The Effect of Intra-abdominal Pressure on Heart Rate Variability and Hemodynamics During Laparoscopic Cholecystectomy: A Prospective Observational Study.

Introduction This study aimed to evaluate hemodynamic changes using heart rate variability (HRV) measurements in diabetic and nondiabetic patients who will undergo laparoscopic cholecystectomy and to provide our preoperative measurements to guide us for better perioperative anesthesia management. Materials and methods The study included 143 patients aged 40 years and older who would undergo elective laparoscopic surgery, did not have any comorbidities other than diabetes mellitus (DM) type II, and were in the American Society of Anesthesiologists (ASA) class I-III risk group. Patients were divided into two groups: the control group (n = 77) and the DM group (n = 66). The preoperative glycated hemoglobin (HbA1C) level was measured. Peripheral oxygen saturation (SpO2) and hemodynamic parameters such as systolic arterial pressure (SAP), diastolic arterial pressure (DAP), mean arterial pressure (MAP), heart rate (HR), and HRV parameters were measured preoperatively, perioperatively, and postoperatively. Intra-abdominal pressure (IAP) was administered at 10-12 mmHg. Results Even though SAP, DAP, MAP, and HR decreased with induction, they increased with insufflation, and an overall decrease was seen at the postoperative 24th hour for all parameters. When the groups were evaluated, no difference was observed except that the DAP was significantly lower in the DM group (p = 0.029) at insufflation and the HR was higher in the DM group at induction, and the difference was significant (p = 0.001). Preoperative HRV parameters were significantly lower in the DM group. According to the HRV parameters, although a decrease was observed after induction and insufflation, conversely, an increase was observed postoperatively. When the postoperative and preoperative values were compared, the standard deviation of the NN (R-R) intervals (SDNN), SDNN index, high frequency (HF), low frequency (LF), and LF/HF parameters were found to be significantly lower in the DM group than in the control group. Conclusion Diabetic patients are more sensitive to increased intra-abdominal pressure (IAP) in laparoscopic surgery, and the effects on cardiac autonomic functions can be determined by HRV measurements without clinically reflecting on hemodynamic data. Additionally, in diabetic patients with preoperative LF and/or HF values less than 100, we believe that careful follow-up in terms of autonomic neuropathy complications and anesthesia management should be done more meticulously in these patients.

The effects of online art therapy on ego functions, emotion regulation, and interpersonal relationship styles in neurotic personality organization.

Art therapy, as an effective therapeutic intervention, is used to improve positive self-image and self-awareness, promote insight, and enhance therapeutic communication. This study aimed to evaluate the efficacy of art psychotherapy on ego functions, emotion regulation, and interpersonal relationship styles of individuals with neurotic personality organization. Using a quasi-experimental pretest-posttest design, 60 participants were assigned to intervention and control groups, each further divided into three subgroups (n = 10 per subgroup). The intervention group engaged in online art therapy sessions twice weekly over nine weeks, while the control group received no intervention. Data analysis involved descriptive statistics, paired samples t-tests, and independent t-tests. There was a significant decrease in the intervention group's judgmental subdimensions of the Ego Function Assessment Scale. A significant decrease was found in the intervention group in "awareness" (p < 0.01), "clarity" (p < 0.05), and "impulse" (p < 0.001) subdimensions and total scores of the Difficulties in Emotion Regulation Scale. There was no statistical difference between the intervention and control groups' mean pretests and posttests and comparing those groups with each other concerning IRSQ scores. The online group art therapy led to successful improvements in participants' ego functions and emotion regulations.

Relationship between Psychological Resilience, Perceived Stress, Death Anxiety and Progression of Disease in Individuals with COVID-19.

Introduction: This study examines the association between perceived stress, death anxiety, psychological resilience and the sociodemographic and clinical features of patients with Coronavirus Disease 2019 (COVID-19). Methods: 304 patients with COVID-19 diagnosis, who were admitted to Istanbul University Istanbul Faculty of Medicine Hospital "COVID-19 Patients Monitoring Center" were recruited. No sample selection was made, all the patients who were followed up and treated in the center were included. Data was collected by the researchers through face-to-face interviews using the Sociodemographic Information and Disease Progression Form, Psychological Hardiness Scale (PHS), Perceived Stress Scale (PSS), and Templer Death Anxiety Scale (TDAS). Results: Women scored higher in PSS and TDAS. Participants with chronic diseases reported higher death anxiety whereas perceived stress was higher in individuals with psychiatric disorders and ones without a history of intensive care unit stay. Participants without psychiatric disorders, who had longer hospitalization and who fully recovered scored higher in PHS-Control. Patients' report of negative attitudes from their relatives/friends was associated with lower scores in PHS. Perceived stress was correlated with death anxiety and psychological resilience. Conclusion: Being female, comorbid physical and mental illnesses, continuation of disease symptoms and low psychological resilience were found to be risk factors in terms of stress and death anxiety in COVID-19 patients. These vulnerable groups need to be closely evaluated with a bio-psychosocial approach and provided psychological support during the course of the disease. Health institutions are recommended to conduct medical treatment in cooperation with psychological care.

Effects of taxifolin on tramadol-induced oxidative and inflammatory liver injury in rats: an experimental study.

In this experimental study we aimed to investigate the biochemical and histopathological effects of concomitantly administered taxifolin on tramadol-induced liver damage in rats. The rats were divided into three groups; control group (CG), tramadol alone (TRG), and taxifolin + tramadol given (TTRG) groups. Malondialdehyde (MDA), total glutathione (tGSH), total oxidant status (TOS), total antioxidant status (TAS), nuclear factor-kappa beta (NF-kB), tumor necrosis factor-α (TNF-α), and interleukin-1ß (IL-1ß) levels were measured in liver tissues. Liver tissues were also examined histopathologically. Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) activities were determined in blood samples. In tissue analyses, determinants of oxidative stress and inflammation, all were significantly higher in the TRG group compared with the control and TTRG groups. In the TTRG group, all oxidative stress and inflammation markers were significantly lower than in the TRG group. In addition, there was not any significant difference between the control and TTRG groups regarding the TOS and TAS status. Serum liver enzymes were also significantly higher in the TRG group than in the other two groups. In histopathological examinations, the control group had a normal histological appearance. Degenerative-necrotic hepatocytes and hemorrhage, which were seen at a severe level in the TRG group, were found to be moderate in the treated TTRG group. In addition, mononuclear cell infiltrations were found to be severe in the TRG group and mild in the treated TTRG group. Finally it was concluded that Taxifolin alleviated the toxic effects of tramadol on the liver including the histopathological and biochemical changes as well as the oxidative damage.

Effect of a long-term art-based group therapy with eating disorders.

Eating disorders (EDs) affect the physical, psychological, emotional and interpersonal areas of the individual and cause serious medical and mental consequences. Their treatment should be handled in a multidisciplinary manner.The objective of this study was to investigate potential benefits of long-term art-based group therapy (ABGT) as an adjunct to treatment for a variety of EDs. This study examined the effects of ABGT on disease symptoms, difficulty regulating emotions, depression, anxiety, targeted problems, functioning of individuals with EDs and therapeutic efficiency of the group. The study was carried out as a pre-test-post-test, quasi-experimental study with a control group, with a small sample diagnosed with an ED. In addition to their standard treatment at the outpatient centre, participants were included in a 30-week long-term semistructured ABGT focused on raising awareness of their psychological problems. Participants who received ABGT had significantly better functioning and lower severity of target problems compared with the control group. The severity of the three most important problems reported by patients post-ABGT compared with pre-ABGT and the effects of these problems on their social/private lives reduction was observed. The participants mostly benefited from catharsis, universality, self-understanding, existential factors and family re-enactment in the group process. Through the artwork, participants recognised the mental conflicts causing the symptoms of their ED. We found that art-based interventions are useful in the treatment of EDs, as they positively changed the functioning and symptoms of people with EDs. We recommend that clinicians keep these interventions in mind in formulating treatment protocols for these disorders.

Development and validation of the Mental Health Promotion Scale.

PURPOSE: This study aimed to develop and validate a scale that assesses adults' mental health promotion abilities. DESIGN AND METHODS: This study was conducted in Istanbul from October 2016 to May 2018. Three rounds of the Delphi method were conducted to develop the scale. FINDINGS: After the third Delphi round, the experts reached a consensus on 93 scale items. Forty-six items were excluded from the scale based on exploratory factor analysis (EFA) results. In the last EFA of the 47-item scale, a 12-factor construct was found with an eigenvalue >1 that explained 64.3% of total variance. The overall Cronbach's alpha of the scale was .93. PRACTICE IMPLICATIONS: This scale can be used to assess adults' mental health promotion abilities.

Effects of activity groups, in which art activities are used, on resilience and related factors in families with disabled children.

PURPOSE: This study aims to examine the effects of activity groups using art activities on resilience and related factors in mothers with disabled children. DESIGN AND METHODS: This randomized controlled experimental design study was conducted with 33 mothers (18 in the control and 15 in the intervention group). FINDINGS: A statistically significant difference was found between the intervention group's pretest and posttest mean scores on the Resilience Scale for Adults, the Satisfaction with Life Scale, Zarit Burden Interview, and 12-item General Health Questionnaire scales. IMPLICATIONS FOR NURSING PRACTICE: The psychological activity groups that used art activities were found to increase psychological well-being and satisfaction with life among the families of disabled children with various types of distress (physical, psychological, economic, and social), as well as reducing their mothers' perceived caregiving burden.

Evaluating the Relationship between the Pleth Variability Index and Hypotension and Assessing the Fluid Response in Geriatric Hip Fracture under Spinal Anaesthesia: An Observational Study.

OBJECTIVE: We aimed to test the efficacy of the pre-operative Pleth variability index (PVI) in evaluating hypotension that developed after spinal anaesthesia in patients who were spontaneously breathing, pre-operatively hypovolemic, and were at an advanced age. METHODS: This observational study included 94 patients aged >65 years with hip fracture. Demographic data, pre-operative heart rate, non-invasive arterial pressures, PVI values, and haemogram values were continuously measured following spinal anaesthesia. The measurements with and without hypotension were distinguished and their data were compared. RESULTS: The mean age of the patients was 77.4±8.2 years. In total, 56.4% of the patients developed hypotension after spinal anaesthesia, and hypotension was higher in women (p=0.037). Low pre-operative diastolic arterial pressures values were associated with the development of hypotension (p=0.037). The relationship between PVI and post-spinal hypotension was negative but significant (r=-0.239; p<0.05). Depending on the volume loss, an increase in the PVI (p<0.001) and its subsequent significant decrease after treatment in patients with hypotension (p<0.001) was observed. The correlation between noninvasively measured haemoglobin values and the values obtained from arterial blood gas samples was significant (p<0.001). CONCLUSION: This study showed that post-spinal hypotension may be associated with increased as well as decreased PVI values. However, these values cannot be clinically used for predicting pre-operative hypotension in hypovolemic patients.

Comparison of Subjective Wellbeing and Positive Future Expectations in Between Working and Nonworking Adolescents in Turkey.

BACKGROUND: Wellbeing is one's evaluation and judgment of one's life. It consists of 3 dimensions: positive affectivity, negative affectivity, and life satisfaction. OBJECTIVES: This study aimed to compare the subjective wellbeing and positive future expectations between working and nonworking adolescents. PATIENTS AND METHODS: The study was designed as descriptive and comparative. The study sample consisted of 420 working and 482 nonworking adolescents (n = 902) aged 15 - 20 years, who were randomly recruited from two occupational education centers in Istanbul, Turkey and two high schools (formal educations) in the same district. RESULTS: Adolescent subjective wellbeing scale (ASWS) total mean (SD) scores for working adolescents and nonworking adolescents were 48.76 (9.50) and 49.72 (8.01), respectively. In addition, positive future expectations scale (PFES) total mean (SD) scores for working adolescents and nonworking adolescents were 18.71 (4.50) and 19.06 (3.49), respectively. In this study, no significant difference was found between the general wellbeing (scale total median score) scores of the working and nonworking adolescent groups (Z = 1.01, P = 0.315). However, significant differences were found in the family relations satisfaction (Z = 3.23, P = 0.002) and relations with significant others (Z = 2.85, P = 0.004) subscales of the ASWS. CONCLUSIONS: A positive relationship was found between adolescent subjective wellbeing and positive future expectations. It was found that nonworking adolescents scored higher on the dimensions of "family relations" and "relations with significant others" of subjective wellbeing compared to those dimensions in working adolescents.

Nurses' attitudes toward ethical issues in psychiatric inpatient settings.

BACKGROUND: Nursing is an occupation that deals with humans and relies upon human relationships. Nursing care, which is an important component of these relationships, involves protection, forbearance, attention, and worry. OBJECTIVES: The aim of this study is to evaluate the ethical beliefs of psychiatric nurses and ethical problems encountered. RESEARCH DESIGN: The study design was descriptive and cross-sectional. RESEARCH CONTEXT: Methods comprised of a questionnaire administered to psychiatric nurses (n=202) from five psychiatric hospitals in Istanbul, Turkey, instruction in psychiatric nursing ethics, discussion of reported ethical problems by nursing focus groups, and analysis of questionnaires and reports by academicians with clinical experience. PARTICIPANTS: PARTICIPANTS consist of the nurses who volunteered to take part in the study from the five psychiatric hospitals (n=202), which were selected with cluster sampling method. Ethical considerations: Written informed consent of each participant was taken prior to the study. FINDINGS: The results indicated that nurses needed additional education in psychiatric ethics. Insufficient personnel, excessive workload, working conditions, lack of supervision, and in-service training were identified as leading to unethical behaviors. Ethical code or nursing care -related problems included (a) neglect, (b) rude/careless behavior, (c) disrespect of patient rights and human dignity, (d) bystander apathy, (e) lack of proper communication, (f) stigmatization, (g) authoritarian attitude/intimidation, (h) physical interventions during restraint, (i) manipulation by reactive emotions, (j) not asking for permission, (k) disrespect of privacy, (l) dishonesty or lack of clarity, (m) exposure to unhealthy physical conditions, and (n) violation of confidence. DISCUSSION: The results indicate that ethical codes of nursing in psychiatric inpatient units are inadequate and standards of care are poor. CONCLUSION: In order to address those issues, large-scale research needs to be conducted in psychiatric nursing with a focus on case studies and criteria for evaluation of service, and competency and responsibility needs to be established in psychiatric nursing education and practice.

Psychometric Properties of Difficulties of Working with Patients with Personality Disorders and Attitudes Towards Patients with Personality Disorders Scales.

INTRODUCTION: In this study, we aimed to develop two reliable and valid assessment instruments for investigating the level of difficulties mental health workers experience while working with patients with personality disorders and the attitudes they develop tt the patients. METHODS: The research was carried out based on the general screening model. The study sample consisted of 332 mental health workers in several mental health clinics of Turkey, with a certain amount of experience in working with personality disorders, who were selected with a random assignment method. In order to collect data, the Personal Information Questionnaire, Difficulty of Working with Personality Disorders Scale (PD-DWS), and Attitudes Towards Patients with Personality Disorders Scale (PD-APS), which are being examined for reliability and validity, were applied. To determine construct validity, the Adjective Check List, Maslach Burnout Inventory, and State and Trait Anxiety Inventory were used. Explanatory factor analysis was used for investigating the structural validity, and Cronbach alpha, Spearman-Brown, Guttman Split-Half reliability analyses were utilized to examine the reliability. Also, item reliability and validity computations were carried out by investigating the corrected item-total correlations and discriminative indexes of the items in the scales. RESULTS: For the PD-DWS KMO test, the value was .946; also, a significant difference was found for the Bartlett sphericity test (p<.001). The computed test-retest coefficient reliability was .702; the Cronbach alpha value of the total test score was .952. For PD-APS KMO, the value was .925; a significant difference was found in Bartlett sphericity test (p<.001); the computed reliability coefficient based on continuity was .806; and the Cronbach alpha value of the total test score was .913. Analyses on both scales were based on total scores. CONCLUSION: It was found that PD-DWS and PD-APS have good psychometric properties, measuring the structure that is being investigated, are compatible with other scales, have high levels of internal reliability between their items, and are consistent across time. Therefore, it was concluded that both scales are valid and reliable instruments.