Long-term intensive care unit outbreak of carbapenemase-producing organisms associated with contaminated sink drains

BACKGROUND

Between 2018 and 2022, a Belgian tertiary care hospital faced a growing issue with acquiring carbapenemase-producing organisms (CPO), mainly VIM-producing P. aeruginosa (PA-VIM) and NDM-producing Enterobacterales (CPE-NDM) among hospitalized patients in the adult intensive care unit (ICU).

AIM

To investigate this ICU long-term CPO outbreak involving multiple species and a persistent environmental reservoir.

METHODS

Active case finding, environmental sampling, whole-genome sequencing (WGS) analysis of patient and environmental strains, and implemented control strategies were described in this study.

FINDINGS

From 2018 to 2022, 37 patients became colonized or infected with PA-VIM and/or CPE-NDM during their ICU stay. WGS confirmed the epidemiological link between clinical and environmental strains collected from the sink drains with clonal strain dissemination and horizontal gene transfer mediated by plasmid conjugation and/or transposon jumps. Environmental disinfection by quaternary ammonium-based disinfectant and replacement of contaminated equipment failed to eradicate environmental sources. Interestingly, efflux pump genes conferring resistance to quaternary ammonium compounds were widespread in the isolates. As removing sinks was not feasible, a combination of a foaming product degrading the biofilm and foaming disinfectant based on peracetic acid and hydrogen peroxide has been evaluated and has so far prevented recolonization of the proximal sink drain by CPO.

CONCLUSION

The persistence in the hospital environment of antibiotic- and disinfectant-resistant bacteria with the ability to transfer mobile genetic elements poses a serious threat to ICU patients with a risk of shifting towards an endemicity scenario. Innovative strategies are needed to address persistent environmental reservoirs and prevent CPO transmission.

The effect of online and face-to-face active learning methods on learning attitudes

AIM

This study aims to compare the effects of online and face-to-face education models using active learning methods on students' learning attitudes.

METHODS

This retrospective and quasi-experimental study included total 203 third-grade nursing students who took the Obstetrics and Gynecological Health Nursing course face-to-face and online in the fall semester of the 2019-2020 and 2020-2021. Active Learning Methods Questionnaire and the Scale Attitude Towards Learning (SATL) were used.

RESULTS

The mean score of active learning methods of the students receiving online education (77.35 ± 18.63) was higher than the face-to-face education group (67.00 ± 20.67). Although there was no difference between the face-to-face and online education groups in terms of the effort to learn and caring for learning, online students had a lower attitude towards learning avoidance (t: 6.540, p: 0.000). There was a negative and low-level significant correlation between the evaluation of active learning methods and the total score of SATL in the online education group (r = -0.200; p = .043), no correlation in face-to-face group (r: 0.004; p: 0.963).

CONCLUSION

Online education, which uses active learning methods, affected positively students' attitudes towards learning and decreased their avoidance of learning more than face-to-face education. This study has shown that active learning methods allow online students to question theoretical knowledge, convey it to patient care, contribute to clinical knowledge, and facilitate their learning and analytical thinking based on the more positively evaluation by online students.

Effects of Relaxation-Focused Nursing Program in Women with Ovarian Cancer: A Randomized Controlled Trial

BACKGROUND

Surgical treatment is a major cause of hospitalization in ovarian cancer. In this process, physical problems, such as pain and changes in respiratory functions, and psychological problems, such as anxiety and stress, may develop.

AIM

This study aims to investigate the effects of the Relaxation-Focused Nursing Program on pain, anxiety, lung volume, level of knowledge, and nursing care satisfaction in ovarian cancer surgery.

METHOD

A randomized controlled trial in which participants were randomly assigned to either the experimental (preoperative relaxation exercises and education; n = 24) or control (usual nursing care; n =22) groups. The intervention consisted of practicing four sessions of relaxation exercises and education in the hospital for two days before surgery. Data were collected using the Trait and State Anxiety Inventory, Surgical Information Form, and Perioperative Assessment Form. The results were analyzed using the Friedman and Wilcoxon tests.

RESULTS

The findings showed significant reductions in pain (p = .045) and anxiety scores (p < .001). The level of knowledge means scores were higher in the experimental group, but there was no significant difference between mean scores of spirometer volume and care satisfaction.

CONCLUSIONS

The program was more effective than usual nursing care in preoperative anxiety, pain, and level of knowledge. Although there was no difference between the care satisfaction scores of the patients, the reasons for care satisfaction were different in the program. Developing and implementing care that combines stress reduction interventions and preoperative education can improve the preoperative outcomes of patients.

An investigation of vitamin and mineral supplement recommendation among first-trimester pregnancies

Background Healthy and balanced nutrition in pregnancy can affect the mother's and the fetus' health. Therefore, health professionals should provide information about this issue to pregnant women. The aim of the study was to examine the rate of vitamin and mineral supplement recommendation among first-trimester pregnant women. Methods The study sample consisted of 697 first-trimester pregnant women between 18 and 40 years of age. The pregnant women who registered to an obstetric outpatient clinic between January and June 2018 were retrospectively reviewed, and data were collected from patient medical records using a questionnaire. Results Physician's laboratory test orders from the women included the following: ferritin was 18.4%, mean corpuscular hemoglobin (MCH) was 99.7%, folic acid was 10.2%, vitamin D was 6.3%, vitamin B12 was 17.2% and calcium was 20.4%. All of the women's hemoglobin levels had been examined. A total of 58.8% of the women were recommended to take folic acid, 32.7% iron, 25.7% iodine, 18.8% calcium, 17.2% vitamin A, 21.1% vitamin B12, 17.4% vitamin C, 31.6% vitamin D and 17.5% vitamin E supplements. Conclusion It was determined that ferritin, vitamins B12 and D, calcium, folic acid, iron and iodine levels were not examined routinely in this study. Folic acid and iron supplementation were the most commonly suggested nutrient supplements in the first trimester.

Feelings, thoughts and experiences of women diagnosed with adnexal mass: A qualitative study

Adnexal masses have a risk of malignancy, especially in postmenopausal women, thus affecting the physical, psychological, and social lives of women with such masses. In addition, patients require a long duration of hospitalization during treatment. In earlier studies, researchers have focused on the experiences of newly diagnosed women or the side effects of treatment. However, women's experiences during the hospitalization period have been ignored. In this study we explored the feelings, thoughts, experiences, and nursing care needs of women hospitalized with adnexal mass diagnosis. In this qualitative study, interviews were conducted with 11 women hospitalized for an adnexal mass or ovarian cancer diagnosis. The feelings, thoughts, and experiences of the women were negatively affected. They were more likely to rely on internal motivation and had lesser expectations of professional support. Thus, nurses should provide women with this diagnosis social support and facilitate their adaptation to the hospital. The diagnosis and treatment of adnexal masses is a complex process that requires teamwork. Therefore, navigator nurses can be of great help to women during their illness.

Apical extrusion of debris using reciprocating files and rotary instrumentation systems

BACKGROUND

To compare the preparation time and amount of apically extruded debris after the preparation of root canals in extracted human teeth using the reciprocating files and rotary nickel-titanium systems.

PROCEDURE

Sixty extracted human mandibular premolars were used. The root canals were instrumented using reciprocating (WaveOne, Reciproc, SafeSider) or rotary motion (Typhoon, ProTaper Universal, Mtwo), and the debris produced was collected in glass vials. The remaining debris was assessed using a microbalance and statistically analyzed using the one-way ANOVA and Duncan multiple range tests at a significance level of P < 0.05. The time required to prepare the canals with different instruments was also recorded.

RESULTS

The Reciproc group produced significantly less debris when compared to the Typhoon group (P < 0.05), and instrumentation with the single-file systems was significantly faster than in the multi-file systems (P < 0.05). The WaveOne group extruded significantly more debris per unit of time than the other groups, with the exception of the Typhoon group (P < 0.05).

CONCLUSION

According to our study, all systems caused apical debris extrusion. However, the Reciproc group was associated with less debris extrusion when compared to the other groups.

Measurements of axial length and radius of corneal curvature in the rabbit eye

The axial length of the eye, the radius of the anterior corneal surface, and the diameter of the cornea were measured on 40 eyes of 20 New Zealand White rabbits. The ultrasonographic measurements of the axial length of the eye showed a mean value of 15.12 +/- 0.51 mm (15.33 +/- 0.50 mm in males, 14.96 +/- 0.46 mm in females). The mean corneal radius was 7.26 +/- 0.26 mm (7.18 +/- 0.9 mm in males, 7.32 +/- 0.33 mm in females); the mean value of the difference in corneal curvature between two principle meridians was 0.21 +/- 0.12 mm; and the mean horizontal and vertical diameters of the cornea were 13.41 +/- 0.34 mm and 13.02 +/- 0.30 mm, respectively. Although the diameter of the cornea of rabbits was bigger than that of humans (average, horizontal 11.75 mm, vertical 10.55 mm), the axial length of the eye was 0.7 times that of humans (23-24 mm), and the radius of corneal curvature was relatively smaller than that in humans (7.7-7.8 mm).