Multicenter evaluation to determine the deficiencies of emergency nurses in forensic case management.

INTRODUCTION: Emergency services are the first places where victims and/or perpetrators of different types of violence are brought for medical treatment. Emergency service nurses are the first health workers who first encounter with the forensic case, first communicate and are in an important position in the rapid and accurate continuation of the forensic process. In this study, it was aimed to determine the level of knowledge of emergency department nurses regarding the management of forensic cases. METHODS: The study was a cross-sectional, descriptive. Ninety-eight emergency nurses working in the emergency departments of three different public hospitals in the same province participated in the study. Study data were collected with the "Nurse Personal Information Form" and the "Knowledge Levels of Nurses related to the Approaches to Forensic Cases Questionnaire". RESULTS: 70.4 % of the nurses participating in the study were women, their mean age was (X ± SD = 27.36 ± 5.21). It is seen that 87.8 % of the nurses have a total working time in the emergency unit between 1 and 5 years and 11.2 % have received training on forensic nursing. "Total Knowledge Score" of undergraduate graduate nurses The mean score was higher and there was a significant difference between the groups (p > 0.05). The nurses who received in-service training and forensically evaluated all cases admitted to the emergency department had a higher mean score in the "Knowledge Score Regarding the Duties of Nurses Regarding Forensic Cases" mean was higher and there was a significant difference between the groups (p > 0.05). CONCLUSION: We recommend the use of institutional guides/protocols together with in-service training for emergency nurses to provide medically and legally correct forensic care and to have sufficient knowledge.

The utility and reliability of the PreViAs questionnaire forthe assessment of vision in Turkish neonates and infants. / Utilidad y confiabilidad del cuestionario PreViAs para la evaluación de la visión en neonatos y lactantes turcos.

Introduction: Evaluating the visual functions of children with an easy-to-use and evidence-based method during the preverbal period will enable early diagnosis and intervention of visual impairments. The aim of this study is to determine the utility and reliability of the Turkish version of the Preverbal Visual Assessment (PreViAs) questionnaire, which was developed to evaluate the visual functioning of preverbal infants. Population and Methods: The PreViAs questionnaire was administered to primary caregivers of term infants under 24 months of age, and their responses were recorded. Results: Data from the 278 participating infants were analyzed to assess the internal consistency of the PreViAs questionnaire. Results showed a high level of consistency with Cronbach's alpha value of 0.958 for the total score, suggesting strong internal coherence. In addition, the Cronbach's alpha values for each domain were 0.890, 0.913, 0.951, and 0.922 for visual attention, visual communication, visual processing, and visual-motor coordination, respectively, indicating good internal consistency for each subdomain. Conclusion: The Turkish version of the PreViAs questionnaire is useful and reliable for assessing functional vision during the preverbal period.

Introducción. La evaluación de la visión en los niños durante el periodo preverbal, con un método fácil de usar y basado en la evidencia, permitiría el diagnóstico temprano y la intervención en los trastornos visuales. El objetivo del estudio fue determinar la utilidad y confiabilidad de la versión en idioma turco del cuestionario Preverbal Visual Assessment (PreViAs), desarrollado para evaluar la visión en niños preverbales. Población y métodos. El cuestionario PreViAs se administró a los cuidadores primarios de niños nacidos de término, antes de los 24 meses de edad. Se registraron sus respuestas. Resultados. Se analizaron los datos de 278 participantes para evaluar la consistencia interna del cuestionario PreViAs. Se encontró un alto nivel de consistencia con un alfa de Cronbach de 0,958 para el puntaje total, lo que sugiere una fuerte coherencia interna. Los valores del alfa de Cronbach para cada dominio fueron: 0,890 ­ 0,913 ­ 0,951 y 0,922 para la atención visual, la comunicación visual, el procesamiento visual y la coordinación visomotora respectivamente; esto indica una buena consistencia interna para cada subdominio. Conclusión. La versión en idioma turco del cuestionario PreViAs es útil y confiable para evaluar la visión durante el periodo preverbal.

Pediatricians` attitudes, practices, and perceived barriers to school readiness.

BACKGROUND: School readiness (SR) has been adopted by the American Academy of Pediatrics (AAP) as a component of health supervision, but the medical community`s role is unknown. We evaluated the pediatricians` attitudes, practices, and perceived barriers to SR. METHODS: This multicenter, cross-sectional descriptive study was performed among 787 general pediatricians, pediatric residents, subspecialists, and subspecialty fellows. A 41-item survey was administered. RESULTS: Forty-nine point two percent of the pediatricians defined SR as a multidimensional issue, as outlined by the AAP, whereas 50.8% defined it as the child`s set of skills or passing the SR tests. Three-quarters of pediatricians believed that SR assessment tests are necessary before starting school, and children who do not appear ready should wait a year. To promote SR, the rates of usually fostering at least four of the five `Rs` (reading, rhyming, routines, rewarding, relationships) and integrating developmental surveillance into daily practice were 37.8% and 23.8%, respectively. Only 2.2% of pediatricians usually inquired about eight adverse childhood experiences (ACEs), and 68.9% did not usually ask about any. Usually fostering at least four of the five `Rs` was associated with usually integrating developmental surveillance (p < 0.001), usually inquiring about each ACE (p < 0.001), and being perceived as responsible for promoting SR (p < 0.01). Training on SR during pediatric residency was 2.7%. Time constraints and insufficient knowledge were the most common barriers. CONCLUSIONS: Pediatricians were not familiar with the concept of SR and had some misconceptions. There is a need for additional training regarding pediatricians` roles in promoting SR along with addressing multiple, modifiable barriers within the health system. < strong > Supplementary: < a href="https://www.turkishjournalpediatrics.org/uploads/2573-supplementary.pdf" target=`_blank` > Supplementary Appendix < /a > < /strong >.

Stressful experiences and coping strategies of parents of young children with Down syndrome: A qualitative study.

BACKGROUND: Previous studies have focused mostly on the negative experiences of parents of children with Down syndrome. We aimed to explore both the stressful experiences and coping strategies of parents from a non-Western country. METHODS: Twenty-six parents of children aged 8-48 months with Down syndrome were included. Semi-structured interviews were conducted, and the data were analysed using thematic analysis. RESULTS: The main themes of the stressful experiences were emotional burdens, caregiving burdens, struggle against stigma and discrimination, concerns about the future, challenges related to health, education, and financial issues. Parents used a variety of coping strategies to overcome the challenges by seeking support and help, searching for information, accepting and adapting, and adopting optimistic attitudes. CONCLUSION: Although being a parent of a child with Down syndrome has many challenges, most parents effectively used coping strategies and adapted their lives to their new parental roles in their child's early years.

Shared reading: Parental attitudes, practices and barriers in Turkey.

AIM: Understanding the nature of parent-child shared reading (SR) practices is important to reach children's developmental potential and subsequent achievement. We evaluated the parental attitudes and practices, associated variables and barriers related to SR. METHODS: This prospective study enrolled 624 parents of children aged 1-72 months who presented to a tertiary hospital for well-child care or acute minor illness. Face-to-face interviews were conducted using a questionnaire. RESULTS: The median age for starting SR was 12 (0-72) months. Daily SR activities were provided by 29.5% of the parents. Owning >10 children's books, higher socioeconomic status, attending pre-school/kindergarten and being a single child were associated with daily reading (P < 0.001). In total, 36.5% of the parents reported that they had not yet started SR and planned to start SR when their children reached a median age of 20.5 (2-72) months. The most commonly reported barriers were time constraints and the perception that their child was too young. Almost 10% of the parents had received an SR recommendation. Parents who had received a recommendation and those who had a habit of self-reading multiple times a week were more likely to begin SR at younger child age and to read daily (P < 0.001). CONCLUSIONS: This study demonstrated low rates of parent-child SR activities in early childhood, particularly in the first years of life, in Turkey. Our findings emphasise the need for a national strategy integrated into the healthcare system to promote SR.

Pediatric dysphagia overview: best practice recommendation study by multidisciplinary experts.

BACKGROUND: Currently, there is no comprehensive and multidisciplinary recommendation study covering all aspects of pediatric dysphagia (PD). This study aimed to generate PD management recommendations with methods that can be used in clinical practice to fill this gap in our country and in the world, from the perspective of experienced multidisciplinary experts. METHODS: This recommendation paper was generated by a multidisciplinary team, using the seven-step process and a three-round modified Delphi survey via e-mail. First, ten open-ended questions were created, and then detailed recommendations including management, diagnosis, treatment, and follow-up were created with the answers from these questions. Each recommendation item was voted on by the experts as overall consensus (strong recommendation), approaching consensus (weak recommendation) and divergent consensus (not recommended). RESULTS: In the 1st Delphi round, a questionnaire of 414 items was prepared based on the experts' responses to ten open-ended questions. In the 2nd Delphi round, 59.2% of these items were accepted as pre-recommendation. In the 3rd Delphi round, 62.6% of 246 items were accepted for inclusion in the proposals. The final version recommendations consisted of 154 items. CONCLUSIONS: This study includes comprehensive and detailed answers for every problem that could be posed in clinical practice for the management of PD, and recommendations are for all pediatric patients with both oropharyngeal and esophageal dysphagia.

Bevacizumab and neurodevelopmental outcomes of preterm infants with retinopathy of prematurity: should we still worry?

AIM: Bevacizumab may affect preterm infants' ongoing organogenesis with its antiangiogenic effects. We aimed to compare neurodevelopmental outcomes (NDO) of preterm infants treated for retinopathy of prematurity (ROP) with laser photocoagulation (LP), intravitreal bevacizumab (IVB) or both treatments, and to find out the effects of IVB on NDO. METHODS: Medical records of preterm infants with ROP treatment and evaluation for NDO were retrospectively collected between 1 January 2017 and 31 June 2019. Primary outcome was Bayley Scales of Infant and Toddler Development 3rd Edition (Bayley-III) scores including cognitive, language, and motor scores. Secondary outcomes were neurodevelopmental impairments (NDIs) classified as the presence of any of cerebral palsy (CP), sensorineural/mixed hearing loss, visual impairment, and developmental delay with any Bayley-III score <85. Severe NDI (sNDI) was defined as presence of any of CP with a Gross Motor Function Classification Scale of 3, 4, or 5, requirement for hearing aids or cochlear implants, bilateral visual impairment or severe developmental delay with any Bayley-III score <70. RESULTS: LP, IVB, and IVB + LP groups included 32, 12, and 10 patients, respectively. Patent ductus arteriosus treatment rates were as 68.7, 75, and 90% in groups, respectively (p<.05 between LP and IVB + LP groups). Grades 3 and 4 intraventricular hemorrhage (IVH) was lower in LP group than IVB group (9.4% vs. 33.4%, p<.05) while IVB + LP group had no grades 3 and 4 IVH. Other neonatal characteristics were similar (p > .05). CP was in 50%, 28%, and 0% of LP, IVB, and IVB + LP groups (p<.05). There was no difference in median Bayley-III cognitive, language, and motor scores between groups (p > .05). Moderate and severe developmental delays were similar between groups (p > .05) whereas IVB group had more moderate cognitive delay; and more severe cognitive, language, and motor delay. NDI rate was not different (59.3%, 50%, and 40% in groups, p > .05). sNDI was highest in IVB group but not statistically significant (31.2, 41.7, and 10% in groups, p > .05). Multiple logistic regression analysis showed that ROP treatment type and grades 3 and 4 IVH did not have any significant effect on NDO (p > .05). Odds of NDI was not effected by ROP treatment type (p > .05). CONCLUSIONS: Patients treated with bevacizumab should be carefully monitored for neurodevelopmental problems, although the frequency of grades 3 and 4 IVH in the bevacizumab group is thought to contribute to higher rates of sNDI and Bayley-III score <70.

Early-auditory intervention in children with hearing loss and neurodevelopmental outcomes: cognitive, motor and language development.

BACKGROUND: To date, studies have mostly focused on the language outcome of early-auditory interventions including amplification for congenital hearing loss within the first 6 months. We aimed to examine the effect of early-auditory intervention in patients with congenital hearing loss on cognitive, motor and language outcomes, and determine the clinical variables that affect developmental outcomes. METHODS: The medical records of 104 patients were retrospectively reviewed. Children were evaluated by the Bayley Scales of Infant and Toddler Development, Third Edition. RESULTS: The median ages of confirmation of hearing loss, amplification, starting auditory-verbal intervention and cochlear implantation were 9, 10, 13 and 19 months, respectively. Of the patients, 26% received a hearingaid fitting ≤6 months of age. Fifty-one children (49%) had additional disabilities. The median cognitive, language and motor scores of children with no additional disabilities were 95 (65-115), 68 (47-103) and 97 (58- 130), respectively and children with early-auditory intervention (≤6 months) demonstrated higher cognitive, receptive and expressive language subscale scores than late-auditory intervention group (p < 0.05) whereas there was no significant difference in motor scores (p > 0.05). A significant negative correlation was found between additional disability and cognitive, language and motor outcomes (r=-0.78, r=-0.54 and r=-0.75, respectively p < 0.01). There was a significant negative correlation between language outcomes and the degree of hearing loss (r=-0.20, p < 0.05). Multiple regression analyses revealed that additional disability and early-auditory intervention showed a significant amount of variance in cognitive and language scores. The early intervention did not make a significant, independent contribution on motor outcomes whereas additional disability did. CONCLUSIONS: Presence of additional disability was the strongest significant variable on developmental outcomes in hearing-impaired children. In children with no additional disability, significantly better cognitive and language scores were associated with the early-auditory intervention. Motor skills were not affected by the early-auditory intervention.

Which Bayley-III cut-off values should be used in different developmental levels?

Background/aim: Latest version of Bayley Scales (Bayley-III) and its predecessor (BSID-II) are the most widely used standardized developmental tools in infancy and early childhood. Recent studies showed that Bayley-III scores were higher than BSID-II in 18­24 month-old and mostly premature infants. We aimed to evaluate the generalization of inflated scores of Bayley-III to children aged 6­42 months with different disease groups, and to find out which cut-off points should be used in Bayley-III to detect mild, moderate, and severe developmental delay according to BSID-II standard cut-off points. Materials and methods: Two hundred and fifty-five children aged 6­42 months with different diseases and developmental levels were administered both the Bayley-III and BSID-II in the same session between 15 November 2017 and 15 April 2018. Results: The mean Bayley-III Cognitive Composite (CC) and Cognitive Language Composite (CLC) scores were respectively 13.1 ± 9.1 and 8.6 ± 8 points higher than BSID-II Mental Development Index (MDI) scores (P < 0.001). The mean Bayley-III Motor Composite (MC) scores were 14.4 ± 10.5 points higher than BSID-II Psychomotor Developmental Index (PDI) scores (P < 0.001). Cognitive delay was found in 126 (49.4%) and 59 (23.1%) children according to BSID-II MDI and Bayley-III CC scores, respectively. Motor delay was found in 174 (69.3%) and 86 (34.3%) children according to the BSID-II PDI and Bayley-III MC scores, respectively. Children had less cognitive (48.6%) and motor delay (54.5%) according to Bayley-III scores. Bayley-III scores were significantly higher than BSID-II scores for all ages (P < 0.001). According to ROC analysis the cut-off scores for mild, moderate, and severe delay were 92.5, 83.2, and 71.2 for Bayley-III CLC; and 98.5, 86.5, and 74.5 for Bayley-III MC, respectively. Conclusion: Bayley-III scores should be interpreted carefully for all age ranges and different diagnosis. The risk for underestimation of developmental delays by Bayley-III should be kept in mind. Different Bayley-III cut-off scores should be used to define developmental delay levels.

Identification of candidate gene FAM183A and novel pathogenic variants in known genes: High genetic heterogeneity for autosomal recessive intellectual disability.

The etiology of intellectual disability (ID) is heterogeneous including a variety of genetic and environmental causes. Historically, most research has not focused on autosomal recessive ID (ARID), which is a significant cause of ID, particularly in areas where parental consanguinity is common. Identification of genetic causes allows for precision diagnosis and improved genetic counseling. We performed whole exome sequencing to 21 Turkish families, seven multiplex and 14 simplex, with nonsyndromic ID. Based on the presence of multiple affected siblings born to unaffected parents and/or shared ancestry, we consider all families as ARID. We revealed the underlying causative variants in seven families in MCPH1 (c.427dupA, p.T143Nfs*5), WDR62 (c.3406C>T, p.R1136*), ASPM (c.5219_5225delGAGGATA, p.R1740Tfs*7), RARS (c.1588A>G, p.T530A), CC2D1A (c.811delG, p.A271Pfs*30), TUSC3 (c.793C>T, p.Q265*) and ZNF335 (c.808C>T, p.R270C and c.3715C>A, p.Q1239K) previously linked with ARID. Besides ARID genes, in one family, affected male siblings were hemizygous for PQBP1 (c.459_462delAGAG, p.R153Sfs*41) and in one family the proband was female and heterozygous for X-chromosomal SLC9A6 (c.1631+1G>A) variant. Each of these variants, except for those in MCPH1 and PQBP1, have not been previously published. Additionally in one family, two affected children were homozygous for the c.377G>A (p.W126*) variant in the FAM183A, a gene not previously associated with ARID. No causative variants were found in the remaining 11 families. A wide variety of variants explain half of families with ARID. FAM183A is a promising novel candidate gene for ARID.

Evaluation of emergency department nursing services and patient satisfaction of services.

AIMS AND OBJECTIVES: To identify nursing services and assess patient satisfaction in patients who present to the emergency department. BACKGROUND: Emergency nursing care is a significant determinant of patient satisfaction. Patient satisfaction is often regarded as a reliable indicator of the quality of services provided in the emergency department. DESIGN: This is a descriptive study. METHODS: Eighty-four patients who presented to the university emergency department were included in the study. The study data were collected by the Patient Information Form and the Satisfaction Level Form. RESULTS: Emergency nursing services, including history taking, assessing vital signs, preparing the patient for an emergency intervention, oxygen therapy, drug delivery and blood-serum infusion were shown to be more commonly provided compared with other services such as counselling the patients and the relatives about their care or delivering educational and psychosocial services. However, 78·6% of the patients were satisfied with their nursing services. The highest satisfaction rates were observed in the following sub-dimensions of the Satisfaction Level Form: availability of the nurse (82·1%), behaviour of the nurse towards the patient (78·6%) and the frequency of nursing rounds (77·4%). CONCLUSIONS: The most common practices performed by nurses in the emergency department were physical nursing services. Patient satisfaction was mostly associated with the availability of nurses when they were needed. Our results suggest that in addition to the physical care, patients should also receive education and psychosocial care in the emergency department. RELEVANCE TO CLINICAL PRACTICE: We believe that this study will contribute to the awareness and understanding of principles and concepts of emergency nursing, extend the limits of nursing knowledge and abilities, and improve and maintain the quality of clinical nursing education and practice to train specialist nurses with high levels of understanding in ethical, intellectual, administrative, investigative and professional issues.

Bond strength and microleakage of self-adhesive and conventional fissure sealants.

The aim of this study was to compare the shear bond strengths (SBS), failure modes (adhesive, cohesive, or mixed), and marginal microleakage occurrence of conventional resin (CR)-based, glass ionomer (GI)-based, and self-adhesive resin (SAR)-based fissure sealants with or without prior phosphoric acid (PA) etching. Fifty extracted premolars were randomly and equally assigned into five groups -G1:PA+CR, G2:PA+GI, G3:GI, G4:PA+SAR, and G5:SAR. Prior PA etching significantly (p<0.05) increased the SBSs of sealants. Adhesive failure mainly occurred in teeth treated with SAR- or GI-based fissure sealants, and cohesive failure mainly occurred in PA-etched teeth. Microleakage occurrence differed significantly (p<0.05) among the five groups of treated teeth. We concluded that conditioning of a tooth's enamel surface is crucial to creating strong bonds and leak-free sealing between tooth and fissure sealant.