Effects of cold spray on thirst, frequency of oral care, and pain of general surgery intensive care unit patients

This study aims to investigate the effects of intraoral cold water spray on thirst, frequency of oral care and postoperative period pain at surgical incision site in patients having abdominal surgery. The study was carried out as a randomized controlled trial, registered under Clinical Trial Number: NCT05940818. The study involved 110 participants, divided equally into two groups (n = 55): the experimental group and the control group. Data were collected using patient information form, NRS, Intensive Care Oral Care Frequency Assessment Scale (ICOCFAS) and Visual Analog Scale (VAS). The severity of thirst at 1st, 8th, 16th h of post-operative period (p < 0.01) and the frequency of oral care application at 16th h were statistically significantly decreased in the experimental group when compared to the control group (p < 0.01).There wasn't statistically significant difference between the patients in the experimental and control groups in terms of pain at surgical incision site (p > 0.05). The patient's thirst and need for frequent oral care in the postoperative period were reduced by the application of a cold water spray. In patients undergoing abdominal surgery, the use of cold water spray application may be recommended to reduce thirst and the need for frequency of oral care application.

Hemodialysis vascular access coordinator: Three-level model for access management

Management of vascular access is a challenge for the dialysis team, particularly to keep the arteriovenous access working. The vascular access coordinator can positively contribute to increase the number of arteriovenous fistulas and reduce central venous catheters. In this article, we introduce a new approach to vascular access management centered on (the results of setting up) the role of vascular access coordinator. We described the three-level model (3Level_M) for vascular access management organized in three levels: vascular access nurse manager, vascular access coordinator, and vascular access consultant. We defined the instrumental skills and training required to be developed by each element and clarify the articulation between the model and all members of the dialysis team related to vascular access.

The Effect of Aromatherapy with Lavender on Pain of Needle Insertion and Severity of Restless Legs Syndrome in Hemodialysis Patients; a Systematic Review and Meta-analysis

Introduction

Pain experienced during the insertion of a catheter into the arteriovenous fistula (AVF) and restless legs syndrome (RLS) are prevalent issues among Hemodialysis (HD) patients. The primary objective of this systematic review and meta-analysis was to consolidate the findings from randomized clinical trial (RCT) studies examining the impact of aromatherapy with lavender on the pain associated with AVF catheter insertion and RLS in HD patients.

Methods

A systematic search was conducted on PubMed, Web of Science, Scopus, Cochrane, Embase, ClinicalTrials.gov, and Google Scholar search engine from inception to August 1, 2022, using keywords extracted from Medical Subject Headings, such as "Aromatherapy", "Lavender", "Arteriovenous fistula", "Pain", "Restless legs syndrome", and "Hemodialysis".

Results

Finally, eleven articles were included in this systematic review and meta-analysis. The results showed that aromatherapy reduced the average pain of catheter insertion in AVF compared to the control group (Standard Mean Difference: -1.60, 95% Confidence Interval: -2.32 to -0.87, Z=4.32, I2:90.3%, P<0.001). Also, aromatherapy massage reduced the average severity of RLS compared to the control group, which was statistically significant (Weighted Mean Difference: -13.21, 95% Confidence Interval: -17.50 to -8.91, Z=6.03, I2:93.0%, P<0.001). Also, the subgroup analysis showed that lavender in the intervention group significantly decreased the pain intensity compared to the "no intervention" group (P<0.001), yet it was not significant compared to the placebo group (P=0.12).

Conclusion

In summary, the findings indicate a notable reduction in catheter insertion pain in AVF and relief from RLS among HD patients through the use of lavender essential oil. As a result, future research is encouraged to include a comparison of lavender's effects with those of a placebo group.

Prevention of microbial colonization of feeding tubes in the intensive care unit

BACKGROUND

Various microorganisms which increase the mortality rate in the intensive care unit (ICU) cause microbial colonization of the nasogastric tube (NGT) and use the NGT as a reservoir.

AIM

To detect the colonization on the NGT and to determine the effect that training regarding hand hygiene, NGT management, and enteral feeding (EF) provided to ICU nurses and auxiliary service staff (ASS) has on the level of NGT colonization.

STUDY DESIGN

A quasi-experimental pre-test and post-test control design was used in this study. Microbial samples were taken from the outer and inner parts of NGT. The microorganisms were categorized as: group 1, no risk; group 2, low risk pathogenic; group 3, high-risk pathogenic group. The training was given to nurses (n = 15) and ASS (n = 7). Hand hygiene, NGT, and EF care training are provided to nurses and ASS by researchers. A total of three training sessions were scheduled to be held in 3 weeks so that all health care staff members were trained. Each session lasted 2 h in total. Patients were assigned to a group if one of the microorganisms presented on the outer surface of the patient's feeding tube and/or on the hub. The hand hygiene compliance was evaluated by direct observation according to the World Health Organization hand hygiene indications.

RESULTS

The study was conducted with 46 patients. Evaluating the patients for the presence of microorganisms before education revealed that 4.3% were in group 1, 21.8% were in group 2, and 73.9% were in group 3. After the education, evaluating the samples for the presence of microorganisms revealed that 39.1% were in group 1, 13% were in group 2, and 47.8% were in group 3. A statistically significant difference was found between the number of samples included in the groups after the participants had received training (H = 8.186; p = .017).

CONCLUSIONS

An NGT could act as a reservoir of microbial colonization and high-risk microorganisms could be on the tube. Providing training not only to nurses but also to ASS will help reduce the risk of colonization.

RELEVANCE TO CLINICAL PRACTICE

Eliminating such colonization with effective hand hygiene during NGT feeding is a cost-effective method. Providing training not only to nurses but also to ASS will help obtain the optimum benefit from patient care.

Effects of using a stress ball on anxiety and depression in patients undergoing hemodialysis: A prospective, balanced, single-blind, crossover study

INTRODUCTION

Use of a stress ball is a known t non-pharmacological method to distract attention and to relieve stress and anxiety. The goal of our study was to evaluate the effect of stress ball use on anxiety and depression in hemodialysis patients.

METHODS

The study utilized a single-blind, balanced crossover design. There were two sequential 4-week intervention periods separated by a 4-day washout period. During one intervention period stress ball use at home was encouraged while the other 4-week "intervention" period served as a control. The order in which the two evaluation periods were applied was randomized for a given patient. Anxiety and depression were assessed using the Hospital Anxiety and Depression Scale before and after each 4-week intervention period.

FINDINGS

A total of 65 patients participated in this study. There were statistically significant reductions in both anxiety (p < 0.001) and depression (p < 0.001) during the stress ball intervention periods vs. no change during the control interventions. A delayed follow-up evaluation showed that the anxiety level of patients remained reduced after 1 month of no longer using a stress ball.

DISCUSSION

The use of a stress ball at home for 4 weeks significantly decreased anxiety and depression levels in our group of hemodialysis patients.

Obstructive sleep apnea in surgical patients and its relationship with difficult intubation: two years of experience from a single center

BACKGROUND AND OBJECTIVES

In this study, we aimed to determine the risk of obstructive sleep apnea (OSA) in patients undergoing elective surgery and its relationship with difficult intubation (DI).

METHODS

This prospective, descriptive, cross-sectional study was conducted between December 2018 and February 2020 in the anesthesiology and reanimation service of a training and research hospital. The study included patients who were ASA I...II, 18 years of age, and older who underwent elective surgery under general anesthesia. A form regarding the baseline characteristics of the participants as well as STOP-Bang score, Mallampati, and Cormack-Lehane classification was used to collect the data.

RESULTS

The study included 307 patients. It was determined that 64.2% of patients had a high risk of OSA. The presence of DI (determined by repeated attempts at intubation) was 28.6% in the high-risk OSA group, while there was no DI in the low-risk OSA group. A statistically significant difference was found between the groups in terms of OSA risk according to the presence of DI according to repeated attempts, Cormack-Lehane classification, and Mallampati classification (p...<...0.001).

CONCLUSION

Due to the high rate of DI in patients with a high risk of OSA, the security of the airway in these patients is endangered. Early clinical recognition of OSA can help in designing a safer care plan.

Investigation of the effect of breathing exercise on invasive pain associated with arteriovenous fistula cannulation in hemodialysis patients: Randomized controlled, single-blind study

BACKGROUND

Pain due to puncture during arteriovenous fistula (AVF) cannulation is a very important symptom that affects the quality of life in patients undergoing continuous hemodialysis (HD) therapy. The aim in this study is to examine the effect of breathing exercise applied for long-term on invasive pain experienced during AVF cannulation in HD patients.

METHODS

This randomized controlled, single-blind design study was conducted in a private dialysis center in Istanbul between November 2021 and April 2022. The patients in the intervention group were given breathing exercises before fistula cannulation during 12 HD sessions. Before the dialysis nurse performed the cannulation procedure, the patient was told by the researcher to perform breathing exercises and the exercise was completed after intervention for the cannulation. No intervention was made for the patients in the control group. Pain was assessed with the Visual Analog Scale (VAS) by a nurse who is not involved in the study. Mann-Whitney U Test, Chi-Square Test, Fisher's Exact Test, Friedman Test for repeated measurements were used in statistical analysis of data.

FINDINGS

The study was completed with a total of 112 patients, 59 in the intervention group and 53 in the control group. It was determined that the VAS scores of the patients in the intervention group were statistically significantly lower than the patients in the control group from the first measurement to the twelfth measurement (p < 0.001).

CONCLUSION

It was determined that the breathing exercise applied before the AVF cannulation reduced the invasive pain experienced during cannulation.

Effect of pilates performed during pregnancy on postpartum stress urinary incontinence in primipara women

INTRODUCTION

Stress urinary incontinence (SUI) constitutes the majority of urinary incontinence (UI) cases that occur due to anatomical and physiological changes during pregnancy and postpartum period. The objcetive of this study was to evaluate the effect of pilates in preventing the occurrence of SUI in the postpartum period.

METHODS

A retrospective case-control study was conducted in a private hospital. Participants consisted of patients who gave birth vaginally at the hospital and were admitted to the hospital for routine control at the postpartum 12th week. The women did pilates for two days a week from the 12th week of pregnancy until the birth were included in the case group. The women did not do pilates in the control group. Data was collected using the "Michigan Incontinence Symptom Index". To detect the presence of SUI, researchers asked women "Do you have urinary incontinence problems in your daily life?". STROBE research check-list was used for reporting the study.

RESULTS

The study was completed with a total of 142 women consisting of 71 women in each group. Of the women, postpartum SUI occurred in 39.4%. The severity score of women who did pilates were found to be statistically significantly lower than those who did not do pilates.

CONCLUSION

During pregnancy, women should be encouraged to do pilates about the prenatal period by health professionals.

The modified thoracoabdominal nerve block for post-operative analgesia in paediatric laparoscopic cholecystectomy

The limited data on post-operative analgesia management after laparoscopic cholecystectomy in the paediatric population make it difficult for clinicians to manage pain in this group. Administration of a modified thoracoabdominal nerve block through a perichondrial approach (M-TAPA) has recently been identified as a technique providing effective analgesia on the anterior and lateral thoracoabdominal wall. Unlike thoracoabdominal nerve block through the perichondrial approach block, the local anaesthetic (LA) with M-TAPA block provides effective post-operative analgesia in abdominal surgery by affecting T5-T12 dermatomes, just like when applied to the lower part of the perichondrium. As far as we know, all patients in previous case reports were adults, and we did not come across any study on the effectiveness of M-TAPA in paediatric patients. We present our case who did not need any additional analgesic during the post-operative 24 h after an M-TAPA block was administered before paediatric laparoscopic cholecystectomy.

Effects of Long-term Administration of Inhaled Lavender During Hemodialysis on Patients' Invasive Pain, Anxiety, and Comfort During Cannulation: A Single-blind Randomized Controlled Trial

Context

Although a number of studies have shown that lavender administered via inhalation can decrease the invasive pain and anxiety experienced by hemodialysis (HD) patients during cannulation, the evaluation has mostly been on the short-term effectiveness of lavender oil. Also, no study has evaluated the effects of lavender on comfort level.

Objective

The study aimed to investigate the long-term effectiveness of lavender oil, when administered via an inhaler during HD sessions, on a patient's experience of invasive pain, anxiety, and comfort during access to the fistula.

Design

The research team designed a prospective, single-blind, randomized, controlled clinical trial.

Setting

The study took place in an HD unit of a public hospital in Kirklareli, Turkey.

Participants

Participants were 24 patients receiving HD in the unit between January and March 2021.

Intervention

Participants were randomly assigned to the intervention or control group. Pure lavender essence was diluted with sweet almond oil at a ratio of 1:10. Before the cannulation procedure at 12 HD sessions, three drops of a 1:10 mixture were placed on sterile gauze and held at a distance of about 10 cm from the participant's nose to ensure its inhalation before the fistula puncture with the needle. No extra procedure was performed for the control group.

Outcome Measures

Participants completed a visual analogue scale (VAS) right after puncture of the fistula during each HD session. The STAI and HD Comfort Scale were scored at baseline prior to the first HD session and postintervention at the twelfth HD session.

Results

The VAS (P < .001) and state anxiety scores (P = .027) were significantly lower in the intervention group than in the control group at all time points, except at baseline. The comfort scale in the intervention group was significantly higher than that in the control group (P < .05).

Conclusions

Lavender aromatherapy could be a good option for reducing the pain, anxiety, and discomfort level of HD patients.

How to choose the appropriate cannulation technique for vascular access in hemodialysis patients

The cannulation technique is important for the survival of the arteriovenous access. Choosing the appropriate technique is a complex decision. Such choice must be customized to patients, considering their characteristics, the type of arteriovenous access and the experience of the hemodialysis team. We describe seven items that can help nurses to identify the appropriate cannulation technique: type of arteriovenous access; drainage vein; hygienic self-care profile; experience of the nursing staff in the cannulation technique and nurse-to-patient ratio; hemodialysis treatment method; patient's condition; and patient's decision. Such items can help nurses in decision-making on the "ideal" cannulation technique for each patient.

Effect of the arterial needle bevel position on puncture pain and postremoval bleeding time in hemodialysis patients: A self-controlled, single-blind study

AIM

This study aimed to investigate the effect of the bevel orientation (facing upwards or downwards towards the skin) of the needle inserted into the arterial limb of the arteriovenous fistula (AVF) on puncture pain and postremoval bleeding time.

METHODS

This study, using a single-blind crossover design, was conducted on 35 maintenance hemodialysis patients who had been dialyzed for at least 6 months and in whom blood access was via an AVF. AVF cannulation was performed with the needle bevel pointing upward in the first six sessions and the needle bevel pointing downwards (towards the skin) in the subsequent six sessions. Needles were always inserted in the direction of blood flow. At each dialysis session, cannulation pain was measured using a visual analog scale (VAS), and the bleeding time at the end of dialysis after needle removal was recorded.

FINDINGS

The VAS score and postremoval bleeding time were lower when the needle bevel pointed downwards towards the skin during insertion (P < 0.05).

DISCUSSION

Insertion of the needle with the bevel pointed downward decreased puncture pain during cannulation and bleeding time postdialysis on needle removal.

The reliability and validity of the Turkish version of the Shortened Xerostomia Inventory in hemodialysis patients

INTRODUCTION

The aim of this study was to translate, linguistically validate and evaluate the psychometric properties of the Shortened Xerostomia Inventory (SXI) among Turkish patients undergoing hemodialysis.

METHODS

The study was conducted with 81 chronic hemodialysis patients in the hemodialysis units of two state hospitals between June and August 2020. Explanatory Factor Analysis (EFA) were implemented to test the construct validity. In addition, the test-retest method was performed to test the reliability and consistency of the scale over time.

RESULTS

A total of 81 patients participated in the study. The Cronbach's alpha coefficient of SXI was 0.788. The mean values for the test was 12.84±6.78 and re-test scores was 11.03±6.88. ICC value calculated as 0.992 and accordingly a statistically significant relationship between the test and retest scores (p<0.001).

CONCLUSIONS

Our study showed that the SXI is a valid and reliable measurement tool for Turkish hemodialysis patients.

Ultrasound-Guided Pudendal Nerve Block versus Ultrasound-Guided Dorsal Penile Nerve Block for Pediatric Distal Hypospadias Surgery

INTRODUCTION

The primary aim of the study was to use the duration until the first postoperative analgesic requirement after two different block techniques to compare the analgesic effect. The secondary aims were to compare the two methods for postoperative Children's Hospital Eastern Ontario Pain Scale (CHEOPS) scores, complications, and parental satisfaction level.

MATERIALS AND METHODS

This prospective, observational study was conducted with male patients aged 1-7 years in the ASA I-II group, who were scheduled for hypospadias surgery between November 2019 and April 2020. Ultrasound (US)-guided pudendal nerve block (PNB) or US-guided dorsal penile nerve block (DPNB) was administered under general anesthesia before the operation. Postoperative analgesic need, postoperative pain, complications, and parental satisfaction were noted. The STROBE checklist was followed for reporting.

RESULTS

The study was conducted with 30 patients in total, divided into 15 patients receiving PNB and 15 patients receiving DPNB. The effective minimum block duration was longer in the pudendal group at 22.22 ± 0.61 h than in the DPNB group at 22.19 ± 0.57 h. Additional analgesic was required in 4 subjects in the pudendal group and 5 in the DPNB group. There was no statistically significant difference in terms of the variables between the two groups (p > 0.05).

DISCUSSION

US-guided DPNB and PNB were shown to provide successful postoperative analgesia and to have similar effectiveness in pediatric patients undergoing hypospadias surgery in this first prospective study of its kind in the literature.

CONCLUSIONS

US-guided DPNB and PNB have been demonstrated to provide effective, safe, and long-term postoperative analgesia in pediatric patients who have undergone hypospadias surgery. Parental satisfaction in both groups is positively influenced by the minimum postoperative analgesia requirement, the long-term analgesic effect, and the lack of any complications.

Noise levels in the dialysis unit and its relationship with sleep quality and anxiety in patients receiving HD: A pilot study

INTRODUCTION

HD unit is a noisy environment for patients, and noise can affect anxiety levels and sleep quality.

METHODS

The aim of the study is to determine noise level, the relationship between noise levels, and sleep quality and anxiety in patients in HD unit. A descriptive and observational study design was used. Three Benetech GM1351 manual sound-level meters were used to measure noise. A patient information form, the State Anxiety Inventory, and the modified Post-Sleep Inventory were used for data collection.

RESULTS

The noise range detected in the HD unit ranges from 48.40 to 72 dB(A). Our findings show that patients in the HD unit are exposed to high noise levels and the noise significantly negatively impacts quality of sleep and anxiety level of the patients.

CONCLUSIONS

It is important to be aware that HD patients are constantly exposed to high levels of noise and to plan nursing interventions to reduce this noise level.

Effects of Demographic and Clinical Character on Differences in Self-care Behaviour Levels with Arteriovenous Fistula by Haemodialysis Patients: An Ordinal Logistic Regression Approach

INTRODUCTION

Haemodialysis (HD) patients should be trained to develop self-care behaviors in order to prevent and preserve their arteriovenous fistula (AVF). The aim of this study was identifying the factors that affect the levels of self-care behavior with AVF by HD patients.

METHODS

A cross-sectional study was conducted involving 89 patients.

RESULTS

Self-care levels were negatively affected by patients' location (Azores) and positively affected by marital status, education, employment, AVF duration and absence of complications with the AVF. Concerning the management of signs and symptoms, self-care levels were negatively affected by patients' location. Regarding prevention of complications, self-care levels were negatively affected by age and marital status and positively affected by marital status, employment, CKD etiology, AVF duration and previous AVF.

CONCLUSION

Further studies are required in order to confirm whether the considered factors affect levels of self-care behaviors with AVF, or whether other factors are needed as well.

The reliability and validity of the Turkish version of the postdialysis fatigue scale

AIM

Haemodialysis (HD) commonly leads to postdialysis fatigue (PDF) and, thus, worsens the quality of life and the clinical outcomes. The aim of this study was to translate, linguistically validate and determine the psychometric properties of the "Postdialysis Fatigue" Scale for Turkish patients with HD.

STUDY DESIGN

A methodological study.

METHODS

The standard lingual translation and validation methods for the initial translation of the PDF Scale and then assessed the psychometric properties of reliability and validity of the translated scale. Visual analogue scale (VAS) and Piper Fatigue Scale were used to assess concurrent and construct validity. In addition, postdialysis recovery time was used it as an indirect measurement method for PDF.

RESULTS

A total of 93 patients participated in the study. The Cronbach's alpha coefficient of PDF was 0.773. There was a statistically significant relationship between the test and retest scores (ICC: 0.973; P < .001). PDF Scale was acceptable with 11 items. There was a positive correlation with a statistically significant relationship was present between the PDF scores and Piper Fatigue Scale (r = .488; P < .001) and VAS score (r = .656; P < .001). There was a statistically significant positive correlation between the PDF Scale and the postdialysis recovery time (r = .270; P = .009), CONCLUSION: The study results have shown that the Turkish form of the PDF Scale is a valid and reliable tool in patients undergoing HD treatment. Postdialysis recovery time may be used as an indirect measurement method to evaluate PDF.

Do biochemical parameters and intradialytic symptoms affect post-dialysis recovery time? A prospective, descriptive study

The recovery time is defined as the time required to recover from the feelings of lassitude and fatigue. The daily activities of patients are affected by dialysis sessions, requiring significant time for patients to return to their routines. This situation implies a lower quality of life for HD patients. The aim of this study was to investigate the effects of biochemical parameters and intradialytic symptoms on post-dialysis recovery time in maintenance HD patients. This study was conducted at a private dialysis center during June and August 2019. Data were collected using the "Descriptive Characteristics Form" and the "Dialysis Symptom Index." "STROBE check-list" was used for the report of the study. The study was completed with 86 participants. The median post-dialysis recovery time was 240 min (interquartile range, 120-360 min), and female patients exhibit significantly higher recovery time than male patients. The median BMI was statistically significantly higher in patients whose post-dialysis recovery time was ≥240 min. Additional findings show that the post-dialysis recovery time was shortened by 0.230 times for male patients, while intradialytic hypotension (IDH) prolonged the median post-dialysis recovery time by 3.141 times. Factors underlying the IDH should be determined in order to eradicate the issue. The study was registered in ClinicalTrials.gov with the number NCT04274556.

Relationship between arteriovenous fistula cannulation practices and dialysis adequacy: A prospective, multicenter study

BACKGROUND

Successful arteriovenous fistula cannulation ensures maximum patient benefit in the haemodialysis procedure.

OBJECTIVE

The aim of this study was to determine the effect of various cannulation methods used for arteriovenous fistulas on dialysis adequacy.

DESIGN

It is a descriptive, cross-sectional and multicenter study.

PARTICIPANTS

A total of 164 dialysis patients from four dialysis centers were included.

MEASUREMENTS

Data were collected by determining patients' characteristics and the arteriovenous fistula cannulation method used, in addition to recording the Kt/V and urea reduction ratio values to evaluate dialysis adequacy. The mean Kt/V and urea reduction ratio values over 3 months after dialysis initiation were used. This trial is registered with ClinicalTrials.gov, NCT04270292.

RESULTS

Cannulation with the puncture method was used in 53% of the patients; the fistula needles were inserted in the antegrade direction in 43.9% of the patients; the arterial needle was rotated after fistula needle placement in 63.4% of the patients; and the arterial and venous needles were on the same vascular line in 15.2% of the patients. Placement of the fistula needle in the antegrade direction increased the Kt/V value 0.164 times (95% confidence interval: 0.002-0.212, p = .047).

CONCLUSION

Antegrade placement could be a factor influencing dialysis adequacy. We suggest antegrade interventions to the fistula to maximize the patient benefit from the haemodialysis treatment.

Scale of Assessment of Self-Care Behaviors with Arteriovenous Fistula in Hemodialysis: A Psychometric Study in Brazil

The purpose of this study was to evaluate the psychometric properties of the Brazilian Scale for the Assessment of Self-Care Behaviors with Arteriovenous Fistula in Hemodialysis. Cross-sectional validation study, followed the recommendation provided by Sousa and Rojjanasrirat. Content validity, explanatory and confirmatory factor analyses used to check validity and Cronbach's alpha was the reliability measure. Three hundred hemodialysis patients with arteriovenous fistula were included in the study. The expert committee assessed the content validity. Exploratory factor analysis confirmed the same two-factor structure found for the original scale, explaining 60.10% of the variance. Such solution was checked by confirmatory factor analysis with Cronbach's alpha equal to 0.920, 0.810, and 0.884 for the overall scale, the self-care in management of signs and symptoms and the self-care in prevention of complications subscales respectively. The scale has good psychometric properties to assess self-care behaviors and can be used with Brazilian patients on hemodialysis with arteriovenous fistula.

Investigating the Effect of a Structured Intervention on the Development of Self-Care Behaviors With Arteriovenous Fistula in Hemodialysis Patients

This study aimed to assess the effectiveness of a structured intervention on the frequency of self-care behaviors with arteriovenous fistula (AVF) by patients on hemodialysis. This is a quasi-experimental study with pre- and post-measurements. Participants were assigned to an intervention group (IG) (n = 48) or to a control group (CG) (n = 41). IG patients were subject to a structured intervention on self-care with AVF (SISC-AVF) consisting of both a theoretical and a practical part. After SISC-AVF application, patients in the IG showed better overall self-care behaviors with AVF than patients in the CG (79.2% and 91.4%, respectively, p < .001) as well as better self-care concerning both the management of signs and symptoms (90.1% and 94.4% respectively, p = .004) and the prevention of complications (72.7% and 89.5%, respectively, p < .001). The study results suggest that the SISC-AVF had positive effects on patients in the IG.

The effect of chewing gum on dry mouth, interdialytic weight gain, and intradialytic symptoms: A prospective, randomized controlled trial

INTRODUCTION

The major salivary glands can be stimulated by chewing gum to increase saliva flow and decrease xerostomia. The aim of this study was to investigate the effect of chewing gum on dry mouth, interdialytic weight gain, and intradialytic symptoms in hemodialysis (HD) patients.

METHODS

This prospective randomized controlled single-blind study was conducted with patients who had been treated for at least 6 months with sessions 3 days a week for 4 hours at two HD units. Patients were randomly allocated to chewing gum group or the control group. In the chewing gum group, gum was chewed for 10 minutes six times a day, and when the patients felt mouth dryness or were thirsty. In the nonchewing gum group, gum was not chewed. The patients were followed-up for 3 months. A total of three saliva samples were taken before starting treatment at the first, 12th, and 36th HD session. Data were collected with the "Visual Analogue Scale (VAS)," "Hemodialysis Patients Fluid Control Scale," "Dialysis Symptom Index," and "Hospital Anxiety and Depression Scale" at baseline, week 4, week 8, and week 12.

FINDINGS

The study was completed with a total of 44 patients consisting of 22 patients in the each group. The second and third month VAS values (xerostomia) of the patients in the chewing gum groups were statistically significantly lower than those in the control group (P = 0.014, P < 0.001, respectively). The third month salivary flow rate in the chewing gum group was higher than the values in the control group patients (P < 0.001).

DISCUSSION

It is anticipated that this study will raise nurses' awareness of dry mouth and encourage future studies on interventions to increase the salivary flow rate to prevent or treat dry mouth.

Intradialytic hypotension prevalence, influencing factors, and nursing interventions: prospective results of 744 hemodialysis sessions

INTRODUCTION

The aim of this study was to evaluate intradialytic hypotension (IDH) prevalence, influencing factors, and nursing interventions in hemodialysis (HD) patients.

METHODS

This descriptive and cross-sectional study was conducted at a private dialysis center. The patients were followed-up in terms of IDH development based on the European Best Practice Guidelines criteria during six consecutive HD sessions. The study followed the STROBE checklist.

RESULTS

A total of 744 hemodialysis sessions of 124 patients were monitored. IDH developed in 51.6% of the patients and the prevalence was 17.60%. The most common nursing interventions were stopping ultrafiltration and isotonic saline solution administration. White blood cell (WBC) (p = 0.017) and creatinine (p = 0.005) values were statistically significantly higher in patients developing IDH. WBC was found to increase IDH development risk 0.796 times (95% CI [0.657-0.996], p = 0.021).

CONCLUSION

Nursing staff awareness regarding the frequency of IDH in hemodialysis patients and the related symptoms needs to be increased.

Does Adequate Hemodialysis Prevent Symptoms?: A National Cross-Sectional Survey

The aim of this study was to identify the relationship between dialysis adequacy and the incidence of symptoms in subjects treated with HD. This descriptive and cross-sectional study was conducted at two HD centers. The data were collected with the 'Descriptive Characteristics Form of the Participants' and the 'Dialysis Symptom Index (DSI)'. The study was reported according to the STROBE Declaration. The study was completed with 120 patients. The most common symptom reported was feeling tired or decreased energy and the least common was difficulty concentrating. No statistically significant relationship was found between DSI results and the Kt/V or urea reduction rate levels used to evaluate dialysis adequacy. Dialysis-related symptoms can also be seen in patients with adequate dialysis levels. It is therefore necessary to query the symptoms experienced by the patients at regular intervals.

Does Being A Cancer Patient or Family Caregiver of A Cancer Patient Affect Stem Cell Donation Awareness?

Objective:

One of the most difficult challenges regarding hematopoietic stem cell transplantation in Turkey is finding donors for allogeneic transplantation candidates who do not have related donors. This study aims to determine whether there is any difference in the awareness of stem cell donation and transplantation between cancer and noncancer patients and their family caregivers. In addition, this study aims to determine the awareness of stem cell donation and transplantation in the entire study population.

Methods:

This descriptive study was conducted in Turkey using a data collection form comprising questions about demographics, stem cell transplantations, donations, and medical history. On analyzing the research data, variables were expressed as mean ± standard deviation and as numbers (n) and percentages (%). The Chi-square and Fisher's exact tests were performed to evaluate differences among cancer and noncancer diagnosed patients and their family members.

Results:

A total of 192 patients and 169 family caregivers participated in the study. In comparison with noncancer patients, cancer patients showed more awareness on what stem cell transplantation is, how lifesaving it is, and how to donate stem cells. Similarly, the family caregivers of cancer patients were more aware of what stem cell transplantation is and how to donate stem cells.

Conclusions:

The results of this study showed that cancer patients and their families were more aware of stem cell donation and transplantation; however, most of the patients and families did not know enough about the national registry program and how to donate stem cells.

Nonadherence in Hemodialysis Patients and Related Factors: A Multicenter Study

BACKGROUND

Nonadherence to dietary and fluid restrictions, hemodialysis (HD), and medication treatment has been shown to increase the risks of hospitalization and mortality significantly. Sociodemographic and biochemical parameters as well as psychosocial conditions such as depression and anxiety are known to affect nonadherence in HD patients. However, evidence related to the relative importance and actual impact of these factors varies among studies.

PURPOSE

The aim of this study was to identify the factors that affect nonadherence to dietary and fluid restrictions, HD, and medication treatment.

METHODS

This descriptive study was conducted on 274 patients who were being treated at four HD centers in Turkey. The parameters used to determine nonadherence to dialysis treatment were as follows: skipping multiple dialysis sessions during the most recent 1-month period, shortening a dialysis session by more than 10 minutes during the most recent 1-month period, and Kt/V < 1.4. The parameters used to determine nonadherence to dietary and fluid restriction were as follows: serum phosphorus level > 7.5 mg/dl, predialysis serum potassium level > 6.0 mEq/L, and interdialytic weight gain > 5.7% of body weight. The Morisky Green Levine Medication Adherence Scale was performed to determine nonadherence to medication treatment. A patient was classified as nonadherent if he or she did not adhere to one or more of these indices. The Hospital Anxiety and Depression Scale was used to identify patient risk in terms of anxiety and depression. Logistic regression was used to determine the predictors of nonadherence.

RESULTS

The nonadherence rate was 39.1% for dietary and fluid restrictions, 33.6% for HD, and 20.1% for medication. The risk of nonadherence to dietary and fluid restriction was found to be 4.337 times higher in high school graduates (95% CI [1.502, 12.754], p = .007). The risk of nonadherence to HD treatment was 2.074 times higher in men (95% CI [1.213, 3.546], p = .008) and 2.591 times higher in patients with a central venous catheter (95% CI [1.171, 5.733], p = .019). Longer duration in HD resulted in 0.992 times decrease in risk of nonadherence to treatment (95% CI [0.986, 0.998], p = .005).

CONCLUSIONS/IMPLICATIONS FOR PRACTICE

Educational status, being male, having a central venous catheter, and having a short HD duration were found to be risk factors for nonadherence. Nurses must consider the patient's adherence to the dietary and fluid restrictions, HD, and medication treatment at each visit.

Health literacy of nursing students and its effective factors

BACKGROUND

The insufficiency of health literacy negatively affects the national economy as it leads to increased health service expenditure. It is very important for individuals to have accurate health-related information to reduce these negative effects.

AIM

The aim of the study is to examine the health literacy of nursing students and its effective factors.

METHODS

This descriptive study was carried out with students from the nursing department of a vocational school of health sciences between September and October 2018 in Turkey. A semi-structured questionnaire regarding the descriptive features of the participants and the European Health Literacy Scale were used for data collection.

RESULTS

The study included 283 nursing students; 29.3% had a problematic-limited health literacy level. The study found a statically significant difference between student year, high school graduation and family's income level and the total mean score of the HLS-EU scale.

CONCLUSION

The subject of health literacy should be integrated into the educational program of nursing students. The nurses are the most important workforce in health services, and awareness about this subject should be raised.

Do patients with diabetes use the insulin pen properly?

AIM

This study was conducted to evaluate the insulin pen application knowledge and skills of patients with diabetes.

METHODS

In our descriptive study, 200 patients with diabetes were asked to present the insulin pen injection technique on a mannequin and the steps of the pen injection implementation were noted on the data collection form as correct/incorrect by researchers.

RESULTS

More than 3 out of 4 (79.5%) of the participants were using the insulin pen or the cartridge after the expiry date, 70.5% were not rotating the injection site, and 63.0% were massaging the skin after injection. Injection sites complications were significantly more in those who were using the insulin pen or the cartridge after the expiry date, those who don't know the proper length of the needle and the possible body injection sites, those who don't rotate the injection sites, those who massage after injection, and those who don't use a new needle at each injection (p<0.05).

CONCLUSION

This study put into light some failures in the knowledge and skills of patients with diabetes regarding insulin pen use. Nurses should provide patients with diabetes an effective and repetitive training concerning insulin pen use.

Gastric residual volume measurement in the intensive care unit: an international survey reporting nursing practice

BACKGROUND

Gastric residual volume measurement is routinely used to evaluate the feeding tolerance and gastro-oesophageal reflux in patients receiving enteral feeding therapy in the intensive care unit. However, little supportive evidence for this intervention is available as the usefulness of gastric residual volume measurements in patients receiving enteral feeding therapy in the intensive care is controversial.

AIM

The aim of this study was to assess the practice of intensive care unit nurses related to gastric residual volume measurement in patients receiving enteral nutrition.

METHODS

A survey was conducted among a sample of intensive care unit nurses (n = 832) from four hospitals in Turkey (n = 182) and attendees of the Annual Congress of the Flemish Society for Critical Care Nurses in Flanders, Belgium (n = 650). The survey instrument was developed by the researchers based on the related literature.

RESULTS

A total of 480 nurses completed the questionnaire (response rate = 73%). Gastric residual volume is measured by 98·0% of respondents, with wide variations in the frequency of measuring. A 50-200 mL gastric residual volume is considered problematic by 45·5% (n = 183) of the participants, and only 18·4% (n = 81) reported their practice to be based on a current guideline. Strikingly, more experienced intensive care unit nurses appear to perform gastric residual volume measurements more commonly than their less experienced colleagues (p = 0·004), while the practice is more often reported to be performed in Belgium than in Turkey (p < 0·001).

CONCLUSION

Gastric residual volume management could be improved by applying current evidence to daily nursing practice.

RELEVANCE TO CLINICAL PRACTICE

Our results show that increased awareness of these guidelines by nurses is needed to reduce inefficient use of working time and resources, streamline clinical practices and improve patient outcomes. Current gastric residual volume measurement guidelines and up-to-date, relevant training should be provided to nurses.

Uremic pruritus and associated factors in hemodialysis patients: A multi-center study

Background

Uremic pruritus is a common and disturbing problem in hemodialysis patients. Although its pathogenesis is not completely understood, it is thought to be multifactorial. The aim of this study was to identify risk factors of uremic pruritus in hemodialysis patients.

Methods

A total of 249 patients from four dialysis centers were included in this study. Data were collected using a questionnaire, the visual analogue scale, and the Hospital Anxiety and Depression Scale. We investigated whether socio-demographic and biochemical parameters were correlated to uremic pruritus.

Results

Pruritus was present in 53.4% of the hemodialysis patients. The mean visual analogue scale severity was 6.47 ± 1.56. Patients with white blood cell (WBC) counts > 6.7 × 10³/μL had 1.73 times (95% confidence interval [CI], 1.360-2.888; P = 0.036) more pruritus than did those with WBC counts < 6.7 × 10³/μL. Patients with dry skin were 0.2 times (95% CI, 0.070-0.182; P = 0.028) more likely to suffer from very severe pruritus than were those with normal skin.

Conclusion

Uremic pruritus remains a serious problem in dialysis patients. The WBC level and presence of dry skin are thought to be among its causes. Therefore, data regarding the possible risk factors of uremic pruritus must be followed closely in patients at risk.

Predictive value of relative changes in serum total sialic acid level for response to neoadjuvant chemotherapy in patients with locally advanced breast carcinoma

The aim of this study was to determine whether relative changes in total serum sialic acid (TSA) levels are associated with response to neoadjuvant chemotherapy in locally advanced breast carcinoma (LABC) patients. Forty-seven patients with stage III-B breast carcinoma and 20 healthy subjects (controls) were included to the study. TSA levels were determined in serum from patients at baseline and after completion of preoperative chemotherapy. Pathological responses to chemotherapy were determined on specimens of modified radical mastectomy underwent in responders. Association between the relative changes in serum TSA levels and the pathological response to chemotherapy was investigated. The baseline mean serum TSA level of LABC patients was 88.6+/-0.6 mg/dl and 66.9+/-0.7 mg/dl for the control group (p<0.0001). After 3 cycles chemotherapy, the serum levels of TSA were markedly decreased with pathological partial response (pPR) (73.8+/-1.0 mg/dl) and complete response (pCR) (68.1+/-1.9 mg/dl) compared to baseline values (p<0.05). In 8 non-responders, mean TSA value was 88.9+/-1.1 mg/dl (p=0.9 for pretreatment vs posttreatment TSA levels). Of 39 responders, 6 had pathological complete response (pCR) and remaining had pathological partial response (pPR). TSA levels derived from patients with pCR and from those with pPR were 68.1+/-1.9 mg/dl and 73.8+/-1.0 mg/dl, respectively (p=0.03). While TSA levels from pCR were not different from those of controls (p=0.4), there was a significant difference between TSA levels from pPR and from controls (p<0.0001). A significant correlation was demonstrated between the relative changes in TSA levels and pathological response (p<0.0001, coefficient of correlation [rs]=0.81). The ROC analysis showed that the discriminating ability was satisfactory and relative decrease by more than 21% in TSA levels indicated a pCR with the sensitivity by 83%, specificity by 76%. In conclusion, there is a significant correlation between the relative changes in TSA levels by chemotherapy and clinical/ pathological response to neoadjuvant chemotherapy in LABC patients.

Contrast-enhanced power Doppler US in the diagnosis of acute appendicitis

INTRODUCTION/OBJECTIVE

To determine the value of power Doppler (PD) ultrasonography (US) and contrast-enhanced power Doppler (CEPD) US in the diagnosis of acute appendicitis and the prediction of histopathologic stages.

METHODS AND MATERIAL

50 patients with suspected acute appendicitis were evaluated by the same radiologist with PD US and CEPD US. Air micro bubbles stabilized by a granulate of "galactose and palmitic acid" were used as a contrast medium for sonography with the concentration of 400 mg/ml. PD US and CEPD US results were later correlated with the surgical and histopathologic findings. PD US and CEPD US findings were considered positive for appendicitis; if there was depiction of hyperemia in the wall of the appendix or if there was depiction of prominent peripheral vascularity when compared with normal soft tissues; and negative if both hyperemia and peripheral hyperemia were not prominent.

RESULTS AND DISCUSSIONS

Of the 50 patients, 35 patients had histopathologically proven acute appendicitis. CEPD US showed prominent hyperemia in the appendiceal vessels or feeding vessels of the inflamed appendix, and resistance index (RI) calculations were easier. There was statistically significant difference between mean RI values of the normal appendix, suppurative appendicitis and gangrenous appendicitis. PD US has accuracy of 80%, sensitivity of 74% and CEPD US has 98%, and 100% in the diagnosis of acute appendicitis. CEPD US identified 100% of suppurative appendicitis and gangrenous appendicitis.

CONCLUSION

CEPD US is a promising method in the diagnosis of acute appendicitis and determination of the inflammation stage.

Are percutaneous transgastric biopsies using 14-, 16- and 18-G Tru-Cut needles safe? An experimental study in the rabbit

We evaluated perforation, peritonitis and bleeding after 14-, 16-, 18-G Tru-Cut needles were passed through the stomach in an animal model. Insertions were performed on seven anaesthetized rabbits with 18-, 16- and 14-G needles simulating the clinical technique. Diluted contrast medium with methylene blue (60 mL) was administered through a nasogastric tube after the biopsy. Computed tomography (CT) scanning of the upper abdomen was performed 10 min after the insertion for leakage. The abdominal contents were inspected by laparotomy. There was no contrast medium leakage outside the gastrointestinal tract on CT images. Neither methylene blue nor other stomach content leakage was identified by laparotomy, even with manual squeezing. A tiny spot of blood was observed on the serosal surface of the stomach with the 18-G needle passes (five cases), whereas a relatively large haematoma was present with 14-G needle (four cases). Six of the rabbits survived and one died due to an inadvertant aortic injury. The results of the study show that transgastric route with an 18-G cutting needle can be used without fear of peritonitis and bleeding.

Trace elements in hydatid disease

The serum and cyst fluid levels of selenium, zinc and copper were investigated both in patients and sheep with hydatid cysts. Results were compared with those of healthy subjects in both species. The serum values of Se, Zn and Cu in healthy subjects were 60.24 +/- 1.96 micrograms/L, 0.59 +/- 0.07 mg/L, and 1.01 +/- 0.08 mg/L, respectively. The corresponding serum values of the three trace elements in patients with hydatidosis were 41.30 +/- 1.94 micrograms/L, 1.27 +/- 0.08 mg/L, and 0.89 +/- 0.09 mg/L. These results show a decrease in Se and Zn, and a rise in Cu in sera of patients with hydatid disease. Similar results were obtained in infested sheep as related to the healthy control animals. Our results on the three trace elements were found to correlate well with the incidence of cirrhosis, malignant and infectious diseases and arthritis. Se was not detectable in cyst fluid, while Cu and Zn levels were found significantly lower than serum levels. Cu and Zn levels in cyst fluid showed no difference in both species. Variations in serum Cu, Zn and Se levels were insignificant with regard to the genus of the host and the fertile capacity of the hydatid cyst.

Research note: utilizing hazelnut kernel oil meal in layer diets

The present study was conducted in order to investigate the possibility of utilizing hazelnut kernel oil meal (HKOM) in layer diets as a replacement for soybean oil meal (SBM). Two hundred and sixteen brown egg layers raised in contiguous wire cages were used. The duration of the experiment was 24 wk consisting of six periods of 4 wk. In the trial, six diets containing different levels of HKOM replacing 0, 20, 40, 60, 80, and 100% of SBM protein, respectively, were utilized as the treatments. Differences among the diets in terms of egg yield, feed consumption, feed efficiency ratio, egg weight, egg yolk and albumen ratios, shell thickness, shell weight, and Roche color values of the yolk were not statistically significant (P greater than .01). Results indicated that SBM could be replaced totally by HKOM in layer diets. However, replacement of more than 40% of SBM with HKOM is not recommended.

Effect of appendicectomy on development of right inguinal hernia

The effect of appendicectomy on the subsequent development of right inguinal hernia was investigated in 583 patients with hernias, 42 of whom had previously had appendicectomies. The incidence of right sided hernias was no greater among these patients than among those who had not had their appendixes removed. Neither sex was more prone to develop an inguinal hernia after appendicectomy, and no type of hernia (direct or indirect) predominated. The cause of right sided inguinal herniation after appendicectomy has been thought to be damage to the nerve supply of the inguinal muscles during the appendicectomy incision. All our 42 cases except two had had their appendicectomies through classic McBurney incisions, which were some distance away from the most common areas of nerve damage. We conclude that development of a right inguinal hernia is an unlikely complication of appendicectomy if a classic McBurney incision was used.

Regulation of rat liver phosphatidylethanolamine N-methyltransferase by cytosolic factors. Examination of a role for reversible protein phosphorylation

The nature of cytosolic factors which modulate the activity of rat liver phosphatidylethanolamine (PE) methyltransferase was investigated. The combined additions of cytosol, Mg X ATP, and NaF to incubations with rat liver microsomes produced a 1.6-fold activation of the methyltransferase at pH 9.2 and a 1.3-fold stimulation at pH 7.0. Nonhydrolyzable 5'-adenylylimidodiphosphate could not substitute for ATP, although GTP could. The activation was time dependent, stable to reisolation of the microsomes by ultracentrifugation, and partially preventable by other cytosolic components. Despite these indications that PE methyltransferase might be a substrate for cytosolic protein kinases, cAMP and Ca2+-calmodulin exerted little influence on the activation reaction. Furthermore, microsomal PE methyltransferase activity was unaffected by purified preparations of cAMP-dependent protein kinase, calmodulin-dependent protein kinase, and casein kinase II, nor was methyltransferase activity influenced by the purified catalytic subunits of protein phosphatases 1 and 2A. Cytosol also contained inhibitors of PE methyltransferase which could overcome the Mg X ATP X NaF-mediated activation of the enzyme, but were not affected by the thermostable phosphatase inhibitors 1 and 2. Part of this inhibitory activity (apparent molecular mass of 15 X 10(3) daltons) was insensitive to trypsin and chymotrypsin, stimulated by Mn2+, and partly inhibited by NaF. Therefore, regulation of methyltransferase by reversible phosphorylation, while still a tenable hypothesis, is apparently more complex than previously proposed.

Cardioglobulin B content of the blood plasma of newborn infants

A comparative study was made of the cardioglobulin B content of the plasma of 26 normal adults and 20 newborn infants with the bioassay technique described by Hajdu and Leonard. The cardioglobulin B content in the plasma of infants was significantly lower than that of adults. Heparin was used as the anticoagulant in the blood samples throughout this study. It was noted that, when heparin containing phenol as a preservative was employed, the cardioglobulin B levels were lower in both groups.