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BACKGROUND: It is essential to relieve bronchospasm or specific asthma symptoms by administering immediate inhaler treatment during an asthma exacerbation. The present study compared the effect of Fowler position and forward-leaning positions during nebulization on heart rate, SpO2, breathing frequency, pain, and anxiety levels in children experiencing asthma exacerbations. METHODS: The data originated from a randomized trial that compared 86 participants (study group n = 43, control group n = 43) who presented to the pediatric emergency department with asthma exacerbations between October 2019-February 2020. The subjects were administered nebulization 3 times, during which the study group was placed in the forward-leaning position and the control group in the routine Fowler position. The subjects provided information on chest pain and anxiety levels before and after nebulization, and heart rate, SpO2, and breathing frequency were measured before and after each nebulization. RESULTS: The difference in the mean SpO2 measured at admission and after the third nebulization was significantly higher (3.2 ± 1.5% vs 2.3 ± 1.9%, P = .01); the difference in the mean breathing frequency was considerably higher (-6.0 ± 1.7 breaths/min vs -3.2 ± 1.8 breaths/min, P < .001), and the difference in the mean pain scores was significantly higher (-3.3 ± 2.5 vs -2.0 ± 2.3, P = .02) in the study group than in the control group. In addition, after the third nebulization, the breathing frequency (22.8 ± 2.8 breaths/min vs 24.2 ± 2.7 breaths/min, P = .02) and pain score of the study group were lower (0.8 ± 1.3 vs 1.5 ± 1.5, P = .01). There was no difference in the mean heart rate (20.6 ± 16.2 beats/min vs 20.0 ± 15.4 beats/min, P = .85) and anxiety levels (-2.0 ± 2.2 vs -1.9 ± 2.2, P = .90) between the groups. CONCLUSIONS: Placing children in a forward-leaning position during nebulization was effective in improving SpO2 and reducing breathing frequency and chest pain. The forward-leaning position implemented during nebulization is a non-pharmacologic method that supports recovery in children with asthma exacerbations. [ABSTRACT FROM AUTHOR]

Aims: The aim of this study was to research the effect of different bed head angles on the hemodynamic parameters of intensive care patients lying in the supine position. Methods: This study was a non‐randomized and non‐controlled, quasi‐experimental repeated measures study. The study was conducted with 50 intensive care patients aged 18 and over in a general surgery intensive care unit in Turkey. With each patient in the supine position, the bed head was raised to an angle of 0°, 20°, 30°, and 45° without a pillow, and the hemodynamic parameters of central venous pressure, systolic and diastolic blood pressure, heart rate, breathing rate, and peripheral oxygen saturation were recorded after 0 and 10 min. Results: It was found that the mean central venous pressure value measured at min 0 and 10 was higher when the intensive care patients' bed head angle was raised to 45° than when the bed head was at an angle of 0° or 20° (p <.05). It was found that the patients' other hemodynamic parameters were not affected by different bed head angles. Conclusions: It was concluded as a result of this research that in intensive care patients in the supine position, only central venous pressure was affected by bed head angle, and that central venous pressure measurement can be reliably made at a bed head angle of 30°. [ABSTRACT FROM AUTHOR]

Objective: A pressure injury (PI) happens on the skin and in deeper tissues. Generally, it occurs due to prolonged compression over bony structures. A PI, when occurring during a hospital stay, is regarded as a hospital-acquired pressure injury (HAPI), and is considered as a marker for patient care quality. It might cause medical, legal or economic problems, and could be a burden on health systems. In this study we evaluate the factors contributing to HAPI formation. Method: Between June 2014–June 2021, we retrospectively investigated the files of patients who were hospitalised with different medical conditions in Bayindir Sögütözü Hospital, Ankara, Turkey, for patients' age, sex, Waterlow scale score, mobilisation status, application of zinc-containing and/or barrier creams (ZnBC), airbed usage, hospitalisation period, and the day of wound opening. Results: The study cohort comprised 2327 hospitalised patients: 303 (13%) developed Stage 2 and deeper PIs; 2024 patients were hospitalised and discharged without wound opening. We found an increased risk in male patients and a lack of efficacy of ZnBC in protection from HAPI in our study population. However, we observed that ZnBC helped to delay wound opening and that the most protective treatment was the use of airbeds. Conclusion: Health professionals should be more aware of HAPI formation with prolonged hospitalisation periods. Only the use of an airbed for a patient hospitalised for a long period appears to be protective against PI formation. On the other hand, use of ZnBC delays wound opening. However, further research is needed to demonstrate the protective effect of ZnBC, due to the lack of randomisation in our study and the lack of some nursing records. [ABSTRACT FROM AUTHOR]

Background/Aim: Cuffed-tunneled catheter patients encounter various problems during their catheterization period. Early detection and resolution of these problems prolong the life of the catheter. The purpose of the present study was to investigate the problems and solution methods of cuffed-tunneled catheters in hemodialysis patients during their use in light of our experience and literature. Methods: The study was designed as a retrospective cohort study. Twenty-four months of patient data who had a diagnosis of renal failure and who received cuffed-tunneled hemodialysis catheters between January 2013 and June 2021 in the Department of Cardiovascular Surgery of Adiyaman University Faculty of Medicine were analyzed electronically based on the hospital data recording system. The demographic characteristics, localization of the inserted catheter, and duration of catheter use were determined. Primary and secondary patency ratios were calculated and recorded along with the complications in the patients and our treatment approaches to these complications. Finally, the collected data were discussed with reference to the literature data. Results: The data from 322 cuffed-tunneled catheters were collected in a total of 228 patients during the observation period. It was found that no revision procedure was applied to 73 patients (catheter) during the 24-month period, and a total of 204 revision procedures were applied to 155 patients. The revision procedure consisted of 110 thrombolytic treatments, 64 vein exchanges, 18 tunnel changes, and 12 catheter changes. Primary and secondary patency ratios at 6, 12, 18, and 24 months were calculated as 90.79%, 63.60%, 40.11%, and 32.02% and 96.05%, 89.91%, 72.37%, and 58.33%, respectively. The most common factors that affected primary and secondary patency ratios were determined to be gender (P<0.001 and P=0.056, respectively), body mass index (P<0.001 and P<0.001, respectively) and diabetes mellitus (P=0.018 and P=0.690, respectively). Conclusion: Thrombolytic treatment is an effective and safe method in catheter thrombosis, which is one of the most important factors rendering the cuffed-tunneled hemodialysis catheters dysfunctional. Also, in tunnel infections, tunnel replacement is a salvage procedure in patients with vascular access problems. [ABSTRACT FROM AUTHOR]

Background/Aim: Optic nerve sheath diameter (ONSD) measurement is one of the non-invasive techniques used for intracranial pressure (ICP) measurement. ICP changes have been evaluated based on ONSD measurements during many laparoscopic surgeries. However, such analyses in the obese patient populations are limited. This study aimed at investigating the effects of pneumoperitoneum and reverse Trendelenburg and head-up position on ICP based on ONSD measurements in obese patients undergoing laparoscopic cholecystectomy. Methods: This observational study included 60 female patients who were scheduled for laparoscopic cholecystectomy. Obese patients with a body mass index (BMI) of 30 and above were assigned to Group 1, while BMI < 30 patients were assigned to Group 2. The first ONSD measurement was performed just before insufflation (T1). The second measurement was taken 5 min after insufflation (T2), the third measurement 5 min after placing patients in the reverse Trendelenburg and head-up position (T3), and the last measurement 5 min after the deflation while the reverse Trendelenburg and head-up position was maintained (T4). Results: ONSD measurements at the T2 and T3 time points in Group 1 patients were higher than in Group 2 patients (P = 0.012 versus P = 0.020). Both measurement values were higher in obese patients. In Group 1 patients, T2 and T3 measurements were significantly higher than T1 and T4 measurements (T2 > T1; P < 0.001, T2 > T4; P < 0.001, T3 > T1; P < 0.001, and T3 > T4; P < 0.001). No significant difference between T2 and T3 and between T1 and T4 measurements were found. In Group 2 patients, T2 measurements were significantly higher than the T1, T3, and T4 measurements, while T3 measurements were significantly higher than T1 and T4 measurements (T2 > T1; P < 0.001, T2 > T3; P = 0.022, T2 > T4; P < 0.001, T3 > T1; P < 0.001, and T3 > T4; P = 0.048). No significant difference between T1 and T4 measurements was noted. Conclusion: Laparoscopic cholecystectomy does not cause an increase in ICP of obese patients with limited pneumoperitoneum pressure, reverse Trendelenburg and head-up position, and controlled anesthesia. [ABSTRACT FROM AUTHOR]

Aim: This descriptive study was conducted to determine the awareness of nurses working in intensive care units about the daily patient checklist. Background: Checklists are used in the daily follow‐up and evaluation of patients admitted to the intensive care unit. Method: The research was carried out with 180 nurses through the social media account of the Turkish Intensive Care Specialists Association Nurse Commission between July 2021 and March 2022. Data were collected with a descriptive information form and intensive care unit daily patient checklist. Necessary permissions were obtained before the study. Results: Among nurses, 45.0% of them got 15 full points from the Checklist. Moreover, 81.1% of the nurses stated that they knew that a checklist should be used to help eliminate the deficiencies of daily care and treatment in the intensive care unit, while 66.7% stated that they used a checklist. It was determined that nurses knew the most about parameters 'Check the daily infection parameters', 'Glycaemic control', 'Therapy', and the least about parameters 'Thromboprophylaxis', 'Ulcer prevention', 'Hypo‐hyper delirium' and 'Use a daily checklist'. Conclusion: It was determined that the level of awareness of intensive care unit nurses about some parameters that should be followed daily for patient care was low. Implications for Nursing Management: Checklists can be used as a guide for health care professionals in the routine daily evaluation of intensive care unit patients. It is thought that these reminder abbreviations will provide efficiency in preventing the disruption of applications, reducing medical errors, reducing mortality and morbidity, and cost. [ABSTRACT FROM AUTHOR]

Aim: We aimed to examine the frequency, reasons, correlates and predictors of missed nursing care in Turkey. Methods: This descriptive and cross‐sectional study sample consisted of 1310 nurses working in inpatient units of 10 public, university and private hospitals in Istanbul. Data were collected using the Nursing Teamwork Survey‐Turkish and the MISSCARE Survey‐Turkish between February and June 2019. Descriptive analysis, parametric comparative analysis, correlational analysis and regression analysis were used to analyse the data. Results: The total occurrence of missed nursing care was 2.93 (on a scale of 1.00–4.00), which differed across 21 nursing care elements. The most frequently missed care was turning patients every 2 hours. Multiple regression analysis determined that nurses' tenure in the profession, patient–nurse ratio, days absent in the last 3 months and nursing teamwork significantly affected missed nursing care. Nursing teamwork alone accounted for 23.6% of the variance in missed nursing care. Conclusions: The level of missed nursing care was found to be high, and labour resources issues were the most important reason. Nurse professionals should apply interventions to improve nurses' work environment factors such as patient–nurse ratio and nursing teamwork to reduce the incidence of missed nursing care. Summary statement: What is already known about this topic? Missed nursing care is a globally common patient safety issue that threatens quality nursing care.Although there are many studies from different countries in the international literature on missed nursing care, studies on this subject in Turkey have been limited. What this paper adds? Missed nursing care correlated with age, tenure in hospital, tenure in unit, weekly work hours, satisfied in current position, satisfaction with being a nurse, satisfaction with salary, technological, educational and career opportunities of the hospital, satisfaction with the level of teamwork in the unit, and satisfaction with support of first‐line nurse manager.Nurses' tenure in the profession, patient–nurse ratios, days absent in the last 3 months and nursing teamwork significantly affected missed nursing care. The implications of this paper: Strategies to improve nurses' work environment characteristics, especially teamwork, should be organized to prevent or reduce missed nursing care.Hospital administrators and nurse managers should address levels of missed nursing care through balancing patient–nurse ratios, providing adequate human and material resources, increasing technological, educational, and career opportunities of hospitals, meeting nurses' needs and providing support and performing activities to reduce absenteeism. [ABSTRACT FROM AUTHOR]

Aims: This study aims to investigate the effects of semi‐elevated right lateral and semi‐elevated supine positions on feeding tolerance, stress severity and pain levels among premature infants during tube feeding. Methods: This was a randomized cross‐over clinical trial. A total of 34 premature infants who were fed via orogastric tube were included in this study. Feeding tolerance was assessed by abdominal circumference measurements and checking gastric residuals; this assessment was single blinded. Physiological values were evaluated before, during and after tube feeding. The stress severity and pain levels of the infants were also evaluated independently by the researchers before, during and after tube feeding. A significance level of.05 was accepted for all statistical analyses. Results: There were no difference between infants' vital signs, stress and pain scores according to feeding positions before tube feeding (p >.05). By feeding positions, a statistically significant difference was found between infants' vital signs, abdominal circumference and gastric residuals of infants during tube feeding. Pain and stress levels of infants were found to be significantly higher in the semi‐elevated supine position during tube feeding (p <.05). Conclusions: Use of the semi‐elevated right lateral position during tube feeding was found to have a more helpful effect in reducing stress and pain among premature infants when compared with the use of the semi‐elevated supine position. SUMMARY STATEMENT: What is already known about this topic? Tube feeding, one of the ways of giving the nutrients that premature infants need, is a stressful and painful nursing intervention.One of the complications with tube feeding of premature infants is feeding intolerance, which is an important and serious problem. What this paper adds? The result of this randomized cross‐over clinical trial provides evidence that semi‐elevated right lateral position is effective in reducing pain and stress levels of premature infants during tube feeding.Semi‐elevated right lateral position during tube feeding is effective to increase the feeding tolerance of premature infants. The implications of this paper: This study contributes to the literature on positioning methods to manage stress and pain associated with tube feeding and increase feeding tolerance in premature infants.Nurses should be aware that tube feeding is a stressful practice for infants and should take interventions to reduce stress. During tube feeding, semi‐elevated right lateral position is an effective nursing intervention to reduce stress and pain and increase feeding tolerance. [ABSTRACT FROM AUTHOR]

Objective Down syndrome is a chromosomal abnormality in which muscle tone, motor development, and sensory systems are affected. The objectives of this study were to examine the changes in movements and postures of 3- to 5-month-old infants with Down syndrome and infants who were neurotypical controls during exposure to a rough-textured surface and to compare the differences occurring before and during an exteroceptive condition that was different between the 2 groups. Methods In this quasi-experimental study, participants were 20 infants with Down syndrome (8 female infants; age range = 10–18 weeks, mean [SD] = 12 weeks 2 days [2 weeks 2 days]) and 20 age-matched infants with typical development (8 female infants; age range = 9–17 weeks, mean (SD) = 12 weeks 6 days [1 week 5 days]). The movements and postures of the infants, including fidgety movements, were assessed according to the General Movements Assessment, which determines the Motor Optimality Score (MOS), on 2 surfaces. Results The MOS outcomes of the infants with Down syndrome (median = 21.5, range = 6–28) were significantly lower than those of the infants who were neurotypical (median = 28, range = 23–28) on a standard mattress. The postures were found to be significantly better in infants with Down syndrome during exposure to a rough-textured surface. The MOS did not change due to the different exteroceptive experiences in infants with Down syndrome and infants who were neurotypical. Conclusion The different exteroceptive experiences caused only postural alterations, which might play a crucial role in early intervention programs for infants with Down syndrome. Impact This is the first study, to our knowledge, on the effects of different exteroceptive conditions, such as a coco coir mattress covered with muslin fabric, on the early motor repertoire in infants with Down syndrome. The findings showed that infants with Down syndrome had heterogeneity in their fidgety movements and large variability of the MOS, and the MOS results from infants with Down syndrome were lower than those of infants who were neurotypical. Fidgety movements and the MOS did not change due to the different exteroceptive experiences in either group. Significant improvements in posture were observed during exposure to a rough-textured surface. The improvement of posture is essential; clinicians might consider the positive effect of putting an infant with Down syndrome on a rough-textured surface and include this strategy in early intervention programs. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to determine mother's baby care traditional practices and their practices reasons in a town of western Turkey. Methodology: This descriptive study was completed with 176 mothers with 0-2 year old babies living in a town in western of Turkey. Ethical permissions were obtained. The data were collected face-to-face by the researcher in two Family Health Centers between December 2018 and February 2020 with a questionnaire. Data were analyzed using SPSS software, version 25.0 for Windows. Data are given as number and percent. Results: It was determined that 16.5% of the mothers waited three or five azan to breastfeed their baby; 61.4% salted their baby; 84.7% of them made their baby sleep by shaking; 9.7% of them used a holluk; 36.9% of them did not cut their baby's nails until their forties; 55.1% of them swaddled their babies and applied to many traditional practices to protect them from flushing. Additionally, reasons for mothers to use traditional practices; 65.3% of mothers see and adopt traditional practices from their elders; 61.9% of them want their babies to be healthy; 58% of them applied because it was a part of their culture and 57.4% because it was easier to reach health institutions. Conclusion: It was determined that some traditional practices that mothers follow, do not give any harm to babies. Some practices may cause serious health problems for the babies in the short term or long term. [ABSTRACT FROM AUTHOR]

Background: Ventilator-associated pneumonia (VAP) is common in intensive care units. One of the important practices for preventing VAP is the 30°--45° elevation head of bed (HOB) angle. Aim: Determining whether or not intensive care nurses can determine the HOB required to prevent VAP formed the primary study objective. Methods: The study was conducted with 36 intensive care nurses in an Education and Research Hospital. The data collection form developed by the researchers was used to collect demographic information in addition to the accuracy of the nurses' knowledge, practices, and estimations concerning the HOB angle required for VAP prevention. The HOB elevation estimates and accuracy of the nurses were measured by the researcher using an inclinometer. Results: When asked about the recommended HOB angle to prevent VAP, 55.6% of the nurses responded with 45°, 22.2% responded with 30°--45°, and 11.1% responded with 30°. While 91.7% of the nurses used the estimation method when setting the HOB angle, only 48.5% stated that they were confident of their estimate and often set the intended HOB angle incorrectly. There were no significant relationships between the nurses' length of nursing experience or intensive care experience and nurses' accuracy when estimating the HOB angle. Conclusions: The number of nurses who used the estimation method to determine the HOB angle was high, but the angle estimates were often incorrect. The importance of using an external angle indicator when setting the recommended HOB angle to avoid VAP should be emphasized in training programs. [ABSTRACT FROM AUTHOR]

Background. Neonates are exposed to many stimuli in the Neonatal Intensive Care Unit (NICU). Pharmacological agents and Nonpharmacological Interventions (NPI) are used to reduce or prevent such stimuli. This study was conducted to determine which NPI's NICU nurses use and the impact of these interventions. Methods. The research was of qualitative descriptive design. Sixty-eight nurses work in in three neonatal intensive units of two state hospitals in Istanbul participated and constituted the study sample. The data were collected with two questionnaires, which were analyzed using numbers, percentages and the chi-squared test. Results. It was found that 98.5% of the neonatal nurses had performed one or more NPI. The nurses more commonly performed the interventions of positioning (86.8%), reducing environmental stimuli (79.4%), picking up the neonate (75%), initiating non-nutritive sucking (73.5%), offering breast milk (73.5%) and massaging (58.8%), but performed the inventions of feeding sucrose (48.5%), kangaroo care (42.6%) and exposing the neonate to music (13.2%) to a lesser degree. It was concluded that these interventions reduced the neonate's crying and pain and regulated oxygen saturation. Conclusions. It was observed that the NICU nurses performed NPI's frequently and that such interventions had a positive impact on the health of the neonate. [ABSTRACT FROM AUTHOR]

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Aims and objectives: To determine the effect of position change that is applied after percutaneous coronary intervention on vital signs, back pain and vascular complications. Background: In order to minimise the postprocedural complications, patients are restricted to prolonged bed rest that is always accompanied by back pain and haemodynamic instability. Design: Randomised‐controlled quasi‐experimental study. Methods: The study sample chosen for this study included 200 patients who visited a hospital in Turkey between July 2014–November 2014. Patients were divided into two groups by randomisation. Patients in the control group (CG, n = 100) were put in a supine position, in which the head of the bed (HOB) was elevated to 15°, the patient's leg on the side of the intervention was kept straight and immobile; positional change was applied to patients in the experimental group (EG, n = 100). Results: After the procedure in the EG, the systolic blood pressure (T4–T6), the rate of postprocedural vascular complications (1%) and the back pain scores were significantly lower (between T5–T6) than the CG, also, the back pain was the lowest level in the standard fowler's position in the 6th hr wherein the HOB was elevated by 45–60°. Conclusions: It was found that systolic blood pressure and back pain were at the lowest levels in the standard fowler's position in the 6th hr after the procedure when the HOB was elevated 45–60° and the result was clinically significant and the position change decreased back pain without causing any vascular complications. Relevance to clinical practice: Low fowler's position was applied in which HOB was elevated 15–30° and standard fowler's position was applied in which the HOB was elevated 45–60° could be safe and applicable in patients by nurses after the procedure. [ABSTRACT FROM AUTHOR]

Pain is a stressor for intensive care unit (ICU) patients, and inadequate pain assessment has been linked to increased morbidity and mortality. One hundred and twenty patients were evaluated during three periods: (T1) 1 min before, (T2) during, and (T3) 20 min after the nociceptive procedure. For each patient, data were obtained through at least two nociceptive procedures. Conscious patients' self‐reports of pain were assessed using the Numerical Rating Scale and Visual Analog Scale. For unconscious patients, the Behavioral Pain Scale was used instead. Descriptive statistical methods, Friedman's test, and Spearman's rank correlation coefficient were used for the data analysis. Significant changes were observed in heart rate (HR), respiratory rate (RR), and peripheral oxygen saturation (SpO2) during nociceptive procedures. The HR, RR, and pain scores increased, while the SpO2 decreased. Positive correlation coefficients were observed between the pain intensity and HR and RR levels. According to our study findings, vital signs are not strong indicators for pain assessment in neurosurgery ICU patients. However, HR and RR can be used as cues when behavioral indicators are not valid in these unconscious patients. [ABSTRACT FROM AUTHOR]

Aims and objectives: To explore the effect of immobility on sacral tissue oxygen saturation in patients lying on a supporting surface in supine position. Background: Guidelines in regard to preventing pressure ulcers recommend that patients lying on a standard bed should change their positions every 2 hr and that patients on a supporting surface should change their positions every 4 hr. But there is no strong evidence that justifies this practice. Design: Quasi‐experimental. Methods: Data for the research were collected over the period October 2014–March 2015 at Anesthesiology and Reanimation and Neurosurgery Clinic Intensive Care Units. A total of 46 patients matching the research criteria were left in the supine position for 4 hr without having a position change, during which time sacral tissue oxygen saturation was measured every hour on the hour. Sacral tissue oxygen saturation was measured with the InSpectra Tissue Oxygenation Monitor. Results: Mean sacral tissue oxygen saturation was 73.4% at baseline and was then measured as 74.9% at the first hour, 72.3% at the second hour, 71.9% at the third hour and 71.9% at the fourth hour. The changes observed between measuring times were not found to be statistically significant (p = .09). Conclusions: No statistically significant differences were found between sacral tissue oxygen saturation values recorded over a period of 4 hr in immobile patients lying on a supporting surface in the supine position. However, it was observed that sacral tissue oxygen saturation values did not change significantly depending upon the type of supporting surface that was being used. Relevance to clinical practice: The study outcome supports changing the position of a patient lying on a supporting surface every 4 hr and provides evidence that justifies the recommendation made in the guidelines. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study is to determine the frequency of stroke patients' caregivers to utilize the supportive web site after their patients are discharged. Method: This descriptive study was conducted between December 2014 and 2015. Being prepared for caregivers of stroke patients, the web site was introduced at the hospital by delivering brochures. The web site is used without password and accessible for everybody The caregivers were called three times after the discharge. While the content of the web site was evaluated by the caregivers, the utilization period was assessed over its administrator panel. Results: It was found that 74% (n=147) of the caregivers examined only the web site and 42% (n=62) of these caregivers completed the questionnaires. 52% (n=32) utilized Internet considerably, the average daily computer use time was 109±14 minutes, and the rate of using the web site weekly was averagely 60±78 minutes. 76% (n=47) of the caregivers reported that they used the web site "always and usually." Those using the videos on the web site responded as "I utilized them very much" with the rate of 71% (n=44). According to panel results of the web site, the most viewed videos were the positions used for preventing bedsores, pressure points, and arm and leg exercises. Totally 3235 users accessed to the web site. Conclusion: This result indicated that the web site achieved its purpose. Many people along with the caregivers of the stroke patients utilized the web site. [ABSTRACT FROM AUTHOR]

Abstract: Purpose: The aim of this randomized controlled study was to determine the effect of semielevated side‐lying (ESL) and semielevated supine (ESU) positions, which are used to bottle‐feed preterm infants, on their physiological characteristics and feeding performance. Design and Methods: The sample consisted of preterm infants who were born in the 31st gestational week and below, and met the inclusion criteria. A randomization was provided in the sample group with a total of 80 infants including 38 infants in the ESL (experimental) group and 42 infants in the ESU (control) group. Both groups were compared in terms of their SpO2 values, heart rates, and feeding performances before, during, and after the feeding. The data were obtained by using a form for infant descriptive characteristics, feeding follow‐up form, a Masimo Radical‐7 pulse oximeter device, and a video camera. Results: It was determined that the infants in the ESL group had statistically significantly higher SpO2 values (ESL: 96.77 ± 2.51; ESU: 93.48 ± 5.63) and lower heart rates (ESL: 155.87 ± 11.18; ESU: 164.35 ± 6.00) during the feeding compared to the infants in the ESU group (p < .05). Besides, oxygen saturation levels of the infants in the ESU group decreased more (p < .01) and their heart rates increased more (p < .05) during the feeding than those obtained before the feeding compared to the infants in the ESL group. Practice Implications: The ESL position has a more positive effect on oxygen saturation and heart rate of infants and it is more effective in providing a physiological stabilization during the feeding, compared to the ESU position. According to these results, the ESL position can be recommended for preterm feeding. [ABSTRACT FROM AUTHOR]

Background: Increased central venous pressure secondary to an increase in intraabdominal pressure has been reported during laparoscopic surgery. However, no study has yet determined the effect of pneumoperitoneum on cross-sectional area (CSA) of central veins by ultrasonography during laparoscopic cholecystectomy. Herein, we aimed to quantify changes in CSAs of internal jugular (IJV) and subclavian veins (SCV) by ultrasonography during this surgery. Methods: This study included 60 ASA HI patients scheduled for laparoscopic cholecystectomy surgery under general anesthesia. Pneumoperitoneum was performed with CO2 at 12 mmHg. The CSAs of right IJV and right SCV were measured using a 6 Mhz ultrasonography transducer in supine and neutral positions before anesthesia induction (T1), 5 min after connecting to mechanical ventilator (T2), 5 min after creation of pneumoperitoneum (T3), at the end of pneumoperitoneum (T4), and 5 min after desufflation and before extubation (T5) both at end-expiration and end-inspiration. Results: The comparison of IJV CSA at inspiration showed significant increase in T3 value compared to T2 value (p < 0.001). Similarly the expiratory measurements of IJV CSA demonstrated significant increase in T3 value compared to T2 value (p< 0.001). The comparison of inspiratory CSA measurements of SCV showed significantly increased in T3 (p = 0.009) than T2 value. In expiratory measurements there was a significant increase in T3 (p = 0.032) value compared to T2. All measurements of IJV and SCV SCAs both end-inspiration and end-expiration T5 values significantly decreased compared to T4 values (p< 0.001). Conclusions: Pneumoperitoneum with an intraabdominal pressure of 12 mmHg produces significant increases in IJV and SCV CSAs during laparoscopic cholecystectomy procedure. We believe that this finding may enhance our understanding of pneumoperitoneum-induced hemodynamic changes and facilitate catheterization attempts. [ABSTRACT FROM AUTHOR]

Aims and objectives The research was conducted to evaluate oxygen saturation values measured in healthy individuals in different body positions. Background Changes in position affect ventilation-perfusion rates, oxygen transport and lung volume in normal lungs. There have been few studies and not enough information about which positioning of a healthy individual can increase oxygenation. Design A descriptive study. Methods A sample of 103 healthy individuals with no chronic disease, anaemia or pain was included in the research. Individuals were positioned in five different positions: sitting upright, supine position, prone position, lying on the left side and lying on the right side. Oxygen saturation and pulse rates were then measured and recorded after the individuals held each position for ten minutes. Results It was found that the average oxygen saturation value when measured while sitting in an upright position in a chair was significantly higher than that measured when the individual was lying on the right or left side of the body. Oxygen saturation values measured in the five different body positions were significantly higher in women, in individuals below the age of 35, in those with Body Mass Indexes of below 25 kg/m2, and in nonsmokers. Conclusion All of the oxygen saturation values measured in the five different body positions were in the normal range. Although oxygen saturation values were within the normal range in the five different body positions, post hoc analysis showed that the best oxygenation was in the 'sitting upright' position while the lowest oxygenation was in the supine position. Relevance to clinical practice Based on the results of this research, it can be concluded that the differences among oxygen saturation values according to the different body positions were statistically significant. [ABSTRACT FROM AUTHOR]

Background: This study was conducted to evaluate the pain perceptions of newborns during the hepatitis B (HBV) vaccinations performed in the facilitated tucking position and the classical holding position, respectively. Methods: The randomized controlled experimental study was conducted between 1 September 2014 and 30 December 2014 at the neonatal intensive care unit of a Turkish university hospital. One group of infants was held in the facilitated tucking position (the treatment group; n = 30) during HBV vaccination; infants in the other group were held in the classical holding position (the control group; n = 30) during HBV vaccination. The Neonatal Infant Pain Scale (NIPS) scores of the infants in the treatment and control groups were compared during procedure. Also, the infants' physiological parameters were compared before, during, and after the procedure. Descriptive statistics, a chi-square test, and an independent samples t-test were used to assess the data. Results: The mean pain scores of infants vaccinated in the facilitated tucking position (2.83 ±1.18) were significantly statistically lower than the scores of infants vaccinated in the classical holding position (6.47 ± 1.07) (p < 0.05). Conclusions: The pain perceptions of newborns held in the facilitated tucking position during HBV vaccination were lower. The facilitated tucking position, a non-pharmacological method, is recommended as an effective and useful method for reducing pain during the procedure. [ABSTRACT FROM AUTHOR]

Objectives: This study aims to investigate a possible relationship between long standing eye drop usage and neck pain and to determine the optimal neck position while instilling the eye drop. Patients and methods: Sixty-seven patients who admitted to the ophthalmology outpatient clinic with the diagnosis of glaucoma and using eye drops for at least one year were included in the study as group 1 (n=31). The ages of the patients were between 18 to 80 years. A control group (group 2, n=36) was selected from age-matched individuals who did not use eye drops. The neck disability index form and a study form which included demographic data and the method of eye drop usage of patients were filled. Results: The mean age of the patients were 55.7±11.5 and 53.5±17.1 years for group 1 and group 2, respectively. There was no significant difference in the age and sex between the groups (p=0.526 and p=0.396, respectively). Compared to the controls, the chronic eye drop usage and its application method produced significant difference in neck disability index (p<0.001). Also, there was a positive correlation between neck disability index and number of eye drop usage per a day and period of eye drop usage (p=0.003 and p=0.004, respectively). Conclusion: Neck posture which is not placed in hyperextension position during administration of eye drop may reduce postural neck malposition- related neck disability. Patients who are on eye drop for a long time should be informed about postural disorders and instructed to correct the administration of eye drop technique to avoid neck pain. [ABSTRACT FROM AUTHOR]

Aim and objective. To assess the effect of individualised developmental care practices on the growth and hospitalisation duration of premature infants. Background. It is known that individualised developmental care practices enable premature infants to have enhanced weight gain, decreased intensive care complications, and earlier discharge from the hospital. Design. The study used an experimental design. Methods. The study was carried out with premature infants who received treatment and care in the newborn intensive care unit (n = 97). Infants were randomised into three groups: mother's scent, flexion and control. Infants were monitored each day until discharge and the measurements were recorded. The data obtained were analysed by t-test, percentage distributions, means, chi-square test, analysis of variance and Bonferroni test. Results. There was a significant difference between experimental and control groups in terms of means of their discharge weight and height, and this difference was associated with the mother-scent group (p < 0.05). While the within-group difference between hospitalisation and discharge weight means was significant only in the mother-scent group (p < 0.05), the within-group difference between hospitalisation and discharge height means was significant in all three groups (p < 0.05). Even though the within-group difference between means of hospitalisation duration of premature infants was insignificant (p > 0.05), means in the experimental groups were determined to be lower than the means in the control group. Conclusion. As the methods of mother's smell and flexion position interventions support premature infants' growth and shorten their hospitalisation duration, it is important to use them routinely at newborn intensive care unit. Relevance to clinical practice. Newborn intensive care unit nurses may nurse premature infants in the flexion position to enable them to sense their mother's scent and this may to accelerate their growth and shorten their hospitalisation duration. [ABSTRACT FROM AUTHOR]

Elemental mercury exposure occurs frequently and is potentially a toxic, particularly in children. Children are often attracted to elemental mercury because of its color, density, and tendency to form beads. Clinical manifestations of elemental mercury intoxication vary depending on its form, concentration, route of ingestion, and the duration of exposure. We present data on 179 pediatric cases of elemental mercury poisoning from exposure to mercury in schools in two different provinces of Turkey. Of all patients, 160 children had both touched/played with the mercury and inhaled its vapors, while 26 children had only inhaled the mercury vapor, two children reported having tasted the mercury. The median duration of exposure was 5 min (min 1-max 100), and 11 (6 %) children were exposed to the mercury for more than 24 h at home. More than half of the children (51.9 %) were asymptomatic at admission. Headache was the most common presenting complaint. The results of physical and neurological examinations were normal in 80 (44.6 %) children. Mid-dilated/dilated pupils were the most common neurological abnormality, and this sign was present in 90 (50.2 %) children. Mercury levels were measured in 24-h urine samples daily, and it was shown that the median urinary level of mercury was 29.80 μg/L (min, 2.40 μg/L; max, 4,687 μg/L). A positive correlation was also found between the duration of exposure and urinary mercury levels ( r = 0.23, p = 0.001). All patients were followed up for 6 months. On the first follow-up visit performed 1 month after discharge, the neurological examinations of all patients were normal except for those patients with peripheral neuropathy and visual field defects. On the last follow-up visit at the sixth month, only two children still experienced visual field defects. In conclusion, this study is one of the largest case series of mercury intoxication of students in schools. Elemental mercury exposure can be potentially toxic, and its symptomatology is variable, particularly in children. Therefore, school staff and children should be aware of the risk of mercury toxicity. Pediatricians also need to warn parents and children about the hazards of playing with any chemical. [ABSTRACT FROM AUTHOR]

Aim and objectives. The aim of this study was to investigate the effects of head and neck positions on the cerebral blood flow velocity by transcranial Doppler ultrasound in patients who underwent cranial surgery. Background. Inappropriate head elevation and body positioning in patients who undergo cranial surgery may affect cerebral blood flow and cerebral perfusion pressure. Designed. Experimental clinical study. Method. Our sample consisted of 38 patients who underwent cranial surgery between October 2009 and May 2010. The measurments of mean cerebral blood flow velocity were taken by the transcranial Doppler ultrasound through the temporal window. The mean cerebral blood flow velocity of the patients was measured in supine position with 0° and 30° head elevations, right and left lateral positions, right and left lateral positions with head flexion and extension. The measurements were taken before surgery and within 72 hours after surgery. Results. The mean cerebral blood flow velocity of the middle cerebral arteries was increased in head elevations from 0° to 30°, in right and lateral positions with 30° head elevations, but the velocity was decreased in head flexion and extension positions in preoperative and postoperative periods. Discussion. Head and body positioning, which is one of the nursing care activities, may affect intracranial pressure and cerebral perfusion pressure. Our results are similar with those of previous studies, which showed that head elevation did not affect the cerebral blood flow velocity. Relevance to clinical practice. By the results of this study, the head elevation of the patients, who underwent cranial surgery, should be 30° during the nursing care to provide optimum cerebral blood flow. Right and left lateral positioning is safe and recommended for these patients if there is no medical contraindication. [ABSTRACT FROM AUTHOR]

Background: It was the aim of this study to analyze the clinical manifestations, the incidence of each variant and the comorbid conditions of benign paroxysmal positional vertigo (BPPV) as well as the response to treatment. Methods: One hundred and fifty-seven patients with BPPV were reviewed prospectively. An extensive neurotologic examination was performed. All patients were treated with an appropriate canalith repositioning maneuver (CRM). Results: In 138 patients, the posterior canal (PC) was involved, in 14 patients, the horizontal canal (HC), in 2 patients, the anterior canal (AC), and in 3 patients, both the PC and HC. A history of head trauma was identified in 17 patients. In 1 patient sensorineural hearing loss on the affected side and in another bilateral peripheral vestibular loss was present. A history of migraine was reported in 21 cases. A resolution attributable to the first CRM was achieved in 132 patients. Conclusions: PC involvement was the most frequent type constituting 87.9% of all BPPV cases. HC, AC and mixed canal types were relatively rare constituting 8.9, 1.3 and 1.9% of the cases, respectively. Response to the first CRM was recorded in 84.1%. Association with migraine was recorded in 13.4% of the patients. Copyright © 2008 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to evaluate the effects of infant positioning on pain, heart rate, oxygen saturation and crying time during examination., Design & Methods: The randomized controlled experimental study was carried out on 70 preterm infants. ROP position + pacifier was used in the experimental group (n = 35) while only the pacifier was used in the control group. Heart rates, oxygen saturation, crying duration and pain score (Premature Infant Pain Profile-PIPP) were evaluated before, during and after the screening., Results: The preterm infants in the experimental group recorded lower pain scores at the beginning of the screening (p = 0.01), at the end of the screening (p = 0.01) and after screening (p = 0.01) than those in the control group. The heart rate was higher in the control group during screening (p = 0.010) and after screening (p = 0.008) than in the preterm infants in the experimental group. Oxygen saturation was not significantly different between the groups before, during or after screening. Crying duration was lower in the experimental group than in the control group (p = 0.010)., Conclusions: Positioning of the infant to support behavioral organization was found to be effective in reducing pain and shortening crying time during eye examination, and had favorable effects on physiological variables with ROP position during eye examinations., Practice Implications: ROP position is a practical and effective non-pharmacological method during eye examinations by neonatal nurses., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Background: Body position affects the gastric emptying rate and hence the amount of gastric residue., Objective: This study aims to analyze the effect of the post-feeding position of preterm infants on gastric residue., Materials and Methods: This experimental study was conducted in the neonatal intensive care unit (NICU) of a university hospital (İnönü University Turgut Özal Medical Center) in Eastern Turkey. The study included 40 preterm infants weighing less than 2,000 g, who were fed orogastrically. The preterm infants were sequentially placed in four positions and were fed before each change of position. The infants were sequentially placed in the right lateral, left lateral, supine, and prone positions; their gastric residues were measured with a nasogastric tube. The gastric residue was recorded in percentages at 30, 60, 120, and 180 minutes. Ethical principles were applied in all phases of the study., Results: The lowest mean gastric residue level was observed in the right lateral position at 30 minutes (58.16 ± 12.71%) and 60 minutes (33.97 ± 15.00%). The prone position showed the lowest mean gastric residue level (1.74 ± 1.08%), followed by the right lateral (3.06 ± 1.97%), supine (3.53 ± 2.18%), and left lateral position (5.14 ± 1.85%) at 120 minutes. The final measurements were taken at 180 minutes with the right lateral position showing the lowest mean gastric residue level (0.38 ± 0.34%)., Conclusion: The premature infants had similar lower levels of gastric residue in the right lateral and prone positions and higher levels of gastric residue in left lateral and supine positions. The gastric emptying rate was found to be highest in the right lateral position at 30, 60, and 180 minutes and in the prone position at 120 minutes.

Introduction: Upper pole access in percutaneous nephrolithotomy (PCNL) provides a straight tract to the ureter, resulting in easier placement of a guidewire to the ureter, good exposure of the pelvis, calices, and upper ureter, and comfortable manipulations. However, despite these benefits, upper pole access is usually avoided because of the risk of chest complications in both pediatric and adult patients., Objective: We aimed to evaluate the safety and morbidity of single upper pole access in pediatric patients undergoing PCNL., Study Design: We retrospectively reviewed patients aged ≤17 years with renal stones who underwent PCNL with a single access between August 2004 and February 2016. The patients were separated into two groups: the single upper pole access group (SUPAG) and the single other pole access group (SOPAG). We compared the SUPAG and SOPAG in terms of the demographic features of the patients, stone burden and location, operative data, and postoperative outcomes. Complications were classified according to the modified Clavien system., Results: During the study period, 101 PCNL procedures were performed, 77 of which were managed with only one access. The median age of the 77 patients managed with a single access was 12 years (range 3-17 years). The number of cases in the SUPAG and SOPAG was 10 and 67, respectively. There were no statistically significant differences between the SUPAG and SOPAG in terms of age, sex, stone location, hydronephrosis status, stone area, side of kidney, and previous stone treatment or renal surgery. Furthermoret, there were no significant differences between the groups in terms of the operative parameters. Although the difference was insignificant, the median operation times in the SUPAG and SOPAG were 37 and 45 min, respectively. There was no chest complication or bleeding that required transfusion in the SUPAG. Two cases required transfusion, and one case was managed with a double pigtail catheter (double-J) placement because of prolonged extravasation in the SOPAG. The stone-free ratios were 100% and 82.1% in the SUPAG and SOPAG, respectively., Conclusion: Upper pole access provides similar outcomes to other (middle and lower) pole accesses, and may be performed without serious complications. These results indicate that this is a safe and effective approach of PCNL, and it presents a good alternative for removal of renal stones in pediatric patients., (Copyright © 2018 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.)