Nurses' knowledge and practice in preventing pressure injuries in intensive care units.

OBJECTIVE: Globally, pressure injuries (PIs) are an important problem affecting healthcare institutions and patients. Nurses in multidisciplinary teams, play a crucial role in preventing PIs. Nurses working in intensive care units (ICUs) provide care to patients who are at risk of developing PIs. The aim of this study was to ascertain the knowledge and practices of intensive care nurses in preventing PIs, and to highlight the relationship between this knowledge and the prevalence of PIs. METHOD: This study used a descriptive and correlational design. It was carried out in the level 3 ICU of a university hospital in Kayseri, Turkey. A total of four instruments were used at the data collection stage: a nurse information form; the PI prevention knowledge assessment instrument; PI prevention practices; and a PI Prevalence Form. RESULTS: The population of the study consisted of 111 nurses, 91 (82%) of whom fully participated. The mean score of the nurses' knowledge in preventing PIs was found to be 43.2±11.4%. The most common answer regarding the clinical use of PI prevention practices was: 'always applied'. There was no relationship between PI prevalence and PI prevention knowledge scores of the ICU nurses. CONCLUSION: In this study, it was observed that although nurses reported incorporating PI prevention practices in ICUs, their related knowledge level was insufficient.

Comparison of two surgical techniques in Chiari Malformation Type 1 Patients: Duraplasty alone vs duraplasty with arachnoid dissection.

OBJECT: Optimal surgical technique to restore the cerebrospinal fluid flow through the foramen magnum remains to be debated in Chiari malformation type 1 (CM-1) patients. METHOD: This study included 46 patients with CM-1 who underwent surgical treatment by one of two methods: posterior fossa bone decompression (BD) with arachnoid preserving duraplasty (Group 1) and BD with duraplasty and arachnoid dissection (Group 2). Complaints of the patient population and neurological findings were assessed with Neck Disability Index (NDI) and Europe Quality of Life 5 Dimensions (EQ-5D) in pre- and postoperative periods. RESULTS: NDI and EQ-5D scores improved in overall patient population and in each individual surgical group. Both groups showed a significant decrease in size of syringomyelia cavity. Complications resulting in recurrent treatments and re-operations occurred in 15% of patients (n = 7); six of them were from Group 2. CONCLUSION: CM-1 patients benefit significantly from surgical treatment. Duraplasty should be included to surgical technique. Avoiding arachnoid dissection may lead to better results regarding complication rates.

Mixed Lasso estimator for stochastic restricted regression models.

Parameters of a linear regression model can be estimated with the help of traditional methods like generalized least squares and mixed estimator. However, recent developments increased the importance of big data sets, which have much more predictors than observations where some predictors have no impact on the dependent variable. The estimation and model selection problem of big datasets can be solved using the least absolute shrinkage and selection operator (Lasso). However, to the authors' knowledge, there is no study that incorporates stochastic restrictions, within a Lasso framework. In this paper, we propose a Mixed Lasso (M-Lasso) estimator that incorporates stochastic linear restrictions to big data sets for selecting the true model and estimating parameters simultaneously. We conduct a simulation study to compare the performance of M-Lasso with existing estimators based on mean squared error ( mse ) and model selection performance. Results show that M-Lasso is superior in terms of mse and it generally dominates compared estimators according to the model selection criteria. We employ M-Lasso to estimate parameters of a widely analysed production function under stochastic restrictions raised from economic theory. Our results show that M-Lasso can provide reasonable and more precise estimates of model parameters that are in line with the economic theory.

Posturographic examination of body balance in patients with Chiari type I malformation and correlation with the presence of syringomyelia and degree of cerebellar ectopia.

OBJECTIVES: We aimed to evaluate balance using the Tetrax Interactive Balance System (TIBS) in patients with Chiari type I malformation (CM-I) and to assess their fall risk with other clinical parameters. PATIENTS AND METHODS: This cross-sectional, prospective study was conducted at physical medicine and rehabilitation outpatient clinics and neurosurgery department of a university hospital between December 2013 and December 2014. The study included a total of 36 patients (31 females, 5 males; mean age 40.6±10.0 years; range, 18 to 60 years) with CM-I. Dynamic balance was assessed using the Berg Balance Scale (BBS), and posturographic examinations were performed using the TIBS. RESULTS: The mean Fall Risk Index (FI) value was 42.4±29.8 and the mean BBS score was 55.5±1.5. The most common complaints were neck pain (94.4%), headache (88.9%), paresthesia (86.1%), fatigue (83.3%), and vertigo (80.6%). The mean tonsillar herniation below the foramen magnum was 8.7±3.8 (mm). Of the patients, 15 (42.85%) had syringomyelia. The degree of tonsillar ectopia was statistically significantly lower in patients with syringomyelia (p<0.05). The BBS scores were near identical among the patients with or without syringomyelia, although the FI values were lower in the patients with syringomyelia. Comparing cerebellar ectopia ≤9 mm versus >10 mm, the FI values were slightly higher in the patients with ectopia >10 mm, although there was no statistically significant difference in the FI or BBS values. CONCLUSION: Our study results suggest that CM-I can decrease the body balance stability and, thus, increase the fall risk. Evaluation of balance in patients with CM using TIBS static posturography is a simple and effective technique.

Endoscopic approach to a collision tumor of growth hormone-secreting adenoma and gangliocytoma in the pituitary gland.

The authors share their experience on a collision tumor of growth hormone (GH)-secreting adenoma and gangliocytoma in the pituitary gland, which was reported by few articles in the literature. Also, an intraoperative view of this tumor, operated via endoscopic endonasal transsphenoidal approach, is presented for the first time. A 39-year-old female patient was admitted with clinical manifestation of acromegaly present in a 2-year period. Laboratory investigations revealed high levels of GH and insulinlike growth factor 1. Sellar computed tomography scan and magnetic resonance imaging showed a sellar mass diagnosed as a pituitary adenoma. Based on clinical, biochemical, and radiologic evaluations, GH-secreting pituitary adenoma was diagnosed and operated by endoscopic endonasal transsphenoidal approach achieving total removal of the tumor. Histopathologic examination revealed a collision tumor of GH-secreting adenoma and gangliocytoma. Postoperative radiologic and biochemical investigations showed no residual tumor and total remission. The endoscopic endonasal transsphenoidal approach promotes a close intraoperative view of sellar pathologies. We believe that a detailed histopathologic workup is necessary to diagnose collision tumors, because even a close intraoperative view does not facilitate to differentiate these tumors from a regular pituitary adenoma.