Evaluation of Pain During Endotracheal Aspiration in Intensive Care Patients Diagnosed with COVID-19.

BACKGROUND: Endotracheal aspiration, a procedure that is particularly painful for intensive care patients, has received little attention in terms of pain evaluation specifically among intubated patients with COVID-19 in intensive care. AIM: The study aims to assess the level of pain experienced by intubated intensive care patients diagnosed with COVID-19 during an endotracheal aspiration procedure. METHOD: The study population was composed of patients admitted to the COVID-19 intensive care unit of the specified hospital between February and March 2021. Of the 56 patients admitted during that period, 47 were contacted and participated in the study. These 47 intubated and sedated patients were evaluated for 94 different expressions of pain during endotracheal aspiration twice a day before and during the procedure. Data were collected using the patient descriptive information form, the Non-Verbal Pain Scale for adults and data observation record form. RESULTS: In the study, pain behavior was observed in 54.2% (n = 51) of the 94 observations. The patients were found to experience mild pain with an average score of 3.6 ± 1.07 on the Non-Verbal Pain Scale. The mean pain score before the procedure was found to be significantly different from the mean pain score during the procedure (p < .05), with an increase in pain during the procedure. During the procedure, 33.3% (n = 17) of the patients had a 10% decreased SpO2, and 29.4% (n = 15) had an increase in systolic blood pressure (>20), pulse (>20), and respiration (>10). Additionally, 21.5% (n = 11) of the patients experienced severe incompatibility with the ventilator, and 15.68% had muscle tension. CONCLUSIONS: The study findings showed that nonverbal pain scores of sedated and intubated intensive care patients diagnosed with COVID-19 increased during endotracheal aspiration, accompanied by physiologic pain indicators. Effective pain management should be a priority for nurses. It is important to remember that patients with COVID-19 in the intensive care unit may experience pain while sedated and intubated. A holistic approach should be adopted for the evaluation and relief of pain in these patients. Intensive care nurses should consider physiologic and nonverbal behavioral pain indicators when evaluating pain in patients diagnosed with COVID-19.

Elderly patients and falls: a systematic review and meta-analysis.

OBJECTIVE: The predetermination of the risk for falls in elderly patients, who will have or had a surgery, enables one to carry out the protective/preventive interventions on this matter. The aim of this review was to provide an up-to-date meta-analysis with regard to falls in elderly surgical patients. MATERIALS AND METHODS: The studies, which were carried out on elderly patients between January 2009 and November 2019 and which investigated the risk factors for falls in elderly surgical patients, were screened on the databases of Google Scholar, Pubmed, Ovid, Cinahl through various combinations of keywords, such as "geriatrics", "aged", "surgery", "accidental falls" in English or Turkish, to determine the risk factors for the falls in elderly surgical patients. RESULTS: Meeting the study inclusion criteria, 18 studies were analyzed. Of these studies, three were retrospective, seven descriptive, two case-control, four cross-sectional, and two prospective. The kappa value of the general rate of agreement was found as 0.84. No publication bias found in the studies included (Kendall's tau b = 0.31; p = 0.07) in the meta-analysis based on the values calculated. CONCLUSION: In this meta-analysis, it was determined that the falls in elderly surgical patients were quite a prevalent public health problem, that the presence of chronic diseases and previous history of falls constituted an extremely high risk for the falls in elderly patients, and that the age or the presence of a gait-inhibiting condition did not constitute any risk for the falls in elderly patients.

The effect of comorbidity on mortality in elderly patients undergoing emergency abdominal surgery: a systematic review and metaanalysis

Background/aim: With the increase in the elderly population, the elderly proportion needing emergency surgery is also increasing. Despite medical advances in surgery and anesthesia, negative postoperative outcomes and high mortality rates are still present in elderly patients undergoing emergency surgery. Comorbidities are described as the main determining factors in poor outcomes. In this metaanalysis, it was aimed to investigate the effect of comorbidity on mortality in elderly patients undergoing emergency abdominal surgery. Materials and methods: The studies published between 2010-2019 were scanned from databases of Google Scholar, Cinahl, Pub Med, Medline and Web of Science. Quality criteria proposed by Polit and Beck were used in the evaluation of the included studies. Interrater agreement was calculated by using the Kappa statistic, effect size by using the odds ratio, and heterogeneity among studies by using the Cochran's Q statistics. Kendall's Tau-b coefficient and funnel plot were used to determine publication bias. Results: A total of 9 studies were included in the research. There was a total of 1330 cases in the studies. The total mortality rate was 21% (n = 279), the total rate of having a comorbid factor was 83.6% (n = 1112), and the rate of having a comorbid factor in mortality was 89.2% (n = 249). According to the fixed effects model, the total effect size of comorbid factors on causing mortality was not statistically significant with a value of 1.296 (C.I; 0.84-1.97; P > 0.05). Conclusion: Our study revealed that comorbidity had no significant effect on causing mortality in geriatric patients undergoing emergency abdominal surgery. There are controversial results in the literature, and in order to reach more precise results, studies involving wider groups of patients and further studies examining the specific effect of certain comorbid conditions are needed.

Comparison of case and control groups in terms of postoperative complications, outcomes, and survival in total hip arthroplasty patients with and without COVID-19.

Introduction: Total hip aarthroplasty (THA) is not performed worldwide as an emergency surgical procedure and has often been postponed during the COVID-19 pandemic. The hypothesis of this study was that COVID-19 caused the extra burden and mortality of THA patients. This study aimed to investigate the problems caused by comorbid COVID-19 in addition to the current clinical status in patients who had undergone THA. Materials and methods: A case-control group study was conducted with the participation of patients with COVID-19 and without COVID-19 who had undergone THA and were hospitalized in an orthopedic clinic and intensive care unit at a research and training hospital. IBM Statistical Package for Social Sciences 25.0 was used for data analysis. Results: A total of 291 patients who had undergone THA were included in the study: 161 patients with COVID-19 constituted the control group and 130 patients without COVID-19 constituted the case group. In this study, the authors found that THA patients with COVID-19 had higher rates of nausea, vomiting, diarrhea, musculo-articular pain, and headache compared to those without COVID-19, and the difference was statistically significant (p < 0.01); 17.7% of the patients with COVID-19 died, and delirium developed in 35.4%. The difference between the case and the control groups was statistically significant in terms of delirium and death (p < 0.01). Discussion: COVID-19 increases the risk of delirium and death in THA patients, as well as extending the hospital stay. The fact that the pandemic is not over yet and that despite vaccination, COVID-19 continues to have its devastating effects experienced, especially by individuals in their advanced age.

Prevalence of pain in adult population in Türkiye.

vObjectives: The aim of this study is to determine the incidence and characteristics of pain in adults in Türkiye. METHODS: This cross-sectional study was carried out with 1391 participants in 28 provinces spread across seven demographic regions of Türkiye, between February 1 and March 31, 2021. The data were collected through the introductory and pain assessment information form prepared by the researchers and the online Google forms. SPSS 25.0 statistical program was used for data analysis. RESULTS: As a result of the analysis of the data obtained, it was found that the average age of the participants included in the study was 40.83±7.78 years, education level was 70.4% at most, and 80.9% was female at most. It was determined that 58.1% lived in the Marmara region and 41.8% lived in Istanbul, and 41.2% were private sector employees. It was determined that the pain prevalence of adults in Türkiye was 80.84% and 79.07% of them had pain in the last year. It was determined that the region with the most pain was the head and neck region with 37.88%. CONCLUSION: According to the results of the research, the prevalence of adult pain is quite high in Türkiye. Despite the high prevalence of pain, the rate of preference for drug therapy to relieve pain is low and the preference for non-drug treatment methods is high.

The effect of adherence to immunosuppressant therapy on gastrointestinal complications after liver transplantation.

AIM: In our study, we examined the relationship between gastrointestinal system problems and adherence to immunosuppressant therapy after liver transplantation. METHOD: We performed this study as descriptive and cross-sectional research with the participation of liver transplant recipients. In the data collection, we used the Personal Information Form, the Gastrointestinal Symptom Rating Scale, and the Immunosuppressant Therapy Adherence Scale. In the data analysis, we utilized the IBM Statistical Package for Social Science 25.0. FINDINGS: In our study, it was discerned that, of all liver transplant recipients (n = 331), 45.9% were aged 45-64 years, 77.3% were male, and 93.4% were married. Besides, 36.9% of liver transplant recipients were utilizing immunosuppressive agents for 1 month - 89 days. Next, it was identified that liver transplant recipients mostly used tacrolimus (67.4%), mycophenolate mofetil (65.6%), and prednisolone (76.7%). It was found that tacrolimus, mycophenolate mofetil, biological agents, and other immunosuppressants were associated with the development of gastrointestinal system problems. CONCLUSION: The management of gastrointestinal system disorders is extremely importance to ensure that liver transplant recipients can adhere to immunosuppressant therapy. The awareness of liver transplant recipients about gastrointestinal system disorders and complications should be increased and their management should be assisted.

The Effect of Environmental Stressors on Patient Experience in Medical, Surgical, and COVID-19 Intensive Care Unit.

This study was conducted to evaluate the effects of environmental stressors on patients' intensive care experiences in medical, surgical, and COVID-19 intensive care units (ICUs). The sample group consisted of 231 patients hospitalized in medical and surgical ICUs and agreed to participate in the study. The data analysis was performed with IBM SPSS Statistics 25. The average age of the patients was 53.67 ± 13.3, 55.4% were male, 47.6% were high school graduates, and 45.5% were followed up in the COVID-19 ICU. It was also found that there was a negative and moderate degree of correlation between the Intensive Care Experience Scale (ICES) and the Intensive Care Unit Environmental Stressors Scale (ICUESS). Environmental stressors in ICUs are associated with patient experiences. It is clear that ICU stressors create a negative perception in the patient and this situation is emotionally exhausting.

Validity and Reliability Study of the Turkish Form of Post-Discharge Surgical Recovery Scale.

AIM: This study was carried out to adapt the "Post-Discharge Surgical Recovery Scale " developed by Kleinbeck into Turkish and analyze the scale's validity and reliability. METHODS: The study sample consisted of 343 patients who underwent surgery in a state hospital operating in the province of Diyarbakir, in the province of Istanbul. The sample consisted of 271 people due to voluntary participation and reasons for not being able to reach. This research, which is of methodological type, was carried out between April and July 2019. The Individual Information Form and the Post-Discharge Surgical Recovery Scale, which the researchers developed by scanning the literature, were used to collect the data. In the validity and reliability study of the scale; Linguistic equivalence, content validity for expert assessment, the correlation between items for internal consistency/reliability, and calculating Cronbach alpha values and confirmatory and exploratory factor analyzes were performed for construct validity. IBM SPSS Statistics 25 and IBM SPSS Amos 21 programs were used for statistical evaluation of the data. RESULTS: It was determined that the content validity index of the scale was 0.96, the correlation values between the items were r=0.47-0.97, the explained variance was 75.238%, and it was gathered under a single factor. The general reliability of the scale is very high as alpha=0.975. In the confirmatory factor analysis for the scale, the fit indices of the scale were CFI = 0.76; NNFI = 0.93; It was determined that RMR =0.11 and RMSEA = 0.13, AGFI=0.69, GFI=0.77. CONCLUSION: The research results suggest that the Turkish version of the "Post-Discharge Surgical Scale" is a valid and reliable measurement tool and can be used in scientific research and health care institutions to measure recovery post discharge.

Evaluation of Postoperative Delirium: Validity and Reliability of the Nursing Delirium Screening Scale in the Turkish Language.

PURPOSE: Postoperative delirium is the most well-known form of postoperative cognitive impairment in all patient groups, especially in the elderly. Delirium is a syndrome that causes serious consequences, increasing mortality and morbidity rates and extending the length of hospital stay. The aim of this study was to evaluate the validity and reliability of the Turkish version of the Nursing Delirium Screening Scale (Nu-DESC). METHOD: One hundred twelve patients who were hospitalized for a surgical operation in the orthopedics, neurosurgery, and general surgery clinic of a state hospital for 3 months were evaluated concurrently (and independently for delirium). Patients were observed by clinical nurses 3 times over a 24-h period. The presence of delirium was diagnosed by 2 neurologists according to DSM-IV criteria. Student's t test, the χ2 test, and the Mann-Whitney U test were used, and construct validity, intrascale factor analysis, interrater reliability, and specificity and sensitivity (ROC) analyses were performed for descriptive analysis. SPSS 25.0 and MedCalc18.6 were used for statistical analysis. RESULTS: Delirium was detected in 28 patients according to the Nu-DESC. The ICC (intraclass correlation) is 0.97 in the 95% confidence interval from 0.96 to 0.98 for agreement between nurses and neurologists for the total Nu-DESC score. Weighted κ rates were between 0.78 and 0.92. In the ROC analysis of the Nu-DESC scale, the optimum cutoff value calculated for the 1,344 observations and 112 patients was determined as >1 according to the maximum sensitivity and the specific situation. Sensitivity at the cut-off point was 92.27; specificity was determined as 92.72. The Youden index was found to be J = 0.845 (0 < J = 0.845 < 1). CONCLUSION: We believe that Turkish translation of Nu-DESC is valid and reliable for clinicians, nurses, and researchers and will contribute to delirium studies.

An examination of the effect of loneliness on the innovative behavior of health science faculty students.

BACKGROUND: Contributing to the innovative behavior of individuals in the health management process is a desirable condition for increased health institution performance. The relationship between the sense of loneliness and individual innovation behaviors has not been studied and relevant literature is extremely limited. The purpose of this research was to examine the effect of an individual's sense of loneliness on their innovative behavior. METHODS: The research was performed between January and October 2018. The effects of loneliness feelings on the individual innovative behaviors of 451 health science faculty students were measured. The data were collected using the "Individual Information Form," the "individual innovation scale," and the "University of California Los Angeles loneliness scale." The reliability and validity of the scales were tested with Structural Equation Modeling. RESULTS: It was found that the female participants showed exhibited more innovative behavior than the men. However, there was no significant difference in the loneliness status of participants by gender. A group of 23-year-old individuals showed a significant difference in the risk taking dimension compared to other age groups. First-grade students had more points in the experimental openness and opinion leadership sub-dimension than the other classes. It was observed that the behavior is molded as the education level increases. The regression models showed that loneliness has a negative effect of -0.254 on experiential openness and the leadership of ideas, and has a negative effect of -0.216 on risk taking. There was no effect of the sub-dimensions of loneliness on change resistance. Moreover, on the individualistic behavior of physical loneliness, a -0.267 negative effect was observed. Emotional loneliness has no effect on the sub-dimensions of individual innovation. Finally, the total sense of loneliness was found to have a negative effect on total individual innovation. CONCLUSIONS: The study results clearly show that physical loneliness has a negative effect on individual innovation. It can be said that individuals living in social environments exhibit more innovative behaviors. However, emotional loneliness has no significant effect on innovative behavior. In this context, designing social spaces in health institutions will stimulate individuals' innovative behaviors.