Search

Copyright of West Indian Medical Journal is the property of West Indian Medical Journal (WIMJ) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective: The aim of this study was to investigate the effect of using a stress ball during sharp debridement on the pain and anxiety in patients with diabetic foot ulcers., Methods: This study with a randomized, controlled and single-blind design was conducted at a single-center on patients diagnosed with diabetic foot ulcers who were being treated at the endocrinology and metabolic diseases clinic of a university hospital. Patients in the intervention group started using a stress ball before the debridement procedure and continued to use it until the procedure ended. No intervention was made to the patients in the control group. Data were collected by using the Descriptive Information Form, Diabetic Foot Meggit-Wagner Classification, Visual Analogue Scale (VAS), and State Anxiety Inventory (STAI)., Results: The study was completed with a total of 76 patients, 38 each in the intervention and control groups. The use of stress balls led to a reduction in anxiety and pain symptoms in the intervention group. The anxiety score of the patients in the intervention group was also found to be statistically significantly lower than those in the control group after the procedure (p = 0.008; η2 = 0,091). The VAS scores of the patients in the intervention group were found to be statistically significantly lower than those in the control group both during (p < 0.001; η2 = 0.348) and after (p < 0.001; η2 = 0.438) the procedure., Conclusions: The use of a stress ball was found to be an effective method of reducing the level of pain and anxiety that occurs during the sharp debridement procedure. Stress ball application is a practical, easy, and cost-effective non-pharmacological method., Clinical Trial Number: The study was recorded in the ClinicalTrials.gov website with the number NCT06316115., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2025 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: Dialysis recovery time (DRT) refers to the period during which fatigue and weakness subside following hemodialysis treatment, allowing patients to resume their daily routines. This study aimed to identify the factors influencing DRT in hemodialysis patients in Turkey and Portugal, where the prevalence of chronic kidney disease is notably high., Methods: A cross-sectional observational study was conducted in a private dialysis center in Turkey and three dialysis centers in Portugal. The study included hemodialysis patients aged 18 years or older who had been undergoing four-hour hemodialysis sessions three times a week for at least six months. Participants had no communication barriers and voluntarily agreed to take part in the study. Data were collected using a semi-structured questionnaire to gather descriptive characteristics and the Hospital Anxiety and Depression Scale. Logistic regression analysis was employed to identify independent variables influencing DRT., Results: A total of 294 patients participated in the study, including 187 from Turkey and 107 from Portugal. In Turkey, increased interdialytic weight gain (P = 0.043) was associated with prolonged recovery time, while the use of high-flux dialyzers (P = 0.026) was linked to shorter recovery times. In Portugal, older age (P = 0.020) was found to extend recovery time., Conclusion: Recovery time after dialysis is influenced by varying factors across different countries. Further research with larger sample sizes is needed to deepen understanding of these factors and their implications., Clinical Trial Number: NCT04667741., Competing Interests: Declarations. Ethics approval and consent to participate: The study was conducted in accordance with the Declaration of Helsinki and was approved by the local ethics committees in Turkey (Kapadokya University Scientific Research and Publication Ethics Committee, permission no: 2020.19, date: July 14, 2020) and Portugal (Escola Superior de Enfermagem do Porto, permission no: 8/2020, date: September 7, 2020). Informed consent was obtained from all subjects and the written permission was obtained from the institutions. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Background: Pain due to puncture during arteriovenous fistula (AVF) cannulation is a very important symptom that affects the quality of life in patients undergoing continuous hemodialysis (HD) therapy. The aim in this study is to examine the effect of breathing exercise applied for long-term on invasive pain experienced during AVF cannulation in HD patients., Methods: This randomized controlled, single-blind design study was conducted in a private dialysis center in Istanbul between November 2021 and April 2022. The patients in the intervention group were given breathing exercises before fistula cannulation during 12 HD sessions. Before the dialysis nurse performed the cannulation procedure, the patient was told by the researcher to perform breathing exercises and the exercise was completed after intervention for the cannulation. No intervention was made for the patients in the control group. Pain was assessed with the Visual Analog Scale (VAS) by a nurse who is not involved in the study. Mann-Whitney U Test, Chi-Square Test, Fisher's Exact Test, Friedman Test for repeated measurements were used in statistical analysis of data., Findings: The study was completed with a total of 112 patients, 59 in the intervention group and 53 in the control group. It was determined that the VAS scores of the patients in the intervention group were statistically significantly lower than the patients in the control group from the first measurement to the twelfth measurement ( p  < 0.001)., Conclusion: It was determined that the breathing exercise applied before the AVF cannulation reduced the invasive pain experienced during cannulation., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Outer membrane proteins (OMPs) play a key role in facilitating the survival of Helicobacter pylori within the gastric tissue by mediating adherence. Among these proteins, Outer inflammatory protein A (OipA) is a critical factor in H. pylori colonization of the host gastric epithelial cell surface. While the role of OipA in H. pylori attachment and its association with clinical outcomes have been established, the structural mechanisms underlying OipA's action in adherence to gastric epithelial cells remain limited. Our study employed experimental and computational approaches to investigate the interaction partners of OipA on the gastric epithelial cell surface. Initially, we conducted a proteomic analysis using a pull-down assay with recombinant OipA and gastric epithelial cell membrane proteins to identify the OipA interactome. This analysis revealed 704 unique proteins that interacted with OipA. We subsequently analyzed 16 of these OipA partners using molecular modeling tools. Among these 16 partners, we highlight three human proteins, namely Hepatocyte growth factor (HGF), Mesenchymal epithelial transition factor receptor (Met), and Adhesion G Protein-Coupled Receptor B1 (AGRB1) that could play a role in H. pylori adherence to the gastric epithelial cell surface with OipA. Collectively, these findings reveal novel host interactions mediated by OipA, suggesting their potential as therapeutic targets for combating H. pylori infection., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Akcelik-Deveci et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Abstract: The limited data on post-operative analgesia management after laparoscopic cholecystectomy in the paediatric population make it difficult for clinicians to manage pain in this group. Administration of a modified thoracoabdominal nerve block through a perichondrial approach (M-TAPA) has recently been identified as a technique providing effective analgesia on the anterior and lateral thoracoabdominal wall. Unlike thoracoabdominal nerve block through the perichondrial approach block, the local anaesthetic (LA) with M-TAPA block provides effective post-operative analgesia in abdominal surgery by affecting T5-T12 dermatomes, just like when applied to the lower part of the perichondrium. As far as we know, all patients in previous case reports were adults, and we did not come across any study on the effectiveness of M-TAPA in paediatric patients. We present our case who did not need any additional analgesic during the post-operative 24 h after an M-TAPA block was administered before paediatric laparoscopic cholecystectomy., (Copyright © 2023 Copyright: © 2023 Journal of Minimal Access Surgery.)

This study aims to investigate the effects of intraoral cold water spray on thirst, frequency of oral care and postoperative period pain at surgical incision site in patients having abdominal surgery. The study was carried out as a randomized controlled trial, registered under Clinical Trial Number: NCT05940818. The study involved 110 participants, divided equally into two groups (n = 55): the experimental group and the control group. Data were collected using patient information form, NRS, Intensive Care Oral Care Frequency Assessment Scale (ICOCFAS) and Visual Analog Scale (VAS). The severity of thirst at 1st, 8th, 16th h of post-operative period (p < 0.01) and the frequency of oral care application at 16th h were statistically significantly decreased in the experimental group when compared to the control group (p < 0.01).There wasn't statistically significant difference between the patients in the experimental and control groups in terms of pain at surgical incision site (p > 0.05). The patient's thirst and need for frequent oral care in the postoperative period were reduced by the application of a cold water spray. In patients undergoing abdominal surgery, the use of cold water spray application may be recommended to reduce thirst and the need for frequency of oral care application., (© 2024. The Author(s).)

Management of vascular access is a challenge for the dialysis team, particularly to keep the arteriovenous access working. The vascular access coordinator can positively contribute to increase the number of arteriovenous fistulas and reduce central venous catheters. In this article, we introduce a new approach to vascular access management centered on (the results of setting up) the role of vascular access coordinator. We described the three-level model (3Level&#95;M) for vascular access management organized in three levels: vascular access nurse manager, vascular access coordinator, and vascular access consultant. We defined the instrumental skills and training required to be developed by each element and clarify the articulation between the model and all members of the dialysis team related to vascular access., (© 2023 Wiley Periodicals LLC.)

Introduction: Pain experienced during the insertion of a catheter into the arteriovenous fistula (AVF) and restless legs syndrome (RLS) are prevalent issues among Hemodialysis (HD) patients. The primary objective of this systematic review and meta-analysis was to consolidate the findings from randomized clinical trial (RCT) studies examining the impact of aromatherapy with lavender on the pain associated with AVF catheter insertion and RLS in HD patients., Methods: A systematic search was conducted on PubMed, Web of Science, Scopus, Cochrane, Embase, ClinicalTrials.gov, and Google Scholar search engine from inception to August 1, 2022, using keywords extracted from Medical Subject Headings, such as "Aromatherapy", "Lavender", "Arteriovenous fistula", "Pain", "Restless legs syndrome", and "Hemodialysis"., Results: Finally, eleven articles were included in this systematic review and meta-analysis. The results showed that aromatherapy reduced the average pain of catheter insertion in AVF compared to the control group (Standard Mean Difference: -1.60, 95% Confidence Interval: -2.32 to -0.87, Z=4.32, I 2 :90.3%, P<0.001). Also, aromatherapy massage reduced the average severity of RLS compared to the control group, which was statistically significant (Weighted Mean Difference: -13.21, 95% Confidence Interval: -17.50 to -8.91, Z=6.03, I 2 :93.0%, P<0.001). Also, the subgroup analysis showed that lavender in the intervention group significantly decreased the pain intensity compared to the "no intervention" group (P<0.001), yet it was not significant compared to the placebo group (P=0.12)., Conclusion: In summary, the findings indicate a notable reduction in catheter insertion pain in AVF and relief from RLS among HD patients through the use of lavender essential oil. As a result, future research is encouraged to include a comparison of lavender's effects with those of a placebo group., Competing Interests: The authors declare that there is no conflict of interest.

Background: Various microorganisms which increase the mortality rate in the intensive care unit (ICU) cause microbial colonization of the nasogastric tube (NGT) and use the NGT as a reservoir., Aim: To detect the colonization on the NGT and to determine the effect that training regarding hand hygiene, NGT management, and enteral feeding (EF) provided to ICU nurses and auxiliary service staff (ASS) has on the level of NGT colonization., Study Design: A quasi-experimental pre-test and post-test control design was used in this study. Microbial samples were taken from the outer and inner parts of NGT. The microorganisms were categorized as: group 1, no risk; group 2, low risk pathogenic; group 3, high-risk pathogenic group. The training was given to nurses (n = 15) and ASS (n = 7). Hand hygiene, NGT, and EF care training are provided to nurses and ASS by researchers. A total of three training sessions were scheduled to be held in 3 weeks so that all health care staff members were trained. Each session lasted 2 h in total. Patients were assigned to a group if one of the microorganisms presented on the outer surface of the patient's feeding tube and/or on the hub. The hand hygiene compliance was evaluated by direct observation according to the World Health Organization hand hygiene indications., Results: The study was conducted with 46 patients. Evaluating the patients for the presence of microorganisms before education revealed that 4.3% were in group 1, 21.8% were in group 2, and 73.9% were in group 3. After the education, evaluating the samples for the presence of microorganisms revealed that 39.1% were in group 1, 13% were in group 2, and 47.8% were in group 3. A statistically significant difference was found between the number of samples included in the groups after the participants had received training (H = 8.186; p = .017)., Conclusions: An NGT could act as a reservoir of microbial colonization and high-risk microorganisms could be on the tube. Providing training not only to nurses but also to ASS will help reduce the risk of colonization., Relevance to Clinical Practice: Eliminating such colonization with effective hand hygiene during NGT feeding is a cost-effective method. Providing training not only to nurses but also to ASS will help obtain the optimum benefit from patient care., (© 2022 British Association of Critical Care Nurses.)

Background: Neoadjuvant chemotherapy (NAC) is widely used in the treatment of primary breast cancer. Different staging systems have been developed to evaluate the residual tumor after NAC and classify patients into different prognostic groups. Ki67, a proliferation marker, has been shown to be useful in predicting treatment response and prognosis. We aimed to investigate the prognostic importance Neo-Bioscore stage and pretreatment and posttreatment Ki67 levels in breast cancer patients who received NAC and correlations between Neo-Bioscore stage and pretreatment and posttreatment Ki67 levels., Methods: A total of 176 invasive breast carcinoma patients who underwent NAC were included in the study. Ki67 levels were evaluated by immunohistochemical methods in Trucut biopsy and surgical excision specimens. Patients were classified into prognostic groups using the Neo-Bioscore staging system., Results: Patients with high pretreatment Ki67 score were more likely to be in the higher Neo-Bioscore risk group (p < 0.001). Patients with a high posttreatment Ki67 score were more likely to be in the higher Neo-Bioscore prognostic risk group (p < 0.001). Overall survival (OS) and disease-free survival (DFS) were shorter in patients with high posttreatment Ki67 scores and in patients in the higher Neo-Bioscore risk group. We also determined a cutoff 37% for pathological complete response., Conclusion: Neo-Bioscore staging system is found to be important in predicting survival. The posttreatment Ki67 level is more important than pretreatment Ki67 level in predicting survival., (© 2023. Springer Science+Business Media, LLC.)

Helicobacter pylori OipA (Outer Inflammatory Protein A) is an outer membrane protein that takes role in the adherence and colonization to the stomach. oipA gene expression is regulated by the slipped-strand mispairing mechanism through a hypermutable CT dinucleotide repeat motif in the 5΄ region. Alterations in the CT number repeats cause frame-shift mutations to result in phase variation of oipA expression. While a functional "On" status has been recognized as a risk factor for peptic ulcer diseases and gastric cancer in many studies, some controversial findings still exist. To this end, this study compiled the sequence data of oipA from 10 different studies between 2000-2019 and 50 oipA DNA sequences from our own research that examined the relationship between the phase On/Off status of oipA and gastric diseases based on CT repeat number. Overall, we have reached 536 oipA DNA sequences from patients. This large collection of oipA sequences first clarified the absolute conservation of the peptide-pentamer of FWLHA for phase ''On'' status, suggesting this pentamer as a superior marker for the determination of oipA status than counting the number of CT repeats. Combining the sequence and patient data, we have re-analyzed the association between the ''On'' status of oipA and gastric diseases. Our results showed a strong association between oipA ''On'' status and gastric cancer supporting previous findings. We also investigated the AlphaFold2 computed structure of OipA that adopts a beta-barrel fold closely resembling to the autotransporter family of H. pylori. Altogether, this study confirms a strong association between oipA ''On'' statuses and severe gastrointestinal diseases like cancer and provides useful insights into the FWLHA pentamer as an indicator of "On" status of oipA putative autotransporter function rather than CT repeats number., (© 2023. Springer-Verlag GmbH Germany, part of Springer Nature.)

Introduction: Use of a stress ball is a known t non-pharmacological method to distract attention and to relieve stress and anxiety. The goal of our study was to evaluate the effect of stress ball use on anxiety and depression in hemodialysis patients., Methods: The study utilized a single-blind, balanced crossover design. There were two sequential 4-week intervention periods separated by a 4-day washout period. During one intervention period stress ball use at home was encouraged while the other 4-week "intervention" period served as a control. The order in which the two evaluation periods were applied was randomized for a given patient. Anxiety and depression were assessed using the Hospital Anxiety and Depression Scale before and after each 4-week intervention period., Findings: A total of 65 patients participated in this study. There were statistically significant reductions in both anxiety (p < 0.001) and depression (p < 0.001) during the stress ball intervention periods vs. no change during the control interventions. A delayed follow-up evaluation showed that the anxiety level of patients remained reduced after 1 month of no longer using a stress ball., Discussion: The use of a stress ball at home for 4 weeks significantly decreased anxiety and depression levels in our group of hemodialysis patients., (© 2023 International Society for Hemodialysis.)

Background and Objectives: In this study, we aimed to determine the risk of obstructive sleep apnea (OSA) in patients undergoing elective surgery and its relationship with difficult intubation (DI)., Methods: This prospective, descriptive, cross-sectional study was conducted between December 2018 and February 2020 in the anesthesiology and reanimation service of a training and research hospital. The study included patients who were ASA I...II, 18 years of age, and older who underwent elective surgery under general anesthesia. A form regarding the baseline characteristics of the participants as well as STOP-Bang score, Mallampati, and Cormack-Lehane classification was used to collect the data., Results: The study included 307 patients. It was determined that 64.2% of patients had a high risk of OSA. The presence of DI (determined by repeated attempts at intubation) was 28.6% in the high-risk OSA group, while there was no DI in the low-risk OSA group. A statistically significant difference was found between the groups in terms of OSA risk according to the presence of DI according to repeated attempts, Cormack-Lehane classification, and Mallampati classification (p...<...0.001)., Conclusion: Due to the high rate of DI in patients with a high risk of OSA, the security of the airway in these patients is endangered. Early clinical recognition of OSA can help in designing a safer care plan., (Copyright © 2021 Sociedade Brasileira de Anestesiologia. Published by Elsevier España S.L.U. All rights reserved.)

Introduction: Stress urinary incontinence (SUI) constitutes the majority of urinary incontinence (UI) cases that occur due to anatomical and physiological changes during pregnancy and postpartum period. The objcetive of this study was to evaluate the effect of pilates in preventing the occurrence of SUI in the postpartum period., Methods: A retrospective case-control study was conducted in a private hospital. Participants consisted of patients who gave birth vaginally at the hospital and were admitted to the hospital for routine control at the postpartum 12th week. The women did pilates for two days a week from the 12th week of pregnancy until the birth were included in the case group. The women did not do pilates in the control group. Data was collected using the "Michigan Incontinence Symptom Index". To detect the presence of SUI, researchers asked women "Do you have urinary incontinence problems in your daily life?". STROBE research check-list was used for reporting the study., Results: The study was completed with a total of 142 women consisting of 71 women in each group. Of the women, postpartum SUI occurred in 39.4%. The severity score of women who did pilates were found to be statistically significantly lower than those who did not do pilates., Conclusion: During pregnancy, women should be encouraged to do pilates about the prenatal period by health professionals., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

The cannulation technique is important for the survival of the arteriovenous access. Choosing the appropriate technique is a complex decision. Such choice must be customized to patients, considering their characteristics, the type of arteriovenous access and the experience of the hemodialysis team. We describe seven items that can help nurses to identify the appropriate cannulation technique: type of arteriovenous access; drainage vein; hygienic self-care profile; experience of the nursing staff in the cannulation technique and nurse-to-patient ratio; hemodialysis treatment method; patient's condition; and patient's decision. Such items can help nurses in decision-making on the "ideal" cannulation technique for each patient., (© 2023 International Society for Apheresis and Japanese Society for Apheresis.)

Context: Although a number of studies have shown that lavender administered via inhalation can decrease the invasive pain and anxiety experienced by hemodialysis (HD) patients during cannulation, the evaluation has mostly been on the short-term effectiveness of lavender oil. Also, no study has evaluated the effects of lavender on comfort level., Objective: The study aimed to investigate the long-term effectiveness of lavender oil, when administered via an inhaler during HD sessions, on a patient's experience of invasive pain, anxiety, and comfort during access to the fistula., Design: The research team designed a prospective, single-blind, randomized, controlled clinical trial., Setting: The study took place in an HD unit of a public hospital in Kirklareli, Turkey., Participants: Participants were 24 patients receiving HD in the unit between January and March 2021., Intervention: Participants were randomly assigned to the intervention or control group. Pure lavender essence was diluted with sweet almond oil at a ratio of 1:10. Before the cannulation procedure at 12 HD sessions, three drops of a 1:10 mixture were placed on sterile gauze and held at a distance of about 10 cm from the participant's nose to ensure its inhalation before the fistula puncture with the needle. No extra procedure was performed for the control group., Outcome Measures: Participants completed a visual analogue scale (VAS) right after puncture of the fistula during each HD session. The STAI and HD Comfort Scale were scored at baseline prior to the first HD session and postintervention at the twelfth HD session., Results: The VAS (P < .001) and state anxiety scores (P = .027) were significantly lower in the intervention group than in the control group at all time points, except at baseline. The comfort scale in the intervention group was significantly higher than that in the control group (P < .05)., Conclusions: Lavender aromatherapy could be a good option for reducing the pain, anxiety, and discomfort level of HD patients.

Introduction: The primary aim of the study was to use the duration until the first postoperative analgesic requirement after two different block techniques to compare the analgesic effect. The secondary aims were to compare the two methods for postoperative Children's Hospital Eastern Ontario Pain Scale (CHEOPS) scores, complications, and parental satisfaction level., Materials and Methods: This prospective, observational study was conducted with male patients aged 1-7 years in the ASA I-II group, who were scheduled for hypospadias surgery between November 2019 and April 2020. Ultrasound (US)-guided pudendal nerve block (PNB) or US-guided dorsal penile nerve block (DPNB) was administered under general anesthesia before the operation. Postoperative analgesic need, postoperative pain, complications, and parental satisfaction were noted. The STROBE checklist was followed for reporting., Results: The study was conducted with 30 patients in total, divided into 15 patients receiving PNB and 15 patients receiving DPNB. The effective minimum block duration was longer in the pudendal group at 22.22 ± 0.61 h than in the DPNB group at 22.19 ± 0.57 h. Additional analgesic was required in 4 subjects in the pudendal group and 5 in the DPNB group. There was no statistically significant difference in terms of the variables between the two groups (p > 0.05)., Discussion: US-guided DPNB and PNB were shown to provide successful postoperative analgesia and to have similar effectiveness in pediatric patients undergoing hypospadias surgery in this first prospective study of its kind in the literature., Conclusions: US-guided DPNB and PNB have been demonstrated to provide effective, safe, and long-term postoperative analgesia in pediatric patients who have undergone hypospadias surgery. Parental satisfaction in both groups is positively influenced by the minimum postoperative analgesia requirement, the long-term analgesic effect, and the lack of any complications., (© 2022 S. Karger AG, Basel.)

Background: Liver transplantation is a life-saving treatment in end-stage liver failure. Hemorheological features as blood fluidity and red blood cell aggregation may alter effective tissue perfusion, graft function and hemodynamic variables., Objective: The aim of the study is to investigate effect of albumin infusion on red blood cell deformability and aggregation, blood viscosity and hemodynamics in liver transplant patients., Methods: Seventeen live or cadaveric donors were included in this prospective study. Hemorheological and hemodynamic measurements were performed in order to evaluate the effects of albumin infusion in perioperative period., Results: Erythrocyte aggregation was significantly reduced 90 minutes after albumin infusion (p < 0.01). Mean blood viscosity revealed significant decrease at 20 rpm and 50 rpm after 90 minutes of albumin infusion (p < 0.05). Plasma viscosity decreased significantly compared to the value before albumin infusion at 20 rpm (p < 0.05). Albumin replacement improved hemodynamic variables in patients with low blood pressure and cardiac index measurements (p > 0.05)., Conclusions: Human albumin infusion led to decrease in whole blood and plasma viscosities, red blood cell aggregation and induced blood pressure and cardiac index elevation in perioperative liver transplant patients. Determination of hemodynamic and hemorheological effects of human albumin replacement in various patient populations may serve beneficial clinical data.

Aim: This study aimed to investigate the effect of the bevel orientation (facing upwards or downwards towards the skin) of the needle inserted into the arterial limb of the arteriovenous fistula (AVF) on puncture pain and postremoval bleeding time., Methods: This study, using a single-blind crossover design, was conducted on 35 maintenance hemodialysis patients who had been dialyzed for at least 6 months and in whom blood access was via an AVF. AVF cannulation was performed with the needle bevel pointing upward in the first six sessions and the needle bevel pointing downwards (towards the skin) in the subsequent six sessions. Needles were always inserted in the direction of blood flow. At each dialysis session, cannulation pain was measured using a visual analog scale (VAS), and the bleeding time at the end of dialysis after needle removal was recorded., Findings: The VAS score and postremoval bleeding time were lower when the needle bevel pointed downwards towards the skin during insertion (P < 0.05)., Discussion: Insertion of the needle with the bevel pointed downward decreased puncture pain during cannulation and bleeding time postdialysis on needle removal., (© 2022 International Society for Hemodialysis.)

Introduction: Hemodialysis (HD) patients should be trained to develop self-care behaviors in order to prevent and preserve their arteriovenous fistula (AVF). The aim of this study was identifying the factors that affect the levels of self-care behavior with AVF by HD patients., Methods: A cross-sectional study was conducted involving 89 patients., Results: Self-care levels were negatively affected by patients' location (Azores) and positively affected by marital status, education, employment, AVF duration, and absence of complications with the AVF. Concerning the management of signs and symptoms, self-care levels were negatively affected by patients' location. Regarding prevention of complications, self-care levels were negatively affected by age and marital status and positively affected by marital status, employment, chronic kidney disease etiology, AVF duration, and previous AVF., Conclusion: Further studies are required in order to confirm whether the considered factors affect levels of self-care behaviors with AVF, or whether other factors are needed as well., (© 2022 International Society for Apheresis and Japanese Society for Apheresis.)

Introduction: The aim of this study was to translate, linguistically validate, and evaluate the psychometric properties of the Shortened Xerostomia Inventory (SXI) among Turkish patients undergoing hemodialysis (HD)., Methods: The study was conducted with 81 chronic HD patients in the HD units of two state hospitals between June and August 2020. Explanatory factor analysis was implemented to test the construct validity. In addition, the test-retest method was performed to test the reliability and consistency of the scale over time., Results: A total of 81 patients participated in the study. The Cronbach's alpha coefficient of SXI was 0.788. The mean values for the test were 12.84 ± 6.78 and re-test scores was 11.03 ± 6.88. Intraclass correlation coefficient value calculated as 0.992 and accordingly a statistically significant relationship between the test and retest scores (p < 0.001)., Conclusions: Our study showed that the SXI is a valid and reliable measurement tool for Turkish HD patients., (© 2022 International Society for Apheresis and Japanese Society for Apheresis.)

Introduction: HD unit is a noisy environment for patients, and noise can affect anxiety levels and sleep quality., Methods: The aim of the study is to determine noise level, the relationship between noise levels, and sleep quality and anxiety in patients in HD unit. A descriptive and observational study design was used. Three Benetech GM1351 manual sound-level meters were used to measure noise. A patient information form, the State Anxiety Inventory, and the modified Post-Sleep Inventory were used for data collection., Results: The noise range detected in the HD unit ranges from 48.40 to 72 dB(A). Our findings show that patients in the HD unit are exposed to high noise levels and the noise significantly negatively impacts quality of sleep and anxiety level of the patients., Conclusions: It is important to be aware that HD patients are constantly exposed to high levels of noise and to plan nursing interventions to reduce this noise level., (© 2022 International Society for Apheresis and Japanese Society for Apheresis.)