Determination of Nursing Care Times Based on the Perroca Patient Classification Instrument in the Inpatient Oncology Unit: A Mixed Method Study

OBJECTIVES

The aim of this study was to determine the daily nursing care times of hospitalized inpatient oncology unit patients according to degree of acuity using the Perroca Patient Classification tool.

DATA SOURCES

This study used a mixed method sequential explanatory design. The "Nursing Activity Record Form" and "Perroca Patient Classification Instrument" were used for quantitative data collection, and direct observation was performed for 175 hours via time-motion study. Descriptive statistics, between-group comparison, and correlation analysis were used for data analysis. Using a semistructured questionnaire, qualitative data were collected from individual in-depth interviews with seven nurses who participated in the quantitative part of the study. Qualitative data were analyzed by thematic analysis. The reporting of this study followed GRAMMS checklist.

CONCLUSIONS

As a result of the integration of quantitative and qualitative data, daily nursing care duration was determined as 2 to 2.5 hours for Type 1 patients, 2.6 to 3.5 hours for Type 2 patients, 3.6 to 4.75 hours for Type 3 patients, and 4.76 to 5.5 hours for Type 4 patients. The findings showed that in an inpatient oncology unit, nursing care hours increased as patients' Perroca Patient Classification Instrument acuity grade increased; thus, the instrument was discriminative in determining patients' degree of acuity.

IMPLICATIONS FOR NURSING PRACTICE

Nurse managers can utilize this study's results to plan daily assignments that are sensitive to patient care needs. The results can also help nurse managers to identify relationships between nurse staffing and patient outcomes at the unit level, as well as to develop ways to analyze such relationships.

Assessment of the Psychometric Properties of the Online Education Student Satisfaction Scale: A Methodological Study

Background and Purpose: Assessing student satisfaction is essential in evaluating the quality of education. The number of valid and reliable tools that measure students' satisfaction with online education is limited. This methodological study aimed to assess the psychometric properties of the online education student satisfaction scale. Methods: Eleven academicians from the nursing field provided expert opinions on content validity. Separate 25 students evaluated the language clarity of the draft scale. The study sample included 525 third- and fourth-year nursing students. Finally, a group of 30 nursing students different from the sample participated in the test-retest. The study created an item pool based on the recent literature. The researchers calculated the items' content validity rates and the scale's content validity index by taking the experts' opinions. In addition, item-total score correlation analysis, exploratory factor analysis, discrimination analysis, stability test, and internal consistency analysis were performed. Results: An item with a low-correlation value was excluded from the scale. The correlation coefficients of the remained items were between .536 and .811. In the second round of exploratory factor analysis, a five-factor structure emerged that explained 72.1% of the total variance. In addition, item discrimination, stability, and internal consistency test results ensured that the scale was valid and reliable. Conclusions: The online education student satisfaction scale with five subdimensions containing 28 items is a valid and reliable tool. Researchers, educators, and managers may use it to evaluate students' satisfaction with online education.

Effect of moral sensitivity on professional values of undergraduate nursing students: Mediating effect of empathic tendency

BACKGROUND

The development of professional values in nursing students is an important issue for the nursing profession. However, the research on nursing students' professional values and its related factors is very limited.

PURPOSE

This cross-sectional and correlational study aimed to examine the mediating effect of empathy between moral sensitivity and professional values.

METHODS

This study was conducted with 328 second, third and fourth-year students. The participants completed an online survey consisting of the student information form, Modified Moral Sensitivity Questionnaire for Student Nurses, Empathic Tendency Scale and Nursing Professional Values Scale.

RESULTS

The results showed that moral sensitivity affected undergraduate nursing students' professional values not only directly but also indirectly through empathic tendency.

CONCLUSIONS

The results of the study show that moral sensitivity and empathic tendency support the acquisition of professional values in undergraduate nursing students. Nurse educators needs to realize that can be improved professional values by integrating moral sensitivity and empathic tendency in their curriculum.

Nurse performance: A path model of clinical leadership, creative team climate and structural empowerment

AIMS AND OBJECTIVES

This study aimed to: (a) identify and examine the influence of clinical leadership, creative team climate (CTC) and structural empowerment (SE) on the nurse performance (NP) of clinical nurses in hospitals in Turkey, and (b) establish a model designed to verify the fit and effect of these factors.

BACKGROUND

Nurse performance is a significant indicator of work efficiency, patient care quality and patient safety. Existing studies explaining the mechanisms that lead to higher nurse performance have been limited.

DESIGN

This descriptive, cross-sectional study used relation prediction modelling and adhered to STROBE guidelines.

METHODS

This study used an online survey to collect data from volunteered 664 clinical nurses working in hospitals in Turkey. The data were analysed using SPSS version 26.0 and the AMOS 24.0 program. Path analysis was used to verify/test the hypothetical model, and the fit was evaluated by χ² /df, GFI, AGFI, NFI, CFI, IFI, RFI, TLI, RMR and RMSEA.

RESULTS

The fit index of the modified path model was χ² /df = 3.730, GFI = 0.904, AGFI = 0.892, NFI = 0.907, CFI = 0.923, IFI = 0.923, RFI = 0.906, TLI = 0.912, RMR = 0.078 and RMSEA = 0.064. Through creative team climate and structural empowerment, clinical leadership had the greatest standardised direct (β = .35) and indirect (β = .17) effects on clinical nurse performance, the final outcome variable. Creative team climate (β = .23) and structural empowerment (β = .19) also had a significant standardised direct effect on nurse performance. Clinical leadership, creative team climate and structural empowerment explained 39% of the total variance of nurse performance.

CONCLUSIONS

This study shows that clinical nurse performance in hospitals was significantly influenced by clinical leadership, creative team climate and structural empowerment. The results suggest that intervention programmes considering these factors could be implemented to enhance nurse performance.

RELEVANCE TO CLINICAL PRACTICE

Improved nurse performance requires strong clinical leadership, creative team climate and structural empowerment. Therefore, healthcare organisations may implement initiatives to enhance nurse performance by taking these factors into account.

Opinions and experiences of healthcare professionals regarding structured virtual patient visits in ICUs: A qualitative study

OBJECTIVES

This study aimed to reveal the experiences of healthcare professionals regarding a structured Virtual Patient Visit (sVPV) program implemented in an ICU during the coronavirus disease 2019 (COVID-19) pandemic and to share the process of establishing the program.

DESIGN

This qualitative, exploratory study was conducted using a semi-structured, in-depth interview method.

SETTING

The study was conducted in a university hospital ICU in Turkey (where a sVPV program was implemented) and comprised one physician, eight nurses, and one clerk who volunteered to participate in the study. The data were evaluated with content analysis, and themes and sub-themes were determined.

FINDINGS

Five themes and 13 subthemes were obtained: (1) an essential program during the pandemic, (2) contributing to patient's recovery, (3) family-centered care, (4) innovativeness, and (5) sustainability.

CONCLUSION

The results show that the sVPV program is highly innovative and effective and contributed to positive patient outcomes and family-centered care practices during the COVID-19 pandemic. In addition, it was revealed that in order to conduct sVPVs effectively, organizational planning, such as legal processes, and the employment of experienced and competent healthcare professionals, should be well managed.

CLINICAL RELEVANCE

A well-designed sVPV program specific to the setting alleviates anxiety among patients and family members, increases patient motivation and healing, and decreases the workloads of healthcare professionals. It is recommended that the sVPV program, which can be easily used during not only COVID-19 pandemics but also during other crises, be adopted in all ICUs and carried out by a dedicated nurse or healthcare provider.

Predicting work performance and life satisfaction of nurses and physicians: The mediating role of social capital on self-efficacy and psychological resilience

PURPOSE

To examine the mediating role of social capital in the effects of self-efficacy and psychological resilience on nurses' and physicians' work performance and life satisfaction.

DESIGN AND METHODS

In this cross-sectional study, data were collected using an online questionnaire.

FINDINGS

Social capital had 0.04 indirect effects of general self-efficacy and psychological resilience on work performance, and accounted for 48% and 35% of the total effect, respectively. Social capital had 0.11 and 0.07 indirect effects of general self-efficacy and psychological resilience on life satisfaction, and accounted for 16% and 19% of the total effect, respectively.

PRACTICE IMPLICATIONS

The study suggests the existence of social capital when nurses' and physicians' self-efficacy and psychological resilience affect their work performance and life satisfaction.

The effect of structured virtual patient visits (sVPVs) on COVID-19 patients and relatives' anxiety levels in intensive care unit

AIM AND OBJECTIVES

To determine the effect of structured Virtual Patient Visits (sVPVs) on the anxiety, satisfaction, hospital anxiety and depression levels of intensive care unit (ICU) COVID-19 patients and their relatives.

BACKGROUND

There is no evidence regarding the direct effect of virtual patient visits in the ICU.

DESIGN

The STROBE statement guided this study. This investigator-initiated, prospective and single-centre study included COVID-19 patients and their relatives in an adult ICU between July and December 2020. We implemented daily sVPVs between all patients and their relatives. The study's primary outcome was the daily anxiety levels of patients and relatives immediately before and after sVPVs. The secondary outcomes were as follows: 1) hospital anxiety (HADS-A) and depression (HADS-D) levels during admission to and after discharge from the ICU and 2) satisfaction levels regarding the ICU and sVPVs of patients' relatives.

RESULTS

A total number of 301 daily sVPVs were conducted between 50 patients and their relatives. There was a significant difference between daily anxiety levels before and after sVPVs in both patients (2.97 vs. 1.49) and their relatives (5.70 vs. 3.53; p > .05). Whereas the anxiety levels of patients with basic face or high flow nasal cannula and non-invasive mechanical ventilation decreased statistically significantly more than those with IMV after a sVPV (p < .001), there was not a significant difference in decreased anxiety levels of patients' relatives according to the type of respiratory support provided to the patient (p > .05). HADS-A levels of relatives decreased statistically significantly after discharge/death. There was no statistically significant difference in HADS-A and HADS-D levels after discharge/death between the relatives of patients who died or did not die (p > .05). Furthermore, the overall ICU satisfaction rates were statistically significantly lower in relatives of patients who died than those who did not die (p < .05).

CONCLUSION

Regardless of whether the patients were intubated, sVPVs reduced the anxiety levels of all patients and relatives. The sVPV programme offered emotional support to patients and family members, with high levels of satisfaction, as well as provided regular informative updates and the opportunity for daily visits or final goodbyes.

RELEVANCE FOR CLINICAL PRACTICE

The sVPV programme is essential for all ICUs during the COVID-19 pandemic.

Effects of demographic, occupational, and practice environment variables on organizational silence among nurse managers

AIM

To define nurse managers' organizational silence behaviors and examine the demographic, occupational, and practice environment factors that may influence their silence.

BACKGROUND

Organizational silence is affected by organizational structures, policies and procedures, team structures, and practice environments. Whether nurse managers' behaviors affect the organizational silence and practice environment in particular has not been thoroughly studied.

METHODS

This cross-sectional study was conducted using an online survey of 169 nurse managers working in a group of private hospitals in Turkey. Data were collected using the Nurse Manager Practice Environment Scale, the Organizational Silence Behavior Scale, and a questionnaire with 16 sociodemographic and job-related questions, and descriptive statistics, correlations, and regression analyses were used to analyze the data.

RESULTS

Nurse managers exhibited acquiescent silence and silence for the protection of the organization. There was a negative correlation between scores on the two scales. Regression analysis showed that nurse managers' organizational silence was affected by the two subscales of nurse managers' practice environment and the ability to express opinions openly.

CONCLUSION

Positive work environment and being able to express opinions comfortably decrease the level of organizational silence of nurse managers. Implications for nursing and health policy: In order to reduce organizational silence behaviors, along with open-door policies and a corporate culture where ideas can be expressed freely, health institutions should implement measures to ensure a positive work environment that empowers administrative leaders to create a culture of patient safety and culture of generativity. Regulating the roles and responsibilities of nurse managers at the institutional level and implementing appropriate nursing laws and regulations at the national level will facilitate changes to improve their management practices.

Why do nurses choose to stay silent?: A qualitative study

AIM

This study aimed to explore nurses' views and experiences regarding remaining silent.

BACKGROUND

Silence is a barrier for organizational improvement and can occur for many reasons; it cannot be simply defined as the opposite of speaking out.

METHOD

An exploratory qualitative design was used for this study. Data were collected using semi-structured interviews in 2016 with 24 nurses who were recruited by using a snowball sampling method.

RESULTS

Three themes emerged as a result of the thematic analysis: fear, silence climate and disengagement. The first theme contained three subthemes: avoidance of being seen as a troublemaker, financial loss and reluctance to reveal lack of ability or knowledge. The results indicated that nurses remained silent when they felt unsupported or psychologically unsafe in their work environment.

CONCLUSION

Encouraging nurses to express their opinions is essential for creating a psychologically safe nursing work environment and an organizational climate that supports open communication. Because the majority of healthcare professionals are nurses, they can act as role models and change agents for other nurses if they are encouraged to share their ideas and opinions without fear of retribution.

Determining nursing service management standards in Turkey: A Delphi study

OBJECTIVE

To establish the current management standards needed by nurse managers in Turkey and to share the process of establishing standards.

BACKGROUND

Relevant and utilizable nursing management standards are needed for effective and efficient nursing administration to achieve better outcomes in health care.

METHODS

A three-round e-Delphi method was used in this study. First, the experts were asked an open-ended question. In the second and third rounds, data analysis measurements included item-by-item per cent agreement, standard deviation, average, median and interquartile range.

RESULTS

At the end of the third round, 49 standards were obtained under five main standards for nurse managers: management and organisation; leadership; human resources management; quality management; and professionalism.

CONCLUSION

The results of this study, which represent a consensus on nursing management standards drawn from the views of experts across regions and institutions in Turkey, provide a baseline to design, manage and evaluate nursing services.

IMPLICATIONS FOR NURSING MANAGEMENT

Nursing management standards, which are fundamental for designing, leading and evaluating nursing services, give a framework for nurse managers to provide effective and efficient administrative practices.

The transcultural adaptation and the validity and reliability of the Turkish Version of Perroca's Patient Classification Instrument

AIM

This study examines the transcultural adaptation and the reliability and validity of the Turkish version of Perroca's Patient Classification Instrument.

BACKGROUND

Nurse managers need valid and reliable patient classification tools for determining patients' acuity or dependency levels on nursing care for measuring nursing workloads.

METHODS

This study was conducted in two stages in a private hospital in Istanbul, Turkey. First, the instrument was translated, and its content validation was analysed. In the second stage, data were gathered from 300 hospitalized patients and were analysed by factor analyses, Cronbach's alpha and Cohen's kappa.

RESULTS

Validity testing with ten experts revealed a scale-content validity index of 0.93. Exploratory factor analysis revealed a two-dimensional instrument with distinct factor loadings and a variance of 66.97%. The confirmatory factor analysis revealed that the fit indices were satisfactory. This instrument had an overall Cronbach's alpha coefficient of .86 and Cohen's kappa coefficient of .826.

CONCLUSION

The study provides evidence that the Turkish version of Perroca's Patient Classification Instrument is a valid and reliable tool to determine patients' acuity levels on nursing care.

IMPLICATIONS FOR NURSING MANAGEMENT

This instrument may be used by nurse managers to determine acuity levels of patients and measure nursing workload.

Relationship between nurses' practice environments and nursing outcomes in Turkey

AIM

This study aimed to understand nursing practice environment characteristics in Istanbul-area hospitals in Turkey, the relationship between these characteristics, nurse burnout levels and nurses' intentions to leave work.

BACKGROUND

A well-known relationship exists in many countries between nursing practice environments and nurse burnout and intention to leave work. However, little is known about the relationship between practice environment characteristics and nursing outcomes in Turkey.

METHODS

This cross-sectional study was conducted among 2592 nurses in 20 Ministry of Health and 29 private hospitals in Istanbul, Turkey. A demographic questionnaire, Practice Environment Scale of the Nursing Work Index and Maslach Burnout Inventory were used for data collection.

RESULTS

Almost half of nurses suffered from high-level burnout related to emotional exhaustion and personal accomplishment, and one-third reported depersonalization and the intent to leave their jobs within a year. A poor nursing practice environment was the leading factor, increasing nurses' burnout levels in all subdimensions. Burnout related to emotional exhaustion, personal accomplishment and poor practice environment increased intention to leave. Permanent positions decreased intention.

DISCUSSION

There was a relationship between poor practice environments and nursing outcomes in Turkey.

LIMITATIONS

The use of a survey data collection method is a potential study limitation. Quantitative and qualitative methods could be combined to obtain more detailed objective data about nursing practice environments.

CONCLUSION

Poor practice environments, high-level burnout and intention to leave work are significant problems in Istanbul, Turkey. Favourable practice environments and job security should be provided to improve nursing outcomes.

IMPLICATIONS FOR NURSING POLICY

Policymakers and nurse managers should be aware of any negative issues regarding nursing practice environments and job security to improve nursing outcomes.

Turkish critical care nurses' views on end-of-life decision making and practices

BACKGROUND

Life-sustaining treatments are increasingly used in intensive care units (ICUs) for EOL care, but the decision to use these may cause ethical issues.

AIMS AND OBJECTIVES

The aim of this study was to investigate the views and practices of critical care nurses in Turkey on the end-of-life (EOL) care.

DESIGN

This was a cross-sectional study.

METHODS

The research was conducted in 32 second- and third-level ICUs of 19 Ministry of Health research hospitals in Turkey. The Views of European Nurses in Intensive Care on EOL Care tool was used for data collection.

RESULTS

The total sample size was 602. While half of the nurses stated that the withholding and withdrawal of life support were ethically different decisions, 40% felt both decisions were unethical. The expected quality of life as viewed by the patient, the medical team, the family and the nursing team (90·4%, 85·4%, and 83·4%, respectively) was an important factor in EOL decision making. The majority of the nurses (75·7%) were not directly involved in the EOL decision making and 78·4% of nurses were committed to family involvement in EOL decisions. When withdrawing treatment, 87·2% of ICU nurses agreed that the patient and family members should perform their final religious and spiritual duties. Further results showed that after withdrawing treatment, a majority of nurses (86%) agreed to continue pressure sore prevention, effective pain relief (85·5%), nutritional support (77·6%) and hydration (64·8%). Almost half (48·2%) indicated that keeping the patients in the ICU was unnecessary.

CONCLUSION

ICU nurses expressed a range of experiences and practices regarding EOL care. ICU nurses should be more involved in the decision-making process about EOL care.

RELEVANCE TO CLINICAL PRACTICE

Due to their unique relationship with patients, nurses should be involved in EOL care decision making; however, patients, families or nurses are not often involved in the decision-making process in Turkey.

Intensive care units in Turkish hospitals: do they meet the minimum standards?

BACKGROUND

International and national standards for ICUs have been developed to ensure patient safety and provide effective and efficient service in these units. However, global economic crises along with shortages in professional health care staff affect the ability of ICUs to meet and maintain these standards.

AIMS AND OBJECTIVES

The aim of this study was to ascertain whether the equipment and workforce in intensive care units (ICUs) in Turkish hospitals meet current ICU standards.

DESIGN

This is a descriptive study based on the results of a survey questionnaire.

METHODS

In total, 145 ICUs in university and private hospitals in Turkey participated in this survey. Data collection was done by means of a survey questionnaire that assessed the current equipment and workforce in these ICUs.

RESULTS

We found that 97·0% of the occupied beds in the ICUs had a cardiac monitor. Crash-carts were present in every ICU. Transport monitors and transport ventilators were available in two of three and in one of two ICUs, respectively. In 82·8% of the ICUs, a physician (as a trainee level) was present at all times, while only a few ICUs had ICU-care team members such as respiratory- and physiotherapist, clinical pharmacists and dieticians available. There was a general shortage of nursing staff in ICUs.

CONCLUSION

Currently, ICUs in Turkish hospitals meet the majority of standards for ICU equipment, but they fail to meet both the international and national standards for ICU workforce requirement.

CLINICAL RELEVANCE

Hospital and ICU managers could use our findings to compare their facilities with others or to identify areas in need of improvement.

Tumour necrosis factor alpha -308G/A gene polymorphism: lack of association with knee osteoarthritis in a Turkish population

OBJECTIVE

To study the association between TNFalpha-308 G/A polymorphism and susceptibility to and severity of knee osteoarthritis in a Turkish population.

METHODS

Genomic DNA was obtained from 151 patients with knee osteoarthritis and 84 ethnically matched healthy controls. Polymerase chain reaction-restriction fragment length analysis was used to identify G/A polymorphism at position -308 in the promoter region. Genotype distributions and allelic frequencies of TNFalpha-308 G/A polymorphism were compared between osteoarthritis patients and controls. Thereafter, this association was investigated between patients and controls of the same sex. In addition, the standard Kellgren-Lawrence grading score and the Turkish version of the Western Ontario and McMaster Universities Osteoarthritis Index were used to assess the radiological and functional severity of the disease and their relationship with the TNFalpha-308 gene polymorphism was investigated.

RESULTS

Genotype distribution and allelic frequencies of -308 G/A polymorphism in the TNFalpha gene did not differ significantly between patients with knee osteoarthritis and controls (p>0.05). Moreover, there were no significant differences between patients and controls of the same sex (p>0.05). In addition, no association was observed between the radiological and functional severity of the disease and TNFalpha-308 G/A polymorphism (p>0.05).

CONCLUSION

These findings suggest that the examined polymorphism in the TNFalpha gene does not contribute to susceptibility to or severity of knee osteoarthritis in the Turkish population.

Polyenylphosphatidylcholine pretreatment ameliorates ischemic acute renal injury in rats

AIM

Polyenylphosphatidycholine has been demonstrated to have antioxidant, cytoprotective and anti-inflammatory effects. Whether polyenylphosphatidycholine pretreatment affects ischemia/reperfusion-induced renal damage in vivo is not known and was investigated here in rats.

METHODS

Forty female Sprague-Dawley rats were divided into three groups. Group 1 (n = 10) was given saline (control, sham operated). Group 2 (n = 15) were given saline, and Group 3 (n = 15) were given polyenylphosphatidycholine (100 mg/day for 10 days prior to experiment). Groups 2 and 3 were subjected to bilateral renal ischemia (60 min) followed by reperfusion (6 h). After the reperfusion period, the rats were sacrificed and kidney tissue superoxide dismutase, glutathione, total nitrite and nitrate, malondialdehyde and myeloperoxidase levels, plasma aspartate aminotransferase, blood urea nitrogen and creatinine concentrations, and nuclear factor kappa beta expression were determined.

RESULTS

Serum levels of aspartate aminotransferase, blood urea nitrogen and creatinine were significantly decreased (P < 0.05) in the treatment group compared to those in the ischemic group. There were significant differences between treatment and ischemic groups regarding the tissue superoxide dismutase, glutathione, total nitrite and nitrate, malondialdehyde, and myeloperoxidase levels (P < 0.05). In addition, polyenylphosphatidycholine pretreatment reduced nuclear factor kappa beta expression in ischemic kidney tissue. Kidneys obtained from rats pretreated with polyenylphosphatidycholine demonstrated marked reduction of the histological features of renal injury compared to kidneys obtained from Group 2 rats, including a little vacuolization, pyknosis and necrosis.

CONCLUSIONS

Polyenylphosphatidycholine pretreatment provided significant protection against ischemia/reperfusion injury to the kidney. This treatment could be therapeutic in kidney transplantation and other conditions associated with ischemia/reperfusion injury to the kidney.

Glial cell line-derived neurotrophic factor and synaptophysin expression in pelviureteral junction obstruction

OBJECTIVES

To examine the expression of neuronal markers in congenital pelviureteral junction (PUJ) obstruction as a causative factor. The findings from some investigations have suggested that defective neuronal innervation may play an important role in the pathogenesis of PUJ obstruction.

METHODS

Using specific antibodies, we studied the neuronal markers of specimens from 12 cases of PUJ obstruction and 10 normal PUJs by immunohistochemistry using glial cell line-derived neurotrophic factor (GDNF), synaptophysin, S-100, and neurofilament.

RESULTS

In the PUJ obstruction specimens, staining with hematoxylin-eosin and Masson's trichrome revealed muscular hypertrophy and an increase in collagen tissue and fibrosis in the lamina propria and tunica muscularis. The most striking finding on immunohistochemistry was the marked nuclear staining of cells with synaptophysin in all layers of the PUJ obstruction specimens that was totally absent in the normal PUJ specimens. In addition, significantly less intense staining for GDNF was found in the PUJ obstruction specimens compared with the normal PUJ specimens. The underexpression of GDNF in PUJ obstruction specimens was localized in the muscular layer especially. Immunohistochemical staining for S-100 and neurofilament showed no differences in the expression level of these neuronal markers in normal and PUJ obstruction specimens.

CONCLUSIONS

Because GDNF is a survival factor for central and peripheral neurons, defective expression of GDNF could play an important role in the defective neuronal innervation of PUJ obstruction. Intense nuclear expression of synaptophysin in all layers of obstructed PUJ specimens suggested that obstructed PUJs have a serious structural abnormality.

Polyenylphosphatidylcholine pretreatment protects rat liver from ischemia/reperfusion injury

BACKGROUND

Hepatic injury induced by ischemia/reperfusion following surgery, transplantation, or circulatory shock combined with resuscitation is a major clinical problem. Polyenylphosphatidylcholine (PPC) has strong antioxidant, cytoprotective and anti-inflammatory effects.

AIM

In this study, the influence of PPC pretreatment on ischemia-reperfusion (I/R) injury of the liver was examined in rats.

METHODS

The animals were divided into three groups: control (n=10), I/R (n=15) and I/R+PPC (n=15). PPC was given 100mg/day for 7 days before experiment. Several parameters of hepatic damage, oxidative stress, neutrophil infiltration and nuclear factor kappa beta (NF-kappaB) expression were measured as well as microscopic examination.

RESULTS

We observed that a significant reduction in AST and ALT values in the PPC treated group when compared with the ischemic group. The increases in hepatic total NO(2)+NO(3) and MDA, and decreases in SOD and GSH levels after reperfusion were partially, but significantly, inhibited by PPC pretreatment. I/R induced increase in hepatic myeloperoxidase content and NF-kappaB expression were also lowered by PPC pretreatment. Animals pretreated with PPC presented minimal hemorrhage and reduced signs of liver injury.

CONCLUSION

PPC pretretament provided significant protection againts I/R injury to the liver. This treatment could be therapeutic in liver transplantation and other conditions associated with I/R injury.

Obstructive congenital gingival granular cell tumour

Congenital gingival granular cell tumours (CGCT) are rare and always benign intraoral tumours originating from the alveolar ridge. They are also known as congenital epulis, congenital myoblastoma or Neumann's tumour. They are typically seen as a mass protruding out of a newborn child's mouth. In general, CGCT occurs as a solitary tumour. The main differential diagnosis is epignathus (oral teratoma). This report describes a newborn with a mass originating from lower alveolar ridge obtruding into the oral cavity. Clinical features, histiogenesis and necessity for early surgical treatment due to risk of airway obstruction and difficulty in feeding were discussed.

Spindle cell lipoma in an intramuscular lipoma

Intramuscular lipoma (IML) is a relatively common variant of lipomas. The most important sites for IML are the large muscles of the extremities. Spindle cell lipoma (SCL) is a rare and distinct variant of lipoma. Most SCL arise in the neck, shoulders or back. It has also been described in unusual sites, such as the oral cavity, larynx, bronchus, breast, orbit and extremities. However, localization of a SCL in an IML has not been described yet. Thus, we present the first SCL located in an IML, which was localized underneath the fascia and embedded within the left sartorius muscle of a 55-year-old man. Microscopically, the SCL component of the tumor was sharply circumscribed by a fibrous capsule and clearly separated from the IML in which it was localized. The collagen-forming spindle cells of the SCL showed neither atypia nor pleomorphism. These cells stained positive for CD34, while the mature fat tissue component of the SCL was positive for S-100 protein and negative for CD34. Spindle cells were negative for S-100 protein. Vimentin stained both components of the SCL, as well as the striated muscle fibers and mature fat tissue of the IML. In conclusion, careful morphological observation along with immunohistochemistry for CD34 and S-100 protein are essential to differentiate this rare tumor from lesions that enter the differential diagnosis.

Comparison of the efficacy of medium chain triglycerides with long chain triglycerides in total parenteral nutrition in patients with hematologic malignancies undergoing peripheral blood stem cell transplantation

BACKGROUND AND AIMS

The purpose of this randomized study was to compare the efficacy of medium chain triglycerides (MCT) plus long chain triglycerides (LCT) with LCT alone in total parenteral nutrition (TPN) solutions in patients with various hematologic malignancies who underwent a hematopoietic peripheral blood stem cell (PBSC) transplantation.

METHODS

Of 36 patients entering into this study, 18 received MCT + LCT (group I) and the remaining 18 received LCT alone (group II) in TPN solutions. Patients were comparable regarding age, gender, donor-recipient gender, diagnosis, body weights, blood group differences and number of infused CD34(+) cells/kg. Post - transplant parameters such as duration of platelet and neutrophil engraftment, coagulation parameters, number of days of febrile neutropenia and antibiotic administration, plasma glucose, triglyceride, cholesterol and albumin levels, graft-versus-host disease (GVHD) and first 100 day mortality were compared in both groups.

RESULTS

Median days of neutrophil >0.5 x 10(9)/l and platelet of >20 x 10(9)/l in group I and group II were 15 (range, 8-21), 11 (10-29) and 14 (range, 9-31), 13 (9-18) respectively (P>0.05). Median days of febrile neutropenia in group I and II were 10 (range, 4-23) and 7 (2-13) respectively (P=0.01). Median days of antibiotic administration in group I and II were 12 (range, 6-22) and 8 (4-25) respectively (P=0.04). Pre, peri- and post-transplant coagulation parameters such as PT, aPTT, and fibrinogen did not differ significantly between two groups (P>0.05), as well as plasma glucose, triglyceride, cholesterol, albumin levels, GVHD and first 100 day mortality.

CONCLUSION

There was no difference between patients receiving MCT + LCT (group I) and LCT alone (group II) in TPN solutions regarding duration of engraftment and coagulation parameters, but numbers of median days of febrile neutropenia and days of antibiotic administration were significantly shorter in patients receiving LCT alone (group II) than those receiving MCT + LCT (P<0.01 and 0.04 respectively).