Ethical dilemmas in perinatology: Perinatolojide etik ikilemler

The development of science and technology and in parallel with this, advancements in new applications in health area, confront nurses with ethical problems. It is considerably important that nurses decide based on the ethical problems and ethical principles they face and the effective professional care. Perinatology nursing   are the area, in which the ethical dilemmas are most experienced.  Due  to the fact that  nurses  do not mostly  have   freedom of choice  and the environmental factors,  they are obliged to make a choice  between professional obligation and ethical responsibility  Approach  in obstetric care has to be conducted by considering   the health of  both mother  and baby.  Although the legal regulations, policies, and cooperation with women organizations concerning women enhance quality of care, they influence nursing applications. While the nurses working in the area of perinatology realize the consultancy, educator, and care roles in their every sorts of intervention and decisions in presenting health service, it is highly important for them to behave in the framework of ethical principles. Due to the fact that nurses are the closest health profession members to the patient, have the changing roles and responsibilities in their working areas, and sometimes make decisions and applications on the name of patients, they face to the ethical problems and experience confliction. Therefore, nurses need guidance and support about solution of ethical problems. In this study; ethical dilemmas the nurses working on the perinatology area face and how to be acted in the face of these dilemmas were discussed.  ​Extended English summary is in the end of Full Text PDF (TURKISH) file. Özet Bilim ve teknolojinin gelişmesi, buna paralel olarak sağlık alanında yeni uygulamalarda ilerlemeler hemşireleri etik sorunlarla karşı karşıya bırakmaktadır. Hemşirelerin, karşılaştıkları etik sorunlara etik ilkelere dayanarak karar vermesi ve etkili profesyonel bakım oldukça önemlidir. Perinatoloji hemşireliği etik ikilemlerin en çok yaşandığı alandır. Hemşirelerin çoğu kez seçme hakkının olmaması ve çevresel faktörler nedeniyle kendilerini mesleki yükümlülük ve ahlaki sorumluluk arasında ikilemde bulmalarına neden olmaktadır. Obstetrik bakımda yaklaşım hem annenin hem de bebeğin yararı düşünülerek yapılmalıdır. Kadınları ilgilendiren yasal düzenlemeler, politikalar, kadın kuruluşlarıyla işbirliği yapılması bakım kalitesini artırmakla birlikte hemşirelik uygulamalarını etkilemektedir. Perinatoloji alanında çalışan hemşireler sağlık hizmeti sunmadaki her türlü müdahale ve kararlarında, aynı zamanda danışmanlık, eğitici ve bakım rollerini gerçekleştirirken etik ilkeler çerçevesinde davranış göstermeleri oldukça önemlidir. Hemşireler hastaya en yakın sağlık meslek üyeleri olmaları, çalışma alanlarında değişen rol ve sorumlulukları, kimi zaman hastalar adına karar verme ve uygulamalarda bulunmalarından dolayı etik sorunlarla karşı karşıya kalmakta ve çatışma yaşamaktadır. Bu nedenle etik sorunların çözümü konusunda hemşirelerin rehberliğe ve desteğe gereksinimleri vardır. Bu derlemede perinatoloji alanında çalışan hemşirelerin karşılaştıkları etik ikilemeler ve bu ikilemler karşısında nasıl hareket edilmesi gerektiği amacıyla gerçekleştirilmiştir

Our Experience with Percutaneous and Surgical Tracheotomy in Intubated Critically Ill Patients

Objective:Open surgical tracheotomy (OST) and percutaneous dilatational tracheotomy (PDT) are commonly used for securing airway in intubated critically ill patients. The purpose of this study was to compare the safety of OST and PDT, particularly in intubated critically ill patients.Methods:The medical records of intubated critically ill patients who underwent tracheotomy between August 2006 and July 2017 were analyzed retrospectively. Minor and major complication rates were compared according to the tracheotomy technique. Preoperative intubation time, postoperative decannulation time, reason for hospitalization, and demographic data, including the Acute Physiology and Chronic Health Evaluation (APACHE II) and Sequential Organ Failure Assessment (SOFA) scores, were evaluated.Results:A total of 332 cases were enrolled into the study. The minor and major complication rates for both techniques were 27.2%, 8.8%, 9.7% and 3.2%, respectively. Minor and major complication rates were higher in the OST group (p=0.01, p=0.03, respectively). The rate of every single complication was also compared on groups’ basis. Accidental decannulation (p=0.02) and pneumothorax (p=0.05) were found to be significantly frequent in the OST group. There was no impact of the preoperative intubation time on the minor (p=0.20) and major complication (p=0.29) rates found. There was no statistically significant difference regarding the postoperative decannulation time (p=0.32). Also, there was no statistically significant difference between two groups in terms of the APACHE II (p=0.69) and SOFA (p=0.37) scores. However, a statistically significant difference between the groups in terms of overall survival was found, in favor of PDT (p<0.001).Conclusion:This study revealed that PDT is safer than OST, particularly in intubated critically ill patients

Öğretmen Adaylarının Fen Öğrenimi ile ilgili Beklentilerini Belirleme

The purpose of this study was to examine the expectations of the pre-service science (biology, chemistry, and physics) teachers about learning science on independence, coherence, concept, reality link, math link, and effort dimensions by using Science Expectations Questionnaire (SEQ) and conducting interviews with selected pre-service teachers on their questionnaire responses. The SEQ was applied to 121 pre-service science teachers in a public university. The results show that most of the pre-service science teachers had sophisticated view of learning in terms of independence and reality link dimensions; they had naïve view of learning in terms of other dimensions. Hence, teacher educators could determine pre-service science teachers’ view of learning and encourage them to have more sophisticated view of learning.Bu çalışmanın amacı, Fen Beklenti Anketini (FBA) kullanarak bağımsız, tutarlı, kavramsal, gerçek hayatla ilişkili, matematiğe dayalı, çaba göstererek öğrenme hakkında biyoloji, fizik ve kimya öğretmen adaylarının beklentilerini incelemek ve anket cevaplarına göre seçilen öğretmen adayları ile mülakat yapmaktı. FBA bir devlet üniversitesindeki 121 öğretmen adayına uygulanmıştır. Öğretmen adaylarının çoğunun bağımsız ve gerçek hayatla ilişkili öğrenme boyutlarında gelişmiş öğrenme görüşüne sahip olduğu, diğer boyutlarda ise yetersiz öğrenme görüşüne sahip olduğu sonucuna varılmıştır. Dolayısıyla, öğretmen eğitimcileri öğretmen adaylarının ne tür öğrenme görüşüne sahip olduklarını belirleyerek yetersiz öğrenme görüşüne sahip olanların gelişimine katkıda bulunabilirler

Discovery of very high energy gamma rays from PKS 1424+240 and multiwavelength constraints on its redshift

We report the first detection of very-high-energy (VHE) gamma-ray emission above 140 GeV from PKS 1424+240, a BL Lac object with an unknown redshift. The photon spectrum above 140 GeV measured by VERITAS is well described by a power law with a photon index of 3.8 +- 0.5_stat +- 0.3_syst and a flux normalization at 200 GeV of (5.1 +- 0.9_stat +- 0.5_syst) x 10^{-11} TeV^-1 cm^-2 s^-1, where stat and syst denote the statistical and systematical uncertainty, respectively. The VHE flux is steady over the observation period between MJD 54881 and 55003 (2009 February 19 to June 21). Flux variability is also not observed in contemporaneous high energy observations with the Fermi Large Area Telescope (LAT). Contemporaneous X-ray and optical data were also obtained from the Swift XRT and MDM observatory, respectively. The broadband spectral energy distribution (SED) is well described by a one-zone synchrotron self-Compton (SSC) model favoring a redshift of less than 0.1. Using the photon index measured with Fermi in combination with recent extragalactic background light (EBL) absorption models it can be concluded from the VERITAS data that the redshift of PKS 1424+240 is less than 0.66.Comment: accepted for publication, Ap

Characteristics of food allergy in children: National multicenter study

Conference: Congress of the European-Academy-of-Allergy-and-Clinical-Immunology (EAACI) Location: Lisbon, PORTUGAL Date: JUN 01-05, 2019Background : Food allergies impose a significant burden on the life of the child and the family. In this study, to determine the demographic characteristics of food allergies, we investigated the characteristics of patients with food allergies in different regions of Pediatric Allergy- Immunology departments in Turkey. Method : Turkey ' s National Study of Allergy and Clinical Immunology Society has conducted a Study Group on Food Allergies. 25 centers participated in this multicenter, cross- sectional and descriptive study.European Academy of Allergy and Clinical Immunolog

The Discovery of gamma-Ray Emission From The Blazar RGB J0710+591

The high-frequency-peaked BL Lacertae object RGB J0710+591 was observed in the very high-energy (VHE; E > 100 GeV) wave band by the VERITAS array of atmospheric Cherenkov telescopes. The observations, taken between 2008 December and 2009 March and totaling 22.1 hr, yield the discovery of VHE gamma rays from the source. RGB J0710+591 is detected at a statistical significance of 5.5 standard deviations (5.5{\sigma}) above the background, corresponding to an integral flux of (3.9 +/- 0.8) x 10-12 cm-2 s-1 (3% of the Crab Nebula's flux) above 300 GeV. The observed spectrum can be fit by a power law from 0.31 to 4.6 TeV with a photon spectral index of 2.69 +/- 0.26stat +/- 0.20sys. These data are complemented by contemporaneous multiwavelength data from the Fermi Large Area Telescope, the Swift X-ray Telescope, the Swift Ultra-Violet and Optical Telescope, and the Michigan-Dartmouth-MIT observatory. Modeling the broadband spectral energy distribution (SED) with an equilibrium synchrotron self-Compton model yields a good statistical fit to the data. The addition of an external-Compton component to the model does not improve the fit nor brings the system closer to equipartition. The combined Fermi and VERITAS data constrain the properties of the high-energy emission component of the source over 4 orders of magnitude and give measurements of the rising and falling sections of the SED

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Correction to: Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

The original version of this article unfortunately contained a mistake