Kanser Hastalarında Tromboz Riskinin ve Antikoagülan Tedavinin Rehbere Uygunluğunun Değerlendirilmesi

Cancer patients are at high risk for venous thromboembolism (VTE) and cancer-associated VTE is a major health problem due to its effects on deterioration of disease prognosis, increased treatment costs and delayed cancer treatment. This study aimed to assess the adherence of anticoagulant therapies of cancer inpatients to the National Comprehensive Cancer Network cancer-associated VTE guidelines, to identify the VTE risk profiles of cancer outpatients using the Khorana risk assessment tool and to inform the physicians about patients at high risk. Furthermore, the attitudes and opinions of medical oncologists on anticoagulant therapy in cancer patients was assessed via a survey. As a result, the guideline adherence was assessed retrospectively and prospectively, and an increase in adherence was observed after the guideline-related recommendations made by a clinical pharmacist regarding the initiation of prophylactic anticoagulant upon hospital admission and the appropriate dosing of anticoagulant drug (p=0.002; p=0.001; McNemar Test) in the prospective group. A total of 68 recommendations for 60 cancer inpatients were made by a clinical pharmacist and 32.35% was accepted. Among the outpatients, at high risk patients for VTE (5.5%) were identified, then the consultant physicians were informed. According to the results of the survey, it was shown that the most of medical oncologists particularly consider the risk factors (for inpatients and outpatients) as; a history of VTE (55% and 58%), immobilization (52% and 50%) and tumor/cancer type (42% and 40%) while initiating anticoagulants in cancer patients. It was found that 40.3% of the physicians usually prefer to use anticoagulants for the inpatients and 77.4% of the physicians sometimes prefer to use for the outpatients. The physicians (%) indicated that a clinical pharmacist should be presented in the multidisciplinary team for the issues related with drug interactions (73.8%), patient education (65.6%), dose adjustment (36.1%) and the risk assessment (24.6%). In conclusion, a clinical pharmacist can contribute into the maintenance of cancer related VTE therapy according to the guideline and in the VTE risk assessment of cancer patients by playing an active role in treatment process.Kanser hastaları venöz tromboembolizm (VTE) açısından yüksek risk altındadır ve kanser ile ilişkili VTE hastalığın seyrini kötüleştirmesi, tedavi maliyetlerini arttırması ve kanser tedavisini geciktirebilmesi nedeni ile önemli bir sağlık sorunudur. Bu çalışmada, National Comprehensive Cancer Network kanser ile ilişkili VTE rehberine göre yatarak tedavi alan kanser hastalarında antikoagülan tedavinin rehbere uygunluğunun değerlendirilmesi, ayaktan tedavi alan kanser hastalarında Khorana risk değerlendirmesi yöntemi kullanılarak VTE risk profilinin oluşturulması ve yüksek riskli hastalar hakkında hekimlerin bilgilendirilmesi amaçlanmıştır. Ayrıca, bir anket çalışması ile medikal onkologların kanser hastalarında antikoagülan tedavi hakkındaki tutumları değerlendirilmiştir. Çalışma sonucunda; rehbere uygunluk retrospektif ve prospektif olarak değerlendirilmiş ve prospektif grupta klinik eczacı tarafından rehber doğrultusunda yapılan öneriler ile yatış itibari ile profilaktik antikoagülan başlanması ve uygun dozda antikoagülan ajanın kullanılması konularında rehbere uygunlukta artış saptanmıştır (p=0,002 ve p=0,001; McNemar testi). Yatarak tedavi alan 60 hasta için klinik eczacı tarafından 68 öneri yapılmış ve bu önerilerin %32,35’i kabul edilmiştir. Ayaktan tedavi alan hastalarda ise VTE açısından yüksek riskli hastalar (%5,5) saptanmış ve sorumlu hekime bilgi verilmiştir. Anket çalışması sonucunda, medikal onkologların çoğunun (yatan ve ayaktan tedavi gören) kanser hastalarında profilaktik antikoagülan tedaviye başlarken özellikle; geçirilmiş VTE (%55 ve %58), immobilizasyon (%52 ve %50) ve tümör/kanser tipi (%42 ve %40) gibi faktörleri göz önünde bulundurduğu saptanmıştır. Hekimlerin %40,3’ünün yatarak tedavi alan kanser hastalarında ‘çoğunlukla’, %77,4’ünün ayaktan tedavi alan hastalarda ise ‘bazen’ antikoagülan kullanımını tercih ettikleri saptanmıştır. Hekimler; ilaç etkileşimleri (%73,8), hasta eğitimi (%65,6), doz ayarlaması (%36,1) ve risk değerlendirmesi (%24,6) gibi konularda multidisipliner ekip içerisinde bir klinik eczacının olmasını istediklerini belirtmiştir. Sonuç olarak, kanser ile ilişkili VTE tedavisinin rehbere uygun şekilde sürdürülmesinde ve kanser hastalarında VTE riskinin değerlendirilmesinde klinik eczacı etkin rol alarak tedavi sürecine katkı sunabilecektir

COVID-19 Enfeksiyonunun Hemşirelik Öğrencileri Üzerindeki Etkisinin İncelenmesi

Amaç: Çalışma hemşirelik öğrencilerinde COVID-19 enfeksiyonunun etkilerini araştırmak amacıyla yapıldı.Yöntem: Çalışma, 307 hemşirelik öğrencisi ile tanımlayıcı olarak yapıldı. Araştırmanın verileri, araştırmacı tarafından literatür bilgileri doğrultusunda hazırlanmış çevrimiçi anket formu ile toplandı. Verilerin analizinde yüzde, ortalama, standart sapma, Kolmogorov-Smirnov testi, Ki kare testi ve Mann Witney U testi kullanıldı.Bulgular: Araştırmaya katılan öğrencilerin büyük bir çoğunluğunu (%86,6) kadınlar oluşturdu. Katılımcıların yarısından fazlasının (%72,3) sabit bir aile gelirine sahip olmadığı, önemli bir kısmının herhangi bir işte çalışmadığı (%91,2) ve ailesi ile birlikte yaşamaya (%94,1) devam ettiği belirlendi.Çalışmada kadın öğrencilerin COVID-19 pandemisi ve sürecine ilişkin yaşadıkları stres ve kaygı düzeyleri daha yüksek bulundu (p lt;0.05). Pandemi sürecinde hastaneye gitmek zorunda kalan öğrencilerin yarısından fazlasının (%62,2) endişe ve korku yaşadığı belirlendi. Öğrencilerin büyük bir kısmının (%68,4), uzaktan eğitim sürecini etkin ve yeterli bulmadığı görüldü. Bu sonuçta sıklıkla sırasıyla “göz teması olmaması, öğrenmede güçlük (%36,7)”, “uygulama gerektiren konularda mesleki becerilerin yapılamaması (%18,6)” ve “kişisel ya da teknik sorunlar (%12,4)” gibi durumların etkili olduğu tespit edildi. Öğrencilerin büyük çoğunluğunun (%69,1) teorik derslere katılımında azalma olduğu anlaşıldı. Hemşirelik mesleğine severek başlayanların pandemi sürecinde hemşirelik mesleğini bırakmayı düşünme oranlarının anlamlı düzeyde daha düşük olduğu saptandı (p lt;0.05).Sonuç: COVID-19 pandemisinin, öğrencileri sosyal hayat, eğitim ve hemşirelik mesleği boyutunda önemli ölçüde etkilediği ve büyük bir kısmının stres ve anksiyete yaşadığı görülmektedir. Öğrencilerin hastalığın toplumsal süreçleri ve uzaktan eğitim yöntemlerine ilişkin bilgilendirilmeleri önerilmektedir

Evaluation of the effect of hypnobirthing education during antenatal period on fear of childbirth

Objectives: The objective of this research was to analyse the effect of hypnobirthing education given to pregnant women during antenatal period on fear of childbirth. Methods: This is an educational interventional case-control study. A total of 51 pregnant women were studied together during the 12th week of pregnancy. Ethical Committee and related consents were taken. Data was evaluated by using descriptive statistics. Results: The age average of the pregnant in the control group was 28.70 ± 5.42 years while it was 25.74 ± 5.16 years for the case group. Women's gestational week averages were 20.87 weeks for study and 24.10 weeks for control group. In the study, the pre-training scale scores of the cases and control groups were compared with the average level of birth fear of the groups (t = 1.848, p = 0.073). There was a significant difference between pre- and post-hypnotic scale scores in the birth preparation class (t = -5.329, p < 0.001). Before the training; 48% of the case group. Fifty-two percent of the control group is adequately informed about the hypnobirthing problem. Conclusions: It was found that among the pregnant women who had attended birth preparation classes, positive labour perception of the intervention group pregnant women was higher than that of the control group pregnant women who hadn’t had hypnobirthing education and there was a significant difference between them

Can gestation be considered as trauma in adolescent girls: post-traumatic stress disorder in teen pregnancy

Although post-traumatic stress disorder (PTSD) in adolescent pregnancy has been reported at high rates in the limited research in this area, no studies have evaluated gestation as trauma in teens. This study, aimed to evaluate PTSD in this high risk group. All pregnant adolescents who presented to our obstetrics and gynaecology clinics in a one-year period were invited to participate in the study. Adolescents with a history of domestic or dating violence, rape, and sexual abuse were excluded. PTSD was rated using the Child Post-Traumatic Stress Disorder-Reaction Index. When the pregnant adolescents and control group were compared, various severities of PTSD were observed in nearly two-thirds of the study group. Although there was clinically significant PTSD among 23.3% of the controls, PTSD was more frequently seen in adolescents with pregnancy compared with their healthy peers. Educating adolescents about birth control methods and preventing child marriages will be protective in this respect.Impact statement What is already known on this subject? Teen pregnancy has significant psychosocial and economic impacts for adolescents, their offspring, and the community in terms of education and employment, increased risk of abuse and neglect, and the physical and emotional well-being of the offspring. Pregnancy and birth-related risks are also higher than in adults. In this context, pregnancy itself may be accepted as trauma for adolescents. What do the results of this study add? There has been limited research on PTSD in pregnant teens and is mainly associated with traumatic childhood events. This is the first study to examine pregnancy-related PTSD and related conditions in this group. What are the implications of these findings for clinical practice and/or further research? The prevalence of pregnancy related-PTSD in pregnant teens can be considered high and alarming, considering the fact that most of them had never been treated for it at all. Healthcare providers serving this population need to be trained to recognise the core symptoms of PTSD, and should direct adolescents for professional assistance if needed. Strategies such as higher quality sexual health education and greater access to reproductive health services to reduce adolescent pregnancy and marriage are also imperative

The impact of the informed consent process on the anxiety levels of patients undergoing rhinoplasty

Septorhinoplasty is one of the most common elective surgical procedures in otolaryngology. The present study aimed to evaluate the anxiety levels of patients who underwent septorhinoplasty at different times, compare the information methods, and determine the understanding of the informed consent through recall rates of the complications explained in the informed consent process. The patients were divided into the following 2 groups: Group 1 (giving information 14 days before the surgery) and Group 2 (giving information 3 days before the surgery). For the preoperative anxiety measurement, the State anxiety scale of the State-Trait Anxiety Inventory (STAI) was used. All patients were asked to recall the complications they remembered from the consent form on the day before the surgery. Each group has consisted of 25 patients. No significant difference was found between the STAI-1 and STAI-2a anxiety scores between groups. In Group 1, the STAI-2b anxiety score was significantly lower than the STAI-1 and STAI-2a scores (P 0.05). When the STAI-2b scores of the two groups were compared, the scores of Group 2 were significantly higher (P < 0.05). The most commonly remembered complications were bruising and swelling in both of the groups. In conclusion, the authors believe that long-term cooperation between the surgical team and the patient will reduce the anxiety levels of the patients and increase patients' satisfaction, resulting in a significant reduction in the amount of potential legal processes. Level of Evidence:

(HfTiZrMnCr)B2 high entropy diboride ceramics: Synthesis mechanism, microstructural, mechanical and thermal characterization

This study explains the synthesis mechanism of (HfTiZrMnCr)B2 high entropy diboride ceramics prepared via a combined route consisting of ball milling and spark plasma sintering. Firstly, metal borides were in-house synthesized using mechanochemical synthesis and leaching processes under optimum conditions from metal oxides, B2O3 and Mg precursors. The (HfTiZr)B2 composition, chosen as the main composition, was hybridized with two different methods: planetary and vibratory ball milling. As a result of milling experiments, 6 h vibratory milling was determined as the optimum duration, and all compositions were produced by spark plasma sintering method (2000 °C, 30 MPa) following this optimum condition. Different compositions were used to see which one of the HfB2, TiB2, ZrB2 compounds acted as a host material. Based on the phase analyses, single-phase HEB structures, Ti-rich phases and Hf, Ti, Zr-oxides were observed in the microstructure. Detailed physical, microstructural, mechanical and termal characterizations were performed: the highest hardness values were observed in the (HfTiMnCr)B2 and (HfTiZrMnCr)B2 samples as ∼ 27 GPa, the lowest wear rate was recorded for the (HfTiZrMnCr)B2 sample as ∼2 × 10−6 Nm/mm3, and the highest oxidation resistance was achieved at the (HfZrMnCr)B2 and (HfTiMnCr)B2 samples as weight gains ∼ 1.90%

International Society of Oncology Pharmacy Practitioners (ISOPP) position statement: Role of the oncology pharmacy team in cancer care.

The Oncology Pharmacy Team (OPT), consisting of specialty-trained pharmacists and/or pharmacy technicians, is an integral component of the multidisciplinary healthcare team (MHT) involved with all aspects of cancer patient care. The OPT fosters quality patient care, safety, and local regulatory compliance. The International Society of Oncology Pharmacy Practitioners (ISOPP) developed this position statement to provide guidance on five key areas: 1) oncology pharmacy practice as a pharmacy specialty; 2) contributions to patient care; 3) oncology pharmacy practice management; 4) education and training; and 5) contributions to oncology research and quality initiatives to involve the OPT. This position statement advocates that: 1) the OPT be fully incorporated into the MHT to optimize patient care; 2) educational and healthcare institutions develop programs to continually educate OPT members; and 3) regulatory authorities develop certification programs to recognize the unique contributions of the OPT in cancer patient care