Efficacy of combination of biofeedback therapy and pelvic floor muscle training in dyssynergic defecation.

BACKGROUND: It is now known that with appropriate exercises, the functions of the muscles in the body ameliorate and increase in strength. We applied pelvic floor muscle relaxation training and exercises that strengthen the abdominal and pelvic muscles in combination with biofeedback therapy (BFT) to patients with dyssynergic defecation (DD). METHODS: Patients who met the criteria for DD and had no underlying organic cause were included in this study. The electromyography (EMG) technique was used for BFT therapy. Patients had received at least six sessions of BFT. BFT was considered successful in patients when the DD pattern in anorectal manometry (ARM) disappeared and/or adequate anal relaxation was obtained following BFT and in patients who had full clinical recovery. RESULTS: Data of 104 patients (58 females [55.8%] and 46 males [44.2%]) was evaluated. Abdominal and rectal symptoms disappeared in 71 (68.26%) patients. Of the patients who achieved symptomatic improvement, 58 (55.76%) saw a disappearance of the dyssynergic defecation pattern. When the differences between anal sphincter pressures before and after treatment were compared in patients who responded to BFT and those who did not, no significant differences were observed, but significant changes were found in anal squeezing pressures. It was found that those who had high squeezing pressures before BFT, those who increased their squeezing pressures after BFT, and those who decreased their resting pressure responded better to BFT. CONCLUSIONS: In this study, BFT was found to be more effective in those with a high squeezing pressure and those that increased squeezing pressure after BFT. These findings will influence the treatment of patients with dyssynergic defecation who do not respond to treatment. A combination of abdominal and pelvic floor muscle exercises and BFT increases patient response.

The attitudes of Turkish nurses towards the employment of internationally educated nurses.

AIM: To define the attitudes of nurses working in public hospitals towards the employment of internationally educated nurses. BACKGROUND: The employment of internationally educated nurses is expected to be an important strategy for solving the nursing shortage in Turkey and many other countries. METHODS: This descriptive and cross-sectional study was conducted with nurses working in seven public university hospitals in different geographical regions of Turkey in September 2015. The data were collected from 1061 nurses in these hospitals using a self-report questionnaire. Data analysis was performed using descriptive statistics, t-test and the Mann-Whitney U test. RESULTS: The participants generally did not have positive attitudes towards the employment of internationally educated nurses citing the possibility of experiencing cultural and professional difficulties. They also indicated that the employment of internationally educated nurses is not a real solution for the nursing shortage unless working conditions for nurses are improved. However, younger nurses have more positive attitudes towards employment of internationally educated nurses than older ones. IMPLICATIONS FOR NURSING POLICY: Defining the attitudes of the nurses working in clinical fields towards the employment of internationally educated nurses is an important issue, because it provides data for reviewing the existing policies and evaluating the possible issues that require attention during implementation of these policies. Policymakers may focus on both creating better working environment conditions and helping both the native and internationally educated nurses during the recruiting process.

Molecular evidence of nosocomial transmission of hepatitis C virus in a haemodialysis unit.

The molecular epidemiology of type 2a hepatitis C virus (HCV) infections in patients undergoing haemodialysis in the same unit in a Turkish hospital was investigated. Of nine HCV-infected patients four were infected with type 2a, four with type 1b and one with type 1a viruses. Since type 2 HCV infections in the Turkish population are rare, the possibility of nosocomial infection was investigated by means of phylogenetic analysis of viral sequences amplified by the polymerase chain reaction in the NS5b region. One of the samples failed to show amplification and therefore could not be sequenced. The sequences of the remaining three virus samples were grouped closely in a cluster within the type 2a group. The results thus showed that three patients were infected with the same HCV type 2a strain. Seroconversion and clinical data suggested that these patients may have been infected on different occasions, there being possibly more than one mode of transmission. Breaches in infection control procedures and lack of environmental decontamination between two haemodialysis sessions were probably the causes of HCV infections in these patients.