. The cost difference was statistically significant. CONCLUSIONS: The two methods yielded similar results but the alternative method was less expensive.