New Graduate Nurses' Approaches to Death and Dying Patients and the Relationship Between Death Anxiety and Death Awareness: A Cross-Sectional Study.

BACKGROUND: One of the challenges experienced by new graduate nurses during the transition into practice is caring for dying patients. This study aimed to determine new graduate nurses' approaches to death and dying patients and the relationship between death anxiety and death awareness. METHODS: This descriptive, cross-sectional study was conducted with 226 new graduate nurses in Istanbul, Türkiye. A personal and work environment characteristics form, the Approach to Death and Dying Patients Attitude Scale, Templer's Death Anxiety Scale, and Multidimensional Mortality Awareness Measure were used to collect data. RESULTS: Hardness in communicating with the dying patients (hardness: meaning difficulty) and their relatives and avoiding death and dying patients were considered moderate, with mean scores of 2.64 ± .63 and 2.45 ± .40, out of 4. Death anxiety accounted for approximately 7% of the variance of hardness in communicating with dying patients and their relatives, which is statistically significant. Death awareness statistically significantly explained 9.7% of avoiding death and dying patients. CONCLUSION: For new graduate nurses, besides simulation-based training on end-of-life care, approaches to sharing their experiences about death and programs to determine a value system related to death may be recommended.

Frailty in older Turkish cancer patients undergoing post-surgical adjuvant chemotherapy.

BACKGROUND: Understanding the frailty levels of older patients undergoing surgery and chemotherapy will contribute to timely and reliable care practices and improve care outcomes. AIMS: To determine the frailty of cancer patients who received chemotherapy treatment after surgery. METHODS: This descriptive study included 192 Turkish patients aged over 60 years who received chemotherapy after surgery for cancer. Data were collected using a patient survey and the Edmonton Frailty Scale. RESULTS: The average age of the participants was 66.3±5.3 years. Around 40% (40.6%) of the sample were diagnosed with breast cancer. The Edmonton Frailty Scale score of the group was 6.6 (SD±3.7). A quarter of the sample (22.9%) were at risk of frailty. Frailty levels were higher in older individuals with gastrointestinal cancers and other cancer groups compared with patients with breast cancer (p<0.001); patients with additional chronic diseases other than cancer (p=0.004); and in those with a history of falling and hospitalisation in the past year (p<0.001). CONCLUSIONS: Older patients with gastrointestinal cancer, additional chronic disease and a history of falling and hospitalisation within the past year should be evaluated closely for frailty before and during chemotherapy. It is crucial to consider the patient's vulnerability when making care and treatment decisions for older patients with cancer. Understanding the frailty levels of older patients who undergo surgery and receive chemotherapy can help health professionals to decide on timely and reliable care practices and improve care outcomes.

[Examination of social media and technology use of mothers in breastfeeding period in a region of Turkey]. / Examen del uso de las redes sociales y la tecnología por parte de las madres en periodo de lactancia en una región de Turquía.

OBJECTIVE: The aim of this study is to examine the social media and technology use of mothers during breastfeeding. METHOD: Descriptive cross-sectional study. The study was carried out with mothers who brought their children for follow-up in the pediatric outpatient clinics of a public hospital, a university hospital and a private hospital located in Turkey. A questionnaire developed «ad hoc¼ was used for data collection. RESULTS: The total sample consisted of 275 mothers (n = 275). Mothers participating in the study 89.8% of the mothers used social media, 86.5% sought on the reliability of the information on the internet, 73.8% used the medical information on the internet to decide on any case about breastfeeding and 66.9% of them used cell phone or computer during breastfeeding. A statistically significant difference was determined between the education level of the mothers and social media use (p < 0.05). It was determined that the mothers who were secondary school graduate and those with three or more children talked on a cell phone while breastfeeding. CONCLUSIONS: Most of the mothers used social media and technology at a level limiting their interaction with their children. It is recommended to protect mothers from digital addiction and improve their digital literacy levels.

The relationship between nurse-nurse collaboration and work readiness among new graduate nurses.

BACKGROUND: Communication and collaboration with colleagues are crucial for new graduate nurses (NGNs) because of the adaptation to both the healthcare system and professional role. Therefore, working units with effective collaboration among nurses may increase new graduates' work readiness. AIM: This study aimed to determine the relationship between the perceptions of nurse-nurse collaboration and the work readiness level among NGNs. METHODOLOGY: This descriptive, cross-sectional study was carried out with 198 NGNs in four private hospitals affiliated with a university. A self-administered questionnaire, including a personal information form, the Nurse-Nurse Collaboration Scale, and Work Readiness Scale, was used to collect data. Data analysis was performed using descriptive tests, and Spearman's rank correlation coefficients. RESULTS: NGNs had moderate perceptions of nurse-nurse collaboration, with a median score of 2.46 (2.23-2.88) out of 4. Work readiness among NGNs was moderate, with a median score of 304 (270-332) out of 460. There was a statistically significant correlation between nurse-nurse collaboration and work readiness (rs = 0.26; p < .001). CONCLUSION: The results of this study demonstrated that improving nurse-nurse collaboration is an effective way to increase work readiness among NGNs.

What Neonatal Intensive Care Nurses Have Experienced in COVID-19 Pandemic in Turkey.

Neonatal intensive care nurses have faced additional difficulties in adapting to a new work environment with a stressful situation brought about by the pandemic. The aim of this study is to evaluate the experiences of nurses working in neonatal intensive care units during the coronavirus disease-2019 (COVID-19) pandemic. Experiences were determined using phenomenology, a form of qualitative research. The study involved 14 neonatal intensive care nurses. The data were analyzed on the MAXQDA qualitative data analysis software in accordance with Colaizzi's 7-step method. Four themes were identified after the interviews: the experiences related to working conditions, neonatal care, psychosocial effect, and social life. In addition, 17 subthemes were created. The study revealed that neonatal intensive care nurses experienced physical, psychological, and social difficulties during the COVID-19 pandemic. It is thought that these results have become even more important to reduce the workload of nurses and to increase the quality of nursing care, especially in times of crisis such as pandemics.

Determination of problems experienced during the COVID-19 pandemic by individuals receiving hemodialysis treatment.

BACKGROUND: Patients receiving hemodialysis treatment are among the risk groups during the COVID-19 pandemic. They must cope with many factors simultaneously like anxiety about being ill, social isolation, inadequate information about protective precautions, and the need to attend regular treatment. OBJECTIVES: This study was performed with the aim of determining problems experienced by individuals receiving hemodialysis treatment during the pandemic. DESIGN: This was a descriptive and cross-sectional type study. PARTICIPANTS: The research included 234 patients receiving chronic hemodialysis treatment. MEASUREMENTS: For collection of data in the research, a patient descriptive information form and COVID-19 phobia scale (CP19-S) scale were used. RESULTS: Patients receiving hemodialysis treatment were determined to have high levels of compliance with individual precautions required during the pandemic. Of patients, 87.6% were determined to experience concern about bringing infection from the dialysis unit to family members. The mean total points for CP19-S were 59.80 ± 14.49. Patients who were female, had low educational level, were not employed, had heart disease in addition to kidney failure, with hemodialysis age from 6 to 8 years, who did not want to go to the dialysis center and had not received education about the pandemic (p < 0.001) were identified to have high phobia at statistically significant levels. CONCLUSIONS: Changes occurring in normal life and to hemodialysis treatment during the pandemic cause concern and anxiety in many patients. In this process, providing patients with education about the pandemic and protective methods is very important.

Nurse-physician collaboration, intention to leave job, and professional commitment among new graduate nurses.

BACKGROUND: The quality of communication and collaboration with colleagues, managers, and physicians affects the intention to leave a job and the profession for new graduate nurses (NGNs). New graduates have difficulties communicating and collaborating with physicians, especially. AIM: This study aimed to determine the relationship between the attitudes of nurse-physician collaboration and the levels of intention to leave the current job and professional commitment among NGNs. METHODOLOGY: This descriptive, cross-sectional study was carried out with 231 NGNs in four private hospitals affiliated with an university. Data were collected by using a self-administered questionnaire, including a personal information form, the Jefferson Scale of Attitudes towards Physician-Nurse Collaboration, Intention to Leave Scale, and Nursing Professional Commitment Scale. Data analysis was performed using descriptive statistics, and Spearman's rank correlation coefficients. RESULTS: NGNs had a high positive attitude towards nurse-physician collaboration with a median score of 49 (45-54). The professional commitment of NGNs was high level with a median score of 75 (69-86). The intention to leave the current job median score was 3 (2.3-3.6) out of 5. There was a statistically significant correlation between attitudes towards nurse-physician collaboration and the levels of intention to leave the current job (rs = -0.22; p < 0.01) and professional commitment (rs = 0.42; p < 0.01). CONCLUSION: The results showed that improving NGNs' attitudes towards nurse-physician collaboration increases the professional commitment and reduces turnover intention.

Effectiveness of lavender inhalation aromatherapy on pain level and vital signs in children with burns: a randomized controlled trial.

BACKGROUND: Burns are a source of pain, which cannot be fully treated with medications. OBJECTIVES: This study aims is to test the effectiveness of lavender oil inhalation aromatherapy applied before dressing change on vital signs and pain levels of children with burns. DESIGN: This randomized controlled study was held between May 2018 and May 2019. A total of 108 children who met the inclusion criteria were studied in three groups: Lavender-15 Group inhaled lavender oil for 15 min before dressing (n:36), Lavender-60 Group inhaled lavender oil for 60 min before dressing (n:36), and Control Group inhaled jojoba (placebo) oil for 15 min before dressing (n:36). Baseline pain levels and vital signs of the children were measured before inhalation. Pain levels and vital signs of the children were re-measured at the 1st and 30th minutes after dressing. RESULTS: There was no significant difference between the groups in terms of pain levels (p = 0.750) and vital signs before dressing. In post-dressing measurements, the number of respiration (after 1 min p = 0.000, after 30 min p = 0.000), heart rate (after 1 min p = 0.000, after 30 min p = 0.000), mean arterial blood pressure (after 1 min p = 0.010, after 30 min p = 0.000) and pain levels (after 1 min p = 0.000, after 30 min p = 0.000) were lower in the Lavender groups compared to the placebo group. DISCUSSION: The result of this research reveals that inhalation aromatherapy which applied before dressing in children with burns affects the reduction of pain levels and stabilization of vital signs.

A catastrophic nightmare of the interventional cardiologist: Iatrogenic left main artery dissection and longitudinal stent deformation.

Iatrogenic left main coronary artery dissection is a rare but potentially life-threatening complication of invasive coronary procedures. The newer generation drug eluting stents have shown a greater safety and efficacy compared to first generation drug eluting stents. We report a 60-year-old woman with iatrogenic left main coronary artery dissection who failed bailout stenting and underwent coronary artery bypass grafting. The strategy for managing left main coronary artery dissection is variable and depends upon the mechanism, the comorbidities of the patient and degree of hemodynamic stability. Longitudinal stent deformation is a rarely encountered complication but can be seen in complex lesions such as ostial, bifurcation and left main coronary artery lesions. The interventionists must be aware of this complication.

Competitive Coronary Flow between the Native Left Anterior Descending Artery and Left Internal Mammary Artery Graft: Is It a Surrogate Angiographic Marker of Over-or-Unnecessary Revascularization Decision in Daily Practice?

Overdiagnosis and overtreatment are often thought of as relatively recent phenomena in modern medicine, influenced by a contemporary combination of technology, specialization, payment models, marketing, and supply-related demand. Several investigators have reported discrepancies between the angiographic and functional severity of coronary angiographic stenosis. However, the visual anatomic assessment of the coronary lesion severity continues in daily practice. We evaluated the consecutive all coronary angiograms performed between January 2015 and December 2015 and examined only patients who had previous coronary artery bypass grafting (CABG) to analyze the cases with regard to presence of the competitive flow (CF) between the native left anterior descending coronary artery (LAD) and left internal mammary artery (LIMA) graft. A total of 8,248 diagnostic coronary angiographies were performed between January 2015 and December 2015 at our facility. Of these, 886 coronary angiographies of CABG patients were detected. Whereas LIMA graft occlusion detected in 19 patient (2.1%), the LIMA-LAD CF rate was found in 86 (9.7%) CABG patients. The angiographic severity of the LAD stenosis in CF group evaluated as mild in 20 (25%), moderate in 61 (70%), and severe coronary artery disease in 4 (5%) patients. Our results showed that there is 9.7% rate of LIMA-LAD CF. Therefore, some unnecessary coronary stenting or CABG procedures might have been performed due to limited use of functional testing for clinical decision making. The functional angiography should play a more prominent role in catheterization laboratories as recommended by current revascularization guidelines to prevent overdiagnosis, misdiagnosis, or incorrect treatment decisions.

Dynamic Systolic Compression of the Left Anterior Descending Coronary Artery by a Postinfarction Dyskinetic Left Ventricular Aneurysm.

Dynamic systolic compression of the coronary arteries is almost always due to the existence of myocardial bridging that is most commonly localized in the middle segment of the left anterior descending coronary artery. However, it has rarely been reported in patients with pericardial adhesions, tumor, foreign body, or pseudoaneurysms. Only rare case reports exist regarding dynamic coronary compression by a dyskinetic left ventricular aneurysm. We present a patient with a myocardial bridge-like systolic compression of the distal left anterior descending caused by postinfarction dyskinetic left ventricular aneurysm.

Nucleation, Growth, and Bundling of GaN Nanowires in Molecular Beam Epitaxy: Disentangling the Origin of Nanowire Coalescence.

We investigate the nucleation, growth, and coalescence of spontaneously formed GaN nanowires in molecular beam epitaxy combining the statistical analysis of scanning electron micrographs with Monte Carlo growth models. We find that (i) the nanowire density is limited by the shadowing of the substrate from the impinging fluxes by already existing nanowires, (ii) shortly after the nucleation stage, nanowire radial growth becomes negligible, and (iii) coalescence is caused by bundling of nanowires. The latter phenomenon is driven by the gain of surface energy at the expense of the elastic energy of bending and becomes energetically favorable once the nanowires exceed a certain critical length.

Chemerin as an independent predictor of cardiovascular event risk.

Currently, coronary artery disease (CAD) is considered a major ailment in humans with widespread prevalence. CAD also accounts for high mortality rates around the world that involves several known risk factors. Chemerin is a novel adipokinine that is associated with inflammation and adipogenesis. Furthermore, experimental and clinical data indicate that localized as well as circulating chemerin expression and activation are elevated in numerous metabolic and inflammatory diseases including psoriasis, obesity, type 2 diabetes, metabolic syndrome and cardiovascular disease. Chemerin is accepted as being a strong marker because the serum chemerin levels are increased in a CAD condition. However, the chimeric characteristics of chemerin have not been fully investigated. Although chemerin is known to be responsible for CAD development among other factors, authors still investigate it at the marker level. This review focuses on chemerin expression, processing, biological function and relevance to human diseases, and on the role of chemerin in the maintenance of a cardiovascular disease.

Spontaneous rectus sheath hematoma in a patient treated with apixaban.

Apixaban, a non-vitamin K antagonist oral anticoagulants, is a Factor Xa inhibitor that is prescribed for the treatment of non valvular atrial fibrillation. Rectus sheath hematoma is a rare but significant complication of oral anticoagulant treatment. The important causes of rectus sheath hematoma include treatment with anticoagulants, hematologic diseases, trauma, intense physical activity, coughing, sneezing and pregnancy. In this report, we describe case of a 71-year-old woman undergoing apixaban treatment for non valvular atrial fibrillation who presented with spontaneous rectus sheath hematoma.

Contact dermatitis after implantable cardiac defibrillator implantation for ventricular tachycardia.

Pacemaker contact sensitivity is a rare condition. Less than 30 reports of pacemaker skin reactions have been described. We report a 57-year-old woman who underwent an implantable cardiac defibrillator (ICD) implantation for ventricular tachycardia. A skin patch test was positive on almost all components of the pacemaker system. She was treated with topical corticosteroids and skin lesions resolved within 2 weeks. Because of widespread use of various devices, we will see this more often and therefore it is important to recognize this problem and its effective management.

Azathioprine-induced atrial fibrillation.

Azathioprine, a purine analogue that competitively inhibits the biosynthesis of purine nucleotides, is used in a wide range of conditions. Although its side-effects are well known, cardiac side effects like paroxysmal atrial fibrillation (AF) are based on only a few case reports. We describe here the case of a 55-year-old woman with primary biliary cirrhosis who presented a first-detected, symptomatic AF 2 h after azathioprine therapy which resolved after discontinuation of the drug with no predisposing factors for supraventricular arrhythmias (systemic hypertension, diabetes or coronary artery disease). The temporal coincidence of atrial fibrillation and azathioprine intake and disappearance of the AF episode after discontinuation of therapy allows us to suggest an intrinsic pro-arrhythmic effect of azathioprine. Therefore, physicians should be aware of this problem when this drug is administered.

Ventricular fibrillation development following atrial fibrillation after the ingestion of sildenaphil in a patient with Wolff-Parkinson-White syndrome.

Complications in the accessory pathway in Wolff-Parkinson-White (WPW) syndrome could cause different clinical conditions by inducing different arrhythmias. Atrial fibrillation (AF) is one of these arrhythmias and is important as it causes life-threatening arrhythmias. It is known that some drugs, underlying cardiac diseases, and the number of accessory pathways, cause a predisposition to this condition. In the current report, we presented a patient with WPW who was admitted to the emergency department with AF, wide QRS and a rapid ventricular response that progressed to ventricular fibrillation.

Early postoperative results for females undergoing isolated coronary artery bypass surgery: comparison of the pre- and postmenopausal periods.

PURPOSE: In this retrospective study, we investigated the demographic data and evaluated our early postoperative results of premenopausal and postmenopausal females who underwent coronary artery bypass graft surgery (CABG). METHODS: A total of 730 female patients who underwent CABG between April 2004 and January 2012 were included in the study. Patients were divided into two groups based on whether they were pre- (group 1) or postmenopausal (group 2). The groups were compared in terms of the demographic and peri-operative parameters. RESULTS: Smoking and the preoperative hematocrit levels were higher in group 1, whereas the incidence of hypertension and obesity and the European system for cardiac operative risk evaluation values were higher in group 2 (p values <0.01; <0.01; <0.01; 0.004 and <0.01 respectively). The utilization of a left internal mammary artery graft and the postoperative drainage volumes were higher in group 1; however, the number of grafts per patient, cardiopulmonary bypass duration, number of patients who needed inotropic support, blood transfusion volumes, the duration of ventilatory support and the hospital stay were higher in group 2 (p values 0.038; 0.040; 0.026; 0.032; 0.014; 0.001; <0.01 and <0.01, respectively). CONCLUSIONS: Although the mortality rates were not significantly different, postmenopausal patients require more intensive postoperative care in comparison to premenopausal patients following CABG.

Association between Plasma Fibrinogen Level and Saphenous Vein Graft Patency.

BACKGROUND: Fibrinogen is related to the pathogenesis of atherosclerosis. The inflammatory process in atherosclerosis may cause an increase in plasma fibrinogen level. Therefore, in this study we proposed to investigate whether plasma fibrinogen is associated with the patency of saphenous vein graft in patients at least 1 year after coronary artery bypass graft (CABG) surgery. METHODS: Patients who had undergone CABG surgery at least 1 year previously with at least one saphenous vein graft were included in the study. Patients were directed to cardiac catheterization for stable anginal symptoms or positive stress test results. Before coronary angiography, all patients underwent routine blood tests including assessment of plasma fibrinogen levels. RESULTS: Saphenous vein grafts were found to be patent in 199 patients and occluded in 132 patients. Plasma fibrinogen levels were significantly different between the two groups (2.85 ± 0.49 g/L vs. 3.62 ± 0.82 g/L, p < 0.001, respectively). Although the time duration after CABG operation differs significantly between the two groups (p = 0.004), multiple logistic regression analysis showed that plasma fibrinogen levels were found to be significantly associated with the patency of vein graft (odds ratio = 0.27, 95% confidence internal: 0.16-0.48, p < 0.001). CONCLUSIONS: Our results demonstrated that plasma fibrinogen levels were higher in patients with an occluded saphenous vein graft. To conclusively prove the relationship between plasma fibrinogen values and saphenous vein graft patency, additional investigation would be necessary. KEY WORDS: Atherosclerosis; Coronary artery bypass graft; Fibrinogen; Saphenous vein.