Nurses' experiences of using a computer-based triage decision support system in the emergency department.

BACKGROUND: Emergency department triage is a vital and complex decision-making process. There is limited knowledge about nurses' experiences with triage decision support systems in emergency departments. AIM: This study was conducted to examine nurses' experiences with a computer-based triage decision support system in the emergency department. STUDY DESIGN: This is a qualitative and phenomenological study. Data were collected through interviews from 14 triage nurses who used a triage decision support system in the emergency department of a university hospital. The nurses were recruited for semi-structured interviews. All interviews were recorded on a voice recorder and then transcribed. Data were analysed with the inductive content analysis method. The interviewer asked comprehensive questions about the nurses' experiences with the triage decision support system. RESULTS: Three main and 11 sub-themes were elicited as a result of the analysis of the in-depth interviews: (a) the facilitating the triage decision theme, which included help in case of a dilemma, team collaboration, monitoring/supervision, and error reduction sub-themes; (b) the contribution to professionalism theme, which included ease of learning and teaching triage, professional autonomy, creating a database, and evidence-based practice sub-themes; (c) the areas that need improvement theme, which included reducing screen clicks, the effect of the hospital automation system performance, and clinical descriptors not included in the algorithm sub-themes. CONCLUSION: Triage nurses stated that the decision support system was beneficial and facilitated decision-making. The decision support system enabled triage nurses to make their own decisions using their clinical knowledge and experience, without a restriction on their professional autonomy, and this was perceived positively. It was emphasized that this system could be a support tool in educating nurses new to triage. However, nurses stated that the pace of the decision support system was affected by the performance of the hospital automation system and that the large number of steps used for electing items caused a waste of time. They also added that these were technical areas that needed improvement. RELEVANCE TO CLINICAL PRACTICE: The study provides important data that will help healthcare organizations and professionals better understand the emergency department nurse triage decision support system and gain a versatile, comprehensive, and general understanding.

Intern nursing students' perceptions of patient safety culture and their experiences with factors affecting the safety of care in hospital settings: A mixed method study.

BACKGROUND: Patient safety culture is a globally studied subject as it plays a significant role in preventing and reducing errors. There is limited mixed-method research into the in-depth investigation of intern nurses' views on patient safety in hospital settings and the factors affecting it. OBJECTIVE: This study was conducted to determine intern nursing students' perceptions of patient safety culture and their experiences with exploring factors affecting the safety of care in hospital settings. DESIGN AND METHODS: A convergent mixed-method design was used. The study group was selected using the purposive sampling method. STROBE and COREQ checklists were followed. The quantitative phase was descriptive and correlational, and the qualitative phase was phenomenological. Quantitative data were collected using a "Personal Information Form" and "Patient Safety Culture Scale" and qualitative data using a "Semi-Structured Interview Form." Mean ± standard deviation, median (min-max), frequency, percentage values, Shapiro-Wilk, and Mann-Whitney U tests were employed to evaluate quantitative data. The inductive content analysis method was used to analyze qualitative data. SETTING AND PARTICIPANTS: The study consisted of intern nursing students from a university in the 2020-2021 academic year. The quantitative phase of the research was conducted with 38 and the qualitative phase with nine intern nursing students. In the qualitative phase, the saturation point was taken as a basis. RESULTS: In the study, nursing students' perceptions of patient safety culture were high (3.24 ± 0.49; min = 1.88 and max = 4). The results of the qualitative data analysis indicated that the factors affecting patient safety in hospital settings consisted of three themes, namely "health professionals, care environment, and patients and caregivers" and nine subthemes. CONCLUSIONS: Intern nursing students had high perceptions of patient safety culture and had highly significant experiences with the factors affecting safe care in hospital settings.

The Effect of Prewarming on Perioperative Hypothermia: A Systematic Review and Meta-analysis of Randomized Controlled Studies.

PURPOSE: One of the methods for maintaining perioperative normothermia is prewarming. This study was conducted to investigate the effect of a preoperative prewarming intervention on perioperative body temperature. DESIGN: Systematic review and meta-analysis. METHODS: A literature review was conducted using PubMed, CINAHL, Cochrane Central, Science Direct, Springer Link, Scopus, Web of Science, and Ovid databases. Randomized controlled trials that investigate the effect of prewarming on body temperature in the prevention of perioperative hypothermia were included. The review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement guidelines. Methodological quality was assessed using the Cochrane Collaboration "risk of bias" tool. Meta-analysis was performed with Comprehensive Meta-Analysis, version 2. Moderator analysis and publication bias assessment were performed. Funnel plots were analyzed using Orwin's fail-safe N, Trim, and Fill test method to investigate the source of heterogeneity. FINDINGS: A total of 907 studies were found. The systematic review included 27 studies. Of these, 23 were included in the intraoperative meta-analysis, and 16 were included in the postoperative meta-analysis. According to the meta-analysis results, the prewarming intervention was effective in maintaining normothermia in the intraoperative (Hedge's g = 0.972, 95% confidence intervaI = 0.674 to 1.270) and postoperative (Hedge's g = 0.818, 95% confidence intervaI = 0.520 to 1.114) periods. CONCLUSIONS: The findings of this systematic review and meta-analysis showed that preoperative prewarming played a significant role in providing and maintaining perioperative normothermia.

Bariatric Surgery and Weight Gain: Bibliometric Analysis.

PURPOSE: Bariatric surgery is the most successful method for weight loss; however, weight regain may occur in the long term. It depends on eating habits and self-management. The study aimed to conduct a bibliometric analysis on bariatric surgery and weight gain and to determine the content and trends in the literature. MATERIALS AND METHODS: The scan was performed using the keywords "bariatric surgery" and "weight gain" in the Web of Science database. The years of publications and citations, the distribution of publications according to journals, research areas, and countries, co-authorship, co-occurrence, and co-citation were analyzed. The VOSviewer program was used for the analysis. Grey literature, books, and book sections were not included. RESULTS: A total of 988 articles were included. The results showed that the most published and cited journal was Obesity Surgery, and the most published country was the USA with 313 publications. The most commonly used keywords were "bariatric surgery," "obesity," and "weight regain." Harvard University was the most publishing institution with 50 publications. The most published year was 2022 since 1993 (n:118). CONCLUSION: In the study, current publications and research trends related to bariatric surgery and weight gain were analyzed through bibliometric analysis. It was concluded that weight regain after bariatric surgery should be focused on since it adversely affects the life of individuals, reduces the probability of success of surgical treatment, and imposes additional burdens on the healthcare system.

Study protocol: The effect of motivational interviewing on self-management in adult kidney transplant recipients (MIAKTR).

BACKGROUND: The aim of the study is to examine the effect of motivational interview sessions on self-management that will be conducted in accordance with the post-discharge requirements of adult kidney transplant recipients. Patient-centered motivational interviews make a significant contribution to activating patients' sense of being capable of changing to realize their self-management. MATERIAL AND METHODS: This study is a single-center, single-blind, prospective randomized controlled trial. The participants of the study will consist of 80 kidney transplant recipients at an organ transplant center in Turkey. The study is a randomized controlled trial compatible with SPIRIT. The CONSORT flow diagram has been used in this study protocol. The sample will consist of participants within the 3rd, 4th, 5th, and 6th months after the kidney transplant. The measurements will be performed in the first and third months after the interviews. The study continues via the collection of data from the intervention and control groups. CONCLUSION: In order to support or improve the self-management of kidney transplant recipients, new tools are required that are suitable for this population. Patient-centered motivational interviews can make a significant contribution to activating patients' sense of being capable of changing to realize their self-management. The first motivational interview program to promote a healthy lifestyle in kidney transplant recipients, prevent unwanted conditions after transplantation, and improve self-management will be used in this study. After the intervention has been developed, we expect improvements in self-management with a motivational interviews through creating their own strategies for behavioral changes and improvements in health outcomes.

The effect of computer-based decision support system on emergency department triage: Non-randomised controlled trial.

BACKGROUND: Deciding on triage in emergency departments is difficult and requires comprehensive knowledge and experience. PURPOSE: This study was conducted to evaluate the effect of a "computer-based emergency department triage decision support system (DSS)," which was designed and integrated into the hospital information management system, on triage decision accuracy and triage duration by using real patient data. METHODS: Single-group, pretest-posttest non-randomised clinical trial. The study was conducted with the real data of patients who had been triaged in the adult emergency department of a university hospital. The pretest was applied between July 16 and September 16, 2019, and the post-test on September 1 and October 31, 2020. In the pre-test and post-test phases of the study, triage decision accuracy rates, and triage duration were evaluated. In the post-test phase, Emergency Triage Decision Support System (ETDSS) was prepared with a rule-based decision trees method using the Emergency Severity Index Version 4 and The Australasian Triage Scale and was integrated into the hospital information management system. The effect of the developed ETDSS was evaluated. The mean, standard deviation, frequency and percentage values were calculated for the descriptive characteristics. Independent samples t-test, analysis of variance, Sidak paired comparison, and Bonferroni tests were applied. RESULTS: The effect of the computer-based emergency triage DSS on triage management was tested based on the data of 16,409 patients in the pretest phase and 7,765 patients in the posttest phase. While the accuracy rate of nurses' triage decisions was 57.8% in the pretest, it was found to increase to 64.9% in the posttest. The mean duration of triage was 1.47 ± 0.72 in the pretest and 1.79 ± 0.85 min in the posttest. CONCLUSIONS: The DSS increased triage decision accuracy independently of professional and triage experience and brought the triage duration closer to the time recommended in the literature. Clinically, this is associated with patient safety, quality improvement processes, and professional accountability.

Pressure Injury Prevalence and Risk Factors: A National Multicenter Analytical Study.

PURPOSE: The purpose of this study was to determine the point prevalence (PP) of general pressure injuries (PIs), hospital-acquired PIs, PI-related risk factors, and PI preventive interventions performed by nurses. DESIGN: Descriptive, multicenter, prospective, analytical study. SUBJECTS AND SETTING: The sample comprised 5088 patients cared for in 13 hospitals in 12 geographic regions of Turkey. Data were collected between November 5, 2018, and July 17, 2019. METHODS: The study was carried out in 2 stages. First, nurses who collected data were trained in the diagnosis of PI, risk assessment, staging, and prevalence studies, and informed about the purpose and methods of the study, including data collection. Second, nurses and researchers who had received training related to data collection for this study conducted a PP study for PIs in their inpatient clinics using the ASSIST II method. The PI Prevalence Study Tool and the Braden Scale for Predicting Pressure Sore Risk were also used during data collection. RESULTS: The PP of general PIs was 9.5%; the prevalence of PIs with hospitalization in intensive care units was 43.2%; medical device-related pressure injuries prevalence was 10.7%. We found that 65.1% of the PIs were acquired after hospital admission. CONCLUSIONS: Similarities exist between PI prevalence in Turkey and reported PI prevalence rates worldwide. However, the prevalence of nosocomial PIs related to intensive care units and the prevalence of all nosocomial injuries were higher than rates previously reported. Based on results, there is a need to develop strategies to reduce the prevalence of nosocomial PIs.

The effect of discharge training with the teach-back method on post-discharge challenges in lumbar disc herniation patients: A quasi-experimental study.

BACKGROUND: Shortened length of hospital stay in patients undergoing lumbar disc herniation surgery forces to undertake interventions that facilitate optimal patient outcomes. AIM: The aim of this study was to investigate the effect of discharge training given by teach-back method, and counseling based on individual needs and a study-specific training booklet on postoperative pain and challenges experienced by lumbar disc herniation patients. METHODS: This study had a quasi-experimental design and was conducted with 94 patients. Patients were divided into a control group (n = 48) and an intervention group (n = 46) using the blocking method. The pain was assessed at the time of patient admission, at discharge, and at follow-up; postoperative challenges were evaluated at discharge and follow-up. RESULTS: Most patients experienced pain and challenges such as kinesiophobia, weakness-exhaustion-fatigue, irritability, constipation, and insomnia. The patients in the intervention group had less back and leg pain and challenges. CONCLUSIONS: The benefits of education given by teach-back method, and counseling in reducing the postoperative problems experienced by patients who underwent surgery for lumbar disc herniation were demonstrated in this study. The findings suggest that study-specific training and counseling may be useful for addressing the pain and challenges of patients with lumbar disc herniation.

Molecular Cloning, Expression and Characterisation of a Bacterial Myrosinase from Citrobacter Wye1.

Glucosinolates are plant natural products which on degradation by myrosinases give rise to the beneficial bioactive isothiocyanates. Recently, a myrosinase activity was detected in a Citrobacter strain isolated from soil. This enzyme was purified enabling its amino acid sequence and gene sequence (cmyr) to be determined. In order to study this myrosinase it was necessary to establish an expression system that would enable future work such as a structural determination of the protein to be carried out. The myrosinase gene was amplified, cloned and expressed in Escherichia coli with a 6XHis-tag. The heterologous expression of cmyr enabled relatively large amounts of myrosinase to be produced (3.4 mg cmyr/100 ml culture). Myrosinase activity was determined by mixing substrate and enzyme and determining glucose release. Optimum pH and temperature were determined to be pH 6.0 and 25 °C for the Ni-NTA purified protein. The kinetic parameters of the purified myrosinase were determined using sinigrin as a substrate. Km and Vmax were estimated as 0.18 mM and 0.033 mmol/min/mg respectively for sinigrin under optimum conditions and compared to other kinetic data for myrosinases. The substrate specificity of myrosinase was determined having the highest affinity for sinigrin followed by glucoiberin, progoitrin, glucoerucin, glucoraphanin and glucotropaeolin.

Knowledge and practices of operating room nurses in the prevention of pressure injuries.

BACKGROUND: Operating room (OR) nurses play an important role in preventing the pressure injuries (PIs) that may develop during the perioperative process. This study was conducted to determine OR nurses' level of knowledge about PIs, and how they manage them. METHODS: This is a cross-sectional, quantitative and descriptive study. The sample of the study consisted of 234 OR nurses working in eight different public hospitals in Ankara. The questionnaire applied in this study was prepared in accordance with the guidelines. This questionnaire consisted of three sections: demographic profiling, common preventive practices, and the knowledge of OR nurses about intraoperative PI prevention. FINDINGS: 66.7% of the participants had received education about PIs during their basic nursing training, and 41.5% had received education after graduation. 97.4% of OR nurses did not follow international guidelines about PIs. The mean total score of the OR nurses for the questions about PIs was 52.0 ± 13.7 out of a possible score of 100. The lowest mean score was obtained for the topic of 'staging pressure injuries', and the highest score was obtained from 'interventions to prevent pressure injuries'. In addition, 81.5% of the OR nurses stated that they were not given information about patients with a high PI risk by clinical nurses. 97.9% of the OR nurses did not use a scale to assess intraoperative PI risks. Fewer than half of the nurses said that they assessed the risk of PIs during surgery. 90.8% the nurses did not record risk assessment and interventions to prevent PIs. CONCLUSION: There is a need to incorporate basic operating room PI (ORPI) training into both the basic nursing and in-service training to improve the knowledge of OR nurses about how to prevent and manage ORPIs. In addition, measures to assess PI risk and prevent ORPI should be included in institutional policies and procedures.

Impact of tailored training about pressure injuries on nurses' knowledge levels and pressure injury point prevalence: The case of Turkey.

AIM: This study was conducted to determine the impact of tailored training provided to nurses for preventing pressure injuries (PIs) on nurses' knowledge levels and the PI point prevalence (PP). MATERIALS AND METHODS: This interventional study was carried out in a university hospital with a bed capacity of 1114 in an urban center in Turkey. Ethics committee approval (28.06.2018/31) and institutional permission were obtained for the study, in addition to the nurses' written, informed consent. The study was completed in three stages. In the first stage an initial PP study was conducted in the clinics with the participation of the nurses and the members of the research team (n = 422 patients). In the second stage the knowledge levels of 194 nurses were measured before training was given on following-up and preventing PIs. The nurses then participated in the tailored training and their knowledge levels were re-measured afterwards. All the nurses were given individual advice related to the prevention of PIs for 30 days after they had completed the training. In the third stage a second PP study was conducted four months after the first PP study (n = 454 patients). The data were collected using the Pressure Injury Prevalence Form, the Braden Pressure Ulcer Risk Assessment Tool and the Knowledge Level Measurement Form. Descriptive values, the paired samples t-test, Pearson's chi-squared test and Fisher's Exact test were used to evaluate the data. RESULTS: The nurses' pretest mean knowledge score was 55.36% ± 14.40 and their posttest mean score was 69.92% ± 9.73. The difference between these scores was statistically significant (p < 0.05). The study found no significant difference between the first PP ratio and the second PP ratio (p > 0.05), and the nurses were better able to evaluate skin and PIs after the training. CONCLUSION: The study determined that the tailored training given to the nurses increased their knowledge; however, it had no impact on the PP after four months. It is recommended that any training programs using this model be continued and that PP studies of institutions be conducted annually.

Emergency nurse triage in the hospital information management system: A quality improvement study.

BACKGROUND: Assessment of nurse triage decision accuracy and triage times is currently carried out through paper-based methods. This quality improvement study aims to develop a method that can assess the accuracy and duration of nurse triage decisions based on a computerized system and to share an example of the application of this method. METHODS: This is a descriptive quality improvement study. The study was carried out in two stages between March and May 2019. The functionality of the developed method was examined using 3835 patients' triage data, which were obtained between June 1 and 14, 2019. RESULTS: With this study, the determination of the accuracy and duration of nurse triage decisions was accomplished with a computerized process based on real patient outputs, and the accuracy and duration of these decisions were continuously measured, monitored, and assessed, which is different from paper-based methods. The functionality of the method was evaluated with data from 3835 real patients. The triage decision accuracy rate was 64.4%, and the average duration of triage was 81.3s. Positive feedback on the method was received from all triage nurses. CONCLUSION: The study result outputs can be integrated into quality processes and can be used internationally as performance assessment criteria and quality indicators for triage nursing.

Perceptions of Clinical Nurses About the Causes of Medication Administration Errors: A Cross-Sectional Study.

AIM: This study was conducted to determine the perceptions of nurses about the causes of medication administration errors and the rates of reporting errors made or witnessed by them. METHOD: This methodological, descriptive, multicenter, and cross-sectional study sample of this study included 590 clinical nurses working in an inpatient setting in Turkey. The data were collected using the Medication Administration Error Reporting Survey, which is a self-report questionnaire. RESULTS: In the study, it was determined that insufficient number of nurses, heavy workloads, and illegible medication orders of physicians were the most common causes leading to medication errors as stated by the nurses. Moreover, 26.1% of the nurses reported that they had made an medication error, and more than half of the nurses reported that they had witnessed medication errors. It was found that 68.8% of medication errors were not reported. CONCLUSION: It is important to determine the nurses' perceptions about the causes of medication errors to prevent repetition of medication errors and to establish standards for medication safety. Therefore, it may be recommended to reduce workloads of nurses and develop methods to increase the rate of reporting medication errors.

A bridge to transplantation: The life experiences of patients with a left ventricular assist device.

BACKGROUND: The Left Ventricular Assist Device (LVAD) is a rapidly spreading treatment given to patients with advanced heart failure due to organ donor shortage. Thus, there is a need to study the life experience of patients who underwent LVAD implantation as a bridge to transplantation. OBJECTIVE: To examine the life experiences of patients who underwent LVAD implantation as a bridge to transplantation. METHODS: This qualitative, phenomenological research was carried out with 13 patients who underwent LVAD implantation as a bridge to transplantation. Data were collected through semi-structured in-depth interviews. Interviews were recorded through an audio recorder, transcribed verbatim, and evaluated using the inductive content analysis method. RESULTS: Two main themes (fear and coping), each with four sub-themes, were obtained after data were analyzed. Participants' fears and coping strategies for these were identified. CONCLUSION: In this study, fears and coping strategies came to the forefront in the life experiences of patients who underwent LVAD implantation as a bridge to transplantation.

Factors affecting the accuracy of nurse triage in tertiary care emergency departments.

OBJECTIVES: The accuracy and duration of triage is vital in emergency departments. However, patient density, diversity of cases, and time pressure make triage difficult. Triage performed properly and at the right time prevents patients from experiencing any untoward incidents that may occur because of waiting. Therefore, the study aimed to share the data obtained from the Hospital Information Management System (HIMS) regarding the accuracy and duration of nurse triage in an adult emergency department. METHODS: This descriptive and cross-sectional study evaluated the accuracy and duration of triage decisions made by nurses for patients admitted to an adult emergency department between June 15 and July 15, 2019. Statistical analysis was performed using Statistical analysis was performed using SPSS software version 23.00. RESULTS: The study included the data of 7705 adult patients. The accuracy rate of nurse triage was 59.3% (n = 4566), and the average duration of triage was 1.52 ± 2.10 min. It was observed that the average duration of accurate triage decisions was longer in patients with triage category 3. A statistically significant relationship was determined between the accuracy of nurse triage and the duration of triage, years of seniority of the nurse, and shifts (P < 0.05). CONCLUSIONS: The accuracy and duration of nurse triage in the hospital where the study was conducted can be evaluated via the HIMS. In order to increase the accuracy of nurse triage in the emergency department, it is necessary to employ experienced and trained nurses, develop computer-based support systems, and increase the number of nurses working in shifts providing care to a large number of patients.

Avocado-Soybean Unsaponifiables: A Panoply of Potentialities to Be Exploited.

Avocado and soybean unsaponifiables (ASU) constitute vegetable extracts made from fruits and seeds of avocado and soybean oil. Characterized by its potent anti-inflammatory effects, this ASU mixture is recommended to act as an adjuvant treatment for osteoarthritic pain and slow-acting symptomatic treatment of hip and knee osteoarthritis; autoimmune diseases; diffuse scleroderma and scleroderma-like states (e.g., morphea, sclerodactyly, scleroderma in bands). Besides, it was reported that it can improve the mood and quality of life of postmenopausal women in reducing menopause-related symptoms. This article aims to summarize the studies on biological effects of the avocado-soybean unsaponifiable, its chemical composition, pharmacotherapy as well as applications in auto-immune, osteoarticular and menopausal disorders. Finally, we will also discuss on its safety, toxicological and regulatory practices.

Obesity in the Kidney Transplant Process.

Obesity, which has become an increasing problem worldwide, poses a risk for kidney transplant recipients both before and after surgery. In this literature review, we studied the effects of obesity before and after kidney transplant. There are numerous studies and different opinions on the effects of obesity on graft function before and after transplant. Obesity prolongs surgery time and the ischemic process. A large cohort study of 11 836 recipients noted a close association between body mass index and delayed renal transplant and delayed graft function. However, another study found that being overweight or obese before transplant did not have any effects over the medium and long term. A 20-year follow-up study indicated that the firstyear body mass index in recipients after renal transplant had a greater effect on graft function and survival than body mass index before transplant. Still, another study found that body mass index had no effects on graft function and survival. In the study, 3-year graft function and mortality rates of morbidly obese people without diabetes, the functional status without dialysis, and living-donor transplant were reported to be much lower than in those with normal weight. In conclusion, there is no consensus on the effects of obesity before and after transplant, and it has been pointed out that more research should be done on this subject.

Effects of Web-Based Educational Intervention on Self-Management in Kidney Recipients.

Information technology and the Internet are rapidly becoming effective tools for teaching. Selfmanagement skills are important for adaptation and long-term survival in kidney recipients. Web-based training may help patients develop self-management skills through information access. This literature review aimed to determine the effects of Web-based educational intervention on self-management in kidney recipients. The Internet supports effective health education intervention strategies by providing a learning environment that is always available. Medicine management, routine follow-up, awareness of the signs and symptoms of rejection, infection prevention, self-monitoring, physical activity, and nutrition are important during the posttransplant period. Another important component of achievement in related matters is the competence of individuals with their own self-management. Webbased training is beneficial for appointment follow-up, nutritional adaptation, and treatment of anxiety and depression. Web-based training allows kidney recipients to access information at any time and place; this information promotes proper self-management.