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Objectives It is common practice to use pain quality indicators (QI) to accurately assess the medical care situation of patients. This literature review identifies the status quo of acute pain QI among adult inpatients. Data Sources Studies published in English or German were identified using a systematic search on CINAHL, Cochrane Library, PubMed, Web of Science, and Google Scholar from 01/2007 to 02/2018. Additional pain management journals, conference proceedings, and websites of health organizations and pain societies were manually screened. Studies about postoperative pain in adults (≥18 years) during inpatient stay after all types of surgery in Europe were included in this review. Review/Analysis Methods The identified study results were categorized into structural, process, and outcome indicators based on Donabedian's framework of evaluating care quality. Results The search identified 319 citations, of which 20 studies used structure, process, and outcome data including 180,988 patients and 1,970 health care professionals to gain insight into the quality of acute pain management. Overall, 80% used patient surveys to collect data. National data on pain management are reported in five European studies (France [2], the Netherlands, Spain, and Austria). Conclusions European studies comprehensively comparing acute pain management results are currently missing. Thus, this report highlights the need to develop consensus-based quality indicators in management of acute pain, which take into account both the methodologic quality and the relevance to clinical practice.

The aim of this study was to examine the association between sleep duration and frailty in community-dwelling Turkish older adults and to determine whether this association varies depending on gender. A cross-sectional study was conducted from August 2013 to December 2013 with 905 individuals, representative of the aged population >= 60 years in community-dwelling elderly. Self-reported sleep duration was classified as short sleep duration (= 9 h). Frailty was assessed according to the FRAIL scale (FRAIL: Fatigue, Resistance, Ambulation, Illness, Low weight).The study included 905 community-dwelling older adults (447 male and 458 female). The median (25p-75p) age of the study population was 71.0 years (67.0-75.0) (range 60-92 years). The number of patients according to the short, middle, and long sleep durations were 120 (13.3%), 341 (37.7%), and 433 (47.8%), respectively. The median duration of sleep time in the total study population was 8.5 (7.0-10.0) h. According to frailty status, the percent of robust subjects was higher in the group with mid sleep duration than the other two groups (p = 0.020). Short sleep duration was associated with frailty in the female gender in both the unadjusted model (OR 2.80, 95% CI 1.42-5.52) and the fully adjusted model (OR 3.42, 95% CI 1.50-7.77). Short sleep duration is independently associated with frailty in community-dwelling Turkish female older adults, thus frailty prevention interventions should consider sleep duration in females.

Background: Type 2 diabetes mellitus is one of the most common diseases worldwide. The demands on health services are rising as more people are diagnosed with the condition. In order to meet this demand, eHealth systems are increasingly being integrated into nursing care. Methods: Between November 2018 and February 2019, a literature search was carried out in the databases PubMed and CINAHL. Results: Twenty articles were found on nurses' use of eHealth systems, the majority with patients with diabetes. From this research, it would seem that eHealth systems have had a proven positive influence on patients' state of health and understanding of therapy. Subjectively perceived communication with the nursing staff also improved. Problems can arise in the implementation phase. Conclusion: In the future, increasingly, nurses will have to integrate eHealth systems into the treatment of patients with type 2 diabetes. It is important that nurses understand such systems in order to guarantee a sustainable and successful implementation.

Der intraoperative Augenschutz ist bei Operationen in Vollnarkose generell von Bedeutung. Im Speziellen zeigen sich aber Herausforderungen, wenn intraoperativ ein Laser verwendet wird. In der Gynakologie und Urologie werden Erkrankungen zunehmend mittels Laser therapiert, aber eine Lege-artis-Augenabdeckung/ein Lege-artis-Augenschutz ist in der internationalen Literatur noch nicht untersucht. Wie gestaltet sich laut PflegeexpertInnen eine lege artis durchgefuhrte Augenabdeckung wahrend einer gynakologischen/urologischen Laseroperation? Fur die Beantwortung der Forschungsfrage wurden standardisierte ExpertInneninterviews via Telefon, direkter „Face-to-face“-Befragung und E‑Mail in Schwerpunktkliniken in Osterreich durchgefuhrt. Die Erkenntnisse einer unsystematischen Literaturrecherche bildeten die Grundlage fur den dafur herangezogenen Interviewleitfaden. Elf ExpertInnen stimmten einer qualitativen Befragung zu. Als geeignete Masnahmen wurden hautfreundliche Pflaster in Kombination mit einer Vitamin-D-Augensalbe, Spezialpflaster/Abdeckungen und/oder Laserschutzbrillen mit einer Vitamin-D-Augensalbe und NaCl-Kompressen empfohlen. Neben dem direkten Schutz des Auges muss eine regelmasige intraoperative Lidschlusskontrolle erfolgen. Die Erkenntnisse aus den standardisierten ExpertInneninterviews verstehen sich als Praxisempfehlung. Zukunftig bedarf es weiteren Forschungen.

Background/aim To assess sarcopenia and dynapenia and their relationship with disease severity and disabilities in PD and to state body composition in PD. Methods We conducted a case-control, cross-sectional study that included 70 patients with idiopathic PD and 85 controls. Sarcopenia was defined according to the European Working Group on Sarcopenia in Older People (EWGSOP) criteria. Dynapenia was detected by a handheld dynamometer. Bioimpedance analysis (BIA) was performed, and the SARC-F questionnaire was applied. Disabilities were appointed according to the Katz and Lawton indexes. Results Sarcopenia and dynapenia were more prevalent in PD than in controls (50 vs 30.6% and 31.4 vs 17.6%, respectively). Dynapenia was significantly associated with the severity of the disease and disabilities (p = 0.047, p = 0.001); however, sarcopenia was not. The skeletal muscle mass index (SMMI), fat mass index (FMI), and fat-free mass index (FFMI) did not differ between the PD and controls. FMI was lower in the advanced stages of the disease. Higher scores in the SARC-F questionnaire were significantly associated with disabilities and the severity of the disease (p < 0.001, p < 0.001). Conclusion Muscle strength was closely associated with the severity of the disease and disabilities in PD, but muscle mass was not. Sarcopenia, defined by the SARC-F questionnaire, was a good predictor of disabilities in PD, while the EWGSOP criteria were not. PD patients have a favorable body composition even in advanced stages of the disease with lower FMI and protected lean mass.

Diarrheal disease is a leading cause of childhood morbidity and mortality worldwide. Multiple interventions, including rotavirus vaccination to infants since 2009, have reduced the incidence of diarrheal disease in South African children. Our study aimed to determine the burden of diarrheal disease 5 years after rotavirus vaccine introduction at a tertiary-level hospital.A retrospective review of a discharge summary database of children less than 5 years of age hospitalized with acute diarrheal illness from 2015 to 2016 at the Chris Hani Baragwanath Academic Hospital.Diarrheal disease accounted for 14.8% of hospital admissions. The incidence (per 100,000 population) was 675.8 (95% CI: 638.8-714.3) in 2015 and 612.2 (95% CI: 577.0-648.9) in 2016. The case fatality ratio was 2.9% over the study period. The median age at diagnosis was 12 months (interquartile range: 6.2-21.4) and 50.4% of cases occurred during infancy. One third of cases were underweight and/or stunted. In a multivariable analysis using logistic regression, the adjusted odds ratio (aOR) for death was higher in children with an associated acute lower respiratory tract infection (aOR: 3.7, 95% CI: 1.2-11.5; P = 0.021), HIV infection (aOR: 9.1, 95% CI: 2.6-31.6; P = 0.001), and an age of less than 6 months (aOR: 6.9, 95% CI: 2.1-22.9; P = 0.002).Sustained reductions in diarrheal disease incidence were observed 5 years post rotavirus vaccine implementation. In children hospitalized with an acute diarrheal illness, an increased risk of mortality occurs in young infants, children that are HIV infected, and those with an associated acute lower respiratory tract infection.

Key summary points Aim To evaluate sarcopenia risk in hospitalized older patients. Findings The percentage of patients at risk of sarcopenia defined by the SARC-F was 48.8%. Sarcopenia risk was associated with unfavorable health care outcomes including dependency, malnutrition, and dysphagia. Message Sarcopenia risk is related with unfavorable outcomes in hospitalized patients and it is important to recognize sarcopenia at an early stage and to prevent its progression, before dependency develops. Purpose To investigate the risk of sarcopenia in hospitalized older patients and to assess the associations between sarcopenia risk and health care outcomes including dependency, malnutrition, and dysphagia. Methods This multicenter cross-sectional study was a part of the annual National Prevalence Measurement of Quality of Care (LPZ) in Turkey. Hospitalized patients age 65 and older were included in the study. The SARC-F was used to assess risk of sarcopenia. Dependency was appraised according to the Care Dependency Scale (CDS). Nutritional status was established with respect to the Malnutrition Universal Screening Tool (MUST). Dysphagia was screened by two structured questions. Results A total of 492 patients were included in the analysis. Two hundred and forty patients (48.8%) were at risk of sarcopenia. Sarcopenia risk was more prevalent among women (p = 0.007) and patients with risk of sarcopenia were older (p < 0.001). Hospital stay was longer and malnutrition and dysphagia were more prevalent in patients with sarcopenia risk than without (all p < 0.001). All nutritional interventions were applied mostly to patients with sarcopenia risk than without. In multivariate analysis, advanced age (OR: 1.068, CI 1.032-1.104, p < 0.001), female gender (OR: 2.414, CI 1.510-3.857, p < 0.001), and dependency (OR: 5.022, CI 2.922-8.632, p < 0.001) were independently associated with sarcopenia risk. Conclusions Sarcopenia risk is related with unfavorable outcomes in hospitalized patients. Primarily older female patients are at risk for sarcopenia. It is important to recognize sarcopenia at an early stage and to prevent its progression, before dependency develops. The SARC-F may be a useful tool for screening sarcopenia risk in hospitalized patients., Nutricia Turkey, This work was supported by Nutricia Turkey. The funding played no role in study design, collection, analysis, interpretation of data, writing the manuscript, or the decision to submit for publication.

Developing spirituality and spiritual care competencies in nursing students is an important task. In German-speaking countries, research investigating spiritual care in nursing teaching and nursing practice is limited. The aim of this study was to measure nursing students’ perceptions of their spiritual care competencies, care attitudes, involvement, perception and well-being. Three groups of second-year undergraduate nursing students in the years 2018, 2019 and 2020 participated in a cross-sectional study using validated scales to measure students’ spiritual well-being (JAREL), spiritual care attitudes and involvement (SAIL), spirituality and spiritual care perceptions (SSCRS), and competencies (SCCS). Nursing students (N = 191) show a high level of spiritual attitude and involvement. The groups attained similar scores on the SSCRS, but the group of 2020 achieved the highest score, indicating a broader view of spirituality. This group also scored highest on the SCCS, which shows a higher self-perceived competence in delivering spiritual care. At the same time, the 2020 group reported significantly low spiritual well-being scores. Students rated their competencies in delivering spiritual care as high. This may be negatively affected if their spiritual well-being remains low. Further investigation is needed to clarify how to tackle this shortcoming in educational training.

The aim of this study was to evaluate the relation between the rate of fluorine-18 (18F) fludeoxyglucose (FDG) uptake and CD38 and CD138 expression in myeloma cells in bone marrow and other clinical parameters in patients with multiple myeloma (MM).Patients with the diagnosis of MM who underwent 18F-FDG positron emission tomography/computed tomography (PET/CT) for initial staging were evaluated retrospectively. We analyzed a total of 42 patients (43-83 years old, mean: 64.4±9.9). Hematological and biochemical tests including hemoglobin, hematocrit, C-reactive protein, β2-microglobulin, creatinine, albumin, calcium, lactate dehydrogenase, and erythrocyte sedimentation rate were recorded. In bone marrow samples, plasma cell ratio and CD38 and CD138 immunohistochemical staining were evaluated. On PET/CT images, mean standardized uptake values (SUVTypes of MM were IgGK (45%), IgGL (21%), IgAIncreased FDG uptake is correlated with the percentage of CD38 and CD138 expression in plasma cells in bone marrow. In addition to initial staging, 18F-FDG PET/CT is useful in treatment planning and prognostic evaluation in MM patients.Bu çalışmanın amacı multipl myelom (MM) hastalarında kemik iliği florin-18 (18F) fluorodeoxyglucose (FDG) tutulumu ile plazma hücrelerinde CD38, CD138 ekspresyonu oranı ve diğer klinik parametreler arasındaki ilişkiyi değerlendirmektir.MM tanısı almış, ilk evreleme amacıyla 18F-FDG positron emisyon tomografi/bilgisayarlı tomografi (PT/BT) yapılan hastalar geriye dönük olarak değerlendirildi. Toplam 42 hasta analiz edildi (43-83 yaş, ortalaması: 64,4±9,9). Hematolojik ve biyokimyasal testlerden hemoglobin, hematokrit, C reaktif protein, beta 2-mikroglobulin, kreatinin, albumin, kalsiyum, laktat dehidrogenaz, sedimentasyon düzeyleri kayıt altına alındı. Kemik iliğinde plazma hücre düzeyi ve immünhistokimya ile CD38 ve CD138 boyanma oranına bakıldı. 18F-FDG PET/BT görüntülerinde sağ proksimal femur, sağ ön ve arka ilyak krest ortalama standart tutulum oranı (SUVort.) kaydedildi. Kemik iliği SUVort. ve myelom hücrelerinde CD38, CD138 ekspresyonu ve diğer klinik parametreler arasındaki korelasyon Spearman korelasyon testi ile analiz edildi. P değerleri0,05 olduğunda anlamlı kabul edildi.Hastaların %45’ini IgGK, %21’ini IgGL, %7’sini IgAK, %10’unu IgAL ve %17’sini diğer myeloma tipleri oluşturuyordu. Otuz iki hasta (%76) Salmon-Durie sınıflamasına göre evre 3 idi. Kemik iliği FDG tutulumu ile plazma hücre oranı ve CD38, CD138 ekspresyonu arasında (r=0,403, r=0,339 ve r=0,409) ve beta 2-mikroglobulin ve C reaktif protein düzeyi arasında (r=0,676, r=0,541) istatistiksel anlamlı pozitif korelasyon vardı. Kemik iliği FDG uptake ile hemoglobin ve hematokrit değerleri arasında negatif korelasyon bulundu (r=-0,377 ve r=-0,368). Diğer hematolojik paremetreler kemik iliği FDG tutulumu arasında bir korelasyon saptanmadı.Kemik iliğinde artmış FDG tutulumu, plazma hücre oranı ve CD38, CD38 ekspresyonu ile ilişkilidir. MM hastalarında 18F-FDG PET/BT, ilk evreleme yanında tedavi planlaması ve prognostik değerlendirmede de yararlıdır.

The objective of this study was to investigate the effect of hyperprolactinemia and high levels of insulin-like growth factor-I (IGF-I) on bone resorption and their relation with receptor activator of nuclear factor-κB ligand (RANKL) and osteoprotegerin (OPG) in patients with prolactinoma and acromegaly. Thirty-one patients with acromegaly, 28 patients with prolactinoma, and 33 healthy individuals were included in the study. Serum concentrations of RANKL, OPG, bone alkaline phosphatase (bone ALP), osteocalcin (OC), C-terminal telopeptide of type 1 collagen (CTX), procollagen type 1 N-terminal propeptide (P1NP) and urine deoxypyridinoline (DPD) levels were detected and bone mineral density (BMD) was measured. Groups were not statistically different from each other with regard to serum levels of RANKL and OPG. The RANKL/OPG ratio was higher in the prolactinoma group than in the control group (p=0.046). A positive correlation between OPG and increasing age was detected in both the prolactinoma and control groups (r=0.524, p=0.004 and r=0.380, p=0.029, respectively). An inverse correlation was observed between IGF-I and OPG after excluding age in the prolactinoma group (r=–0.412, p=0.046). OC and bone ALP were negatively associated with RANKL in the acromegaly group (r=–0.384, p=0.036 and r=–0.528, p=0.003, respectively). There was an inverse correlation between OPG and BMD at the femoral neck in the acromegaly group (r=–0.422, p=0.02). The effect of IGF-I on bone remodeling may be partly mediated by RANKL and OPG. The RANKL/OPG ratio plays an important role in prolactinoma. A positive correlation of OPG with age and an inverse correlation with IGF-I favor the compensatory response of OPG against bone loss in the aging skeleton.

The report entitled "L. Liu, D. Li, F. Bai, A relative Lempel-Ziv complexity: Application to comparing biological sequences, Chem. Phys. Lett. 530 (2012) 107-112" mentions on the powerful construction of phylogenetic trees based on Lempel-Ziv algorithm. On the other hand, the method explained in the paper does not give promising result on the data set on invasive Caulerpa taxifolia in the Mediterranean Sea. The phylogenetic trees are obtained by the proposed method of the aforementioned paper in this short note. (C) 2018 Elsevier B.V. All rights reserved.

Background: Occupational injuries cause major health problems in all nations. Coal mining is one of the largest, oldest industries in the world. However, there is relatively little available literature concerning the health status of coal miners. The purpose of this work is to assess the prevalence of periodontal disease among coal miners and provide a basis for planning and evaluating the data from community oral health services. Methods: A cross-sectional study was conducted 106 men selected based on a stratified cluster sampling procedure. The study was performed among the mine workers of Zonguldak, Kozlu District, Turkey. The questionnaire prepared by the American Academy of Periodontology risk assessment test was used for the evaluation. The data were collected byWorld Health Organization (WHO) oral health assessment form, and clinical examination was conducted by the method recommended by the WHO oral health surveys. Statistical analysis was performed using SPSS software programme. Results: The overall prevalence of periodontal disease was found to be 96.2% and was determined by considering subjects with Community Periodontal Index scores of 1-4 as diseased and the healthy subjects comprised of a mere 3.8%. Furthermore, various disturbing or embarrassing work conditions were reported. Statistically significant differences were observed among the workers who brush their teeth daily and visit dental attendance within the last two years have better periodontal status than those of the others (p < 0.05). Conclusions: The present level of periodontal disease in coal mine workers is severe. Moreover, its distribution and severity are strongly influenced by host susceptibility and risk factors. The priority should be based on population strategy and primary prevention programmes to benefit the periodontal health by promoting self-care and oral hygiene. © 2018 The Author(s).

The aim of this study was to determine a cut-off value for the SNAQ according to both the MNA long and MNA short forms and to assess whether the SNAQ can predict malnutrition or risk of malnutrition in the elderly.Nutritional status was assessed both by the Mini Nutritional Assessment (MNA) long and short forms. All demographic characteristics, mental status, depressive mood, functional status, and frailty were determined. Receiver operating characteristic (ROC) curves were used to calculate the cut-off of the SNAQ according to both the MNA long and short forms for malnutrition or risk of malnutrition. Reliability and validation of the SNAQ was analysed.We included 905 community-dwelling elderly, but those with middle-stage dementia (MMSE score18, n = 30) were excluded. The mean age ± standard deviation (SD) was 71.4 ± 5.5 years (49.3% female and 50.7% male). The prevalence of well-nourished, risk of malnutrition or malnutrition were 55.2%, 44.8%, respectively according to the MNA-long form. The prevalence of elderly at risk of future weight loss (SNAQ score of ≤14) was 31.0% (n = 268; 66.0% female, 34.0% male). The area under the curve (AUC) for SNAQ was 0.725 (95% CI 0.690-0.760). The cut-off value of the SNAQ, according to both the MNA long and short forms, was 14 (sensitivity; 50%, 50% and specificity; 84%, 82%, respectively). The Cronbach's alpha reliability coefficient of SNAQ for internal consistency was 0.639.The SNAQ was reliable and valid as an appetite screening tool in community-dwelling Turkish elderly.

The purpose of this study was to evaluate the physiological effects of Ramadan fasting on muscle function and muscle mass in the older people. We found that body weight and composition were not influenced by Ramadan fasting in both females and males. Ramadan fasting supplied no risk for muscle function and muscle mass in the older people. In Islam, Ramadan fasting is a unique model that is associated with the restriction of food and fluid intake. We aimed to estimate the physiological effects of Ramadan fasting on muscle function and muscle mass in the older people. A random sample was recruited from healthy older Muslims people aged 60 years and older, who expressed an intention to fast for 30 days during the month of Ramadan. Walking speed was expressed in meters per second (m/s). Muscle strength was assessed by hand grip strength (HGS) with a dynamometer. A Bioelectrical impedance analysis (BIA) device (BodystatQuadScan 1500, UK) was used for the evaluation of body composition. Dietary data of the patients during Ramadan were obtained by a 43-item Food Frequency Questionnaire (FFQ). The mean age [Standard Deviation(SD)] of the older people was 66.7(4.7) years of age and 50% were females. There were no significant changes in body weight, muscle function and muscle mass before and after Ramadan fasting in both genders. The mean SMI, mean (SD) kg/m2, values of females and males with adequate milk and yogurt consumption before and after Ramadan fasting were 8.03 (0.75) kg/m2 and 8.43(1.03) kg/m2 for females (p = 0.133) and 10.11(0.79) kg/m2 and 10.35 (0.93) kg/m2 for males (p = 0.59), respectively. Ramadan fasting supplied no risk for muscle function and muscle mass in the older people. If the older people consume enough milk and yogurt in Ramadan, they may not loss muscle mass.

Objective: To determine the prevalence and the factors associated with urinary incontinence (UI) among inpatients in Turkey. Method: the population of this study comprised of patients screened by the "National Prevalence Measurement of Quality of Care (LPZ)" study in 2017 and 2018. Age, gender, comorbidities, length of hospital stay, sedative medications, SARC-F score, anthropometric measurements, and care parameters such as malnutrition, falls, UI-fecal incontinence (FI), restraints, and care dependency score (CDS) were noted. the LPZ questionnaire was performed by trained researchers, and multiple logistic regression analysis was performed to determine the factors associated with UI. Results: the prevalence of UI was 29.4 % among 1176 inpatients, and 41.6 % in patients >= 65 years. Urinary incontinence was associated with older age (OR, 1.966, 95 % CI 1.330-2.905), female sex (OR, 2.055, 95 % CI 1.393-3.030), CDS (OR, 3.236, 95 % CI 2.080-5.035), the number of comorbidities (OR, 1.312, 95 % CI 1.106-1.556), end-of life management (OR, 3.156, 95 % CI 1.412-7.052), sedative medications (OR, 1.981, 95 % CI 1.230-3.191), and FI (OR, 12.533, 95 % CI 4.892-32.112) in all adults, where CDS (OR, 2.589, 95% CI 1.458-4.599), end-of life management (OR, 2.851, 95 % CI 1.095-7.424), sedative medications (OR, 2.529, 95 % CI 1.406-4.548), and FI (OR, 13.138, 95 % CI 4.352-39.661) were associated with UI among geriatric patients. Conclusions: the factors associated with UI in geriatric and all adult inpatients are CDS, sedative medications, end-of life management, and FI plus older age, female sex, and comorbidities for the latter. the factors associated with UI vary in different age groups., Nutricia Turkey, This work was supported by Nutricia Turkey.

PURPOSE To investigate the effect of resin cement color on the post-cementation shade of thin laminate veneers milled from multilayered glass ceramic blocks for each layer. MATERIALS AND METHODS Thin slices (N = 180) with two thicknesses (A: 8 × 8×0.55 mm and B: 8×8×0.8 mm; n = 90/group) were obtained from multilayered glass ceramic blocks using a diamond saw. Resin die specimens were prepared (8 × 8 × 4 mm) (n = 180) and divided into two resin cement colors (D: -3. L: +3) and one control group (C: translucent). Each slice was luted to the composite specimens using a dual-curing resin cement under a constant load of 250 g and light-polymerized for 120 seconds. Specimens were placed on a white background and CIELab values for each layer of the blank slices (incisal [In], body [Bo], and cervical [Ce]) were recorded using a dental contact spectrophotometer. The values were calculated as ΔE, and the data were statistically analyzed (one-way ANOVA, Shapiro-Wilk). RESULTS Mean ΔE values for A and B were significant (p < 0.05) for In (A: 6.2 ± 1.1; B: 6.6 ± 1.2), Bo (A: 5.1 ± 2.6; B: 3.9 ± 1), and Ce (A: 5.3 ± 2.7; B: 3.8 ± 1.2). Mean ΔE values for In for D and L for A and B groups were significantly higher (6.3 ± 1.2; 6.6 ± 1.2) than Bo and Ce for D (4.4 ± 2.4; 4.6 ± 2.6) and L (4.6 ± 1.4; 4.5 ± 1.7) groups (p < 0.05), respectively. Mean differences between Bo and Ce for A and B groups were insignificant (p ≥ 0.05), while for In the differences were significant. Mean differences between Bo and Ce for A (5.1 ± 2.6; 5.3 ± 2.7) and for B (3.9 ± 1; 3.5 ± 1.2) groups were insignificant (p ≥ 0.05), while for In the differences were significant (6.2 ± 1.1 for A and 6.6 ± 1.2 for B). CONCLUSION The color changes for body and cervical regions of multilayered ceramic veneers were not affected by resin color or ceramic thickness, but the incisal area was affected. The translucency of each layer in ceramic veneer fabricated with multilayered blanks should be considered for clinical situations.

The inability to achieve adequate nutrition and weight loss are serious problems for patients with advanced Parkinson's disease (PD). To ensure the optimal intake of nutrition and fluids and to administer levodopa-carbidopa intestinal gel (LCIG) (which patients need to increase or maintain their mobility as long as possible), different artificial feeding tubes can be used. Although percutaneous endoscopic gastrostomy (PEG) tubes are frequently used in medical practice, there is little research that addresses key questions, including if and when to administer artificial fluids, nutrition and/or LCIG via tubes. Weight gain through tube feeding is only possible for some patients; nurses should keep in mind that tube insertion and feeding may lead to frequent adverse events. Administering LCIG via tubes is usually advisable as it seems to enhance patients' mobility and therefore has positive outcomes in terms of the quality of life of patients and their families ( Lim et al, 2015 ). The authors aimed to examine the use and consequences of providing nutrition and LCIG via gastrostomy tubes in PD patients with advanced disease.

WOS: 000415906800020, PubMed: 28910165, Purpose: To evaluate peripapillary choroidal thickness (PPCT), central macular choroidal thickness (CMCT), and retinal nerve fiber layer (RNFL) thickness in untreated patients with obstructive sleep apnea-hypopnea syndrome (OSAHS).Methods: This prospective, randomized, and comparative study was conducted in a university ophthalmology clinic. 106 eyes of 106 patients with OSAHS and 44 eyes of 44 healthy individuals were evaluated in this study. Only right eyes were evaluated. The patients with OSAHS were divided into three groups as mild (group 1), moderate (group 2), and severe (group 3) according to apnea-hypopnea index. The PPCT, CMCT, and RNFL measurements were performed by using spectral domain optical coherence tomography with enhanced depth imaging technique. The main parameters assessed were PPCT-Temporal, PPCT-Superior, PPCT-Nasal, PPCT-Inferior quadrants, CMCT, and RNFL thicknesses.Results: The PPCT of all quadrants was significantly thicker in the control group compared with the moderate and severe subgroups of OSAHS (p < 0.05). The PPCT-Superior and PPCT-Temporal were significantly thinner in the mild subgroup compared with the control group (p = 0.003 and p = 0.028, respectively). There was no difference between the control and mild groups regarding the RNFL thicknesses except nasal RNFL and inferotemporal RNFL which are thinner in the mild group. The RNFL thicknesses of all quadrants were significantly thicker in the control group compared with moderate and severe subgroups (p < 0.05). The CMCT was significantly thicker in the control group compared with all subgroups of OSAHS (p < 0.05).Conclusions: In OSAHS patients, PPCT, CMCT, and RNFL were significantly thinner compared with the control group. These results may explain why OSAHS patients are prone to normotensive glaucoma.

Summary Background Chronic obstructive pulmonary disease (COPD) is a frequent disease of the lungs. Its prevalence was estimated to be 26% in the Global Initiative for Chronic Obstructive Lung Disease (GOLD) I and 11% for GOLD II–IV in Austria. Globally, it ranks third in mortality rate. The particular challenge is that care for these patients falls short due to the lack of structured integrated care. The aim was to assess the current status of multiprofessional COPD care in Austria and identify gaps and potentials. Methods We conducted guided focus group interviews between March and July 2016 addressing current COPD care and treatment gaps with the following professional and interest groups: general practitioners, nurses, patients, pharmacists, physiotherapists and pulmonologists. We interviewed 23 patients and 27 healthcare professionals. The interviews were transcribed verbatim and coded into 12 relevant categories. Results There needs to be a shift in thinking from treatment-based care to prevention. Patients, just like healthcare professionals, need periodic updates and comprehensive information on this disease. Creating internet platforms with useful information for COPD patients and solving the data privacy issues of the Austrian electronic medical record (ELGA) are also perceived as viable steps. There is a need and request for healthcare professionals to work as a team with clear COPD management guidelines in the outpatient sector, the establishment of outpatient rehabilitation centers as well as creating a new professional profile, the COPD nurse. Conclusion Current COPD care needs to be reorganized, particularly in the outpatient sector, to address the needs of patients and healthcare professionals.

Hemophagocytic syndrome (HS) and Adult-onset Still’s disease (AOSD) are both rarely systemic inflammatory disorders. It may be difficult to differentiate these inflammatory disorders from each other. There are some signs that may help clinicians in the diagnosis such as high ferritin levels for AOSD, and leukopenia, thrombocytopenia, hypertriglyceridemia for HS. Hemophagocytic syndrome secondary to Adult-onset Still’s disease was reported rarely in literature. In this article, we aimed to report a patient of 65-year old female diagnosed with HS and AOSD with extremely high serum ferritin levels.

Neurodegenerative diseases progress slowly, creating increasing physical disability with unpredictable disease trajectories. The disease's life-threatening nature often places these patients in palliative care. There are several factors that complicate the care of patients with neurodegenerative diseases in palliative care units. Owing to physical impairments, there are many communication barriers between patients and staff. Nurses are not able to duplicate the patient's meticulous daily routine leading to caregiver mistrust in the nurse's competencies. Even if the patient is hospitalised, caregivers may not take the much-needed time off to recuperate. The placement of patients with neurodegenerative diseases in palliative care is confusing, since they rarely die during in-hospital treatment but might even get better due to multidisciplinary treatment. Finally, patients and caregivers lack adequate knowledge about disease progression and available help and support programmes. Patients with neurodegenerative diseases urgently need palliative care and nurses and caregivers need better preparation to appropriately deal with these diseases.

Early mobilization and rehabilitation of patients in intensive care units (ICUs) may improve physical function, and reduce the duration of delirium, mechanical ventilation, and ICU length of stay. However, safety concerns are an important barrier to widespread implementation.To synthesize safety data regarding patient mobilization and rehabilitation in the ICU, including falls, removal of endotracheal tubes, removal or dysfunction of intravascular catheters, removal of other catheters/tubes, cardiac arrest, hemodynamic changes, and desaturation.Systematic literature review, including searches of five databases. Eligible studies evaluated patients who received mobilization-related interventions in the ICU. Exclusion criteria included: (1) case series with fewer than 10 patients; (2) majority of patients under 18 years of age; and (3) data not reported to permit calculation of incidence of safety events.Number of patients, mobilization/rehabilitation sessions, potential safety events, and events with negative consequences (e.g., requiring intervention or additional therapy).Heterogeneity was assessed by IPatient mobilization and physical rehabilitation in the ICU appears safe, with a low incidence of potential safety events, and only rare events having any consequences for patient management. Heterogeneity in the definition of safety events across studies emphasizes the importance of implementing existing consensus-based definitions.

The aim of this study was to investigate the locomotor activity and anxiety changes in acute and chronic exposure to cigarette smoke in mice. In the chronic exposure group, mice were exposed to the smoke of 10 cigarettes for 5 days a week, over 5 consecutiveweeks. In the acute group, the mice were exposed to the smoke of 10 cigarettes in one day. Locomotor activity tests and plus-maze tests were performed to determine the locomotor activity and anxiety levels of these mice. In the chronic exposure group, comparing with the both acute exposure and the control groups all parameters tested including distance travelled ( p

Macroglossia has been very rarely reported as a first clinical sign of multiple myeloma.

Objective One of the frequently encountered disorders of wound healing following laryngectomy is pharyngocutaneous fistula. However, although studies have been performed with the aim of prevention of pharyngocutaneous fistulae, there are very few studies with tissue adhesives and platelet-rich plasma. In this study, our aim was to investigate the histopathologic changes in wound healing caused by various tissue adhesives and platelet-rich plasma, together with their effects on prevention of pharyngocutaneous fistula. Methods 40 male rats were randomly divided into five groups: control, platelet-rich plasma, fibrin tissue adhesive, protein-based albumin glutaraldehyde and synthetic tissue adhesive groups. The pharyngotomy procedure was performed and was sutured. Except the control group, tissue adhesives and platelet-rich plasma were applied. Then, the skin was sutured. On the seventh day, the rats were sacrificed. The skin was opened and pharyngotomy site was assessed in terms of fistulae. The pharyngeal suture line was evaluated histopathologically by using Ehrlich Hunt scale. Results Inflammatory infiltration was found to be higher in “platelet-rich plasma” group than “fibrin tissue adhesive” and “synthetic tissue adhesive” groups. The fibroblastic activity of “platelet-rich plasma”, “fibrin tissue adhesive” and “protein-based albumin glutaraldehyde” groups was higher than the control group. The positive changes created by platelet-rich plasma and fibrin tissue adhesive at the histopathologic level were found together with no detected fistula. Among the study groups, there was no statistical difference for pharyngeal fistula development. This result may be obtained by the small number of animal experiments. Conclusion These results shed light on the suggestion that platelet-rich plasma and fibrin tissue adhesive can be used in clinical studies to prevent pharyngocutaneous fistula.

Objective: Candidemia rates in liver transplant recipients (LTRs) differs from center to center, geographic locations and type of solid organ transplantation. We aimed to investigate the risk factors and prevalence of candidemia in adult LTRs in our center. Methods: Between January 2003 and December 2012, microbiological and clinical data of adult (>18 years) LTRs were searched from mycology laboratory and patients? records retrospectively. The presence of candidemia was defined by determining at least one positive blood culture. Cases were followed at least 150 days after transplantation (150 days-10 years). The risk factors were investigated in preoperative, intraoperative and postoperative periods. None of the patients received antifungal prophylaxis. Result: In the study period, 388 of 472 patients undergoing liver transplantation were included. Candidemia was detected in 10 (2.6%) patients. Among the important risk factors albumin level below 2.8 mg/dl, the use of vascular graft, the presence of biliary complication, hospitalization in intensive care unit(>6days), re-operation, the presence of surgical site infection and postoperative length of stay were detected as significant risk factors. The most common pathogen was C. albicans. Five (50%) patients with candidemia died and C. albicans was responsible for candidemia. Attributable mortality of candidemia was 60%. The presence of candidemia increases the mortality rate significantly (p-value=0.023) Conclusion: Candidemia should be diagnosed as early as possible. In the population without antifungal prophylaxis, candidemia ratio is not higher than the other studies reported formerly. The lower rate of candidemia can be achieved through good patient preparation in pre-transplant period, meticulous surgical technique, use of biological rather than synthetic vascular graft and early discharge after transplantation.