Do ethical views of end-of-life patients' family members impact organ donation decisions?

Background: The relatives of patients who decide to donate their loved one's organs experience dilemmas about organ donation and are affected by culture, religion, and individual views.Aim: The aim of this study was to determine the relationship between the ethical position and personal characteristics of the family members of the patients receiving end-of-life care and their thoughts about organ donation in Turkey.Research design and participants: The study was completed with 158 family members. For data collection, a personal information form and the Ethics Position Questionnaire were used.Ethical considerations: This study was obtained from the ethics committee of the faculty of medicine in Turkey. It was based on voluntary participation, informed consent, confidentiality, and anonymity.Results: All participants in the study shared the same faith and were Muslims. The idealism and relativism tendencies of the participants tended to be high. The number of children, the participants have, participants' status of waiting for an organ transplant, the view that the clergy and health personnel will increase interest in organ donation were identified as factors associated with idealism tendencies. Participants' status of having children, the number of children participants have, participants' status of organ transplant waiting, the view that the health personnel will increase interest in organ donation were identified as factors associated with relativism tendencies (p < 0.0.5).Conclusion: The results of this study demonstrated a relationship between participants' idealism and relativism tendencies, among those with a large number of children, waiting for organ donation, advocating for clergy guidance to increase organ donations, and believing healthcare professionals need not guide to increase organ donations. In light of this finding, it may be recommended to establish a multidisciplinary team, including healthcare professionals and clergy, and to inform the society with accurate information to increase the number of organ donations.

Does corneal epithelial thickness show the severity of psoriasis? SD-OCT study.

BACKGROUND: Previous studies have generally focused on dry eye test abnormalities and ocular involvements such as uveitis, and blepharitis in psoriasis. Psoriasis area severity index (PASI), which is used to assess psoriasis severity, is a time-consuming and complex tool. OBJECTIVE: To evaluate the relationship between disease severity and central corneal epithelial thickness (CCET) in psoriasis. METHODS: 175 eyes of 175 psoriasis patients and 57 eyes of 57 healthy individuals as a control group was included in this study. Psoriasis patients were divided into three subgroups according to PASI score as < 10 mild, 10‒20 moderate and > 20 severe. CCET was measured by spectral domain-optical coherence tomography (SD-OCT), and mean values were recorded. Mean CCET values were compared between the psoriasis groups and the control group. Additionally, the relationship between PASI score and CCET was examined. RESULTS: The mean CCET value was 58.06±3.1µm in the mild group, 60.10±5.0µm in the moderate group, 65.75±6.3µm in the severe group and 56.16±3.1µm in the control group. It was determined that the mean CCET value was significantly higher in all psoriasis groups compared to the control group (p<0.001). The mean CCET value was significantly higher in the moderate psoriasis group than in the mild psoriasis group (p=0.018), and in the severe psoriasis group compared to the moderate psoriasis group (p<0.001). There was a strong positive correlation between PASI score and CCET (p<0.001, r=0.519). STUDY LIMITATIONS: Cross-sectional design and a relatively small number of participants. CONCLUSIONS: There is a strong positive correlation between psoriasis severity and CCET. Contactless measurement of CCET by SD-OCT can be an indicator of psoriasis severity.

The Concept of a Good Death from the Perspectives of Nurses Caring for Patients Diagnosed with COVID-19 in Intensive Care Unit.

We have witnessed increasing numbers of cases of COVID-19 and associated deaths worldwide. Therefore, the purpose of this descriptive and cross-sectional study was to determine the perception of a good death and the factors contributing to it by nurses caring for patients diagnosed with COVID-19 in the intensive care unit (ICU). It was carried out with nurses caring for patients diagnosed with COVID-19 in the ICU (n = 369). Data were collected using a questionnaire and the Good Death Scale. The mean score of the participants scale was 56.84 ± 7.51. In this study, nurses have seen as important statements that include "ensuring a peaceful death", "being with their loved ones", "meeting a person's spiritual needs", and "having an opportunity to say goodbye" for the good death. The factors contributing to the perception of a good death were gender, marital status, and feeling sad when caring for a dying patient (p < .05).

Does corneal epithelial thickness show the severity of psoriasis? SD-OCT study

Abstract Background Previous studies have generally focused on dry eye test abnormalities and ocular involvements such as uveitis, and blepharitis in psoriasis. Psoriasis area severity ındex (PASI), which is used to assess psoriasis severity, is a time-consuming and complex tool. Objective To evaluate the relationship between disease severity and central corneal epithelial thickness (CCET) in psoriasis. Methods 175 eyes of 175 psoriasis patients and 57 eyes of 57 healthy individuals as a control group was included in this study. Psoriasis patients were divided into three subgroups according to PASI score as < 10 mild, 10‒20 moderate and > 20 severe. CCET was measured by spectral domain-optical coherence tomography (SD-OCT), and mean values were recorded. Mean CCET values were compared between the psoriasis groups and the control group. Additionally, the relationship between PASI score and CCET was examined. Results The mean CCET value was 58.06 ± 3.1 μm in the mild group, 60.10 ± 5.0 μm in the moderate group, 65.75 ± 6.3 μm in the severe group and 56.16 ± 3.1 μm in the control group. It was determined that the mean CCET value was significantly higher in all psoriasis groups compared to the control group (p < 0.001). The mean CCET value was significantly higher in the moderate psoriasis group than in the mild psoriasis group (p = 0.018), and in the severe psoriasis group compared to the moderate psoriasis group (p < 0.001). There was a strong positive correlation between PASI score and CCET (p < 0.001, r = 0.519). Study limitations Cross-sectional design and a relatively small number of participants. Conclusions There is a strong positive correlation between psoriasis severity and CCET. Contactless measurement of CCET by SD-OCT can be an indicator of psoriasis severity.

Predictors of Quality of Life in Adults and Adolescents with Acne: A Cross-Sectional Study.

Background: Acne is becoming more prevalent in adults, particularly women across the globe. Although previous studies have compared clinical and epidemiologic characteristics of adolescent and adult acne, an adequate understanding of the quality of life (QoL) of adult acne patients and associated comorbidities are still lacking. Objectives: We sought to compare the differences between adolescent and adult patient groups, regarding gender, socio-clinico-demographic factors, and comorbid associations, as well as their relatedness with life quality. Methods: This is a cross-sectional study with 1013 acne patients. Data on the severity, onset and location of acne, sex, family history of acne, smoking and alcohol habits, medication history, presence of seborrhea, and other comorbidities were collected. We employed the classification used by the American Academy of Dermatology for assessing acne severity. To assess the QoL in the patients, the Dermatology Life Quality Index (DLQI) score was used. Results: Of the 1013 patients included in this study; 380 (female: 333, male: 47) were adult, and 633 (female: 535 and male: 98) were adolescent cases. The median total DLQI scores of adult and adolescent groups were not significantly different. Our results showed that factors such as age, gender, duration, body mass index, family history, and psychiatric disorders exhibited no impact on QoL in both adolescents and adults. Age of onset was correlated with DLQI scores in the adult group. The main influencers of DLQI in the adult group were allergic disorders, hormonal imbalances, and previous treatment history. Besides, major influencers in adolescent patients were acne severity, acne location, hirsutism, hyperseborrhea, premenstrual exacerbation, menstrual irregularities, previous treatment history, and smoking. Conclusions: The findings of our current study have shown that DLQI has been influenced by different factors in adolescents and adults that should be kept in mind.

Examining effects of the flipped classroom approach on motivation, learning strategies, urinary system knowledge, and urinary catheterization skills of first-year nursing students.

AIM: In nursing education, innovative approaches are crucial to enhancing students' competence and preparing them to respond to the complex healthcare needs of society. The aim of the current study was to compare the efficacy of the flipped classroom and traditional educational approaches on the acquisition of urinary system knowledge and skill level, and on the motivation and learning strategies of first-year nursing students. METHODS: This study was implemented with a single blind and randomized controlled design in the nursing department of a university's faculty of health sciences between December 2018 and December 2019, with 94 first-year undergraduate nursing students (47 in the experimental group adopting a flipped classroom approach, 47 students in the traditional approach control group). The study was conducted over pre-test and posttest phases for both groups. RESULTS: The experimental group had higher mean scores than the controls in intrinsic goal orientation, task value, self-efficacy, rehearsal, elaboration, and organization and effort regulation, but lower scores in test anxiety (p < 0.001). The theoretical and skill exam scores of the experimental group were higher than those of the control group (p < 0.001). CONCLUSION: The flipped classroom approach was effective for improving urinary system knowledge and skill level, and for the motivation and learning strategies of nursing students. This innovative education approach can be recommended as a student-centered method in nursing education for teaching theoretical knowledge and evidence-based practices.

Chronologic improvement in hair yield with follicular unit excision with changes in punch devices: A 10-year experience of a single center.

Follicular unit excision (FUE), which is a newer hair transplant procedure was thought to be only usable in limited areas at the beginning. However, it is the most preferred technique these days. It is known transection rates have decreased with punch technology (and experience) over the years. We analyzed the data from so-so many male patients who underwent hair transplantation by FUE method at our clinic retrospectively to elucidate how the development of punch technology affected the number of total grafts and FU containing multiple hairs. Between the years 2011 and 2020, male hair transplant patients operated with the FUE method at the author's dermatology clinic, was investigated retrospectively. Overall 1415 cases were included in the study. Total graft numbers and 1-4 hair FUs were calculated. There was a statistically significant difference in terms of number of total grafts, one hair follicular unit (I FU) three hair follicular unit (III FU) distributions according to operation year and punch type (p < 0.05). The serrated punch resulted in a significant increase in the numbers of total grafts and the trumpet punch resulted in a significant increase in the number of 3FU grafts. Our study has shown that hair yield has been increased with new punch technologies. With an increasing hair yield by the aid of evolving punch technology, hair transplantation with the FUE method has become the first choice for hair transplantation preferred by both doctors and patients.

The Concept of a Good Death From the Perspectives of Family Caregivers of Advanced Cancer Patients.

This study was conducted to examine the importance of the concept of a good death and the contributing factors from the perspectives of family caregivers of advanced cancer patients. This descriptive and cross-sectional study, conducted with 182 family caregivers, were collected using a questionnaire form and the "Good Death Scale". The number and percentage distribution, multiple linear regression were used evaluation of data. The total score of the Good Death Scale was 62.65 ± 4.60. The factors contributing to the importance of the concept of a good death were determined as the presence of chronic disease; the type of treatment given to the patient; the presence of another family member who was previously diagnosed with cancer; the presence of a family member who has died of cancer and previously caregiving to a terminally ill family member. This study revealed that the concept of a good death is seen as very important.

Analysis of 3702 patients with acne vulgaris and concomitant comorbidities in Turkey: a multi-centered, prospective, controlled study.

BACKGROUND: Acne vulgaris is a chronic inflammatory skin disease that affects the pilosebaceous unit. Although it is considered to be a skin-limited disease, different clinical studies have recently been published in which the disease is accompanied by systemic symptoms. In this study, systemic comorbidities accompanying acne vulgaris and the relationship between existing comorbidities and disease severity are investigated. METHODS: This prospective multicenter study was conducted by the Turkish Society of Dermatology Acne Study Group. Twelve dermatology clinics and 14 clinicians throughout Turkey participated in the study. A structured physician-administered questionnaire was used to collect patient demographics, clinical findings, and lifestyle data. Physicians recorded each participant's medical history, including current and past comorbidities, duration of any comorbidity, smoking, and drinking. Body mass index (BMI) was calculated. RESULTS: There were 3022 patients in the adolescent acne group and 897 in the control group. The incidence of nonmigraine headache in adolescents with acne was significantly higher than in the nonacne group (P = 0.019). There were 680 patients in the postadolescent acne group and 545 in the control group. In the postadolescent group, incidence of metabolic disease was lower than the control group (P = 0.003). In the postadolescent group, premenstrual syndrome (P < 0.001) and PCOS (P = 0.007) were more common than the control group. CONCLUSIONS: In this study, we observed that acne vulgaris does not cause systemic comorbidities. There is also a need for new studies involving a large number of patients to illuminate systemic diseases accompanying acne vulgaris.

Correlation study between clinical classification and disability index in a holistic evaluation of acne severity and impact in Turkey.

BACKGROUND: This study provides a comparison between disease severity observed by inspectors and the disease burden assessed by patients is scanty in acne study. METHODS: In a multicenter prospective hospital-based study, modified Comprehensive Acne Severity Scale (mCASS) and Cardiff Acne Disability Index (CADI) were employed to grade disease severity and to determine the quality of life, respectively. The average of the mCASS and CADI scores, with range at 0-25, was termed as Acne Severity and Impact Grading System (ASIG). RESULTS: In 1331 evaluated patients (mean: 21,51±4,93 years), including 306 men and 1025 women, an overall significant, positive correlation was found between ASIG and mCASS (r=0.862), or CADI (r=0.686), respectively (P=0.001 each). Adult women with back acne and adolescent with décolleté expressed greater concern (higher CADI) than the clinical severity (lower mCASS). The overall prevalence of acne in décolleté area, including neck, was 32.3%. CONCLUSIONS: Discrepancies in the acne severity between self-perception and objective evaluation exist in certain subgroups of patients. Décolleté acne deserves special attention in clinical assessment.

Psoriasis affects self-perception of stress negatively: A prospective, case-control study.

Although stress has been considered a contributor in the development and exacerbation of psoriasis, few prospective studies have presented evaluations of the association between stress and psoriasis. The aim of this study was to evaluate the perceived stress, depression, and anxiety profiles in patients with psoriasis. A total of 195 patients with psoriasis and 114 healthy controls were enrolled in the study. The severity of psoriasis was assessed by a single dermatologist using the body surface area and the Physician Global Assessment (PGA). The questionnaires of Dermatology Life Quality Index, the Perceived Stress Scale, the Beck Depression Inventory, and the Beck Anxiety Inventory were obtained. The PSS scores were significantly higher in the psoriasis group than in the control group (25.14 ± 8.67 vs 23.0 ± 6.93, P < .001, respectively). The PSS subscales for perceived self-efficacy (PSE) were significantly higher in patients with psoriasis than in the control group (P = .034). The PSE scores were positively correlated with PGA values (r: .170, P = .017). The present study supports the role of stress in psoriasis. We believe that the identification and management of stress in patients with psoriasis will help improve treatment strategies.

Acne in pregnancy: A prospective multicenter, cross-sectional study of 295 patients in Turkey.

BACKGROUND: There are only a few studies on acne in pregnancy. This study was aimed to investigate the demographic, clinical, and familial characteristics of acne in pregnancy, triggering factors including endocrine diseases, and association of these findings with acne in different trimesters of pregnancy. METHODS: Pregnant women aged 18 years and older with acne at any stage of pregnancy were consecutively interviewed at the participating centers during the study period from 2016 to 2019. Acne severity was evaluated using the Comprehensive Acne Severity Scale. RESULTS: A total of 295 pregnant women with acne were included, with 167 (56.6%) patients showing mild, 87 (29.5%) moderate, six (12.2%) severe, and five (1.7%) very severe acne. Truncal acne was significantly higher in the third trimester than in the other stages (P < 0.001). Onset of acne before pregnancy, prepubertal, pubertal or adult onset, or acne history in previous pregnancies did not influence acne severity in pregnancy. Women with irregular menstruation before pregnancy, polycystic ovary syndrome, hirsutism, and higher body weight index tended to show severe acne in pregnancy. CONCLUSIONS: Severe acne during pregnancy is generally uncommon, while severity of facial acne, truncal acne, and hirsutism is higher in the third trimester than in other trimesters. Acne in pregnancy shares many characteristics with female adult acne. Substantial changes in different kinds of hormones play a more complex role in acne during pregnancy, but the pathogenesis remains to be determined.

Follicular unit extraction as a valuable method for the restoration of beard: Retrospective case series study.

BACKGROUND: Beard and mustache are important components of body image. Beard transplantation is the procedure to restore congenital absence or inefficient growth of beard and mustache. OBJECTIVES: The aim of the study is to report our results and experience in beard transplantation. METHODS: Patients with a demand for beard restoration who were treated with follicular unit extraction (FUE) hair transplantation method were included in this retrospective, case series study. Patients' birth date, race, presence of eunuchoidism, hair color, type and shaft thickness, and treatment details were retrieved from medical records. Patients were evaluated at least one year after the operation, and defect closure rates were calculated. At the follow-up examination, patients were asked to evaluate their satisfaction from the procedure. RESULTS: Ten patients were consecutively treated between May 2007 and June 2016. The mean age of the patients was 29.6 years. Three of our patients were eunuchoid and the others wanted beard transplantation to have a more masculine look. Follow-up period was median of 39 months. Four patients were satisfied and four patients were very satisfied with the procedure with a mean 53% closure rate. Better closure rates were associated with brown and red hair color, medium and fine hair thickness, and absence of eunuchoidism. Patients with straight hair were satisfied with the procedure significantly. CONCLUSION: Beard reconstruction by using the FUE method is a safe and effective method with high patient satisfaction rates.

Efficacy of high-intensity focused ultrasound in facial and neck rejuvenation.

BACKGROUND: High-intensity focused ultrasound (HIFU) has recently been introduced in the treatment of facial wrinkles and laxity. OBJECTIVE: The purpose of the study was to evaluate efficacy and safety of HIFU in facial and neck rejuvenation. METHODS: High-intensity focused ultrasound treatment was performed on face and neck by using two different probes with focal depth of 3 mm and 4.5 mm. Two independent, blinded clinicians evaluated the clinical improvement at 3 months after treatment. The patients also scored their satisfaction with the treatment. Adverse effects were assessed up to 3 months post-treatment. RESULTS: Seventy-five patients (73 female, 2 male) with Fitzpatrick skin phototypes 2-4 were enrolled in the study. After treatment, improvement in nasolabial, jawline, submental, and neck areas was separately evaluated. The rate of improvement in each area was more than 80% according to the physicians' assessment, while patients' satisfaction degree in each area was over 78%. Most common adverse effect was pain, reported in 25.3% of the patients during the procedure while transient erythema was reported in 6.7%. Both resolved spontaneously after the procedure. Only one patient complained development of numbness on right mandibular region which resolved spontaneously within 10 days. CONCLUSION: High-intensity focused ultrasound can be an effective noninvasive treatment modality in facial and neck rejuvenation with an acceptable safety profile.

Use of combined fractional carbon dioxide laser and fractional microneedle radiofrequency for the treatment of acne scars: A retrospective analysis of 1-month treatment outcome on scar severity and patient satisfaction.

BACKGROUND: Acne scars lead to social and psychological problems for patients, and they should be treated effectively. Ablative and nonablative lasers have been used for the treatment of acne scars in recent years. AIMS: The aim of this study was to evaluate the effectivity of combined FCL and FmRF treatment for acne scars retrospectively. METHODS: A total of 72 patients with acne scars who received FCL + FmRF treatment between 2014 and 2016 were included in this study. Photographs of patients before treatment and 1 month following the last treatment session were scored by two blinded researchers, according to the ECCA acne scar scoring method. Patients were contacted via telephone after 1 month following the last treatment and asked to evaluate their satisfaction with the treatment outcome using a 5-point Likert-type scale. RESULTS: A significant decrease was noted in ECCA scores after the treatment along with temporary side effects. Change from pretreatment scores was significantly higher in patients very satisfied vs satisfied with treatment. The number of treatment sessions was positively correlated with treatment-related change in ECCA scores. CONCLUSIONS: In conclusion, our findings revealed association of FCL + FmRF treatment with significantly improved ECCA scores, mild pain experience, and low rate of side effects in patients with acne scars, despite usage of high-energy FLC dose and five sessions of treatment on average. More remarkable improvement in ECCA scores during treatment seems to be associated with higher patient satisfaction and to be more likely in patients with darker skin types.

Topical polyphenol treatment of sacrococcygeal pilonidal sinus disease: use of ultrasonography to evaluate response to treatment - clinical case series study.

INTRODUCTION: Sacrococcygeal pilonidal sinus disease (SPSD) is a common disorder and encountered more frequently in hairy young males after puberty. AIM: To assess effectiveness of topical polyphenol treatment of SPSD by using physical examination and ultrasonography (USG). MATERIAL AND METHODS: Fourteen patients with SPSD diagnosis were treated by natural polyphenol products and were retrospectively included in this study. All of the patients were assessed by superficial ultrasonography before and after treatment. Demographic and clinical information of the patients was obtained from medical records. RESULTS: Patients were aged 18-45 years and the median disease duration was 2 years. The most common findings in physical examination were sinus openings and subcutaneous nodules and the most common ultrasonographic findings were abscess/cyst formation and presence of fistula at the pre-treatment visit. All of the patients applied topical polyphenols for a median period of 3 months. Topical polyphenol treatment was effective in 92.9% of patients. Follow-up examinations at 18.3 months post-treatment revealed that 12 (85.7%) patients were free of disease. Control physical examination and ultrasonographic assessment were completely normal in 11 (78.6%) patients. CONCLUSIONS: Topical polyphenol therapy is a promising alternative treatment for SPSD and its effectiveness can be objectively evaluated by ultrasonography. It is advised that topical polyphenols should be tried first in every young and active patient with SPSD. Majority of these patients can avoid demanding and expensive alternative treatment methods such as complex surgical procedures. This topical therapy method makes surgical SPSD a dermatologically treatable disease.

The relationship between death anxiety and attitudes toward the care of dying patient in nursing students.

In order to provide dying individuals with the necessary care, firstly nurses and nursing students should be aware of their own emotions regarding death. The aim of this research is to determine the relationship between death anxiety and attitudes toward the care of dying patient in nursing students. This study planned as a descriptive was carried out 376 students who were educated in the first, second, third and fourth grades of the nursing department of faculty of health sciences of a university in Turkey. Data were collected with 'Death Anxiety Scale' and 'Frommelt Attitude Toward Care of the Dying Scale (FATCOD-Form B)'. The students' mean score on the death anxiety scale was 32.98 ± 15.01 and their mean score on the Frommelt Attitude Toward Care of the Dying Scale was 105.09 ± 9.42. The level of death anxiety is different in gender and the classes. Also, it is inversely related to the attitude toward the care of the dying patients. It is important to reduce death anxiety in order to increase positive attitudes toward the care of the dying patient.