Importance of structured training programs and good role models in hand hygiene in developing countries.

The aim of this study is to identify the beliefs and perceptions associated with hand hygiene performance in two different institutions with limited resources and recently established infection control programme later than developed institutions. The study was conducted in two different hospitals (University Hospital-U-hospital and Community Hospital-C-hospital) in the same city by a self administered questionnaire. Most questions were drawn from questionnaires used previously in other studies from "industrialized" countries based on "The Theory of Planned Behavior". All nurses, nurse students (last class), physicians and intern medical students in the U-hospital, and all nurses in the C-hospital were included into the study. Of 1764 questionnaires, 941 (41%) were returned. The return rate was highest for nurses in C-hospital (63.8% [303 of 475]) and lowest for senior physicians in U-hospital (7.5% [16 of 212]). Out of the respondent a total of 16 (1.7%) were senior physicians, 110 (11.6%) were physician assistants, 400 (42.6%) were nurses in the U-hospital, 303 (32%) were nurses in the C-hospital, 66 (7%) were medical students and 46 (4.9%) were nurse students. Seven hundred and ninety five (85.9%) of 926 respondents were female. Respondents provided demographic information and data about various behavioral, normative, and control beliefs that determined their intentions with respect to performing hand hygiene. Among individuals from the other professional categories, a greater percentage of U-hospital nurses (57.6% vs. 53.9%, respectively) believed that healthcare-associated infections to be greater than 20%, and mortality rate among infected patients to be greater than 5%. C-hospital nurses generally believed the frequency, severity, and impact of healthcare-associated infections to be lower than U-hospital nurses and other individuals. However, all professional categories believed that good hand hygiene effectively prevents infections (98%). In univariate analysis, receipt of structured training in hand hygiene, perceived colleagues adherence's as good, adherence models good practices for others, having been observed for their adherence (normative beliefs), the perception that hand hygiene is relatively easy to perform and high workload (control beliefs) was associated with good hand hygiene. However, in multivariate analysis, high self reported adherence to hand hygiene was independently associated with receipt of structured training in hand hygiene, perceived good adherence by colleagues, the perception that hand hygiene is relatively easy to perform and having been observed for their adherence. In a country with limited resources, intention to comply was associated with training and strong normative and control beliefs. Also, in two different kinds of institution with the similar hand hygiene promotion campaign in the same city, the believes of nurses were different. In developing countries, more resources have to be allocated for training of HCWs and easy access for hand hygiene products.

2009 H1N1 influenza and experience in three critical care units.

AIM: We describe futures of ICU admission, demographic characteristics, treatment and outcome for critically ill patients with laboratory-confirmed and suspected infection with the H1N1 virus admitted to the three different critical care departments in Turkey. METHODS: Retrospective study of critically ill patients with 2009 influenza A(H1N1) at ICU. Demographic data, symptoms, comorbid conditions, and clinical outcomes were collected using a case report form. RESULTS: Critical illness occurred in 61 patients admitted to an ICU with confirmed (n=45) or probable and suspected 2009 influenza A(H1N1). Patients were young (mean, 41.5 years), were female (54%). Fifty-six patients, required mechanical ventilation (14 invasive, 27 noninvasive, 15 both) during the course of ICU. On admission, mean APACHE II score was 18.7±6.3 and median PaO(2)/FIO(2) was 127.9±70.4. 31 patients (50.8%) was die. There were no significant differences in baseline PaO(2)/FIO(2 )and ventilation strategies between survivors and nonsurvivors. Patients who survived were more likely to have NIMV use at the time of admission to the ICU. CONCLUSION: Critical illness from 2009 influenza A(H1N1) in ICU predominantly affects young patients with little major comorbidity and had a high case-fatality rate. NIMV could be used in 2009 influenza A (H1N1) infection-related hypoxemic respiratory failure.

An analysis of 682 adult poisonings in Central Anatolia of Turkey.

We defined patient demographics, type of the poisoning, distribution according to month, route and reason for exposure, mortality causes and rates from 682 poisonings admitted to University Hospital in Kayseri, Turkey to evaluate whether they follow the pattern of other countries. Poisoning were drugs (54.5%), inhalational poisonings including carbon monoxide (13.7%), food (12.4%), alcohol (7%), pesticides (5.4%) and corrosives (2.1%). In drug ingestions, psychoactive drugs most common; psychoactive, analgesic, and anti-inflammatory drugs were most frequent agents in multiple drug poisonings. Drugs were the most used poison while pesticides, mushrooms, methanol and carbon monoxide caused more deaths. The mortality rate was 2%.

Efficacy of five days of subcutaneous octreotide treatment after sclerotherapy in preventing rebleeding from esophageal varices.

BACKGROUND/AIMS: Acute variceal bleeding is the most severe consequence of portal hypertension. Mortality due to bleeding among cirrhotic patients is high; between 30 and 50% die within six weeks of the first bleeding episode. This dismal outcome has led to attempts both to stop acute bleeding and to prevent rebleeding. The aim of this study was to investigate the efficacy of subcutaneous octreotide treatment, administered after emergency sclerotherapy, in preventing rebleeding of esophageal varices METHODS: After a bolus injection of 50 microgram octreotide, 34 patients, forming the standard therapy (ST) group, received octreotide infusion at a rate of 50 microgram/h until endoscopic sclerotherapy performed within 36 hours. The same procedure was applied to another 27 patients in the maintenance therapy (MT) group in which octreotide was given at 100 microgram/8h via subcutaneous (sc) route after sclerotherapy for five days. In both groups, sclerotherapy was repeated on the 5th-7th day. Patients were followed for three weeks for rebleeding. RESULTS: Nine patients rebled in the ST group but only one patient bled in the MT group (3.7% vs. 26.5% vs. 3.7%; p<0.05). Transfusion requirement and duration of hospitalization period were similar in both groups. CONCLUSIONS: This study suggests that maintenance subcutaneous octreotide therapy is effective in controlling rebleeding episodes.

The effects of octreotide in dilated cardiomyopathy: an open-label trial in 12 patients.

Octreotide, a somatostatin analogue, has been found effective in the treatment of acromegalic cardiomyopathy. We investigated whether intermittent octreotide therapy had beneficial effects in patients with ischemic or idiopathic dilated cardiomyopathy, which are refractory to conventional therapy. Twelve patients with ischemic or idiopathic dilated cardiomyopathy were enrolled in the study. In addition to conventional treatment, octreotide (first 50 microg and then 25 microg three times per day for 4 days) was administered and repeated after 1, 2, and 3 months. The patients were evaluated 3 times, before and immediately after the first treatment and after 3 months of treatment, using echocardiography, exercise stress testing, ambulatory ECG, right ventricular catheterization, cardiac enzymes, and the Minnesota living with heart failure questionnaire for quality of life. There were no significant changes in parameters after the first treatment. However, after 3 months of treatment, there were significant improvements in the left ventricular ejection fraction, left ventricular posterior wall thickness, hemodynamics, exercise capacity, and quality of life. Additionally, ischemic burden and the number of ventricular premature beats also decreased slightly. Intermittent octreotide therapy led to significant improvements in patients with ischemic and idiopathic dilated cardiomyopathy refractory to conventional treatment. We believe that this therapy should be attempted as an adjunctive therapy in these patients, and that in this respect, randomized, double-blind, clinical, and large-scale studies are required before regular usage is undertaken.

Comparison of high-dose finasteride (5 mg/day) versus low-dose finasteride (2.5 mg/day) in the treatment of hirsutism.

OBJECTIVE: To compare the clinical efficacy and safety of high-dose (5 mg/day) and low-dose (2.5 mg/day) finasteride in the treatment of hirsutism in women. DESIGN: A prospective, randomized and controlled clinical trial. METHODS: Fifty-six hirsute women with moderate to severe hirsutism were prospectively evaluated to see the effects of low-dose (2.5 mg/day) and high-dose (5 mg/day) finasteride. Patients were randomly divided into two treatment groups. Group I (n=29) received 2.5 mg finasteride/day and group II (n=27) received 5 mg finasteride/day orally for 1 year. Hirsutism score, body mass index and hormonal parameters (FSH, LH, estradiol, androstenedione, testosterone, free testosterone, 17alpha-hydroxyprogesterone, dehydroepiandrosterone sulfate and sex hormone-binding globulin) were measured in all the patients before treatment and repeated at six-monthly intervals. RESULTS: The hirsutism scores decreased significantly at months 6 and 12 from a mean+/-s.d. of 18.4+/-4.6 to 13.3+/-5.2 (P<0.001) and 18.4+/-4.6 to 8.6+/-4.2 (P<0.001) in group I and from 18.7+/-5.2 to 13.9+/-5.3 (P<0.001) and 18.7+/-5.2 to 10.3+/-5.0 (P<0.001) in group II respectively. No significant changes in the blood chemistry and hormonal parameters except estradiol levels were observed. No serious side-effects were seen in the two groups. In group II, estradiol levels increased significantly at 6 and 12 months. CONCLUSIONS: In this study, hirsutism scores decreased significantly at 6 and 12 months in both groups I and II. Low-dose (2.5 mg/day) finasteride is safe and cost effective in the treatment of hirsutism and may be used instead of high-dose finasteride (5 mg/day) therapy.

[Is intermittent dobutamine treatment beneficial in patients with dilated cardiomyopathy?]. / Dilate kardiyomiyopatili hastalarda aralikli dobutamin tedavisi faydali midir?

OBJECTIVE: Dobutamine is a sympathomimetic drug, which can be used in patients with dilated cardiomyopathy (DCM). We investigated the effects of intermittent dobutamine use on cardiac parameters and quality of life in patients with DCM. METHODS: Twelve patients with ischemic and idiopathic DCM, refractory to conventional therapy, have been included in the study. In addition to traditional treatment, dobutamine (1-2 micro g/kg/min infusion increasing up to 10 micro g/kg/min for 3 days) was administered, and repeated at the 1st, 2nd and 3rd months. The patients were evaluated 3 times, before and immediately after the first treatment and after the treatment on the third month, using echocardiography, exercise stress testing, ambulatory ECG, right ventricular catheterization, cardiac enzymes (creatine kinase MB isoenzyme - CK-MB, troponin-T) and the Minnesota Living with Heart Failure Questionnaire for quality of life. RESULTS: After the first treatment, left ventricular ejection fraction (LVEF), cardiac output, cardiac index (CI), pulmonary wedge pressure and life quality improved significantly (p<0.05); but, after the treatment on the third month, these parameters except PCWP returned to nearly baseline values. Additionally, a significant increase in the number of patients with ventricular premature beats and with troponin-T positivity was detected after the third month of treatment. CONCLUSION: The use of dobutamine in addition to conventional therapy in patients with DCM provided improvements in some systolic parameters and quality of life particularly after the first treatment. In the late period of the treatment, however, it was determined that these beneficial effects tended to disappear and harmful effects became more evident.