Comparison of mismatch repair and immune checkpoint protein profile with histopathological parameters in pancreatic, periampullary/ampullary, and choledochal adenocarcinomas.

BACKGROUND: Pancreatic, periampullary/ampullary, and choledochal adenocarcinomas are aggressive malignancies with a poor prognosis. Immune checkpoint blockade is a promising treatment option for several tumor types. H long terminal repeat-associating 2 (HHLA2), which is analogous to programmed death-ligand 1 (PD-L1), is a recently discovered member of the B7/cluster of differentiation 28 family and is expressed in many malignancies. AIM: To analyze the expression of HHLA2 and its association with the pathologic biomarkers that predict sensitivity to immunotherapy. METHODS: Ninety-two adenocarcinoma cases located in the pancreas, ampulla, and distal common bile duct were identified. This study assessed 106 pancreaticoduodenectomy and distal/total pancreatectomy samples that were delivered to Ankara City Hospital between 2019 and 2021. Immunohistochemistry was conducted to examine the expression of DNA mismatch repair (MMR), PD-L1, and HHLA2 proteins. RESULTS: Patients with high HHLA2 expression had a higher mean age than those with low expression. Low HHLA2 expression was associated with high perineural invasion. HHLA2 expression was low in pathological stage T3 (pT) 3 cases and high in pathological stage T1, T2, and T4 cases. There was no correlation between HHLA2 expression and the expression of MMR proteins and PD-L1. CONCLUSION: Evaluation of HHLA2 expression in microsatellite stable and PD-L1-negative tumors may be useful for predicting the response of individuals to immunotherapy and may serve as a novel therapeutic target for immunotherapy in advanced-stage disease.

Effects of peritraumatic reactions on post-traumatic stress among Kahramanmaras earthquake survivors.

PURPOSE: Peritraumatic reactions play a crucial role in the development of mental health problems, including depression and post-traumatic stress disorder. Therefore, this study sought to examine the influence of the peritraumatic reactions, including peritraumatic dissociation, peritraumatic distress, mental defeat, and tonic immobility, on post-traumatic stress disorder and major depressive disorder in earthquake survivors. MATERIALS AND METHODS: A total of 261 adult participants aged between 18 and 65 (Mage=29.20, SD = 28.06, 162 were female, and 99 were male) who were exposed to the Kahramanmaras earthquake in February 2023 were recruited in the study. Data were collected between April 10 and 18 2023, two months after the earthquake. Participants completed questionnaires, including The International Trauma Questionnaire, The International Depression Questionnaire, The Mental Defeat Questionnaire, The Tonic Immobility Scale, and The Peritraumatic Dissociative Experiences Questionnaire. RESULTS: Two-step multiple linear regression analyses indicated all peritraumatic reactions predicted both post-traumatic stress disorder and depression. Dominance analysis results showed that the contribution of peritraumatic dissociation in predicting PTSD and depression was higher among other peritraumatic reactions. CONCLUSION: The findings of the study revealed a robust association between peritraumatic reactions and both depression and PTSD, shedding light on the underlying processes in the development of trauma-related disorders. Early assessment of peritraumatic reactions may be useful in identifying individuals at risk of developing PTSD and depression.

Inclination of Nursing Students Towards Ethical Values and The Effects of Ethical Values on Their Care Behaviours.

A descriptive, cross-sectional study aimed to determine the inclination of nursing students towards ethical values and the effects of these values on care behaviours. The data for this study were collected from 466 students studying from May 13-24, 2019. The data were collected using a questionnaire on the sociodemographic characteristics of the students, Inclination to Ethical Values Scale (IEVS), and Caring Behaviors Inventory-24 (CBI-24). In this study, 43.1 per cent of them belonged to families who had a protective attitude. The total mean (SD) IEVS and CBI-24 scores were 63.99 (12.68) and 117.19 (17.95), respectively. The mean item score was 4.88 (0.74). A moderate positive correlation was observed between the inclination of the students towards ethical values and their care behaviours. The general family structure of the nursing students and their participation in an ethics class affected the inclination of the nursing students to ethical values and their care behaviours. This study showed that the ethical values of the students positively affected their care behaviours.

Physical problems and fatigue level of nurses during the COVID-19 pandemic.

PURPOSE: This study was conducted to examine the physical problems and fatigue levels experienced by nurses during the COVID-19 pandemic. METHOD: A descriptive and correlational design was used. The study data were collected in a state and a university hospital in the center of this province between September and December 2020. The population of the study included 460 nurses in these two hospitals, and the sample consisted of 377 volunteer nurses, which represented 81.95% of the population. Data collection tools included a "Personal Information Form," a "Nurses' Physical Problems Questionnaire," and the "Chalder Fatigue Scale (CFS)". RESULTS: The mean score of the nurses on the total CFS was 20.14 ± 6.72. The mean CFS score of nurses who worked in the university hospital compared to the score of those who worked in the state hospital and the score of those who experienced health problems during the COVID-19 pandemic compared to the score of those who did not was significantly higher (p < .05). Regarding the physical problems that the nurses experienced, the highest rate of "yes" responses was given to the question "Have you experienced sweating in PPE?" (94.2%), while the lowest rate of "yes" responses was given to the question "Have you experienced a risk of falling due to the shoe covers you wore on your feet?" (48.0%). CONCLUSION/IMPLICATIONS FOR PRACTICE: The CFS scores of the nurses who said "Yes" to all physical problems evaluated in this study were found to be significantly higher (p < .05). Nurses' work-related fatigue is recognized as a threat to nurse health and patient safety. By providing adequate staffing levels to frontline nurses in the COVID-19 pandemic, nurse managers can effectively reduce or prevent pandemic fatigue and improve their physical health.

Determining the relationship between spirituality and perceptions of care in nursing students: A cross-sectional study.

BACKGROUND: Caring is a core value in nursing education and many of its features can be measured as specific behaviors. It is not clear how nurses' spirituality affects their caring behavior. PURPOSE: The aim of this study was to investigate the relationship between spirituality and spiritual care and nursing students' perceptions of care. DESIGN AND METHODS: This was a descriptive cross-sectional study. The study sample consisted of 467 students in the nursing department of a university in Northeastern Anatolia. Data were collected using a descriptive information form, the Care Assessment Report Evaluation Q-sort (CARE-Q), and the Spirituality and Spiritual Care Rating Scale (SSCRS). Data were analyzed using frequency, percentage, mean, t-test, analysis of variance, and Kruskal-Wallis H, Mann-Whitney U, correlation, and regression tests. RESULTS: The mean age of the participants was 21.14 ± 1.97 years, 55.0% were women, and 63.0% said that nursing was their preferred profession. Most of the students rated their knowledge of spirituality and spiritual care as adequate (17.6%) or partially adequate (48.0%). CARE-Q and SSCRS scores were significantly higher among female students who chose a career in nursing to help people, want to obtain their master's degree, and agreed that providing care is nurses' primary duty (p < 0.05). There was a weak positive correlation between CARE-Q and SSCRS scores (p < 0.001; r = 0.369). CONCLUSION: There was a significant relationship between CARE-Q and SSCRS scores (p < 0.05). PRACTICE IMPLICATIONS: To promote holistic care, nursing students should be provided training on spirituality and spiritual care, with emphasis on the role of nurses in care.

Intensive care nurses' awareness of identification of early sepsis findings.

AIM: To determine intensive care nurses' awareness of identification of early sepsis findings. BACKGROUND: The incidence of sepsis is increasing in intensive care units, and if not identified early, it increases morbidity, mortality and cost of care. Intervention within one hour after the diagnosis of sepsis increases survival. Nurses' ability to identify early findings of sepsis affects the time of diagnosis of sepsis. DESIGN: The study used a cross-sectional design. METHODS: The sample of the study consisted of 544 nurses working in adult intensive care units of hospitals in Turkey. The study data were collected online between 11 January-8 April 2021 using the snowball method. Data were statically analysed. All procedures of the study adhered to the STROBE guidelines. RESULTS: The nurses who had been working for 11 years or more, had worked with a patient diagnosed with sepsis in the last month and used a measurement tool in the diagnosis thought that it was significantly easier to determine the early warning findings of sepsis. In the study, the majority of nurses correctly identified the early findings of sepsis, but the rates of the correct responses to the variables of lactate >2 mM, leucopenia and hypothermia were low. Female gender, having a graduate degree, unit type, total work experience, having received training on sepsis and working with a patient diagnosed with sepsis in the last month made a significant difference in determining the early warning findings of sepsis accurately. CONCLUSIONS: Nurses had a good rate of identifying early sepsis findings. Yet, they could not distinguish between early sepsis and late sepsis findings. RELEVANCE TO CLINICAL PRACTICE: The results of the study can support nursing practices in the diagnostic process by considering the factors affecting nurses' ability to distinguish early sepsis findings from late sepsis findings and to identify them correctly.

The Effect of Nurses' Death Anxiety on Life Satisfaction During the COVID-19 Pandemic in Turkey.

The purpose of the study is to determine the effect of nurses' death anxiety on life satisfaction during the COVID-19 pandemic. This cross-sectional and correlational study was conducted with 411 nurses in Turkey. Data were collected online through Google Forms using a sociodemographic form, the Revised Death Anxiety Scale (RDAS), and the Satisfaction with Life Scale (SWLS). Percentages, means, Pearson's correlation analysis, and hierarchical linear regression models were used to analyze the data. The nurses' mean age was 28.11 (SD = 6.27) years. More than half of the nurses stated that there were COVID-19 patients in the clinic where they worked (56.0%) and that they were afraid to provide care to patients diagnosed with COVID-19 (54.5%). Their mean RDAS total score was 57.33 (SD = 16.20), indicating moderate death anxiety, and their mean SWLS total score was 2.58 (SD = 0.82), indicating a low level of life satisfaction. Sociodemographic variables accounted for 8.8% of the variance. Death anxiety was associated with life satisfaction (ß = - 0.118, p < 0.05). Model 3, which included all of the analyzed independent variables, explained 17% of the variance in life satisfaction (R2 = 0.171, p < 0.001). This study showed that death anxiety adversely affects life satisfaction. Higher death anxiety among nurses was associated with lower satisfaction with life. Based on the findings, we recommend providing more psychological and communication support to nurses and implementing systematic physical and psychological evaluations of nurses to facilitate early intervention.

Prevalence of Lower Urinary Tract Symptoms in Pregnant Adolescents and the Influencing Factors.

STUDY OBJECTIVE: To determine the prevalence of lower urinary tract symptoms (LUTS) and associated risk factors in pregnant adolescents. DESIGN: Descriptive study. SETTING: The obstetrics and gynecology outpatient departments of a training and research hospital in Turkey. PARTICIPANTS: Two hundred six pregnant adolescents younger than the age of 19 years. INTERVENTIONS: None. Questionnaire-based data and the Bristol Female Lower Urinary Tract Symptoms-Short Form (BFLUTS-SF) were collected from pregnant adolescents. MAIN OUTCOME MEASURES: Comparisons were made with independent samples t test, one-way analysis of variance, Mann-Whitney U, and Kruskal-Wallis tests, and linear regression for the analysis of the potential risk factors. RESULTS: The prevalence of at least 1 of the LUTS in pregnant adolescents was 78.6% (162/206). The prevalence of storage symptoms was more than those of urinary incontinence and voiding symptoms. Among LUTS, the prevalence of nocturia, urgency, frequency, bladder pain, and urinary incontinence was 59.3% (122/206), 54.4% (112/206), 39.3% (81/206), 37.4% (77/206), and 27.2% (56/206), respectively. Of pregnant adolescents with LUTS, 30.2% (49/162) of pregnant adolescents with LUTS reported seeking treatment for LUTS in this study. The total median scores from the BFLUTS-SF increased with gestational week, but no statistical significant difference was identified (P > .05). According to the results of the linear regression analysis, daily coffee consumption, smoking, chronic coughing, constipation, and urinary tract infection history were found to be associated with the total mean score on the BFLUTS-SF in pregnant adolescents. CONCLUSION: LUTS were found to be common among pregnant adolescents, with storage symptoms being the most frequently reported. Prenatal education could increase the number of adolescents who seek treatment, thereby improving the clinical course of LUTS.

Nurses' Knowledge and Practices Related to Pressure Injury: A Cross-sectional Study.

PURPOSE: The purpose of this study was to determine nurses' knowledge and practices regarding pressure injury and identify relationships between these factors and professional nurse characteristics. DESIGN: Cross-sectional, descriptive study. SETTING AND SUBJECTS: The sample comprised 347 nurses attending the 2013 and 2015 Wound Management Congresses. The meetings were organized by the Wound Management Association located in Antalya, Turkey. METHODS: A 35-item data collection form was designed for purposes of this study. It divided into 2 parts: 8 items queried demographic and professional characteristics of nurse respondents. The second part comprised 9 cases describing patients with pressure injury; these cases were associated with 27 items querying pressure injury-related knowledge and practices. Demographic and professional characteristics of nurse respondents were summarized via descriptive statistics. The Kruskal-Wallis H and Mann-Whitney U tests were used to identify relationships between nurse characteristics and pressure injury knowledge and practices. RESULTS: The mean score for the 27 items related to pressure injury knowledge and practices was 57.37 ± 14.26 out of 100 points. Pressure injury knowledge and practices were positively associated with nurses having a bachelor's and/or postgraduate degree (P = .012), nurses caring for a higher number of patients with pressure injuries per week (P = .042), nurses practicing in intensive care units and wound care clinics (P = .011), nurses with specific education in pressure injury (P = .000), and those indicating adequate skills and knowledge in pressure injury (P = .005). CONCLUSIONS: Nurses' knowledge and practices regarding pressure injuries were lower than anticipated in this sample. We recommend additional education and training activities to increase nurses' knowledge and practices related to pressure injury.

Effects of Web-Based Instruction on Nursing Students' Arithmetical and Drug Dosage Calculation Skills.

Drug dosage calculation skill is critical for all nursing students to ensure patient safety, particularly during clinical practice. The study purpose was to evaluate the effectiveness of Web-based instruction on improving nursing students' arithmetical and drug dosage calculation skills using a pretest-posttest design. A total of 63 nursing students participated. Data were collected through the Demographic Information Form, and the Arithmetic Skill Test and Drug Dosage Calculation Skill Test were used as pre and posttests. The pretest was conducted in the classroom. A Web site was then constructed, which included audio presentations of lectures, quizzes, and online posttests. Students had Web-based training for 8 weeks and then they completed the posttest. Pretest and posttest scores were compared using the Wilcoxon test and correlation coefficients were used to identify the relationship between arithmetic and calculation skills scores. The results demonstrated that Web-based teaching improves students' arithmetic and drug dosage calculation skills. There was a positive correlation between the arithmetic skill and drug dosage calculation skill scores of students. Web-based teaching programs can be used to improve knowledge and skills at a cognitive level in nursing students.

[Parental involvement in cognitive-behavioral therapy for children with anxiety disorders]. / Kaygi bozuklugu olan çocuklar için bilissel davranisçi terapide anne babalarin tedaviye katilimi.

OBJECTIVE: A growing body of literature suggests that parents play a critical role in the development and/or maintenance of child anxiety. One of the main purposes of this article is to identify common parental involvement techniques and most common obstacles derived from parents in cognitive behavioral therapy (CBT) with anxious children. Another purpose of the present study is to revise empirical studies comparing child-focused CBT with and without parental involvement. METHOD: The PsycARTICLES, MEDLINE and PubMed databases were searched to identify articles in English that were published between the years of 1990 and 2012 (October) using the following keywords; (1) anxiety, (2) cognitive behavioral therapy, (3) parental involvement. Studies were only included in this review if they were comparing the treatment effect of child-only CBT and CBT with additional parental components. RESULTS: Thirteen studies were introduced in the context of method (diagnosis of children, age range of children, follow-up, results, etc.) and therapy characteristics (number of sessions, frequency of sessions, treatment components both child focused CBT and CBT with parental involvement, etc.). CONCLUSION: The common techniques of therapy with parental involvement are psychoeducation, contingency management, cognitive restructuring, reducing parental anxiety, improving parent-child relationship, and relapse prevention. Parental psychopathology, parental inappropriate expectations and family dysfunctions are important difficulties derived from parents in CBT with anxious children. The results of the studies suggested that parental involvement have increased the efficacy of the treatment in CBT especially working with young children and having at least one anxious parent.

Assessment of nurses' knowledge and practice in prevention and management of deep tissue injury and stage I pressure ulcer.

PURPOSE: The aim of this descriptive study was to determine nurses' knowledge and usual practice in prevention and management of deep tissue injury (DTI) and stage I pressure ulcers (PUs). SETTING AND SUBJECTS: The study was conducted in neurology, orthopedics, physiotherapy, rehabilitation, and intensive care units of 3 hospitals located in Ankara, Turkey. These units were selected because they care for patients at risk for developing PUs. The sample comprised 243 nurses. METHODS: A questionnaire was developed in consultation with wound care experts to measure nurses' knowledge and practice for preventing DTI and stage I PUs. The questionnaire form was provided to nurses who consented to participate in the study; the nurses completed the forms in the presence of the investigator. RESULTS: The mean score of correct answers was 48.85±11.99 of 100. Significant correlations were found between the percentage of correct answers and level of nursing education, previous experience with PU management, and participation in in-service training programs. CONCLUSION: The nurses in this study tended to lack sufficient knowledge regarding prevention and management of DTI and stage I PUs.

[Evaluation of the effectiveness of a cognitive-behavioral therapy program for alleviating the symptoms of social anxiety in adolescents]. / Ergenlerde Sosyal Anksiyete Belirtilerini Azaltmaya Yönelik Bilissel-Davranisçi Bir Grup Terapisi Programinin Etkililiginin Degerlendirilmesi.

OBJECTIVE: The aim of this research project is to investigate the effects of cognitive-behavioral group therapy on adolescents suffering from symptoms of social anxiety. METHOD: cognitive behavioral group therapy program for reducing social anxiety was developed by the authors, after which a pilot study was conducted, evaluated for deficiencies, finalized, and implemented in the following study. The final program entailed 13 sessions covering relaxation training, cognitive restructuring and exposure components. To recruit the participants for the intervention program screening tests were applied to 711 students of three different junior high schools in Izmir. 44 students (treatment=24, control= 20) who met the inclusion criteria in the seventh and eighth grades participated in the main study. Evaluation of the therapy program was ascertained using the following instruments; for students, Negative Cognitive Errors Questionnaire (CNCEQ), Cape Social Phobia Scale for Children and Adolescents (CSPSCA), Social Anxiety Scale for Adolescents (SAS-A); and for parents, (SAS-P) was used to compare their pre-program and post-program tests results. RESULTS: Repeated measures ANOVAs yielded significant Group X Time interactions for SAS-A (F (1, 42) =7.511, p< 0.01, eta2 =0.15), CSPSCA (F (1, 42) =6.54, p<.05) and CNCEQ (F (1, 42) = 8.295, p<0.01, eta2 =0.16) scores. Results from parents further indicated that social anxiety in the treatment group had decreased after program completion (F (1, 42) = 9.496, p=0.004, eta2 =0.18). CONCLUSION: Consistent with the literature of school based Cognitive-Behavioral Group Treatment (CBGT) programs for social anxiety, it was found that adolescents in the treatment group exhibited a significant decrease in social anxiety and related cognitive errors.

Prenatal ultrasonographical features of limb body wall complex: a review of etiopathogenesis and a new classification.

Limb body wall complex is a spectrum of multiple severe anomalies. The etiopathogenesis and clinical classification are still under discussion. In our article, while reviewing previous etiopathogenetical hypothesis, we propose a new clinical classification regarding embryological theories and pheneotypical features. According to the Van Allen diagnostic criteria, the findings of 6 affected fetuses are presented. Prenatal diagnosis was performed in 5 of 6 cases. Craniofacial malformations were present in only 1 case. Thoracic defect and abdominoschisis (either infraumbilical or supraumbilical) associated with visceral eventration, placental-umbilical cord anomalies, and limb defects were detected in the other 5 cases. Aberrant development of each of the 4 embryonic folds (cephalic, 2 lateral abdominal, and caudal) associated with faulty umbilical ring development and placental formation were considered responsible for development of various malformations. In previous clinical classifications, existence or absence of the craniofacial malformation was utilized as an unique discriminating criterion while multiple anomalies exist. In this report, we propose a new clinical classification concerning almost all anomalies caused by defective placental attachment and maldevelopment of the 4 folds.