Predictive Factors for Favorable Outcome from Subthalamic Nucleus Deep Brain Stimulation in Parkinson’s Disease.

AIM: To investigate predictive factors for a favorable outcome from subthalamic nucleus-deep brain stimulation (STN-DBS) in Parkinson’s disease (PD) and whether low serum vitamin B12 (vB12) levels can predict an unfavorable outcome. MATERIAL AND METHODS: Thirty-nine patients with PD who underwent bilateral STN-DBS were retrospectively analyzed. A difference of at least 30% between preoperative medication-off and postoperative medication-off stimulation-on Unified PD Rating Scale (UPDRS)-III scores was accepted to be a good outcome. Patients with good and bad outcomes were compared in terms of age, gender, levodopa responsiveness, vB12 levels, UPDRS subscores, presence of diabetes mellitus and hypertension, and presence of lacunes on cranial magnetic resonance imaging (MRI). RESULTS: Twenty-two of 39 patients (56.4%) had a good outcome postoperatively. No significant difference was observed in terms of age, gender, presence of abnormal MRI findings, and comorbid diseases between patients with good and bad outcomes. Mean preoperative bradykinesia score in patients with a good outcome was higher than those with a bad outcome. There was a positive correlation between the benefit of STN-DBS and preoperative levodopa responsiveness. In patients with low vB12 levels, 33.3% had a good outcome, whereas 55.2% of patients with normal vB12 levels had a good outcome (p = 0.589). CONCLUSION: Our results confirm that patients with better levodopa response have better outcomes. Interestingly, patients with worse bradykinesia had a better surgical outcome. A favorable surgical outcome was less frequent in patients with low vB12 levels and was not statistically significant.

Turkish Standardization of Movement Disorders Society Unified Parkinson's Disease Rating Scale and Unified Dyskinesia Rating Scale.

BACKGROUND: Movement Disorders Society Unified Parkinson's Disease Rating Scale (MDS-UPDRS) and Unified Dyskinesia Rating Scale (UDysRS) were developed as standard tools to rate Parkinson's disease (PD) and drug-induced dyskinesias of PD. As these scales have become widely used, there is a need for translation to non-English languages. Here we present the standardization for the Turkish translations. METHODS: The scales were translated into Turkish and then back-translated to English. These back-translations were reviewed by the MDS team. After cognitive pretesting, movement disorder specialists from nine centers tested 352 patients for MDS-UPDRS, and 250 patients for UDysRS. Confirmatory factor analyses (CFAs) were used to determine if the factor structures for the reference standards could be confirmed in the Turkish data. The comparative fit indexes (CFIs) for the scales were required to be 0.90 or higher. Exploratory factor analyses (EFAs) were conducted to explore the underlying factor structure without the constraint of a pre-specified factor structure. RESULTS: For both scales, the CFIs were 0.94 or greater as compared to the reference standard factor structures. The factor structures were consistent with that of reference standards, although there were some differences in some areas as compared to the EFA of the reference standard dataset. This may be due to the inclusion of patients with different stages of PD and different cultural properties of raters and patients. CONCLUSIONS: These results demonstrate that the Turkish translations of MDS-UPDRS and UDysRS have adequate clinimetric properties. They are established as the official translations and can be reliably used in Turkish speaking populations.

Risk Factors and Frequency of Ingrown Nails in Adult Diabetic Patients.

The present study evaluated the properties of nails, frequency of ingrown nails in patients with type 2 diabetes mellitus (DM), risk factors for developing ingrown nails, and effect of diabetic polyneuropathy and vasculopathy on the development and outcome of ingrown nails. Our 6-month epidemiologic prospective study included 300 patients with type 2 DM attending a DM outpatient clinic for routine examinations. The general characteristics and foot changes of the study population were investigated. Diabetic polyneuropathy and vasculopathy were evaluated using a biothesiometer, monofilament tests, and arterial Doppler ultrasonography. The frequency of ingrown nails was 13.6%. Multivariate analysis with logistic regression showed that body mass index (odds ratio [OR] 1.077, 95% confidence interval [CI] 1.007 to 1.15; p = .03), previous trauma (OR 2.828, 95% CI 1.017 to 7,867, p = .042), a weak dorsalis pedis pulse (OR 2.72, 95% CI 1.17 to 6.30, p = .02), trimming type (OR 2.3, 95 CI 1.06 to 4.98), p = .35), onychogryphosis (OR 9.036, 95% CI 2.34 to 34.87, p = .001), and subungual hyperkeratosis (OR 4.3, 95% CI 1.99 to 9.3, p = .001) were predictive variables for ingrown nails in our population. The incidence of onychomycosis was significantly greater in patients with ingrown nails (p = .032) than in patients without ingrown nails. The nail curvature ratio was greater in the patients with ingrown nails than in the group with normal nails. Arterial Doppler ultrasound examinations showed peripheral arterial disease in 19 patients (46.9%) with ingrown nails. The prevalence of ingrown nails was greater in the patients with DM than in the healthy population. Our results indicate that nail type, nail morphology, and diabetic vasculopathy affect the formation and evolution of ingrown nails.

Mokken scaling of the Caring Dimensions Inventory (CDI-25).

AIMS AND OBJECTIVES: To validate a Turkish version of the Caring Dimensions Inventory in a group of Turkish nursing students. BACKGROUND: There are no studies about how nurses or nursing students perceive caring in nursing in Turkey. There is also no valid and reliable instrument in Turkey for evaluating caring in nursing. DESIGN: Descriptive study design. METHODS: Using a convenience sample of nursing students (n = 266), standard forward-back translation techniques were used with the Caring Dimensions Inventory. An expert panel considered the translations and provided content validation. A final version of the Caring Dimensions Inventory was tested with 10 nursing students, and we found no difficulties with the items in the instrument. Mokken Scaling analysis of the Caring Dimensions Inventory was used. RESULTS: A range of psychosocial and professional/technical items was included in the Mokken scale with 'Providing privacy for a patient' as the most endorsed (mean = 4.66) item and 'Being with a patient during a clinical procedure' being the least endorsed (mean = 3.87). There is a tendency for the most endorsed items to be psychosocial with the professional/technical items being less endorsed, with the exception of the least endorsed item 'Being with a patient during a clinical procedure' which is a psychosocial item. CONCLUSION: The Turkish version of the Caring Dimensions Inventory is a reliable instrument for measuring nurses' perceptions about caring. RELEVANCE TO CLINICAL PRACTICE: The results using the Caring Dimensions Inventory will help to identify how caring in nursing is perceived by nursing students in Turkey. Repeating this study in different groups such as working nurses will help to determine nurses who work in clinical settings perceive caring in nursing.

Suitability of Turkish written patient educational materials related to breast cancer.

OBJECTIVE: In this study, written educational materials related to breast cancer used for the education of patients were evaluated for their quality and suitability. METHODS: In this descriptive study carried out between November 2010-March 2011, 17 examples of written educational materials used at 20 hospitals and outpatient clinics were evaluated using a Suitability of Written Materials form. FINDINGS: It was determined that educational materials received average scores (12.5±5.4) for their suitability, 58.8% not being considered written at a readable level. Cultural suitability of the materials scored as 0.9±0.8, which was found to be moderate for Turkish population. CONCLUSIONS: Most of the written patient education materials used for patient education related to breast cancer need some modification in their literacy, plans and graphic parts. More materials related to care after mastectomy appear necessary. Future research needs to focus on patients' understanding of the content and their satisfaction with written educational materials.

Nutritional assessment of patients before gastrointestinal surgery and nurses' approach to this issue.

AIMS AND OBJECTIVES: This study was conducted to evaluate the nutritional status of patients before gastrointestinal surgery and to reveal nurses' opinions about this issue. BACKGROUND: Although there is increasing awareness that malnutrition constitutes an important problem, especially when it accompanies diseases, malnutrition in hospitalized patients is not being diagnosed or treated. DESIGN: This study was descriptive. METHODS: Subjective global assessment and anthropometric/biochemical measurements were used to evaluate the nutritional status of 57 patients hospitalized for gastrointestinal surgery. Related opinions of eight nurses were obtained via semi-structured interviews. RESULTS: The malnutrition rate was high in patients before gastrointestinal surgery, and the nurses were not able to evaluate nutritional status properly. Furthermore, the nurses lacked knowledge. CONCLUSIONS: This study indicates the importance of evaluating the nutritional status of patients before surgery and the necessity of developing nutritional support plans. RELEVANCE TO CLINICAL PRACTICE: Our study showed that subjective global assessment is an easy and useful scale for evaluating the nutritional status of patients. Nurses are suitable team members for continuous nutritional care and therefore must not delegate this role.

Red cell superoxide dismutase activity in sporadic amyotrophic lateral sclerosis.

Specific biologic markers are not available for definitive diagnosis and monitoring of disease progression in sporadic amyotrophic lateral sclerosis (SALS). Oxidative stress plays a role in ALS pathogenesis. The purpose of this study was to determine the association between Cu/Zn superoxide dismutase (SOD1) activity, diagnosis and prognosis. The present study included 25 SALS patients (SALS group; age 51+/-12 years) and 10 healthy subjects (age 45+/-5 years) as a control group. Patients were divided into groups representing four levels of diagnostic certainty of ALS in accordance with the El Escorial Revisited criteria. The disease state was determined using the modified ALS health state scale of Riviere et al. (Arch Neurol 1998:55;526-8). Red-cell SOD1 activity was determined by spectrophotometry. SOD1 activity in red cells was compared statistically with diagnostic criteria and disease state. Red cell SOD1 activity was high in all SALS patients, but there was no significant association between enzyme activity and diagnostic criteria and disease state. In this preliminary study, we did not find any correlation between SOD1 activity level and diagnosis or prognosis. Measured SOD1 activity sometimes supports ALS diagnosis, but it is neither a specific nor a prognostic factor.

Dual benefit from intramuscular interferon-beta treatment in a patient with multiple sclerosis and chronic hepatitis-C virus infection.

In patients with hepatitis C virus infection interferon-beta therapy is most effective when administered by the intravenous route. However we would like to present a patient with multiple sclerosis and chronic hepatitis C virus infection who obtained dual benefit from intramuscular interferon-beta therapy. Intramuscular interferon-beta 1a (Avonex) 6 million U/week was started for prevention of attacks in a 32-year-old woman with multiple sclerosis. She had acquired hepatitis C virus infection from blood transfusion during a Caesarean section. Although serum transaminases were within normal limits anti-hepatitis C virus test by ELISA and hepatitis C virus RNA by polymerase chain reaction were positive. Liver biopsy revealed chronic persistent hepatitis. Considering the use of interferon-beta 1a for multiple sclerosis prophylaxis and the stage of hepatitis the patient was not offered any additional treatment. Repeat liver biopsy performed after one year showed the absence of previous findings. The patient has also cleared the hepatitis-C virus RNA.