Expectations of relatives of Syrian patients in intensive care units in a state hospital in Turkey.

AIMS AND OBJECTIVES: The purpose of the study was to describe the personal experiences of relatives of Syrian patients in the intensive care unit in one hospital in Turkey. BACKGROUND: The concept of the intensive care unit can be particularly frightening for family members. Current recommendations for training Intensive care unit nurses should support a holistic approach to patient (and family) care, including explanations at a level that families can easily understand and allowing family members to see the patient at regular intervals. DESIGN: This qualitative study was conducted between June and August 2014 and included a study sample of 30 Syrian family members related to patients receiving treatment at a state hospital intensive care unit in Turkey. METHODS: Data were collected by semi-structured interviews. We used percentages to represent descriptive data and conducted qualitative content analysis. RESULTS: Following data analysis, six themes arose: (1) communication-related difficulties, (2) difficulties receiving information regarding the patient's condition, (3) difficulties meeting personal needs, (4) difficulties communicating with other family members, (5) difficulties receiving support from other family members, and (6) unmet expectations from nurses and hospital administration. CONCLUSIONS: Syrian patient's relatives receiving treatment in an intensive care unit in Turkey experienced communication difficulties in terms of receiving information from health care personnel, informing other family members, receiving social support from other family members, and having various unmet expectations from nurses and hospital administration. RELEVANCE TO CLINICAL PRACTICE: The results of this study can be used to develop guidelines and predictions for scenarios that are likely to arise for patients' relatives from foreign countries who arrive to support patients who receive healthcare services in our increasingly global world.

The relationship between cultural sensitivity and perceived stress among nurses working with foreign patients.

AIM AND OBJECTIVES: To determine the relationship between cultural sensitivity and perceived stress of nurses working at Kilis State Hospital. BACKGROUND: As foreigners live in and visit Turkey for various reasons, it is essential to provide culturally appropriate healthcare. DESIGN: Descriptive and cross-sectional design. METHODS: This study was implemented at the State Hospital in Kilis on the southeast border of Turkey, between June-July 2014. The study sample consisted of 120 nurses. Data collection tools included a questionnaire about the socio-demographic and professional characteristics of participants, the Chen and Starosta's Intercultural Sensitivity Scale, and Perceived Stress Scale. RESULTS: The average score for nurse cultural sensitivity was 84·32 (SD, 11·40) and the average score for perceived stress was 27·97 (SD, 7·32), corresponding to a medium level. We identified negative correlation between cultural sensitivity and perceived stress. CONCLUSIONS: Nurses working at Kilis State Hospital have a medium level of cultural sensitivity and perceived stress, and cultural sensitivity tended to be affected by perceived stress. RELEVANCE TO CLINICAL PRACTICE: This study suggests that training programmes for cultural sensitivity and stress management should be available for nurses. Furthermore, patient care plans should be adapted to consider different cultural backgrounds of patients. These findings should be considered when designing nurses' education and continuing education programmes.

Effect of metformin on the human T98G glioblastoma multiforme cell line.

Metformin is a guanidine derivative found in Galega officinalis that is commonly used to treat diabetes mellitus. The mechanism of action of metformin involves regulation of the adenosine monophosphate-activated protein kinase/mammalian target of rapamycin signaling pathway, which is implicated in the control of protein synthesis and cell proliferation. This led to the hypothesis that metformin reduces the risk of cancer and slows tumor growth. Thus, in the present study, the effectiveness of metformin as an antiglioma agent was evaluated using the human T98G glioblastoma multiforme cell line. The viability of the T98G cells was assessed using a 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assay. Apoptosis was monitored by measuring caspase-3 levels, as well as by terminal deoxynucleotidyl transferase dUTP nick end labeling and staining with acridine orange and ethidium bromide. The results demonstrate that metformin reduced cell viability and caused apoptotic morphological changes in the T98G cells. Furthermore, the caspase-3 levels in the metformin-treated T98G cells were higher than those in the control cells. Metformin induced apoptosis in the T98G cell line in a concentration-dependent manner. Metformin may provide an important contribution to the treatment of glioblastoma multiforme.

Pyrrolidine dithiocarbamate attenuates the development of monocrotaline-induced pulmonary arterial hypertension.

We aimed to demonstrate the potential protective effects of pyrrolidine dithiocarbamate (PDTC) on monocrotaline (MCT)-induced pulmonary arterial hypertension (PAH). Adult male rats were randomly assigned to 4 groups: control group, MCT-treated rats only, MCT-injected rats treated with PDTC, and PDTC-treated rats only. Blood and tissue samples were collected after the sacrifice. Levels of malondialdehyde (MDA) were measured by using the thiobarbituric acid method. Total antioxidant status (TAS) was determined using a commercially available ImAnOx kit. A histopathological evaluation was accomplished by scoring the degree of severity. Endothelial damage of the main pulmonary artery was evaluated by immunohistochemical labeling of endothelial cells using anti-rat endothelial cell antigen 1 (RECA-1) antibody. MCT-induced right ventricular hypertrophy (RVH) was reduced significantly in the MCT+PDTC-treated group. MDA levels were significantly lowered in the MCT+PDTC-treated group. TAS was significantly higher in the MCT+PDTC-treated group when compared with the rats with PAH. Histopathological examination demonstrated that PDTC treatment reduced the development of inflammation, hemorrhage and congestion, and collagen deposition. In conclusion, PDTC attenuated PAH and protected pulmonary endothelium in rats administered MCT. These findings suggest that PDTC treatment may provide a new effective therapeutic approach in the treatment of PAH.

Prospective study: reducing pressure ulcers in intensive care units at a Turkish medical center.

PURPOSE: The purpose of this study was to determine the impact of an educational intervention on the incidence of stage II pressure ulcers (PUs) in adult patients in intensive care units (ICUs) in a Turkish medical center. DESIGN: This was a prospective study of patients admitted to ICUs. Data were collected over a 3-month period. Subjects were assessed using the Braden Scale for Predicting Pressure Sore Risk to determine the risk for developing a PU; assessment was completed within the first 24 hours of admission and each 48 hours thereafter for a maximum of 12 weeks. Educational intervention was employed: Intervention included education of ICU nurses about PU prevention and risk assessment; and following the educational intervention and implementation of the PU prevention protocol in all ICUs, data were collected for study period II. SUBJECTS AND SETTING: The sample comprised 186 patients admitted to critical care units of a Turkish medical center. Ninety-three subjects participated in a preintervention comparison group, and 93 subjects participated in an intervention group. INSTRUMENTS: Data were collected using a demographic and clinical data form, a nursing intervention checklist, and the Braden Scale for Predicting Pressure Sore Risk. RESULTS: Stage II PUs were observed in a total of 50 patients for the overall sample. The most common site was the sacrococcygeal area, which accounted for 46% of ulcers. A statistically significant difference was observed when the rate of stage II PUs in the comparison group, 37% (34 of 93 patients), was compared to the rate in the intervention group, 17% (16 of 93 patients) (chi2 = 8.86, df = 1, P < .01). CONCLUSION: Education regarding preventive care can be effective in reducing the incidence of PUs in the ICU setting. Therefore, education about risk assessment and PU prevention should be a priority for nurses in critical care settings.

Health beliefs and breast cancer screening behaviors among female health workers in Turkey.

The purpose of this study was to evaluate health beliefs and breast cancer screening behaviors in female health workers in Turkey. This descriptive study was conducted in various health centers located in Erzurum, Turkey. The sample consisted of 268 female health workers (physicians, n=51; nurses, n=169; and midwives, n=48). Data were collected by using a self-administered questionnaire and the Turkish version of Champion's Health Belief Model Scales (CHBMS). The mean age of participants was 31.31 (S.D.=6.89), and 49.9% of them were married. It was found that only 21.9% of the female health workers performed breast self-examination (BSE) regularly, and 12.5% of them had a mammogram. Physicians' health motivation and BSE self-efficacy perceptions were higher than the nurses and midwives. Susceptibility, health motivation to BSE, BSE benefits, BSE self-efficacy perceptions of female health workers who performed BSE were significantly higher than those who did not, and a result indicating that positive health beliefs are effective in stimulating performance of BSE of female health workers. Among the variables related with mammography, only susceptibility perceptions of female health workers who had a mammogram was significantly higher than those who had not had a mammogram.

A prospective, descriptive pressure ulcer risk factor and prevalence study at a university hospital in Turkey.

Valid and reliable patient records regarding pressure ulcers and standard procedures to promote pressure ulcer prevention are not generally available in Turkish hospitals. Consequently, information about pressure ulcer prevalence and risk factors is limited and cannot be obtained retrospectively. A prospective, 1-day, cross-sectional descriptive study was conducted among all eligible, hospitalized patients in the adult medical, surgical, and intensive care units of a university hospital in Turkey. The purpose of the study was to ascertain the prevalence and characteristics of patients with or at risk for developing pressure ulcers. A patient history and demographic and length of stay variables were obtained and skin integrity and Braden scale score variables were assessed for all eligible patients (n = 344 patients admitted more than 24 hours before the study). Forty (40) patients had at least one pressure ulcer (prevalence rate 11.6%) and 111 (32.3%) were found to be at risk for pressure ulcer development. Patients with a low albumin level and other diseases or medical problems as well as those who were comatose or had surgery had a higher rate of pressure ulcers. Patients at risk for pressure ulcer development were found to be male, older, unconscious, and post surgery; additionally, they had a low body mass index and serum albumin as well as other health problems known to be associated with pressure ulcer formation. A significant, negative correlation between hospital length of stay and Braden scale score also was observed. These findings confirm prevalence and risk factor data from studies conducted in other countries and suggest that assessment and prevention efforts in Turkish hospitals must improve in order to decrease the burden of pressure ulcers.

Gentamicin-induced nephrotoxicity in rats ameliorated and healing effects of resveratrol.

In this study, we aimed to investigate the possible protective effect of resveratrol on gentamicin induced nephrotoxicity. Experiments were carried out in male Wistar rats weighing 200-250 g. Gentamicin sulfate (80 mg/kg per day i.p.), resveratrol (10 mg/kg per day i.p.) and gentamicin together with resveratrol were administered for 6 d. The animals were sacrificed 24 h after the last injection. Urine, blood samples and tissue samples were collected from the animals on the seventh day of the treatment before they were sacrificed. Kidneys were collected for histopathological studies and fixed in 10% buffered formalin solution. Tissue samples were stored at -70 degrees C in liquid nitrogen for the determination of glutathione (GSH), glutathione-S-transferase (GST), malondialdehyde (MDA) and catalase (CAT). Glutathione assay was determined by the method of Beutler et al. GST amounts were measured by the method of Habig et al. Catalase activity was tested by Aebi's method and MDA was determined according to Thayer's method. Blood urea level was significantly increased in the gentamicin treated group. The study showed lowered levels of urea and creatinine levels in resveratrol administered groups when compared with gentamicin administered rats, and the difference was statistically significant. It has been determined that resveratrol caused statistically significant decrease in lipid peroxidation and reduced the level of catalase. Histopathological examination showed that resveratrol prevented partly gentamicin induced tubular damage. The results histopathologically demonstrated that resveratrol has a protective effect against gentamicin induced nephrotoxicity, lipid peroxidation and cellular damage in rats.

Cardiac protection by mitoKATP channels is dependent on Akt translocation from cytosol to mitochondria during late preconditioning.

This investigation elucidates the Akt/mitochondrial ATP-sensitive K(+) (mitoK(ATP)) channel signaling pathway in late pharmacological preconditioning, using the mitoK(ATP) channel openers BMS-191095 (BMS) and diazoxide (DE). BMS (1 mg/kg ip) and DE (7 mg/kg ip) alone or BMS plus wortmannin (WTN, 15 microg/kg ip), an inhibitor of phosphatidylinositol 3-kinase, and BMS plus 5-hydroxydecanoic acid (5-HD, 5 mg/kg ip), an inhibitor of mitoK(ATP) channels, were administered to male mice. Twenty-four hours later, hearts were isolated and subjected to 40 min of ischemia and 120 min of reperfusion via Langendorff's apparatus. Both BMS and DE reduced left ventricular end-diastolic pressure and increased left ventricular developed pressure as well as reduced LDH release. Coadministration of BMS and WTN abolished the beneficial effects of BMS on cardiac function. Moreover, BMS and DE accelerated Akt phosphorylation in cardiac tissue as determined by Western blot analysis and also significantly reduced apoptosis compared with ischemic control. WTN significantly suppressed BMS-induced Akt phosphorylation, whereas 5-HD had no effect on Akt phosphorylation in cytosol, and the effect of BMS on apoptosis was abolished. It is concluded that the cardioprotective effect by mitoK(ATP) channels is attributed to the translocation of phosphorylated Akt from cytosol to mitochondria.

Role of NO and prostaglandins in acute hypoxic vasoconstriction in sheep pulmonary veins.

The aim of this study was to investigate the effect of hypoxia on and the role of nitric oxide (NO) and cyclooxgenase inhibition in hypoxia-induced vasoconstriction in sheep isolated pulmonary veins. We used the potent pulmonary vasoconstrictor U46619, a thromboxane analog, as a precontractile agent. Our results showed that hypoxia caused a vasoconstriction both under resting tone and in U46619 (10(-6) mol/l) precontracted pulmonary veins. In the presence of the nonselective NO synthase inhibitior Nomega-nitro-L-arginine methyl ester (L-NAME; 3 x 10(-5) mol/l), the hypoxic pulmonary vasoconstriction (HPV) was significantly increased in veins under resting force. However, there was a decrease in HPV in pulmonary veins precontracted with U46619 in the presence of L-NAME. Moreover, L-NAME markedly augmented the U46619-induced pulmonary contractions under normoxic conditions. Cyclooxygenase inhibition with indomethacin (10(-5) mol/l) significantly reduced the HPV both under resting tone and in precontracted veins. Indomethacin also significantly decreased the U46619-induced pulmonary contractions prior to the induction of hypoxia. Our findings suggest that NO and prostaglandins can act as a modulators of the hypoxic vasoconstriction in isolated pulmonary veins.

Hypobaric-hypoxia-induced pulmonary damage in rats ameliorated by antioxidant erdosteine.

Free radical-mediated injury to lung and pulmonary vasculature is an important mechanism in hypoxia-induced lung damage. In this study, we aimed to investigate the potential protective effects of erdosteine as an antioxidant agent on hypobaric hypoxia-induced pulmonary hypertension. Adult male rats were assigned randomly to three groups. The first group of rats was exposed to hypobaric-hypoxia and the second group was treated with erdosteine (20mg/kg, daily) for 2 weeks, during which time they were in a hypoxic chamber. These groups were compared with normoxic controls. All rats were sacrificed after 2 weeks. The hypoxia-induced increase in right ventricle to left ventricle plus septum weight ratio (from 0.20+/-0.01 to 0.26+/-0.01) was reduced significantly in the erdosteine-treated group (0.23+/-0.01). Malondialdehyde levels were elevated (from 0.33+/-0.11 to 0.59+/-0.02) and total antioxidant status was not changed significantly (from 1.77+/-0.42 to 2.61+/-0.23) by hypoxia. In contrast to the hypoxia-exposed group, malondialdehyde levels were significantly decreased in the erdosteine-treated group (0.37+/-0.02). Total antioxidant status (4.03+/-0.22) was significantly higher in erdosteine-treated rats when compared to non-treated rats. Histopathological examination demonstrated that erdosteine prevented inflammation and protected lung parenchyma and pulmonary endothelium of hypoxia-exposed rats.

Nursing students' opinions and knowledge about complementary and alternative medicine therapies.

The aim of this study was to determine the nursing students' opinions and knowledge of complementary and alternative medicine (CAM) therapies in Turkey. A descriptive study was conducted via questionnaire to a convenience sample of 276 nursing students. Students expressed positive opinions about CAM therapies, but their personal knowledge about CAM therapies was limited. Many students (64.5%, n=178) indicated that they wanted CAM to be integrated into the nursing curriculum and used in clinical practice (62.3%, n=172). Although students expressed knowledge of massage, diet, vitamins, herbal products, and praying, they had limited knowledge of biofeedback. Nursing students knowledge and understanding about CAM therapies in general, was found to be limited. It is suggested that the inclusion of CAM within in the nursing curriculum would prepare nurses to respond to knowledgably to patient questions related to CAM therapies.

Quality of life in women with breast cancer in Turkey.

PURPOSE: To determine quality of life (QoL) of Turkish women with breast cancer, and to examine whether QoL was related to sociodemographic or clinical variables. DESIGN: This descriptive study was conducted with a convenience sample of 72 Turkish women with breast cancer recruited from two hospitals in Turkey. METHODS: The data were collected using a questionnaire, the Quality of Life Scale (QoLS), and the Visual Analogue Scale (VAS), and were analyzed using descriptive statistics. FINDINGS: Two sociodemographic variables (educational background and employment status) were related to QoL of women with breast cancer. No statistically significant difference was found between patients with and without pain on scores obtained from the overall QoLS. CONCLUSIONS: The mean scores of total scale and subscales related to QoL perceived by women were considered to be moderately high. However, findings showed that educational level, employment status, and level of pain affected the level of QoL in Turkish women with breast cancer in varying degrees. Further studies are needed to determine specific effects of sociodemographic and clinical variables on QoL.

Trends in complementary and alternative medicine in eastern Turkey.

OBJECTIVE: To investigate the types and prevalence of complementary and alternative medicine (CAM) use among adults in eastern Turkey and to evaluate the relationship between the use of CAM and sociodemographic characteristics. DESIGN: This study was a random-sampled survey examining patterns of use of complementary therapies in two university hospitals in the Eastern Anatolia region of Turkey. SETTING AND SUBJECTS: Seven-hundred-fourteen (714) adult participants were interviewed at two sites: two university hospitals both located in Erzurum. Subjects were excluded if they did not speak Turkish because this may sometimes cause communication problems between patients and health care professionals. Patients younger than 18 years old and those residing outside of the eastern region of Turkey were not included in this study. MEASUREMENT: Use of CAM within the previous year. RESULTS: Seventy percent (70%) of participants reported the use of CAM. Herbs (41%) were the most frequently cited therapies. Although 87% of the subjects reported that they were satisfied with their use of CAM, the majority (84.8%) did not discuss the use of these therapies with their primary physicians. CONCLUSIONS: This study revealed that there is a high prevalence of use of alternative therapies by individuals living in eastern Turkey.

Involvement of tyrosine kinase pathway in acute hypoxic vasoconstriction in sheep isolated pulmonary vein.

Tyrosine kinase pathway has been shown to be involved in the effects of hypoxia in pulmonary arteries, but its role in pulmonary vein is not known. The aims of this study were to determine the effect of hypoxia in sheep isolated pulmonary veins and to identify the role of tyrosine kinase pathway in hypoxic response. Genistein and tyrphostin were used as selective tyrosine kinase inhibitors, and sodium orthovanadate was administered for tyrosine kinase activation. Hypoxia (95% N(2) to 5% CO(2)) caused a vasoconstriction either under resting tone or in U46619-precontracted pulmonary veins. Genistein and tyrphostin inhibited hypoxia-induced vasoconstriction both under resting tone and in precontracted veins, while sodium orthovanadate increased these hypoxic contractions. Our findings suggest that tyrosine kinase pathway is involved in hypoxic pulmonary vasoconstriction in sheep isolated pulmonary vein rings.

Perceptions and experiences of nurses in Turkey about verbal abuse in clinical settings.

PURPOSE: To determine the frequency and sources of verbal abuse against nurses working in clinical settings in different hospitals in the last 12 months, to identify nurses' perceptions about verbal abuse, and to determine types of emotions experienced by nurses who had encountered verbal abuse. DESIGN AND SAMPLE: This descriptive study was conducted in May 2001 in Turkey. Data were collected from 467 nurses working in various clinical settings in three hospitals. METHOD: The instrument was a 23-item questionnaire on verbal abuse. Data were evaluated using frequency and descriptive statistics. FINDINGS: The findings revealed that the majority of nurses had experienced verbal abuse in the last 12 months (86.7%, n = 405). Most nurses (92%) reported that verbal abuse negatively affected their morale. The most common sources of verbal abuse were patients' relatives and patients themselves. CONCLUSIONS: Workplace verbal abuse events cannot always be anticipated. Contingency plans to handle potential situations should be developed.

Nuclear factor-kappaB inhibitors abolish hypoxic vasoconstriction in sheep-isolated pulmonary arteries.

The aim of this study was to determine the role of nuclear factor-kappaB (NF-kappaB) in hypoxic constriction of isolated pulmonary arteries. Rings were suspended in an organ bath filled with Krebs-Henseleit solution and isometric contractions were recorded continuously. Hypoxia (%95 N(2)-%5 CO(2)) had no marked effect on resting force in artery rings. However, hypoxia caused further contractions in serotonin-precontracted arteries. Hypoxia-induced vasoconstrictions were abolished by preincubation with NF-kappaB inhibitors, pyrrolidine dithiocarbamate (100 microM) or pyrithione (10 microM). These results suggest that reactive oxygen species and/or NF-kappaB activation may be involved in the hypoxia-induced vasoconstriction in sheep-isolated pulmonary arteries.

Role of G(s) proteins in hypoxic constriction of sheep pulmonary artery rings.

The introduction of hypoxia is well known to cause contraction of pulmonary artery rings in vitro. Despite intensive studies, the cellular mechanisms of hypoxic pulmonary vasoconstriction are still not well defined. In this study, we aimed to determine the contribution of G(S) proteins in hypoxia-induced vasoconstriction in large-diameter sheep pulmonary arteries using cholera toxin (CT). Hypoxia caused further contractions in serotonin but not in NaF-precontracted pulmonary artery rings. However, hypoxic vasoconstriction due to lowering of pO(2) from 97 to 5 mm Hg was totally abolished by preincubation with CT in serotonin-precontracted arteries. These preliminary results indicate that signal transduction mediated by G(s) proteins may be an important mechanism in the hypoxic vasoconstriction of isolated pulmonary arteries of sheep.