Assessment of pressure injury risk in intensive care using the COMHON index: An interrater reliability study.

OBJECTIVES: To assess the interrater reliability of the COMHON (level of COnciousness, Mobility, Haemodynamics, Oxygenation, Nutrition) Index pressure injury risk assessment tool. DESIGN: Interrater reliability was tested. Twenty-five intensive care patients were each assessed by five different nurse-raters from a pool of intensive care nurses who were available on the days of assessment. In total, 25 nurses participated. SETTING: Two general and one cardiovascular surgery intensive care units in Istanbul, Turkey. MAIN OUTCOME MEASURES: Interrater reliability was analysed using intraclass correlations, and standard errors of measurement (SEM) were calculated for sum scores, risk level and item scores. Minimally detectable change (MDC) was also calculated for sum score. Consistency between paired raters was analysed using Pearson's Product Moment Correlation (r) for sum score and Spearman's rho (rs) for ordinal variables. RESULTS: All assessments were completed in ≤5 min. Interrater reliability was very high [ICC (1,1) = 0.998 (95 % CI 0.996 - 0.999)] with a SEM of 0.14 and MDC of 0.39. Consistency between paired raters was strong for sum and item scores and risk levels (coefficients >0.6). All scale items showed correlations of >.3 with the sum score. CONCLUSION: The results demonstrate near-perfect interrater reliability. Further research into the psychometric properties of the COMHON Index and its impact on preventative intervention use is warranted. IMPLICATIONS FOR CLINICAL PRACTICE: Pressure injury risk assessment within intensive care should be setting-specific due to the unique risk factors inherent to the patient population, which are not considered by general pressure injury risk assessment tools. An intensive care-specific pressure injury risk assessment tool was tested and demonstrated high reliability between intensive care nurses. Further research is needed to understand how its use in practice affects preventative intervention implementation and, in turn, how it impacts pressure injury outcomes.

Evaluation of perioperative pressure injury in adults 65 years and older: A prospective cohort study.

INTRODUCTION: Old age is an important risk factor for the formation of pressure injury (PI). The aim of this study was to investigate the incidence, risk factors, characteristics of PI and suitability of risk assessment tools for patients aged 65 years and older. METHOD: This prospective monocentric cohort study was conducted in Turkey between September 2022 and March 2023. Data were collected from a total of 240 surgical patients aged 65 years and older using a skin assessment form and the Braden and Munro scales for PI risk assessment. RESULTS: The patients had a mean age of 72.90 ± 5.53 years, 123 (51 %) were male, 203 (85 %) had chronic diseases, and the mean operative time was 194.83 ± 99.45 min. PI occurred in 45 patients (18.8 %). PIs were most commonly stage I and located in the coccyx region. Postoperative Munro score, postoperative Braden score, and operative time were significant in univariate analyses (p < 0.001). According to the multiple logistic regression model, a postoperative Munro score ≥26 and postoperative Braden score ≤20 were independent factors associated with increased risk of PI. CONCLUSION: Measures to prevent PI in surgical patients should begin in the preoperative period. Age alone may not be a risk factor in geriatric surgical patients. The Munro and Braden PI risk assessment scales can be used in geriatric surgical patients, but changes in cut-off score calculations may be required and additional age-related risk factors should be evaluated.

The effect of lavender foot baths on postoperative pain and sleep quality in comparison with foot baths with warm water only-A prospective randomized controlled study.

INTRODUCTION: The aim of the study was to investigate the effect of warm water (WW) foot bath with or without lavender oil for pain and sleep quality in the patients who undergone abdominal surgeries. MATERIALS AND METHOD: This study was designed as a prospective randomized controlled. The three study groups were defined as the control group (n = 44), the WW foot bath group (n = 46), WW foot bath with the lavender group (n = 40). Foot baths were done for 20 min with 40 °C every night for 3 days after surgery. Visual Analogue Scale and Richard-Campbell Sleep Questionnaire were used during data collection. RESULTS: A total of 130 patients, mean age 55.99 ±  ± 13.05 years, 66 male (51 %), 103 of whom underwent abdominal surgery, were included in the study. When the patients during the postoperative three days were evaluated, decreased pain score and increased sleep quality both the WW and WW foot bath with lavender groups (p < 0.001). Noise-related sleep quality was detected to be lesser in the control group patients on the 3rd day (p < 0.001). CONCLUSION: WW foot bath with or without lavender oil is an uncomplicated, economical, and effective complementary therapy to reduce postoperative pain and improve sleep quality. WW foot baths with essential oils are optionally available in clinics and can be used according to patients' preferences.

Pressure injuries in the operating room: who are at risk?

OBJECTIVE: Operating room (OR)-related pressure injuries (PIs) constitute the majority of all hospital-acquired PIs. The aim of this study is to reveal the prevalence and risk factors of OR-related PIs. METHOD: This study used a cohort design. The data were collected at Acibadem Maslak Hospital in Istanbul between November 2018 and May 2019. The study population consisted of all patients undergoing surgery between these dates (n=612). The haphazard sampling method was used following application of the inclusion criteria. A patient identification form, the 3S intraoperative pressure ulcer risk assesment scale and the Braden Scale were used to collect data. RESULTS: Within the scope of the study, data were collected from 403 patients, of which 57.1% (n=230) were female and 42.9% (n=173) were male; mean age was 47.90±18.15 years. During surgery, PIs were detected in 8.4% of patients. In total, 42 PIs were detected in patients in the study; 92.8% were stage 1 and 7.2% were stage 2. It was determined that the PIs observed in 11.8% (n=4) of the patients were related to device/instrument use and 23.5% (n=8) were related to the positioning device. Risk factors found to be significant in the development of PIs were sex (male) (p=0.049), large amount of bleeding during surgery (p=0.001), dry (p=0.020) and lighter skin (p=0.012), duration of surgery (p=0.001), type of anaesthesia (p=0.015), and medical devices used (p=0.001). CONCLUSION: Early identification of risk factors may reduce OR-related PIs. Guidelines and procedures that focus on preoperative, intraoperative and postoperative evaluation can be developed to reduce and prevent surgery-related PIs and to standardise care.

Intra-hospital transfer anxiety of patients in the neurosurgery intensive care unit: A prospective cohort study.

BACKGROUND: Transferring a patient from the intensive care unit to different locations within the hospital can cause transfer anxiety. Transfer anxiety is an important factor that adversely affects various physiological and psychological parameters. OBJECTIVE: The aim of the study is to evaluate the intra-hospital transfer anxiety of patients in a neurosurgery intensive care unit and factors affecting it. METHODS: This prospective cohort study was conducted between November 2021 and June 2022 in a neurosurgery intensive care unit in Istanbul. A total of 171 adult patients who stayed in the intensive care unit for at least 24 h, with a Glasgow Coma Scale score of 14 and above and who had undergone their first intra-hospital transfer were included. Patients' vital signs were recorded, and their anxiety levels were assessed using the State-Trait Anxiety Inventory. RESULTS: The mean age of the patients was 53.16 ± 15.51 years and 56.72% were women, 75.43% of transfers were performed during the day and 64.32% of patients were transferred to an in-patient ward. Factors affecting transfer anxiety were gender, employment status, timing, and purpose of transfer (p < 0.05). Blood pressures and heart rates tended to increase during transfer and decrease again after transfer, while oxygen saturation decreased during transfer (p = 0.035) and increased again after transfer (p < 0.001). State anxiety levels were moderate before transfer and decreased to mild level after transfer (p < 0.001). CONCLUSIONS: The transfer process increased anxiety and caused changes in the vital signs of intensive care patients. Individual and transfer-related factors may influence transfer anxiety. Patients should be monitored for transfer anxiety and nursing interventions to reduce anxiety should be planned. IMPLICATIONS FOR CLINICAL PRACTICE: The patients' demographics and transfer details can influence transfer anxiety. Transfer anxiety can affect both subjective parameters and objective measures such as vital signs. Patients at risk of transfer anxiety should be identified before transfers so that nursing interventions to reduce anxiety can therefore be planned.

Adherence to adjuvant tamoxifen and associated factors in breast cancer survivors.

PURPOSE: Adjuvant endocrine therapy reduces the recurrence and mortality of early hormone receptor-positive breast cancer in both pre- and postmenopausal women. The aim of this study was to investigate adjuvant tamoxifen adherence and associated factors in breast cancer survivors. METHODS: This descriptive, prospective study was conducted in 2019-2020 with the participation of 531 women who survived breast cancer and were under follow-up at the Senology Institute of a hospital in Istanbul. Inclusion criteria were having completed treatment for early hormone receptor-positive breast cancer, being prescribed tamoxifen, and being 18 years or older. Data were collected using a patient information form and the Morisky Medication Adherence Scale-8 (MMAS-8). RESULTS: The mean age of the participants was 44.9 ± 6.5 years, and the mean duration of tamoxifen use was 834.4 ± 685.7 days. The women's mean MMAS-8 score was 6.86 ± 1.39. Medication adherence was significantly positively correlated with current age (p = 0.006) and age at diagnosis (p = 0.002). There was a statistically significant difference between tamoxifen adherence according to participants' employment status (p = 0.028), chronic disease status (p = 0.018), loss of libido (p = 0.012), treatment-related changes in mood changes (p = 0.004), and having negative effects affecting daily life (p < 0.001). CONCLUSION: Overall, breast cancer survivors in this study reported moderate adherence to tamoxifen. The women's individual characteristics and the adverse effects of treatment influenced medication adherence. Healthcare professionals can help increase adherence to this treatment, which reduces the risk of mortality, by explaining the importance of the medication, identifying and eliminating barriers to adherence, and informing women about evidence-based interventions to increase medication compliance.

The Effect of Preoperative Nursing Visit on Anxiety and Pain Level of Patients After Surgery.

PURPOSE: Preoperative education is an important part of surgical preparation. Nursing visits offer nurses the opportunity to provide personalized care. The aim of this study was to determine the effect of nursing visits before laparoscopic surgery on the anxiety and pain levels of patients in the postoperative period. DESIGN: Randomized controlled clinical trial. METHODS: Data were collected from 135 patients who underwent laparoscopic surgery between March and October 2019 in Istanbul. During the nursing visits, the experimental group (n = 72) was educated by the operating room nurse, while the control group (n = 63) was educated by the service nurse. Data were collected using the State-Trait Anxiety Inventory and the Visual Analog Scale. The CONSORT checklist was followed. FINDINGS: The pre-education state anxiety scores of the control and experimental groups were similar and at a moderate level (P > .05). The state anxiety score of the experimental group visited by operating room nurses decreased more than that of the control group after education (P < .001). The postoperative state anxiety and pain scores of the control and experimental groups were found to be similar (P > .05). CONCLUSIONS: Visits by operating room nurses before laparoscopic surgery can be an effective method to reduce the anxiety level of patients. Obtaining the opinions of operating room nurses on care integration and organization of in-service education programs may be necessary.

Effect of simulation-based learning on first clinical day stress and anxiety levels of nursing students in Turkey.

OBJECTIVES: To determine the effect of simulation-oriented skills training on first clinical day stress and anxiety levels in nursing students. METHODS: The quasi-experimental study was conducted from April to June, 2016, in Istanbul, Turkey, and comprised first year nursing students who were divided into two groups. In Group 1, students measured vital signs on simulated patients before their first clinical practice. In Group 2, the students performed this application on each other. Then, on the first day of their clinical practice, the students evaluated the vital signs and then filled out Clinical Stress Questionnaire and the State-Trait Anxiety Inventory. Data was analysed using Number Cruncher Statistical System version 2007. RESULTS: Of the 41 subjects, 16(39%) were in Group 1 with a mean age of 19.31±3.2 years, and 25(61%) were in Group 2 with a mean age of 18.92±0.86 years (p>0.05). There was no significant differences in state-trait anxiety inventory and clinical stress questionnaire scores between the groups (p>0.05). There was a significant difference with respect to benefit subscale of the clinical stress questioaanire (p=0.049). CONCLUSIONS: The use of simulation in nursing education provided relief and confidence during clinical practice.

Examining the effect of simulation based learning on self-efficacy and performance of first-year nursing students.

BACKGROUND: Self-efficacy is an individual's belief in oneself and in one's own judgment and ability to be successful in a task. Strong self-efficacy allows for the achievement of success, well-being, personal development and the diversification of skills. An individual's perception of his/her self-efficacy plays a key role in adopting behaviors and initiating and sustaining change. AIMS: The first aim of this study is to evaluate the effects of simulation-based learning on the self-efficacy and performance of first-year nursing students. The second aim is to examine students' pre- and post-scenario proficiency in their self-assessment of competence in regard to scenario objectives to compare the students' self-assessment and their instructor's assessment in terms of performance evaluations. METHODS: This semi-experimental study was conducted with sixty-five first-year nursing students. A standardized patient method was used as a simulation technique. Students' self-efficacy and their perceptions of their own competence in completing skills were measured using the General Self-Efficacy Scale and the Proficiency Assessment Form, respectively. Students' actual performance was evaluated via an Objective Structured Clinical Assessment and performance evaluation checklists. RESULTS: The mean self-efficacy score of students was 52.68 (±10.19) before the scenario and 49.59 (±12.90) post-scenario (p = .001). With regard to their scenario objectives, a decrease was observed in students' proficiency in their post-scenario self-assessment of competence. This decrease was only statistically significant in the "Establishing a safe patient unit" objective (t = 2.27; p = .03). CONCLUSIONS: We observed that self-efficacy scores declined in the post-simulation scenario. Using standardized patients in simulation training allows novice nursing students to meet a real patient and to recognize their own true self-efficacy.

The process of nurse adaptation to robotic surgery: A qualitative study.

BACKGROUND: This study aimed to reveal the experiences of nurses in robotic surgery and their adaptation to this method. METHODS: This research was planned within the framework of qualitative research methods. The study population consisted of robotic surgery nurses in Turkey. Focus group interviews were conducted after the flow process was developed, and the interviews were supported using a semistructured interview form. Two focus interviews were conducted with 15 participants. RESULTS: As a result of the content analysis, 11 themes were created in four categories. The categories of the study were designed as follows: (1) Training in Robotic Surgery Nursing, (2) Adaptation to Technology in Robotic Surgery Nursing, (3) Changing Roles and Adaptation Process in Robotic Surgery Nursing, and (4) Future of Robotic Surgery. CONCLUSIONS: The lack of clarity regarding the roles and responsibilities of robotic surgery nurses and the lack of arrangements for working conditions are thought to cause professional dissatisfaction and disengagement from work.

Example of a Simulation Design in Nursing Education: Safe Chemotherapy Administration.

Chemotherapy is one of the treatment methods increasingly used in cancer. In this article, we aimed to share our simulation experiences within the scope of the elective course of Cancer Nursing in the Nursing Internship (4th year) program in the process of teaching safe chemotherapy administration methods. Simulation-based experience should be designed to attain specified educational goals and expected results as best as possible. Scenario implementation is based on the criteria of the International Nursing Association for Clinical Simulation and Learning standards. A biologically safe drug preparation cabin in the drug preparation room of a simulation center was used, and a medium-fidelity mannequin-based simulator evaluating the vital signs was utilized as the simulator during the simulation implementation. In the patient history prepared within the scope of the scenario, the students were expected to achieve goals. An analysis was performed by a trainer who followed attentively the implementation during the scenario. In the analysis stage, sessions including 8-10 students were held using the Promoting Excellence and Reflective Learning in Simulation. A checklist was used to evaluate the skill steps of the students objectively. It is thought that this simulation scenario maintained in accordance with the standards of best practice of the International Nursing Association for Clinical Simulation and Learning would guide the readers. The simulation is considered to be an effective method for safe medications, and it is recommended to plan different scenarios according to the levels of students.

Unusual cause of acute neurologic deficit in childhood: primary central nervous system vasculitis presenting with basilar arterial occlusion.

INTRODUCTION: Primary central nervous system (CNS) vasculitis of childhood is a rare disorder. The most common signs and symptoms are acute severe headache and focal neurologic deficit. It should be suspected in children who have an acquired neurologic deficit that remains unexplained after an initial basic evaluation. Diagnosis usually depends on brain magnetic resonance imaging and conventional angiography of cerebral vasculature. Stenosis is the most common angiographic finding and it usually affects the middle cerebral artery and its branches. Anterior and posterior circulation is rarely involved. CASE REPORT: In this report, we describe an 8-year-old boy who presented with vertebrobasilar insufficiency symptoms and primary CNS vasculitis diagnosis was made later.

Cytomegalovirus infection in a patient with atypical Kawasaki disease.

Kawasaki disease (KD) is an acute, febrile, and multisystem vasculitis of early childhood with a striking predilection for the coronary arteries. The most significant complication is coronary artery abnormalities, including coronary aneurysms. The etiology of KD remains unknown. Many infectious agents including viruses have been postulated as possible causes of KD. But standard microbiologic techniques, molecular methods and serologic investigations have failed to identify an etiologic agent. We described a patient with atypical KD during cytomegalovirus infection.

Filariasis in a child from southern Turkey: a case report.

Filariasis is a parasitic condition in which the lymphatic system is invaded by filarial nematodes. The initial signs are those of lymphangitis and lymphadenitis. The manifestations include edema in the extremities and elephantiasis due to lymphatic obstruction. Filariasis is endemic to most parts of the world, but occurs only sporadically in Turkey. This report describes a case of filariasis in a child who presented with fever and extensive lower-extremity edema.

Assessment of left ventricular diastolic function by Doppler tissue imaging in children with end-stage renal disease.

AIM: To evaluate left ventricular (LV) diastolic function in children with end-stage renal disease (ESRD) using conventional pulsed-Doppler echocardiography and Doppler tissue imaging (DTI), and to compare the findings with these two modalities. METHODS: Twenty-four children with ESRD and 22 healthy age- and sex-matched control subjects were assessed with conventional Doppler echocardiography and DTI. The scans of the renal disease patients were done after a dialysis session. Parameters related to LV systolic and diastolic function were compared in the ESRD and control groups. RESULTS: The ESRD patients had lower mean mitral E/A ratio both according to conventional Doppler echocardiography and TDI than the control subjects. The ESRD group also had significantly longer isovolumetric relaxation time (116+/-31 ms vs 97+/-3.1 ms, respectively; p<0.001), and significantly longer deceleration time (235+/-44 ms vs 202+/-35 ms, respectively; p<0.01) than the control group. CONCLUSION: DTI findings correlate well with conventional Doppler echocardiography findings. Children with ESRD show, after dialysis, echocardiographic signs of LV diastolic dysfunction.

Acute renal failure after overdose of colloidal bismuth subcitrate.

Bismuth salts are widely used to treat peptic ulcers. Acute toxicity with colloidal bismuth subcitrate overdose causes nephrotoxicity. There have been numerous reports of encephalopathy after long-term consumption of bismuth salts, but only a few cases of nephrotoxicity (adult and pediatric) have been documented to date. This report presents a case of acute renal failure due to colloidal bismuth subcitrate overdose in adolescent. A 16-year-old girl presented with complaints of nausea, vomiting, and facial paresthesia. Ten days earlier she had tried to commit suicide by taking 60 tablets of De-nol (colloidal bismuth subcitrate 18 g). The physical examination findings on admission indicated minimal fluid overload but no signs of encephalopathy. Laboratory tests on admission showed blood urea nitrogen 102 mg/dl, serum creatinine 19.9 mg/dl, and serum bismuth level 495 microg/l. The patient was started on appropriate fluid therapy and penicillamine as a chelating agent and then began hemodialysis on alternate days. The patient's renal function gradually returned to normal over 9 weeks and by 64 days after the overdose her serum bismuth level had fallen to almost half the level detected 2 days after admission. The patient made a complete recovery. The case demonstrates that acute renal failure can develop as a manifestation of acute toxicity from colloidal bismuth ingestion, and that the prognosis may be favorable if the patient receives appropriate supportive treatment and dialysis.

Acute disseminated encephalomyelitis associated with hepatitis A virus infection.

We describe the case of a 30-month-old boy who developed acute disseminated encephalomyelitis (ADEM) after hepatitis A virus (HAV) infection and ultimately died. As far as we know, this is only the second case of HAV-associated ADEM to be reported in the literature. The child was brought to hospital with fever, lethargy and weakness of 2 days duration. He had developed jaundice, abdominal pain and malaise 2 weeks beforehand and these problems had resolved within 2 days. Neurological examination revealed lethargy, generalised weakness and positive Babinski's signs bilaterally. Cerebrospinal fluid examination showed mild lymphocytic pleocytosis, increased protein and elevated anti-HAV IgM and IgG titres. Serum HAV IgM and IgG titres were also elevated. Despite aggressive treatment with ceftriaxone, acyclovir and anti-oedema measures, he developed papilloedema and coma within 24 hours of admission. Magnetic resonance imaging of the brain revealed diffuse cerebral oedema and multifocal hyperintensities on T2-weighted images, with most lesions in the white matter of both cerebral hemispheres. The diagnosis of ADEM was established and high-dose steroids and intravenous immunoglobulin were added to the treatment regimen. However, his clinical condition continued to deteriorate and he died on the 20th day in hospital. This case shows that HAV infection can be linked with ADEM. Patients with HAV infection should be examined carefully for central nervous system symptoms during follow-up. Likewise, the possibility of HAV infection should be investigated in cases of ADEM.

Glycemic control, oxidative stress, and lipid profile in children with type 1 diabetes mellitus.

BACKGROUND: In diabetes mellitus, persistence of hyperglycemia was reported to cause increased production of oxidative parameters including malondialdehyde (MDA). In the present study, the effect of glycemic control on oxidative stress and the lipid profile of pediatric type 1 diabetes mellitus (DM) patients were investigated. METHODS: Serum total cholesterol, HDL cholesterol, VLDL cholesterol, apolipoprotein A, apolipoprotein B, lipoprotein a, HbA(1c), and MDA levels were assessed in 96 children with type 1 DM. Study cases were evaluated in two groups in view of their mean HbA(1c) values, as metabolically well controlled (HbA(1c) < or =8%) and poorly controlled (HbA(1c) >8%) patients with DM. Fifty healthy children were included as normal controls. RESULTS: Total cholesterol, LDL cholesterol, apolipoprotein A, apolipoprotein B, and MDA levels of total diabetic patients were significantly (p<0.05) higher than those of the control group. Serum MDA levels and MDA/LDL cholesterol index were significantly increased in metabolically poorly controlled in relation to metabolically well-controlled DM patients and were similar in metabolically well-controlled DM patients with relation to control group and in metabolically poorly controlled patients with relation to control group. CONCLUSIONS: In the present study, increased levels of MDA, MDA/LDL index, and dyslipoproteinemia showed that especially metabolically poorly controlled DM children are at high risk of atherosclerosis and vascular complications of DM and that there is a significant relationship between the lipid profile and oxidative stress. Thus, it may be appropriate to evaluate MDA in addition to routine laboratory assessments in evaluation of type 1 DM pediatric patients.