Nurses’ Burnout in Oncology Hospital Critical Care Unit

Objective: Burnout is common in intensive care units (ICU) because of high demands and difficult working conditions. The aim of this study was to analyse nurses’ burnout in our oncology ICU and to determine which factors are associated with. Material and Method: The study was carried out in Ankara Oncology Hospital ICU. A self- reporting questionnaire in an envelope was used for the evaluation of burnout (Turkish- language version of Maslach Burnout Inventory) and depression (Beck Depression Scale). Results: From a total of 37 ICU nurses, 35 participated in the study (%94,5 response rate). High levels of emotional exhaustion in 82% and depersonalization in 51,4% of nurses was determined. Personal accomplishment was higher at 80%. Mild to moderate emotional state and mild anxiety was revealed. Years in profession,finding salary insufficient, finding the profession in its proper, choosing the profession of his own accord, work environment satisfaction and finding the social activity adequate were associated with burnout (p≤0.05). Conclusion: In our study, intensive care unit nurses’ burnout scores were found to be higher. Burnout was rare in nurses that choose the profession of his own accord, find the nursing profession in its proper, and social activity adequate and are satisfied with the work environment. Therefore, we believe that attention should be given to individual needs and preferences in the selection of ICU staff

Anesthesia for a Patient with Myotonic Dystrophy

Myotonic dystrophy is the most common myotonic syndrome causing abnormalities of the skeletal and smooth muscles as well as problems related to the cardiac, gastrointestinal and endocrine systems. In affected people, reduced functional residual capacity, vital capacity, and peak inspiratory pressure are observed within the respiratory system. As would be expected, anesthetic management of these patients is challenging for anesthesiologists. In addition, delayed recovery from anesthesia and cardiac and pulmonary complications may develop in the intraoperative and early postoperative periods due to sensitivity to sedatives, anesthetic agents, and neuromuscular blocking agents. Myotonic dystrophy can be performed with the use of appropriate anesthesia procedures as well as carefully communication between anesthesiologists and surgeons. In conclusion, myotonic dystrophy has variations, which makes it important to preoperatively determine specific surgical and anesthetic management strategies for each patient. In this article, we present a patient with myotonic dystrophy who underwent laparoscopic cholecystectomy surgery for symptomatic cholelithiasis and to discuss the relevant literature

Retrospective Evaluation of Colistin Associated Nephrotoxicity at Oncology Hospital Intensive Care Unit

Objective: The aim of our study, is to determine the nephrotoxicity rates and risk factors for the development of nephrotoxicity by retrospective evaluation of patients who were given colistin therapy oncology hospital intensive care unit. Material and Method: Total of 33 adult patients were included in the study. Renal function tests and hemodialysis requirements were recorded. In addition, patients age, gender, concurrently used drugs with colistin therapy, duration of colistin therapy and total colistin doses were noted. RIFLE criteria (risk, injury, failure, loss, end-stage kidney disease) were used for evaluation of nephrotoxicity. Results: Nephrotoxicity was observed in 69,7% of patients (23 patients). According to RIFLE criteria nephrotoxicity rates were; risk 36,36%, injury 15,15% and failure 18,18%. In patients who developed nephrotoxicity, creatinine and blood urea nitrogen values were observed to rise significantly on the 5th day of colistin treatment (p≤0,05). In patients with malignancy, nephrotoxicity rate was 5.4 times higher than those without the diagnosis of malignancy. Concurrent use of diuretic, aminoglycoside, vancomycin and carbapenem did not increase the risk of nephrotoxicity. Conclusion: In our study, the rate of nephrotoxicity was higher than those in the literature. We found that underlying malignant tumor diagnosis increases the rate of nephrotoxicity

The Effect of Lagenaria Siceraria Molina on Acute Lung Injury Induced by Oleic Acid in Rats

Oleic acid has been used to induce acute lung injury in experimental studies. Lagenaria siceraria (Molina) has been reported to have cardiotonic, hepatoprotective, immunomodulatory,antihyperglycemic, antihyperlipidemic, analgesic and anti-inflammatory properties. In this study, we investigated the effects of Lagenaria siceraria (LS) fruit juice on acute lung injury induced by oleic acid in rats. Thirty five adult female Sprague Dawley rats divided into 5 groups, 7 in each. Group I and group II received normal saline for 30 days, group III, IV and group V received LS at a dose of 200 mg/kg, 200 mg/kg and 400 mg/kg for 30 days by gavage respectively. 100mg/kg oleic acid was administered i.v in group II, group IV and group V. Histopathological examination of the lung was performed with light and electron microscopy. Levels of protein carbonyl, malondialdehyde, superoxide dismutase, catalase and glutathione peroxidase levels were measured in tissue samples. Levels of TNF alpha, IL10, IL6 and total tissue oxidant status and total tissue antioxidant status were measured in serum samples.&nbsp; Light microscopy showed that LS at both doses decreased the total lung injury score compared to group II. In electron microscopy, LS at both doses decreased the thickness of the fused basal lamina when compared to group II. TNF&alpha;, IL6 in serum and MDA in tissue were higher in group II when compared to group me and attenuated in group V&nbsp; ignificantly.&nbsp;Lagenaria siceraria attenuated the extent of acute lung injury induced by oleic acid in rats.</p

Effect of melatonin on antioxidant capacity, ınflammation and apoptotic cell death in lung tissue of diabetic rats

<div><p>Abstract Purpose: To investigate the effects of melatonin on antioxidant capacity, inflammation and apoptotic cell death (through expression of cleaved-caspase 3) in lung tissue samples of diabetic rats. Methods: Thirty male Sprague-Dawley rats were randomly divided into three groups. Group 1 (control group) was made up of healthy rats. Group 2 (diabetes group) received streptozotocin at a dose of 50 mg/kg/day for 5 days.Group 3 (diabetes plus melatonin group) received streptozotocin at a dose of 50 mg/kg/day for 5 days and then they received melatonin at a dose of 20 mg/kg/day between 28thand 35thdays of the study. Results: Tissue MDA and MPO levels were found to be significantly higher in diabetes group compared to control group (p<0.05) whilst administration of melatonin was found to significantly lower this increase down to normal levels (p<0.05). Bronchus associated lymphoid tissue (BALT) was more severe in diabetics whereas administration of melatonin alleviated this hyperplasia. Cleaved caspase 3 activity was severe in hyperplastic BALT in diabetic rats however in lowered down to moderate level when melatonin was administered. Conclusion: The melatonin caused an increase in antioxidant capacity and decreased the expression of cleaved-caspase 3.</p></div

Türkiye´de hematologların transfüzyon tıbbı uzmanlık eğitim hedeflerine ulaşımının öz yeterlilik anketi ile değerlendirilmesi

Background: Proper clinical use of blood andblood products requires competent theoreticaland practical knowledge of transfusion medicine.The Curriculum Development and StandardDetermination System Medical SpecializationBoard is prepared Hematology SpecialistEducation Core Curriculum in Turkey. In thisstudy, we aimed to determine the access ofhematologists to the learning objectives definedby curriculum for the transfusion medicine andthe factors affecting it.Methods: Hematologists who have beenmembers of Turkish Hematology Society since2013 have been included in the study, Thesurvey questions were prepared based on thecurriculum for transfusion medicine. The studywas applied to hematologists with “surveymonkey” application. The questionnaireconsisted of a competence self-assessment withLikert scale and theoretical multiple-choiceknowledge questions.Results: Of the 213 hematologists, 54 (25%)were included in the study. Hematologists ratedtheir competences in the clinical competenceareas as 3,65 ± 0,73 (median 3,60) as “I knowbut not t a sufficient level”. The participants‘perception of competence was “I know, butnot at a sufficient level’” with an average of3.31 ± 0.84 (median3.5) in the blood bankingfield, while the average in hemapheresis andtransfusion medicine was 4.04 ± 0.63 (median4) as “enough”. In interventional procedures,hematologists stated that their vocationalcompetences were 2,79± 0,92 (median 2,93)on average as “I have an idea- I know, but notenough”. The correct answer to 13 theoreticalquestions was an average of 6,96 ± 1,89(median 7). Hematologists performing bloodrotation felt significantly more competent thanthe physicians who could not do the rotation inthe blood bank, blood banking t(52) = -3.9, p <.001 , transfusion medicine and interventionalcompetence t(52) = -2.2, p = .04 . Physicianswho believed that they are sufficient in theblood banking area, were more confident intransfusion medicine r(54) = .67, p <.001 andmanaging interventional procedures r(54) =.85, p <.001.Conclusion: In this study, hematologistsgenerally felt more competent in subjects suchas transfusion and therapeutic apheresis,which they often think of as not having enoughknowledge in the area of blood banking.Hematologists have been more confident inthe field of transfusion medicine as their yearsof expertise increased, but they did not feelbetter equipped in the fields of blood bankingand interventional competence. The currentresults suggested that hematologists who areexpected to be the blood bank supervisors do notinternalize the area of blood banking, are notstrong in their competence, and do not want towork in this area unless they are required.In hematology education curriculum, positiverevisions in education can be achieved byrevising blood banking curriculum and learningobjectives, standardizing blood center rotationswith content and duration, and support fromonline distance education programs.Giriş: Kan ve kan ürünlerinin uygun klinik kullanımı, transfüzyon tıbbı konusunda teorik ve pratik bilgi birikimini gerektirir. Türkiye’de Müfredat Geliştirme ve Standart Belirleme Sistemi Tıbbi Uzmanlık Kurulu tarafından, Hematoloji Uzmanlık Eğitimi Temel Müfredatı hazırlanmıştır. Bu çalışmada hematologların transfüzyon tıbbı müfredatı ile belirlenen öğrenme hedeflerine ulaşımını ve bu durumu etkileyen faktörleri belirlemeyi amaçladık. Metot: 2013 yılından bu yana Türk Hematoloji Derneği üyesi olan hematologlara transfüzyon tıbbı için müfredatı esas alınarak hazırlanan anket “Survey Monkey” uygulaması ile uygulandı. Anket, Likert ölçeği ve teorik çoktan seçmeli bilgi soruları ile öz yeterlilik değerlendirmelerinden oluşuyordu. Sonuçlar: 213 hematologdan 54’ü (%25) çalışmaya katılmıştır. Hematologların yeterlilik algıları klinik yetkinlik alanlarında ortalama 3,65 ± 0,73 (ortanca 3,60) olarak “Biliyorum ama yeterli düzeyde değil”; kan bankacılığı alanında ortalama 3.31 ± 0.84 (ortanca 3.5) puan ile “biliyorum ama yeterli düzeyde değil”; hemaferez ve transfüzyon tıbbı alanında ise ortalama 4.04 ± 0.63 (ortanca 4) “yeterli” olarak ölçüldü. Girişimsel işlemlerde hematologlar mesleki yeterliliklerinin ortalama 2,79± 0,92 (ortanca 2,93) “Bir fikrim var, biliyorum ama yeterli değil” olarak ifade ettiler. 13 teorik sorunun doğru cevabı ortalama 6,96 ± 1,89 idi (ortanca 7). Kan bankası rotasyonu yapan hematologlar yapamayanlara göre kan bankacılığı t(52) = -3.9, p < .001, transfüzyon tıbbı ve girişimsel alanlarda t(52) = -2.2, p = .04 kendilerini çok daha yetkin hissediyordu. Kan bankacılığı alanında yeterli olduğuna inanan hekimler, transfüzyon tıbbında r(54) = .67, p <.001 ve girişimsel işlemlerin r(54) = .85, p <.001yönetiminde de kendilerinden daha eminlerdi. Tartışma: Bu çalışmada, hematologlar genellikle kan bankacılığı alanında yeterli bilgiye sahip olmadığını düşünürken transfüzyon tıbbı ve terapötik aferez gibi konularda kendilerini daha yetkin hissetmistirler. Hematologlar, uzmanlık yılları arttıkça transfüzyon tıbbı alanında kendilerine daha fazla güvenmeye başlarken, kan bankacılığı ve girişimsel yeterlilik alanlarında kendilerini hala yeterli donanımda hissetmiyorlardı. Mevcut sonuçlar, hematologların kan bankacılığı alanını içselleştirmediklerini, yetkinliklerinde güçlü olmadıklarını ve gerekli olmadıkça bu alanda çalışmak istemediklerini göstermiştir. Transfüzyon tıbbı müfredatının ve öğrenme hedeflerinin gözden geçirilmesi, kan merkezi rotasyonlarının içerik ve süresinin standartlaştırılması ve çevrimiçi uzaktan eğitim programları ile desteklenmesi hematoloji eğitimine olumlu katkılar sağlayabilir