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Thoracic CT findings and patient demographics associated with traumatic pneumothorax: recommendations for the emergency department
No full textBackgroundPeople with thoracic trauma often present to the emergency department with low-energy injuries and sustain rib fractures. This study aimed to assess the risk of traumatic pneumothorax in a patient cohort based on the radiological characteristics of rib fractures, along with patient and environmental variables.MethodsWe conducted a retrospective analysis of demographic characteristics, the number and nature of rib fractures, the date of trauma, and the correlation between pneumothorax and rib fractures in patients treated in the thoracic surgery departments of three centers between May 2021 and August 2024.ResultsGender, side of trauma, location of the rib fracture, and season were not found to correlate with traumatic pneumothorax. The probability of pneumothorax reduced by 2.1% with each 1-year increase in age (OR = 0.979; p = 0.006). Each fractured rib increased the incidence of traumatic pneumothorax by 23% (OR = 1.23; p = 0.011). Patients with at least one displaced rib fracture had a 2.08-fold higher incidence of traumatic pneumothorax compared to those without displaced rib fractures (OR = 2.08; p = 0.016). The cut-off number of rib fractures associated with traumatic pneumothorax was determined to be 3.5.ConclusionsYoung patients arriving at the emergency room with acute thoracic trauma, those with at least one displaced rib fracture, and individuals with four or more rib fractures are at risk for traumatic pneumothorax. Patients exhibiting these features should be evaluated by thoracic surgery specialists in the emergency department
Impact of Age, Race and Geographic Region on Efficacy Outcomes Following Gene Therapy for Haemophilia BWith Fidanacogene Elaparvovec: Results from the Phase 3 BENEGENE-2 Trial
No full text[Abstract Not Acaileble
Exploring cell indices as diagnostic biomarkers in children with suspected Crohn disease
No full text[Abstract Not Acaileble
Annelerin emzirme sonlandırma deneyimlerinin transteoritik modele göre incelenmesi ve emzirmeyi sonlandırmaya hazır oluşluk ölçeğinin geliştirilmesi
No full textAmaç: Bu araştırmanın amacı; kadınların emzirmeyi sonlandırma sürecine yönelik deneyimlerinin incelenmesi ve emzirme sonlandırma sürecine yönelik Türkçe ve özgün "Emzirme Sonlandırmaya Hazır Oluşluk Ölçeği"nin geliştirilmesidir. Araştırma, iki aşamada nitel ve metodolojik tipte gerçekleştirilmiştir. Birinci Aşama Yöntem: Birinci aşama fenomolojik tipte olup, 05 Nisan-05 Temmuz 2024 tarihleri arasında, kartopu yöntemi ile ulaşılan 25 emzirme deneyimi olan anne ile görüşülmüştür. Nitel aşama verileri "Tanıtıcı Bilgi Formu" ve "Yarı Yapılandırılmış Görüşme Formu" kullanılarak bireysel derinlemesine görüşme yöntemiyle toplanmıştır. Her anne ile ortalama 35,38 dk (min: 28,43 dk, maks: 44,10 dk) süren derinlemesine görüşmeler yapılmıştır. Veri analizi MAXQDA 2024 programında gerçekleştirilmiştir. Birinci Aşama Bulgular: Araştırmanın birinci aşamasında yedi ana tema; 1.Emzirme Sonlandırmaya İlişkin Düşünceler, 2.Emzirmeyi Sonlandırma Sürecinde Hissedilenler, 3.Emzirmeyi Sonlandırma Kararının Alınma Nedenleri, 4.Emzirmeyi Sonlandırma Sürecindeki Uygulamalar, 5.Emzirmeyi Sonlandırma Sürecinde Yaşanan Kolaylıklar, 6.Emzirmeyi Sonlandırma Sürecinde Yaşanan Zorluklar, 7.Emzirmeyi Sonlandırmanın Anne Hayatına Etkileri ortaya çıkmıştır. İkinci Aşama Yöntem: İkinci aşama metadolojik tipte olup, 20 Temmuz- 20 Aralık 2024 tarihleri arasında Ege Üniversitesi Tıp Fakültesi Hastanesi Çocuk Sağlığı ve Hastalıkları Anabilim Dalı, Sosyal Pediatri Bilim Dalı, Sağlıklı Çocuk Polikliniğine gelen 650 emziren anne ile yürütülmüştür. Veri toplamada "Birey Tanıtım Formu" ve 54 maddelik "Emzirme Sonlandırmaya Hazır Oluşluk" taslak ölçek kullanılmıştır. Dört hafta ara ile 35 emziren anneye tekrar ölçek uygulanmış, test tekrar test ile kararlılık analizi gerçekleştirilmiştir. İkinci Aşama Bulgular: Ölçek son hali 26 madde ve 3 faktörden oluşmaktadır. Ölçek maddelerinin madde-toplam test korelasyon değerleri 0,589 ile 0,878 arasında değişmektedir. Ölçeğin Cronbach alfa değeri 0,958 olup Cronbach alfa katsayıları 0,90 ile 0,93 arasında değişmektedir. Açıklayıcı faktör analizi Kaiser-Meyer-Olkin katsayısının 0,795 ve Barlett testi sonucunun χ² (325) = 13813,159 (p = 0,000) olduğunu ortaya koymuştur. Alt boyutlardaki faktör yükleri 0,519 ile 0,856 arasında değişmektedir. Üç faktör toplamda varyansın %66,825'ini açıklamaktadır. Doğrulayıcı faktör analizinde ölçek uyum iyiliği indeksleri; RMSEA 0,045, χ2 =524.45 (p=0,000), GFI .90, NFI .92, NNFI .95, CFI .97, IFI .93, RFI .95, RMR .052, AGFI .89 değerleri kabul edilebilir uyum düzeyindedir. ROC analizi ile emzirmeyi sonlandırmaya hazır oluşluk ölçeğinin kesme noktası 89.0 olarak belirlenmiştir. Ölçekten alınabilecek minimum puan 26, maksimum puan 130'dur. Ölçekten 89.0 puan ve üzeri alan anneler, emzirmeyi bırakmaya hazır olarak değerlendirilebilir. Puan ortalaması arttıkça hazır oluşluk artmaktadır. Sonuç: Araştırmanın ikinci aşamasında geliştirilen "Emzirmeyi Sonlandırmaya Hazır Oluşluk Ölçeği"nin emziren annelerin emzirmeyi sonlandırmaya hazır oluşluk düzeyini belirlemek amacıyla kullanılabilecek geçerli ve güvenilir bir ölçme aracı olduğu belirlenmiştir.Objective: The aim of this research is to investigate women's experiences regarding the process of breastfeeding cessation and to develop an original and Turkish "Breastfeeding Cessation Readiness Scale" for the process of breastfeeding cessation. First Stage Method: The research was conducted in two stages of a qualitative and a methodological type. The first stage was phenomenological, and 25 mothers were interviewed using the snowball sampling method between April 05 and July 05, 2024. Data from the qualitative stage were collected using the "Introductory Information Form" and "Semi-Structured Interview Form" through individual in-depth interviews. In-depth interviews lasting an average of 35.38 min (min: 28.43 min, max: 44.10 min) were conducted with each mother. Data analysis was carried out using the MAXQDA 2024 program. First Stage Results: In the first stage of the research, seven main themes were identified: 1. Thoughts about breastfeeding cessation, 2. Feelings during the cessation process, 3. Reasons for the decision to breastfeeding cessation, 4. Practices during the cessation Process, 5. Conveniences experienced in the cessation process, 6. Difficulties experienced during the cessation process, 7. Effects of breastfeeding cessation on the mother's life. Second Stage Method: The second stage is methodological and was conducted among 650 breastfeeding mothers who came to the Healthy Child Polyclinic, Department of Social Pediatrics, Department of Child Health and Diseases, Ege University Faculty of Medicine Hospital between 20 July and 20 December 2024. The "Individual Introduction Form" and the 54-item draft "Readiness to Breastfeeding Cessation" scale were used for data collection. The scale was re-administered to 35 breastfeeding mothers at four-week intervals, and a test-retest stability analysis was performed. Second Stage Results: The final version of the scale consists of 26 items and 3 factors. The item-total test correlation values of the scale items vary between 0.589 and 0.878. The Cronbach alpha value of the scale is 0.958, and the Cronbach alpha coefficients vary between 0.90 and 0.93. Exploratory factor analysis revealed that the Kaiser-Meyer-Olkin coefficient was 0.795, and the Barlett test result was χ² (325) = 13813.159 (p = 0.000). The factor loadings in the sub-dimensions ranged from 0.519 to 0.856. The three factors together explained 66.825% of the variance. In the confirmatory factor analysis, the scale fit indices were: RMSEA 0.045, χ2 =524.45 (p=0.000), GFI .90, NFI .92, NNFI .95, CFI .97, IFI .93, RFI .95, RMR .052, AGFI .89 values are at an acceptable level of fit. The cut-off point of "the breastfeeding cessation readiness scale" was determined by ROC analysis to be 89.0. The minimum score that can be obtained from the scale is 26, and the maximum score is 130. Mothers who score 89.0 and above on the scale can be considered ready to breastfeeding cessation. As the mean score increases, readiness increases. Conclusion: It was found that the "Readiness to Breastfeeding Cessation Scale" developed in the second phase of the study is a valid and reliable measurement tool that can be used to determine the level of readiness of breastfeeding mothers for breastfeeding cessation
Correlation of Radiological and Pathological Tumor Sizes in Breast Cancer Based on Molecular Subtypes and Accompanying DCIS: A Retrospective Multicenter Study
No full textPurpose: This study aims to compare radiological tumor sizes obtained by mammography (MMG), ultrasonography (US), and magnetic resonance imaging (MRI) with pathological sizes to determine if molecular subtypes and the presence of accompanying ductal carci Methods: A total of 559 cases diagnosed with breast cancer in 11 different centers between 2010-2023 were included in the study. The patients' MMG, US, and MRI images were re-evaluated, and radiological findings and tumor sizes were recorded. Histological diagnosis (invasive/in-situ/mixed), receptor status, Ki-67 index, and tumor size were recorded from the pathology reports. Pathologic tumor size (pT) was accepted as the gold standard. Results: The mean pT was 21.1 +/- 14.9 (2.7-100) mm in Luminal A tumors, 20.6 +/- 12.6 (2-70) mm in Luminal B tumors, 26.3 +/- 14.7 (6-80) mm in HER-2(+) tumors, 26.3 +/- 14.7 (8-125) mm in triple (-) (TN) tumors. The highest agreement in invasive tumors was obtained with MRI (MRI r:0.831, US r:0.769, MMG r:0.650). In DCIS cases, the agreement was strong with MRI (r:0.770) and intermediate with MMG and US (r:0.517 and r:0.593, respectively). In mixed tumors, agreement was strong with MRI (r:0.817), intermediate with US (r:0.656), and low with MMG (r:0.499). Based on molecular subtypes, MRI had a strong correlation (r > 0.7) in both invasive and mixed tumors of all subtypes. US had a strong correlation in all invasive tumors (r > 0.7). The correlation was intermediate in Luminal mixed tumors. Mammography had a strong correlation only in invasive Luminal A tumors (r > 0.7), and an intermediate correlation in the other invasive tumor subtypes. Regarding mixed tumors, its correlation level was intermediate in Luminal B and TN tumors, and low in Luminal A and HER-2(+) tumors. Conclusion: This multicenter study shows that MRI is the most reliable method for determining preoperative tumor size of invasive and in-situ tumors and all molecular subtypes. The correlation levels of all modalities decreased in pure and mixed DCIS cases, however the difference was minimal with MRI
Complications After Surgery for Anorectal Malformations: An ARM-Net consortium Registry Study
No full textObjective: Establishing the incidence and types of complications following surgical intervention for ARM, primarily after reconstruction. Patient- and treatment-related risk factors were also determined. Background: Postoperative complications of ARM surgery vary widely, with data predominantly derived from single-center retrospective studies with limited number of patients. Whether factors such as ARM type, associated congenital anomalies, prior enterostomy, or type of reconstructive surgery affect complication incidence remains unclear. Methods: This multicenter cohort study was performed using the ARM-Net registry with prospectively collected data. Enterostomy-related and post-reconstructive complications in patients who underwent reconstructive surgery before the age of five years were recorded. Patients with more than 25 % missing data, unknown sex, ARM type, or reconstruction date, or without (information on) reconstruction or complications, were excluded. Multivariable analyses identified independent risk factors for the development of complications. Results: A total of 2,043 patients were eligible for analysis. Complications after enterostomy formation and closure occurred in 25 % and 12 % of patients, respectively. Post-reconstructive complications occurred in 25 % of patients, with wound complications comprising half of the complications. In a multivariable analysis, recto-bladder neck fistula, any associated anomaly, and the LAARP procedure were identified as independent risk factors for post-reconstructive complications. In contrast, anoplasty and mini-PSARP reduce the risk of complications. Conclusions: Post-reconstructive complications in ARM patients are common, and certain patient- and treatment-related characteristics affect postoperative outcomes. These results aid counselling and clinical decision-making, and may guide the operative planning of ARM types that are amenable to several different surgical approaches. © 2025 Elsevier B.V., All rights reserved
Caffeine use in preterm neonates: national insights into Turkish NICU practices
No full textObjective: Caffeine is a proven medication used for the prevention and treatment of apnea in premature infants, offering both short- and long-term benefits. International guidelines provide a range of recommendations regarding the preterm population eligible for caffeine prophylaxis, including the timing, dosage, and duration of treatment. Our national guidelines, published prior to the most recent updates of the international guidelines, recommend the use of caffeine citrate starting from the first day after delivery for preterm infants with a gestational age of <28 weeks. For infants up to 32 weeks, if positive pressure ventilation is required, the decision should be made on an individual basis. This study aims to describe the variability in caffeine usage across neonatal intensive care units in our country. Methods: An online survey was sent to neonatologist who are members of the Turkish Neonatology Society to describe the variability in caffeine usage in neonatal intensive care units in our country. Results: We collected responses from 74 units. Prophylactic caffeine usage was observed as; GA <= 27(6/7): 98.6%, GA 28(0/7)-28(6/7): 89.0%, GA 29(0/7)-29(6/7): 75.3%, GA 30(0/7)-31(6/7): 53.4%. 62.2% of units reported administering loading dose within the first two hours. The initial maintenance dose was 5 mg/kg in 64.8% of units, 10 mg/kg in 32.4% of units, and intermediate dose in 5.3% of units. 47.3% of units reported no routine dose adjustment. The postmenstrual age that caffeine treatment was stopped was found to be 34 (min-max; 32-36) weeks for infants without apnea and respiratory support, 36 (min-max; 34-52) weeks for infants without apnea but any respiratory support. The time to discharge after treatment cessation was found as; 1-4 days: 37.8%, 5-7 days: 68.9%. Among the 56 units with multiple responsible physicians, 32.1% reported intra-unit variations. Conclusion: The significant differences in caffeine usage characteristics between and within units highlight the need for clear recommendations provided by standardized guidelines
Randomized control trial in nursing education: A bibliometric analysis and visualization
No full textAim: The aim of this study was to examine randomized controlled trials in nursing education using bibliometric analysis. Methods: Descriptive and bibliometric analyses were used. Web of Science database was used to determine the most frequently cited studies of nursing education randomised controlled trials, the most influential journals in this field, trends and trends of studies. Bibliometric analysis and visualisation were performed using VOSviewer and Bibliometrix Package in R software. Results: In the study, a total of 141 publications were published in 29 different sources between 2007 and 2025. The most influential journal where the studies were published was Nurse Education Today (n = 53). In the studies, 405 author keywords belonging to 623 authors were found. The most frequently used author keywords were 'simulation (n = 18)', 'knowledge (n = 8)', 'simulation training (n = 8)', 'learning (n = 7)' and 'anxiety (n = 6)'. It was found that the most frequently used trend topics in the early years were 'attitudes', while in recent years, trend topics such as 'simulation', 'knowledge' and 'skills' have become popular. Conclusion: The number of randomized controlled trials in nursing education has been on the rise in recent years. The findings of this study will contribute to the advancement of nursing education literature and inform future scientific studies by addressing existing gaps in knowledge in this field
Instructional Leadership Moderating the Impact of (In)Congruency Between Peer and Individual Student SES on Achievement
No full textThe present study aims to investigate how school segregation, as well as the (in)congruence between the school and individual SES, can explain the variation in student achievement. Additionally, it examines the role of instructional leadership in mitigating this association. Using international large-scale assessments (PISA-TALIS link data) from seven countries - Australia, Colombia, the Czech Republic, Denmark, Georgia, Malta, and Turkey - we applied several multilevel polynomial regressions with response surface analyses. The results showed that both individual SES and school segregation have a profound impact on student achievement, with varying results across countries. Second, we found differential school composition effects, with the school composition effect strongest for low SES students in high SES schools. Third, our results do not support congruence theory, but they do somewhat favor (in)congruence theory. Finally, strong leadership magnifies benefits for low-SES students in high-SES schools and for all students at low-SES schools. Implications for policy, practice, and further research are discussed.Alexander von Humboldt Foundation [TUR-1227776-HFST-E]; German Research Foundation (DFG) [451458391]This work is supported by the Alexander von Humboldt Foundation through a Senior Researcher Fellowship to Mehmet Sukrue Bellibas [TUR-1227776-HFST-E] and by the German Research Foundation (DFG) through a DFG Heisenberg Professorship to Marcus Pietsch [451458391]
The Impact of 18F-FDG PET/CT and Related Parameters on Staging, Disease Management and Prognosis in Patients with Cholangiocarcinoma
No full textObjectives: We aimed to evaluate the relationship of 18Fluorine-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) parameters with diagnostic efficacy, disease management and prognosis in patients with cholangiocarcinoma (CCA). The prognostic value of the spleen/liver 18F-FDG uptake ratio was also investigated. Methods: The clinical and imaging findings of 39 patients who met the diagnostic criteria and underwent 18F-FDG PET/CT imaging for staging between 2013 and 2023 were retrospectively analysed. Results: The tumour was intrahepatic in 34 patients and extrahepatic in 5 patients. PET/CT detected nodal involvement in 21 patients (53.8%) and distant metastases in 35 patients (89.7%). Fourteen cases (35.9%) had regional-distant metastases detected by PET/CT but not by magnetic resonance imaging/CT, and the stage of the disease changed accordingly. SUVmax, SUVmean, metabolic tumor volume, tumour lesion glycolysis, spleen parenchyma SUVmax), and standardized liver ratio (SLR) (spleen/liver SUVmax) did not differ based on tumour location. Recurrence occurred in 14 patients (35.9%), and 2 patients survived. When the cut-off values for the parameters were determined by the Youden index, progressionfree survival (PFS) was significantly shorter in patients with an SLR value of less than 0.94 compared to the others (p=0.04). Nodal involvement, metastatic location, and other PET/CT parameters had no significant effect on PFS and overall survival. Conclusion: Our results highlight the efficacy of 18F-FDG PET/CT in staging nodal and distant metastases, similar to several studies in patients with CCA. Although SLR was found to have significant efficacy in PFS among the parameters we analysed, it is appropriate to evaluate the prognostic significance of these parameters in larger patient groups