Training Hospital Research Articles

Data analysis of patients admitted to the emergency medicine clinic of Mersin City Training and Research Hospital after the Kahramanmaraş earthquake.

In earthquakes and other natural disasters, there is a significant number of injuries directly resulting from trauma. Additionally, due to the disaster's impact on overloaded health institutions, healthcare providers face significant challenges during earthquakes. In this context, nearby hospitals providing health services play a crucial role. Nonetheless, with proper planning, the health crisis can be managed in the best possible way. A single-center retrospective study was conducted on patients admitted to Mersin City Training and Research Hospital due to injuries attributed to the earthquake that occurred in the southern and mid-eastern regions of Türkiye on February 6, 2023. A total of 2,155 patients meeting the study criteria were included in the analysis. Of the 2,155 patients enrolled in the study, 46.8% (n=1009) were male, with a mean age of 45.86±17.68 years. Falls (57.2%, n=1233) were the most common mechanism of injury, and 71.9% (n=1550) of cases presented to the hospital on their own. Among the head injuries, the most common types were soft tissue injury and lacerations, while soft tissue injury and rib fractures were most common in the thoracic region. Soft tissue injury and retroperitoneal bleeding were the most commonly recorded types among abdominal injuries, whereas soft tissue injury and fractures were most common in the upper and lower extremities. Fractures were identified in 11.1% (n=240) of cases in the upper extremities and 21.3% (n=458) in the lower extremities. Rhabdomyolysis was one of the most frequently observed injury types (n=443, 20.6%). Crush syndrome and acute kidney injury were recorded in 9.2% (n=198) of cases, leading to a total of 46 amputations in 40 (1.8%) patients and 164 fasciotomies in 132 (6.1%) patients. The orthopedics department performed the most frequent surgical interventions and hospitalizations. Mortality was noted in 2.87% (n=62) of cases. This study demonstrated a significant increase in workload and patient volume following the earthquake. There is a need for a large number of healthcare professionals for expedient intervention in conditions such as fractures, crush syndrome, amputation, and fasciotomy in disasters with a high risk of serious trauma, such as earthquakes. Disaster planning and preparedness for possible consequences will mitigate the healthcare crisis involving the hospitals and lead to significant reductions in mortality and morbidity.

Empowering Family Nurse Practitioners for Sustainable Community Health

<p>醫療自主權於現今醫療環境中日趨重要，以病人為中心照護的重要環節，就是鼓勵病患積極參與醫療決策，以提升照護品質與滿度度。台灣衛生福利部自2016年開始推行醫病共享決策（shared decision making, SDM），期望促使病人積極參與醫療決策，以提升醫病關係、醫療品質及病人安全。推動至今，共享決策已廣泛運用於臨床實務中。但是，偏鄉及高齡長者，其就醫習慣、喜好、價值觀和醫療新知取得與都市居民有極大的差異。傳統以「醫生」作決策的觀念深植，參與SDM之意願以及推廣策略，值得探討。因此，本文將從專科護理師之角色去探討共享決策於偏鄉醫院推動影響因素，推行過程所遇到困境與經驗，綜整考量偏鄉居民特質及觀念，因應出不同之SDM推行之道。</p> <p> </p><p>Various challenges, such as a nursing workforce shortage, an aging society, and health inequality,seriously affect the sustainable development of Taiwan. Although the specialized nursing system represents a significant milestone in nursing development in Taiwan, it is mainly focused on hospital training, neglecting community health needs. Community health care can be effectively enhanced by promoting the family nurse practitioner system, especially in rural areas. Family nurse practi-tioners provide medical care services, boost local economies, increase employment opportunities, and strengthen community cohesion. The cultivation and investment in family nurse practitioners are crucial for improving the efficiency and quality of medical services. With the adjustment of the med-ical training system in Taiwan, nurse practitioners could redefine their roles and responsibilities in a new environment, and eventually contribute to the sustainability of Taiwan’s primary health care and improve community health. Through the empowerment of family nurse practitioners, Taiwan will be better equipped to address challenges and achieve sustainable development goals</p> <p> </p>

Acute Kidney Injury in COVID-19 Pneumonia Patients Admitted to the Intensive Care Unit.

This retrospective study was conducted at the Izmir Tepecik Training and Research Hospital from January 2020 to December 2021. It aimed to determine acute kidney injury (AKI) frequency and associated factors in critically ill COVID-19 patients. Out of 177 patients, 49.7% developed AKI, with an average onset of 7.63 days. AKI stages varied, and progression occurred in 27 patients within 48 hours. ICU and hospital mortality rates were significantly higher in AKI patients (86.4% and 92%, respectively) compared to non-AKI patients (19.1% and 22.5%). The study highlights age, sequential organ failure assessment (SOFA) score, and nephrotoxic agent presence as significant factors influencing AKI development in COVID-19 patients. Key Words: Critical care unit, COVID-19, Acute kidney failure.

Factors associated with thirty-day mortality and intensive care unit admission in patients undergoing hip fracture surgery.

Various factors contribute to the development of mortality and morbidity in hip fracture surgeries. This study aims to investigate the effects of modifiable factors such as the type of anesthesia, anesthesia management, surgical method, and timing of surgery on 30-day mortality rates, intensive care unit admissions, and complications. A total of 400 patients who underwent hip fracture surgery between January 2021 and December 2023 at a Training and Research Hospital were retrospectively analyzed. Patients were divided into two groups: those followed in the ward, named Group 1 (n=304), and those in the intensive care unit, named Group 2 (n=96). Recorded data included demographic characteristics, American Society of Anesthesiologists (ASA) physical status scores, types of comorbidities, anesthesia type, surgical method, surgical delay time, duration of surgery, blood transfusion requirements, and complications. Patients in Group 2 had higher mean age, comorbidity, and mortality rates compared to Group 1 (p<0.001). In terms of types of comorbidities, the rate of intensive care unit admission was higher in patients with coronary artery disease and chronic renal failure (p<0.001). Mean surgical delay and length of hospital stay were also higher in Group 2 (p<0.001). In multivariate logistic regression analysis, age (p<0.001, Odds Ratio [OR]=1.91, Confidence Interval [CI]=1.046-1.137), ASA score (p<0.001, OR=3.872, CI=1.913-7.838), duration of surgical delay (p<0.001, OR=2.029, CI=1.365-3.017), surgical method (p=0.003, OR=2.003, C=1.258-3.188), and length of hospital stay (p=0.006, OR=1.147, CI=1.04-1.266) were determined as predictive factors for 30-day mortality. This study found that age, ASA classification, length of hospital stay, surgical method, and surgical delay were predictive factors for both morbidity and mortality. Among these, surgical delay time appears to be a modifiable parameter when all factors are considered.

Forensic medical evaluation of penetrating abdominal injuries.

This study aims to discuss the characteristics, origins, degree of injury, results, reporting, and forensic medical aspects of penetrating abdominal injuries. In this study, 28,619 cases who applied to the emergency department of Kutahya Health Sciences University Evliya Celebi Training and Research Hospital between January 1, 2016 and December 31, 2020 were reviewed. The forensic reports and medical documents of 85 cases with penetrating abdominal injuries were evaluated retrospectively, with the approval of the ethics committee. Among the patients included in the study, 87.1% were male and 12.9% were female. The mean age was found to be 31±13 years. When the origins of the cases were analyzed, 87.1% were found to have developed as a result of intentional injury. The incidents predominantly occurred between 20: 00 and 04: 00 hours. As a result of the examinations performed at the hospital after the incident, alcohol was detected in 36.5% of the cases, while 30.6% of the individuals did not consume alcohol. It was observed that 32.9% of the cases were not tested for alcohol. The most common injuries identified were sharp injuries, accounting for 69.4% of cases, and firearm injuries, comprising 27.1%. Organ damage was noted in 68.2% of the cases, with the small intestine being the most frequently damaged organ. The average number of wounds present was 3.6. Intra-abdominal hemorrhage was detected in 61.2% of the cases, and intra-abdominal artery injuries were found in 8.2%. The mortality rate for penetrating abdominal injuries was 8.2%. In forensic traumatology, penetrating abdominal injuries commonly lead to life-threatening conditions and loss of organ function, which represent the most severe category in trauma severity assessment. Penetrating abdominal injuries most often result from violent incidents, as observed in our study and in the literature.

The association between the coping attitudes and compulsive online buying behaviors of nurses

AimThe aim of this study is to examine the relationship between the coping attitudes and compulsive online buying behaviors of nurses. MethodsThis descriptive and correlational study was conducted with 253 nurses working in a research and training hospital in Istanbul between June and December 2022. Data were collected using a ‘Participant Information Form’, the ‘Coping Attitudes Assessment Scale (R-COPE)’, and the ‘Compulsive Online Shopping Scale (COSS)’. Data were analyzed using descriptive statistics, Pearson's correlation coefficient, and multiple linear regression analysis. A p-value of <0.05 was considered statistically significant. ResultsThe mean R-COPE score of the participants was 87.79 ± 10.40, and their mean COSS score was 26.00 ± 25.03. There was a negative and statistically significant correlation between the total R-COPE scores and the total COSS scores of the participants (p < 0.01). The coping attitudes (β = −0.147) were a significant and negative predictor of compulsive online buying behaviors. Marital status (β = 0.152), frequency of access to the internet (β = 0.273), frequency of online shopping (β = 0.365), and monthly amount of money spent for online shopping (β = 0.123) were significant and positive predictors of compulsive online buying behaviors. These variables collectively explained 33 % (R2 = 0.328, p = 0.000) of the total variance in the compulsive online buying behaviors of the participants. ConclusionNurses had moderate levels of coping attitudes and low levels of compulsive online buying behaviors. Having low levels of coping attitudes, being single, accessing the internet frequently, doing online shopping frequently and spending a high amount of money for online shopping every month predicted the compulsive online buying behaviors.

EVALUATION OF MEAN PLATELET VOLUME AND 25 HYDROXY VITAMIN D LEVELS IN GESTATIONAL DIABETIC WOMEN

Aim: According to few studies which tried to evaluate mean platelet volume (MPV) and 25 hydroxy vitamin D, have shown conflicting results in gestational diabetic patients. In this study we aimed to compare main platelet volume and 25 hydroxy vitamin D values between gestational diabetic patients and healty individual pregnant womens. Material and method: The patients were selected from 24-28 weeks pregnant people who made gestational diabetes screening and oral glucose tolerance test from obstetric-gynecology, diabetes and endocrinology polyclinics of Okmeydanı Training and Research Hospital. After the searching 52 gestational diabetic patients and 52 healty pregnant women included to the study. We estimated MPV and vitamin D level. In addition, demographic and clinical data of subjects were recorded. Results: Mean platelet volume (MPV) value was found 8,5 ± 1,0 fl and 8,3 ± 1,1 fl. in gestational diabetic and control group respectively. There was no statistically significant differences in MPV value between case and the control group (p&gt;0.05). Mean 25 hydroxy vitamin D value was found 20.5 ± 11.0 ng/ml and 21,1 ± 9,3 ng/ml. gestational diabetic and control group respectively. There was no statistically significant differences in 25 hydroxy (OH) vitamin D value between case and control group. Conclusion: In our study we found no statistically significant differences in MPV and 25-OH vitamin D values between gastational diabetic pregnant group and healty pregnant group.

Evaluation of Anemia Distribution According to Erythrocyte Morphology in Hospitalized Children

Aim: While the prevalence of anemia among hospitalized children varies in the literature, there is currently a lack of studies in our region that specifically examine the distribution of anemia based on erythrocyte morphology. Therefore, our aim was to compare the prevalence of anemia based on sex and age distribution among children undergoing hospitalization in our region and investigate the distribution of anemia according to erythrocyte morphology. Material and methods: Children aged between 6 months and 18 years who were only hospitalized and followed up in the Department of Pediatrics at the Health Sciences University Konya Beyhekim Training and Research Hospital between January 2021 and March 2024 were retrospectively analyzed. Results: Of the 1148 children hospitalized in the pediatric clinic, 876 (76.3%) had hemoglobin levels within the reference range for their age, while 272 (23.7%) were found to have anemia. A statistically significant difference was observed in the presence of anemia among age groups, with the 6 months-

Pediatric Modification For Alvarado Score: Appearance Of Patients With Apandisitis

ABSTRACT Objective: This study, with the purpose of decreasing the morbidity rate in emergency pediatric surgery clinics, evaluates the reliability of an acute appendicitis diagnosis score we define as “appearance of the patient with appendicitis (APA)”, which is a new modification of Alvarado Score (AS). Methods: One hundred eighty patients, that admitted to Van Training and Research Hospital between February 2018 and June 2018 and were consulted to pediatric surgery with acute appendicitis suspicion; were analyzed as a randomized prospective study. In the new scoring system which we define as APA, instead of a left shift of neutrophils – a state of the patients lying still in the bed, reluctant to speak, with dry lips, with tired eyes, upset and with a troubled expression at the face is placed. For all the patients, AS (AS 1-4, AS 5-6 and AS 7-10) and APA (APA 1-4, APA 5-6 and APA 7-10) scores were independently calculated as three groups and were compared to each other. Results: 180 children (108 males – 72 female) with an average age of 11 (range, 6 – 15) were included in the study. Distribution of patients in the three groups of AS was determined as 1-4: 90 (50%), AS 5-7: 48 (26.7%) and AS 8-10: 42 (23.3%) respectively. Distribution of patients with respect to APA score were as APA 1-4: 72 (40%), APA 5-7: 69 (38.3%) and APA 8-10: 39 (21.7%). Appendectomy was performed on 3 patients from the AS 1-4 group, on 15 patients from AS 5-6 group and on 33 patients from AS 7-10 group. Whereas none of the patients from the APA 1-4 group had an appendectomy, 18 patients from APA 5-6 group and 33 patients from APA 7-10 group had an appendectomy. Conclusion: By means of the APA which we define as a combination of AS and clinical judgment (CJ), the number of pediatric cases with appendicitis suspicion to be kept under observation was increased and unnecessary –too early or too late- surgical intervention incidence was decreased. Our study shows CJ and scoring systems are not alternative methods for each other and collective use of both can decrease morbidity and mortality in acute appendicitis treatment.

Examining the Relationship Between Spiritual Well-Being and Pregnancy Distress in Pregnant Women

Aim: This study was conducted to determine the relationship between pregnant women's spiritual well-being levels and their pregnancy-related stress. Material and Methods: The sample of the descriptive and correlational study consisted of 250 pregnant women aged 18 years and over with the 12th week of pregnancy and above who were admitted to the Obstetrics and Gynecology outpatient clinic of a Training and Research Hospital between November 2020 and April 2021 and who agreed to participate in the study. The data were obtained by collecting the Personal Information Form, Spiritual Well-Being Scale (SWBS), and Tilburg Pregnancy Distress Scale (TPDS). The SPSS statistical program was used to evaluate the data. Results: The mean age of the pregnant women was 26.5±5.3 years. It was determined that 39.6% of the pregnant women were secondary school graduates, 72% had planned pregnancies, 31.6% were primiparous and 60% were in the third trimester. A statistically significant, negative, and weak relationship was found between the spiritual well-being levels of pregnant women and pregnancy-related stress (r=-0.33, p=0.000). Conclusion: In this study, the spiritual well-being of pregnant women was determined to be high, and pregnancy-related stress was found to be low. However, it was found that as the spiritual well-being of pregnant women increased, their pregnancy-related stress decreased.

Rural physician recruitment program in Thailand: factors associated with medical student enrollment and post-graduation intentions

Objectives: Thailand’s Collaborative Project to Increase Production of Rural Doctor (CPIRD) recruits students with a rural background and provides clinical year training in provincial teaching hospitals. We studied the main reasons for students attending this rural recruitment project and their intention to work in rural areas. Methods: In 2018, 2,870 4th–6th year medical students from 34 teaching hospitals under the CPIRD were sent a questionnaire surveying the following factors: their gender; year of study; size of the teaching hospital in which they were training; a domicile of origin and the province where they attended a high school; parent’s occupation; family income and main reasons for choosing to attend the CPIRD rural medical schools, as well as their attitudes towards rural job placement. Factors associated with a student's intention to work in rural areas were also examined, using multiple logistic regression. Results: 1,349 (47%) students responded. 809 (60%) were female, 914 (68%) had adequate family income, 519 (38%) had a domicile of origin in rural areas, 247 (18%) had either a mother or father being health professionals. The top three main reasons for choosing to attend the rural medical schools were: intention to return to work in their hometown(32%); student recruitment being less competitive (18.5%); and pre-specified job placement in their home districts (15%). Medical students who had a domicile of origin in rural areas, CPIRD recruitment track, and trained in medium and small-sized teaching hospitals had higher intention to work in rural areas, with Odds ratio of 1.51 (95% confidence interval (CI) 1.06-2.15), 4.39 (95%CI 3.02-6.39), 1.54 (95% CI 1.09-2.17) and1.74 (95% CI 1.14-2.65), respectively. 1,283 (95%) medical students had a favorable attitude towards rural placement after their graduation. Conclusion: Students´ rural background and training in provincial teaching hospitals may enhance their intention to start and remain working in rural healthcare services.

Evaluation of home health services provided to children in Batman province

Aims: To evaluate the home health services provided to children in Batman, a province in the Southeastern Anatolia Region of Turkiye, where the birth rate and consanguineous marriages are high. Methods: For this descriptive and cross-sectional study, data from 460 patients aged 0-18 years who received services from the Home Health Unit of Batman Training and Research Hospital between January 10, 2018, and January 10, 2023, were retrospectively scanned through the Hospital Information Management System. Results: 57.6% of the patients were male and 42.4% were female. The mean age of the patients was 10.64±4.5 years; the proportion of patients aged 0-6 years was 20%, 7-12 years was 41.1%, and 13-18 years was 38.9%. Mental retardation was observed in 15%, cerebral palsy in 42.8%, hydrocephalus in 7.8%, epilepsy in 17%, spina bifida/meningocele/meningomyelocele in 4.1%, neuromuscular and motor disorders (paresis/plegia, etc.) in 10.4%, and osteogenesis imperfecta in 3%. While 99.6% of reasons for physician visits were non-emergency, the most common reason for visits by non-physician health personnel was dressing and monitoring of fever, pulse, and blood pressure, at 94.8%. The proportion of patients in need of nursing services was 98.7%; the proportion of patients with pressure sore signs was 87.8%; and the proportion of fully dependent patients was 93.9%. Conclusion: To provide home health services more effectively and efficiently, it is necessary to increase social awareness, improve health literacy to eliminate regional differences, and expand telehealth applications. For better quality service delivery, it is of vital importance to provide periodic training to those engaged in patient care, especially on managing bed sores. In this way, home health services for children can become more accessible and effective.

The Efficacy of the Cognitive Exercise Therapy Approach by Telerehabilitation in People Living with HIV: Preliminary Results.

The Cognitive Exercise Therapy Approach, referred to as BETY, is a biopsychosocial model that has demonstrated effectiveness in improving the quality of life among various patient populations with chronic diseases. This study aimed to determine the efficacy of BETY combined with telerehabilitation for people living with HIV (PLWH). Fifty PLWH who were virologically suppressed receiving follow-up and treatment at Şanlıurfa Training and Research Hospital were included in this study. Patients were divided into the telerehabilitation group (TG) and the control group (CG). In addition to routine treatments, the TG underwent group rehabilitation exercises via Zoom application for 60 minutes three times a week for 12 weeks (a total of 36 sessions) under the supervision of a physiotherapist, following the principles of BETY. The CG received no intervention and continued with routine medication treatments. Before and after the exercise therapy, the BETY Scale (BETY-BQ), Short Form-36 (SF-36), Hospital Anxiety and Depression Scale (HADS), Clinical Frailty Scale, and Frail Scale were administered to both the TG and the CG. The responses to the scales were compared between the two groups after the 12-week period. The preliminary results included data from 10 patients in the TG and 15 patients in the CG who completed the 12-week treatment. In the TG, significant differences were observed in the SF-36 pain subscale and the BETY total score, while in the CG, significant differences were found in the SF-36 emotional role functioning and vitality subscales (p<0.05). In the TG, negative values were observed in all BETY-BQ subscales, indicating improvement in all parameters. Additionally, the mean value of the SF-36 pain subscale increased from 79 before treatment to 91.5 after treatment. Our preliminary results indicate that the BETY method applied by telerehabilitation may be effective in reducing pain and improving biopsychosocial conditions in PLWH. Telerehabilitation with cognitive exercise therapy can provide an alternative treatment option by complementing routine therapies and offering the opportunity to participate anonymously in group therapies in PLWH.

Mid-term outcomes of a smoking cessation program in hospitalized patients in Türkiye.

'Teachable moments', such as inpatient treatment periods, can be turned into opportunities for smokers to acquire healthy living behaviors. This study was conducted to evaluate the outcomes of smoking cessation interventions in an inpatient hospital setting. Data were collected for this single-arm prospective intervention cohort study between October 2021 and March 2022 from hospitalized patients at Recep Tayyip Erdoğan University Training and Research Hospital in Türkiye. Smoker patients received smoking cessation counseling and brief smoking cessation interventions during their hospitalization and were informed about how to apply to our hospital's smoking cessation outpatient clinic after discharge. They were followed via phone on the 3rd, 5th, and 7th day and the 1st, 3rd, 6th, and 12th month after their discharge, regarding their quit status as well as admissions to smoking cessation clinics. Quitters were confirmed by exhaled air carbon monoxide testing. Logistic regression analysis was performed to evaluate the presence of admission to the emergency department and family physicians at follow-up at 1st year. The model was adjusted in terms of age, sex, presence of malignancy, and education level. Of the 183 patients included in the study, 163 participants completed periodic follow-up during one year, with quit rate of 47.2%. The rate of anxiety was higher among non-quitters compared to quitters (9.4% vs 1.2%) (p=0.024). Non-quitters were 19 times more likely to have emergency department admissions (AOR=19.64; 95% CI: 8.08-47.68) and eight times more likely to have family doctor visits (AOR=8.43; 95% CI: 4.05-17.53) than quitters. This cessation program evaluated the quit rates of hospitalized patients in the first year and revealed that the rate of anxiety was higher in non-quitters compared to quitters. It would be an important approach to include psychiatric support in this practice.

Psychiatric Emergencies in Perinatal Women: A Retrospective Analysis

Objective: The perinatal period represents a critical juncture in a woman's life marked by profound emotional, social, and physical changes. During this phase, there is a propensity for the exacerbation of pre-existing psychiatric symptoms or the emergence of new ones. Notably, there is often an uptick in psychiatric emergencies and presentations to emergency psychiatric departments among women in the perinatal period. This study aimed to retrospectively evaluate women accessing emergency psychiatric departments during pregnancy and the postpartum period, focusing on their presenting complaints, diagnoses, clinical trajectory, and factors influencing the decision for inpatient treatment. Material and Method: A retrospective review was conducted on the records of 11,419 women aged 18 to 45 who sought care at the Psychiatric Emergency Department of Bakirkoy Prof.Dr. Mazhar Osman Research and Training Hospital Hospital between July 2015 and July 2016. Results: Among them, the records of 163 women who were either pregnant or within one year postpartum were analyzed. Of the women accessing services during the perinatal period, 46% were pregnant, while 54% were in the postpartum phase. Additionally, 38.7% of these women presented to the psychiatric department for the first time. Distress and anxiety emerged as the most common reasons for seeking help. Interestingly, no significant differences were observed between the pregnancy and postpartum periods regarding presenting complaints and clinical progression. However, the incidence of psychotic disorders was notably higher during the postpartum period compared to pregnancy. Through logistic regression analysis involving pregnancy status, presenting complaints, and diagnoses, it was determined that the nature of the presenting complaint significantly influenced the decision for inpatient treatment. Notably, scepticism, agitation, and suicidal ideation were identified as the most prevalent complaints among women who required inpatient care. Conclusion: Mental health challenges during the perinatal period not only jeopardize the well-being of the woman but also impact the health of the infant. Detecting and addressing emergent psychiatric issues during this phase are pivotal for timely intervention and preventive measures.

Exploring the Impact of Obstetric Sonographers Dealing With and Supporting Patients Who Receive Negative Outcomes

Because of the complex circumstances in pregnancy, obstetric (OB) sonography requires dissemination of results, often during the examination, and the sonographer can be highly involved in that reporting. This creates a complex set of work responsibilities, in which patient support is of utmost importance, especially when the results are unfavorable. While patient experiences of receiving a negative outcome, during an OB sonogram, have been widely reported, there is a lack of literature on the experience of the sonographers involved in delivering this information. Thus, it is important to identify variables that impact providing ethical care for grieving OB patients. Sonographers in a maternal-fetal medicine clinic work very closely with a group of physicians, and other providers, in delivering unfavorable results, making communication, and understanding of roles of the utmost importance. Conversely, sonographers in a general OB/gynecology practice may not have the support of colleagues when communicating with the grieving patient. These demands may cause feelings of guilt, uncertainty, and stress, contributing to the experience of burnout for the OB sonographer. To prevent these feelings, it is important to consider ways to create a positive work environment and provide resources to protect sonographer mental health. Health care systems must ensure employee access to resources for managing stress, because of caring for grieving patients, and prioritize a healthy work environment, even during challenging times. Future studies are needed that investigate possible training materials, beyond basic hospital training, which targets the skill set needed to properly care for the grieving OB patient.

The Effect of the Fear of COVID-19 on Treatment Adherence and Health-Seeking Behavior in Individuals with Type 2 Diabetes

Objective: This descriptive and cross-sectional study aimed to determine the impact of COVID-19 induced fear on the treatment adherence and health-seeking behavior of individuals with type 2 diabetes. Methods: The sample for this research consisted of 150 type 2 diabetes patients who attended the Mersin City Training and Research Hospital endocrinology outpatient clinics for treatment and follow-up. Data collection involved the use of a Personal Information Form, the COVID-19 Fear Scale, the Type 2 Diabetes Mellitus Patient Treatment Adherence Scale, and the Health-Seeking Behavior Scale. Data was analyzed using Student’s t-test, One Way ANOVA and Multiple Linear Regression analysis. Findings: Among the individuals participating in the study, it was determined that while 54.7% were female, 48.7% had an HbA1c level of 8.1 and above, 64% used insulin, 80.7% developed complications related to diabetes and the average age of the participants were 62.9±11.9. Furthermore, the majority were not diagnosed with COVID-19, and they did not require hospitalization due to COVID-19. The adherence to diabetes treatment among the patients was found to be moderate, with the lowest adherence was observed in terms of lifestyle changes and the highest adherence was observed in terms of the emotional and behavioral adherence dimensions. Multiple regression analysis revealed that the fear of COVID-19 did not affect diabetes treatment adherence levels of the patients (p&gt;0.05). It was found that only those patients who were using insulin and those who were not adhering to medical nutritional treatment had lower adherence to diabetes treatment (p

Assessment of antimicrobial stewardship programmes and antibiotic use among children admitted to two hospitals in Sierra Leone: a cross-sectional study

IntroductionAntimicrobial resistance (AMR) is a global public health concern and irrational use of antibiotics in hospitals is a key driver of AMR. Even though it is not preventable, antimicrobial stewardship (AMS) programmes will reduce or slow it down. Research evidence from Sierra Leone has demonstrated the high use of antibiotics in hospitals, but no study has assessed hospital AMS programmes and antibiotic use specifically among children. We conducted the first-ever study to assess the AMS programmes and antibiotics use in two tertiary hospitals in Sierra Leone.MethodsThis was a hospital-based cross-sectional survey using the World Health Organization (WHO) point prevalence survey (PPS) methodology. Data was collected from the medical records of eligible patients at the Ola During Children’s Hospital (ODCH) and Makeni Regional Hospital (MRH) using the WHO PPS hospital questionnaire; and required data collection forms. The prescribed antibiotics were classified according to the WHO Access, Watch, and Reserve (AWaRe) classification. Ethics approval was obtained from the Sierra Leone Ethics and Scientific Review Committee. Statistical analysis was conducted using the SPSS version 22.ResultsBoth ODCH and MRH did not have the required AMS infrastructure; policy and practice; and monitoring and feedback mechanisms to ensure rational antibiotic prescribing. Of the 150 patients included in the survey, 116 (77.3%) were admitted at ODCH and 34 (22.7%) to MRH, 77 (51.3%) were males and 73 (48.7%) were females. The mean age was 2 years (SD=3.5). The overall prevalence of antibiotic use was 84.7% (95% CI: 77.9% – 90.0%) and 77 (83.8%) of the children aged less than one year received an antibiotic. The proportion of males that received antibiotics was higher than that of females. Most (58, 47.2 %) of the patients received at least two antibiotics. The top five antibiotics prescribed were gentamycin (100, 27.4%), ceftriaxone (76, 20.3%), ampicillin (71, 19.5%), metronidazole (44, 12.1%), and cefotaxime (31, 8.5%). Community-acquired infections were the primary diagnoses for antibiotic prescription.ConclusionThe non-existence of AMS programmes might have contributed to the high use of antibiotics at ODCH and MRH. This has the potential to increase antibiotic selection pressure and in turn the AMR burden in the country. There is need to establish hospital AMS teams and train health workers on the rational use of antibiotics.

Retrospective Evaluation of Survival and Prognostic Factors in Immune Thrombocytopenia: A Single-Center and Cross-Sectional Study.

Background and Objectives: Immune thrombocytopenia (ITP) is an autoimmune disease characterized by the autoantibody-mediated destruction of platelets. The treatment of ITP aims to maintain a sufficient platelet count to prevent bleeding. First-line treatment options include corticosteroids and intravenous immunoglobulin (IVIg), while second-line treatments include splenectomy, rituximab and other immunosuppressive agents, and thrombopoietin (TPO) receptor agonists. This study aims to discuss the treatment methods and results from 100 patients with ITP at the Muğla Training and Research Hospital through a pharmacological approach. Materials and Methods: Demographic characteristics, clinical findings, bone marrow aspiration and biopsy results, and treatments and treatment responses at the time of diagnosis of the 100 patients with ITP who were treated and followed up in the period 2015-2023 were evaluated retrospectively. Results: In the third month after treatment, the overall response percentage was 100% in patients who received steroids only and 88% in patients who received IVIg treatment alone or in combination with steroids (p > 0.05). The most preferred second-line treatments were splenectomy (41%), eltrombopag (26%), and rituximab (10%). Bone marrow biopsy was performed in 54% of patients, where 35.1% showed increased megakaryocytes, 44.4% adequate megakaryocytes, and 14.8% decreased megakaryocytes. It is noted that eltrombopag and rituximab, in particular, yield higher complete remission rates than immunosuppressive drugs. Conclusions: Considering the side effects of immunosuppressive medications, IVIg, splenectomy, and steroid therapy, the use of new agents such as eltrombopag, which are easily tolerated and have a lower risk of side effects, is expected to increase.

Prevalence of frailty and associated factors in coronary artery bypass graft surgery patients

Abstract Background Frail patients are at increased risk for postoperative delirium, complications, delayed recovery, prolonged hospital and intensive care unit stay, morbidity and mortality. The number of studies examining frailty in cardiovascular surgery patients is limited (1,2). In this context, it is important to determine the prevalence of frailty in cardiac surgery patients (3,4). Purpose This research was conducted to examine the prevalence of frailty in coronary artery bypass graft surgery patients and associated factors with frailty. Methods The research was descriptive cross-sectional type. It was conducted between 18.02.2021 and 18.02.2022 at the cardiovascular surgery department of a training and research hospital in Turkey. A total of 96 patients who had undergone coronary artery bypass graft (CABG) were included. The "Sociodemographic and Clinical Data Form" which was prepared in accordance with the literature, the "Modified Fried Frailty Index", the "Mini Nutritional Assessment Test-Short Form", the "Barthel Daily Living Activities Index", the "Charlson Comorbidity Index", and the "Montreal Cognitive Assessment Scale" were used to collect data. The data were analyzed using the SPSS 23.0 package program. Descriptive statistics, Kolmogorov-Smirnov test, Chi-square test, One Way ANOVA, Kruskal Wallis test and multinomial logistic regression analysis were used in the evaluation of the data. Results As a result of the study, the mean age of the patients was 65.65±8.72 years (min:40-max:85), 62.5% consisted of males. The majority of patients (94.8%) had comorbid diseases, most of whom had hypertension (66.7%) and diabetes mellitus (63.5%). The mean ejection fraction of the patients was normal (54.59±8.70) according to the European Society of Cardiology and the majority (80.2%) were in the preserved LVEF group. The mean EuroSCORE was intermediate (4.79±2.40) and 49% of the patients were at intermediate risk for mortality. The majority of the patients (94.8%) were in the ASA III class according to the American Society of Anaesthesiologists. Of the patients. 14.6% were determined as ‘non-frail’, 45.8% as ‘pre-frail’ and 39.6% as ‘frail’. Age, educational status, income level, beta-blocker use, nutritional status, daily living activities, cognitive status, number of comorbidities, and level of potassium, procalcitonin and creatinine were found to be associated with frailty (p&amp;lt;0.05). Malnutrition, decreased daily living activity, cognitive impairment and creatinine elevation were found to be predictors of frailty (p&amp;lt;0.05). Sociodemographic and Clinical Characteristics by Frailty Status was presented in Table 1. Conclusions More than a third of CABG patients were frail. Malnutrition, decreased daily living activity, impaired cognitive status and high creatinine levels increased the risk. It is important to assesment frail cardiac surgery patients and provide them with appropriate nursing management.