The effect of acupressure on sleep quality of older people: A systematic review and meta-analysis of randomized controlled trials.

BACKGROUND AND OBJECTIVE: The effects of acupressure on sleep quality and insomnia symptoms have been studied in various groups of haemodialysis patients, those undergoing surgery, and those living in elderly care homes. The aim of this study is to determine the effect of acupressure on sleep quality in elderly people. METHODS: This study was conducted with a systematic review and meta-analysis. In this study, electronic databases of PubMed, Science Direct, National Thesis centre, Google Scholar, Web of Science, EBSCO were systematically scanned between December 2020 and February 2021 using the keywords "older, elderly, sleep quality, acupressure". The study included 11 articles published in English and Turkish languages without any year limitation. This systematic review and meta-analysis were done by following the PRISMA reporting system. RESULTS: The total sample size of 11 randomized controlled trials included in this systematic review and meta-analysis was 722 (experiment: 363 and control: 359), and the mean duration of acupressure interventions applied was 19.65 ± 11.28 days. The sleep quality of the acupressure group in the elderly was significantly increased compared to the control group (MD: -1.71,%95 CI: -2.31 to -1.11, Z = 5.60, p< 0.00001, I2 = 91%). After the subjects received training for acupressure application and applied acupressure themselves, their sleep quality improved compared to the control group (MD: -0.86, 95% CI: -1.39 to -0.32, p <0.001). CONCLUSIONS: We have utilized meta-analysis to try to reveal statistical significance by pooling small studies with high quality. This meta-analysis provided a potentially effective intervention on the quality of sleep in elderly people.

Validity and reliability of the Turkish version of brief diabetic foot ulceration risk checklist.

OBJECTIVE: This study aims to determine the validity and reliability of the Turkish translation of brief diabetic foot ulceration risk checklist (BDURC). METHODS: This methodological study was conducted at the diabetes clinic of a state hospital in Istanbul, Turkey. The data were collected with the BDURC developed by Zhou et al. in 2018. A study was conducted with 430 patients with Type 2 diabetes. The scale was retested after 4 weeks by 60 participants. Language equivalence of the scale was provided. Experts' opinions were taken about the content validity of the scale. Reliability of the scale was determined with the test-retest reliability, item-total correlation, and internal consistency analysis. RESULTS: Confirmatory factor analysis revealed a two-factor structure with good model suitability. Cronbach's alpha coefficient for the scale and its subscales was 0.79. Test-retest scores showed no statistically significant difference between the items (p>0.05). The reliability index was higher than 0.80. CONCLUSION: The BDURC-TR is a valid and reliable tool that can be used in clinics to identify the risk factors for diabetic foot ulcers in patients with Type 2 diabetes in Turkey.

The Effect of ShotBlocker on Pain and Patient Satisfaction for Spinal Anesthesia: A Randomized Trial.

BACKGROUND: During spinal anesthesia, patients may experience pain and discomfort associated with dermal puncture. It may also cause involuntary movement, which often disturbs the patient's posture thus affecting the success of spinal anesthesia. Different methods have been studied to cope with needle-related pain. "ShotBlocker" is a flexible, plastic, U-shaped device, which has several blunt points. It is suggested that blunt points provide a nonnoxious physical stimulation and inhibit the transmission of injection pain. OBJECTIVES: The purpose of this study was to examine the effectiveness of the ShotBlocker for dermal puncture pain during spinal anesthesia. STUDY DESIGN: Prospective randomized trial. SETTING: University hospital, operating room. METHODS: Ninety-four patients aged 18 to 65 years with physical status American Society of Anesthesiologists (ASA) I or II scheduled for elective surgery under spinal anesthesia were randomly assigned to either a ShotBlocker (n = 47) or control group (n = 47). In the ShotBlocker group, lumbar punctures were performed with the application of ShotBlocker. Needle-associated pain score and patient satisfaction were assessed by the patient, immediately after completion of the spinal anesthesia using a 10-cm Visual Analog Scale (VAS) and a 5-point Likert scale for satisfaction. Patients were also closely observed for symptoms of discomfort such as spontaneous vocalization and involuntary movement. RESULTS: A total of 88 patients completed the study. There was no significant difference in VAS scores, patient satisfaction, or procedure time between groups (P > 0.05). Spontaneous vocalization did not occur in both groups. However, incidence of unintentional movement during dermal puncture was higher in the control group (6.8% vs. 31.8%; P < 0.05). LIMITATIONS: Study was conducted in a single-center with a relatively small population of patients. Only the attending anesthetist collecting data was blinded to the procedure. Patients older than age 65 years were also excluded from the study, thus our results cannot be generalized. CONCLUSIONS: ShotBlocker did not show any advantage on VAS scores but decreased the incidence of unintentional movement during dermal puncture.

The effect of acupressure (GB30) on intramuscular injection pain and satisfaction: Single-blind, randomised controlled study.

AIMS AND OBJECTIVE: To evaluate the effect of acupressure on intramuscular injection pain, satisfaction and vital signs. BACKGROUND: Pain at the injection site may lead to discomfort and may affect patients' compliance to treatment. DESIGN: This was a prospective, single-blind, crossover study. The study complied with the guidelines of Consolidated Standards of Reporting Trials (CONSORT) Checklist. METHODS: Seventy-two healthy volunteer university students received an intramuscular injection of 2 ml sterile saline (%0.9 NaCl) to the ventrogluteal site with and without acupressure on separate days in a random order following a standard procedure by the same investigator. Pain and satisfaction were assessed immediately after the injection with the visual analog scale (VAS) by a researcher blinded to the study. RESULTS: A total of 134 injections were analysed. The result of the study reveals that acupressure alleviates the severity of pain and increases the patient satisfaction. CONCLUSIONS: The findings of this research support that use of acupressure, which is easy and cost-effective, could reduce injection pain when performed on a specific point. RELEVANCE TO CLINICAL PRACTICE: Safe and accurate administration of medications is one of the crucial responsibilities of nurses. Acupressure is a nonpharmacologic approach, which can be effective in decreasing the injection pain and increasing patient satisfaction.

Comparison of hemodynamic responses to endotracheal intubation with the GlideScope video laryngoscope and Macintosh laryngoscope in patients undergoing cardiovascular surgery.

BACKGROUND: This study aimed to compare hemodynamic response to endotracheal intubation using GlideScope and Macintosh laryngoscopes in patients who underwent cardiovascular surgery. METHODS: A total of 74 patients were enrolled in the study. Patients were randomly assigned into two groups either a GlideScope (n=37) or a Macintosh laryngoscope (n=37). Laryngoscopy time, heart rate, invasive arterial pressure and rate pressure product were compared during induction and until five minutes after laryngoscopy at 11 time points. RESULTS: Seventy patients completed the study. The intubation time was similar in both groups (14.1±4.0 sec vs. 13.2±4.2 sec; p=0.22). Hemodynamic values including heart rate, systolic, diastolic and mean arterial pressure and rate pressure product were similar at all-time points. The laryngoscopy time was also similar between groups. CONCLUSION: The GlideScope video laryngoscope did not show any advantage on hemodynamic response in patients undergoing cardiovascular surgery when compared to Macintosh laryngoscope.

Fetal Cleft Lip/Palate Surgery: End of a Dream?

Recognition that a fetus can scarlessly heal in intrauterine life led to various animal studies in the mid 1980s exploring the possibility of fetal cleft lip/palate surgery. The idea of scarless cleft repair seemed like a possible dream after the promising results from the early animal studies. In this review, we analyze the progress made in the 30 years since our first experience with animal models.

How important is the butyrylcholinesterase level for cesarean section?

OBJECTIVES: Butyrylcholinesterase (BChE), commonly known as pseudocholinesterase or non-neural cholinesterase, hydrolyzes neuromuscular blocker agents containing choline esters such as succinylcholine that is widely used in rapid sequence induction (RSI) for general anesthesia. The aim of this study is to compare plasma BChE levels and investigate the affects and relationship of succinylcholine on BChE levels in preeclamptic, gestational diabetic and healthy pregnants. STUDY DESIGN: We designed a prospective, controlled, pilot single-center study. Thirty (n=30) pregnant women who were scheduled for cesarean section under general anesthesia (refusal of regional anesthesia) with RSI involved. Group 1 included ten (n=10) preeclamptic pregnancies, Group 2 included ten (n=10) gestational diabetic (GD) pregnancies and Group 3 included ten (n=10) healthy pregnancies. MAIN OUTCOME MEASURES: BChE levels of all patients were measured prior to the initiation of cesarean section. Train-of-four recovery of 90% (TOF T1) was used to monitor the degree of neuromuscular block beginning from the administration of succinylcholine. RESULTS: No statistically significant difference was found between the groups comparing BChE levels and the duration between tracheal intubation and formation of TOF T1 (p>0.05). CONCLUSIONS: As similar results were gathered from normal and high-risk pregnancies (preeclamptic pregnancy or gestational diabetic pregnancy) who underwent cesarean section under general anesthesia, we believe that succinylcholine is still neuromuscular agent of choice in cesarean section.

Treatment of compensatory hyperhidrosis of the trunk with radiofrequency ablation.

OBJECTIVES: Although Endoscopic Thoracic Sympathectomy is a widely accepted treatment method for patients with palmar hyperhidrosis, compensatory hyperhidrosis of the trunk remains a challenging side effect of the procedure. No satisfactory treatment options for this side effect were available until now. In this study, we aimed to define a new procedure for the treatment of compensatory hyperhidrosis of the trunk. METHODS: A total of 10 patients admitted our institution for the treatment of compensatory hyperhidrosis of the trunk were enrolled in the study between November 2010 and January 2012 in a prospective manner. Sympathetic blockage was achieved via radiofrequency thermo-ablation technique. The results of treatment were evaluated via telephone calls. RESULTS: Ten patients (2 females, 8 males) underwent radiofrequency thermo-ablation of T6 sympathetic ganglion for compensatory hyperhidrosis of the trunk. The mean age was 29.2 years and the median duration of symptom was 10.5 months. The median follow-up period was 14 months. Six of ten patients (60%) were treated successfully. There was no procedure related complication. CONCLUSION: The radiofrequency treatment for patients with compensatory hyperhidrosis of the trunk is an alternative option with promising results.

Takotsubo Cardiomyopathy Occurring in the Postoperative Period.

Takotsubo cardiomyopathy simulates acute myocardial infarction, and it is characterised by reversible left ventricular failure. A case of Takotsubo cardiomyopathy diagnosed after emergency angiography performed in a patient with evidence of acute myocardial infarction in the postoperative period will be described in this report. Transurethral resection of a bladder tumour (TUR-BT) was performed in a 92-year-old male patient by the urology clinic. The patient was transferred to the post-anaesthesia care unit after the operation. An echocardiography was performed because of the sudden onset of dyspnoea, tachycardia (140-150 beats per minute, rhythm-atrial fibrillation) and ST-segment elevation on electrocardiography (ECG) at the first postoperative hour, and midapical dyskinesia was detected at the patient. An immediate angiography was performed due to suspicion of acute coronary syndrome. Patent coronary arteries and temporary aneurysmatic dilatation of the apex of the heart were revealed by angiography. As a result of these findings, the patient was diagnosed with Takotsubo cardiomyopathy by the cardiology service. The patient was discharged uneventfully following 10 days in the intensive care unit. Aneurysm of the apex of the left ventricle and normal anatomy of the coronary arteries in the angiography have diagnostic value for Takotsubo cardiomyopathy. Diuretics (furosemide) and beta-blockers (metoprolol) are commonly used for the treatment of Takotsubo cardiomyopathy. Even though Takotsubo cardiomyopathy is a rare and benign disease, it should be kept in mind in patients suspected for acute myocardial infarction in the postoperative period.

Effects of dexpanthenol and N-acetylcysteine pretreatment in rats before renal ischemia/reperfusion injury.

BACKGROUND: We investigated the anti-inflammatory and protective effects of concomitant use of dexpanthenol (DXP) and N-acetylcysteine (NAC) induced ischemia/reperfusion (I/R) injury of kidney. METHODS: Forty rats were randomly divided into 5 groups. In all groups except for Group 1(Sham), renal arteries bilaterally occluded with vascular clamp for IR injury. Group 1(Sham), received a single dose of 10 mL/kg isotonic saline daily by intraperitoneal (IP) injection for three days. Group 2(IR), received a single dose of 10 mL/kg isotonic saline daily by IP injection for three days. Group 3(IR + NAC), received 300 mg/kg NAC daily by IP injection for three days. Group 4(IR + DXP), received 500 mg/kg DXP daily by IP injection for three days. Group 5(IR + NAC + DXP), received 500 mg/kg DXP and 300 mg/kg NAC daily by IP injection for three days. Serum urea (BUN), creatinine (Cr) and neutrophil gelatinase-associated lipocalin (NGAL, lipocalin 2, siderocalin) levels were measured as kidney function tests. TNF-α levels were measured as inflammatory marker. Tissue sections were evaluated histopathologically under light microscopy. RESULTS: IR + NAC + DXP group received both NAC and DXP before induction of renal I/R and as the biochemical and histopathological data revealed the results of the IR + NAC + DXP group and sham group were similar. Biochemically and histopathologically, combined use of NAC and DXP has better results when each of them used alone. CONCLUSION: We concluded that concomitant use of DXP and NAC plays a major role against I/R injury and may be useful in acute treatment of I/R induced renal failure.

The effects of gabapentin on acute and chronic pain after inguinal herniorrhaphy.

BACKGROUND AND OBJECTIVE: To find out whether preoperative gabapentin use had a favourable effect on long-term postoperative pain in patients undergoing inguinal herniorrhaphy. METHODS: Sixty male patients--aged 20-40 years--who were scheduled for unilateral inguinal herniorrhaphy under spinal anaesthesia were included in this prospective, randomized, double-blind study. The patients were randomly allocated to two groups: the gabapentin group (n=30) received single-dose 1.2 g oral gabapentin 1 h before surgery, and the placebo group received a placebo capsule instead. Spinal anaesthesia was performed with heavy bupivacaine, and all operations were performed by the same surgeon with the same technique. Postoperative analgesia was evaluated during sitting and lying with a visual analogue scale. Assessment of postoperative pain at 1, 3 and 6 months was carried out with an 11-point numerical rating scale; 0 indicating 'no pain' and 10 indicating 'worst pain imaginable'. Patients who had numerical rating scale scores of more than 0 were further evaluated with regard to the impact of pain on their daily activities. RESULTS: When compared with the placebo group, the gabapentin group displayed significantly lower visual analogue scale scores (lying and sitting) and total tramadol consumption at 8, 12, 16, 20 and 24 h after surgery (P<0.05) and higher postoperative patient satisfaction scores (P<0.05). Numerical rating scale scores at 1, 3 and 6 months after surgery were lower in the gabapentin group than in the placebo group (P<0.05). The number of patients whose daily activities were adversely affected by pain was smaller in the gabapentin group at the first month; however, the two groups were found to be similar at 3 and 6 months. CONCLUSION: We conclude that preoperative single-dose gabapentin decreases the intensity of acute postoperative pain, tramadol consumption and the incidence and intensity of pain in the first 6 months after inguinal herniorrhaphy.

Ecthyma-gangrenosum-like lesions associated with methicillin-resistant Staphylococcus aureus infection.

Ecthyma gangrenosum (EG) manifests as a skin lesion and is commonly associated with Pseudomonas aeruginosa septicemia in immunocompromised patients. Other viral, fungal and bacterial agents can also cause EG. The first clinical observation is grouped vesicles with surrounding erythema. Within a few days, they evolve into a gangrenous ulcer with a black/gray eschar surrounded by an erythematous halo. Herein, we present a patient with chronic obstructive pulmonary disease who developed EG-like lesions due to methicillin-resistant Staphylococcus aureus infection while he was in the intensive care unit.