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Microcirculatory depth of focus measurement shows reduction of tissue edema by albumin resuscitation in burn patients
No full textBackground: Severe burns induce volume shifts via capillary leaks, eventually requiring massive fluid resuscitation and promoting tissue edema. Albumin may help to mitigate the edema, thereby improving perfusion. This study shows that sublingual microcirculation measurements can quantify both tissue perfusion and edema. Methods: This prospective observational study was conducted between November 2018 and December 2019 in the intensive care unit of Maasstad Hospital Burn Center, Rotterdam, The Netherlands. Patients with severe burns affecting > 15% of the total body surface area were included. Fluid management was conducted in accordance with the Parkland formula. Albumin (20%) was administered at a rate of 0.5 mL/(kg h), starting 12 h after the burn incident. Alterations in the sublingual microcirculation, including capillary perfusion and density, were measured at admission (T0) and 4 h (T4) and 12 h (T12) after admission. Sublingual depth of focus (DOF) of the microcirculation was used to quantify the tissue edema. Results: Nine patients were recruited with a mean total body surface area of 36% +/- 23%. By T12, a median of 4085 mL (interquartile range [IQR]: 3714-6756 mL) of crystalloids and 446 mL (IQR: 176-700 mL) of 20% albumin were administered. The DOF increased significantly after crystalloid administration (T4 vs. T0, mean difference [MD] = 27.4 mu m, 95% confidence interval [CI]: 3.4 to 50.9, P = 0.040). Following albumin administration, DOF significantly decreased (T12 vs. T4, MD =-76.4 mu m, 95% CI: -116.6 to -36.1, P = 0.002). Total vessel density decreased significantly with crystalloid administration (T4 vs. T0, MD =-3.5 mm/mm2, 95% CI: -5.7 to -1.4, P = 0.004) but increased after albumin administration (T12 vs. T4, MD = 6.2 mm/mm2, 95% CI: 3.2 to 9.3, P = 0.001). Conclusion: Sublingual microcirculation measurement of DOF and other parameters provide a valuable tool for the assessment of tissue perfusion and edema in patients with severe burns. Further investigation is required to evaluate the role of albumin in increasing microcirculatory convection and reducing tissue edema
Psychometric evaluation of the Chinese version of the BENEFITS-CCCSAT based on CTT and IRT: a cross-sectional design translation and validation study
No full textBackground The importance of culturally competent care in multicultural environments is increasingly recognized; however, effective tools to assess nursing students' cross-cultural competence remain limited. This study aimed to validate the BENEFITS-CCCSAT for Chinese nursing students.Methods The original BENEFITS-CCCSAT was translated, back-translated, culturally adapted, and pre-tested using the Brislin model to form a Chinese version. A combined approach of classical test theory (CTT) and item response theory (IRT) was then used for multidimensional validation.Results The CTT analysis showed that the C-BENEFITS-CCCSAT had a Cronbach's alpha coefficient of 0.80, dimension reliability values ranging from 0.700 to 0.905, a test-retest reliability value of 0.881, and a scale-level content validity index (S-CVI) value of 0.928. The criterion-related validity value was 0.619. The confirmatory factor analysis (CFA) indicated a good model fit (CMIN/DF = 1.071, RMSEA = 0.08), with factor loadings >= 0.50. The Rasch analysis showed an item reliability value of 1, person reliability values ranging from 0.76 to 0.89, item separation index values ranging from 17.37 to 60.34, and person separation index values ranging from 1.76 to 2.89. The information-weighted fit statistic mean square (infit MNSQ) and outlier-sensitive fit statistic mean square (outfit MNSQ) values for all items ranged from 0.86 to 1.27. Overall, the scale demonstrated good reliability and validity for the Chinese nursing students.Conclusion The 25-item C-BENEFITS-CCCSAT demonstrates good reliability and validity and can be applied in educational settings to assess students' ability to provide culturally competent care. Future studies should test the scale in culturally diverse populations to further determine its applicability and generalizability
Psychometric evaluation and clinical compatibility of the Turkish version of the Children Participation Questionnaire (CPQ-T)
No full textAim: The aim of this study was to adapt the Children Participation Questionnaire (CPQ) into Turkish culture and evaluate its psychometric properties in typically developing children aged 4-6 years. This study involved 235 typically developing children and 61 children with autism spectrum disorder (ASD). Parents completed the Turkish CPQ (CPQ-T) and demographic form. The adaptation process followed the World Health Organization's guidelines. Confirmatory factor analysis (CFA) was conducted, and construct validity was assessed using the Mann-Whitney U test to compare participation levels between typically developing children and those with ASD. Reliability was measured through Cronbach's alpha and test-retest reliability, with agreement assessed using Intraclass Correlation Coefficient (ICC) and McDonald's omega. Sensitivity and specificity were determined using ROC curves. The study demonstrated significant differences in participation levels between the study group and children with ASD across all domains (p < 0.001). Confirmatory factor analysis indicated a good model fit (CMIN/DF = 2.692, GFI = 0.862, IFI = 0.932). The CPQ showed excellent internal consistency (Cronbach's alpha = 0.978) and test-retest reliability (ICC = 0.943 to 0.983). Sensitivity and specificity analyses yielded high values, with Area Under the Curve (AUC) ranging from 0.956 to 0.978. The Turkish version of the CPQ is a valid and reliable tool for assessing child participation, effectively distinguishing between typically developing children and those with ASD. This study contributes significantly to the limited literature on the CPQ, highlighting its utility in clinical and research settings for evaluating children's participation
The Help-Seeking Scale for Online Learning Environment (HSOLE): Validity and Reliability
No full textHelp seeking is a critical psycho-educational structure that facilitates learning and ensures the potential and sustainability of online learning environments (OLE). This research aims to develop a scale for measuring help seeking behaviour in two contexts: (1) learning process help seeking and (2) assessment process help seeking. The motivation behind this research is to understand help seeking behaviours in OLE, which can potentially enhance these environments' effectiveness and learning outcomes. Help seeking involves learners recognizing difficulties and actively seeking assistance to overcome them, making their learning processes more efficient. The study group consists of 843 undergraduate students. The data collection tool was developed through three key processes: design, application, and validation. The design process begins with creating an item pool. The scale validity is tested through factorial validity, and its construct validity is measured based on convergent and discriminant validity. Reliability is tested using construct reliability and Cronbach's Alpha reliability coefficients. In conclusion, a valid and reliable measurement tool was developed with 58 items in total. This scale is an important tool for identifying help seeking tendencies in OLE. It contributes to the design of appropriate help systems to enhance the potential and sustainability of these environments. This research offers significant contributions to the literature on online learning and provides insights into strategies for making learning environments more effective
Fear of Cancer Recurrence and Associated Factors in Lymphoma Survivors and Their Family Caregivers: A Cross-Sectional Study
No full textBackground Fear of cancer recurrence (FCR) is a pervasive concern among lymphoma survivors and their family caregivers, influencing psychological and physical health. Given the substantial burden of FCR, identifying its predictors is crucial for targeted interventions that could enhance palliative care. We aimed to evaluate the prevalence of FCR in lymphoma survivors and their caregivers, as well as associated factors Methods A total of 118 patients with lymphoma, along with their family caregivers, were recruited from Hacettepe University Cancer Institute between March 2024 and May 2024. Psychological assessments were conducted using the Depression Anxiety Stress Scales (DASS-21), the Fear of Cancer Recurrence Inventory-Short Form (FCRI-SF) and the Functional Assessment of Cancer Therapy-Lymphoma (FACT-Lym) Results High levels of FCR were experienced by 50.8% (n = 60) of lymphoma survivors and 57.6% (n = 68) of their caregivers. There was a positive correlation between the FCR of the survivors and caregivers (r = 0.349, p < 0.001). Poor overall quality of life (QoL) (aOR: 4.279, 95% CI: 1.738-10.531, p = 0.002), recent diagnosis (< 3 year) (aOR: 5.135, 95% CI: 1.852-14.238, p = 0.002), survivors' anxiety (aOR: 2.540, 95% CI: 1.014-6.363, p = 0.002) and caregivers' FCR (aOR: 2.970, 95% CI: 1.119-7.879, p = 0.029) were associated with high levels of FCR in lymphoma survivors. Conclusion We observed high FCR levels in over half the survivors with lymphoma and a higher FCR risk in patients with anxiety, poor QoL and caregiver FCR. These findings highlight the critical need for developing comprehensive care plans and interventions targeting FCR in patients with lymphoma
Current treatment in macrophage activation syndrome worldwide: a systematic literature review to inform the METAPHOR project
No full textObjective: To assess current treatment in macrophage activation syndrome (MAS) worldwide and to highlight any areas of major heterogeneity of practice. Methods: A systematic literature search was performed in both EMBASE and PubMed databases. Paper screening was done by two independent teams based on agreed criteria. Data extraction was standardized following the PICO framework. A panel of experts assessed paper validity, using the Joanna Briggs Institute appraisal tools and category of evidence (CoE) according to EULAR procedure. Results: Fifty-seven papers were finally included (80% retrospective case-series), describing 1148 patients with MAS: 889 systemic juvenile idiopathic arthritis (sJIA), 137 systemic lupus erythematosus (SLE), 69 Kawasaki disease (KD) and 53 other rheumatological conditions. Fourteen and 11 studies specified data on MAS associated to SLE and KD, respectively. All papers mentioned glucocorticoids (GCs), mostly methylprednisolone and prednisolone (90%); dexamethasone was used in 7% of patients. Ciclosporin was reported in a wide range of patients according to different cohorts. Anakinra was used in 179 MAS patients, with a favourable outcome in 83% of sJIA-MAS. Etoposide was described by 11 studies, mainly as part of HLH-94/04 protocol. Emapalumab was the only medication tested in a clinical trial in 14 sJIA-MAS, with 93% of MAS remission. Ruxolitinib was the most reported Janus kinase inhibitor in MAS. Conclusion: High-dose GCs together with IL-1 and IFN gamma inhibitors have shown efficacy in MAS, especially in sJIA-associated MAS. However, the global level of evidence on MAS treatment, especially in other conditions, is still poor and requires standardized studies to be confirme
Clinical characteristics and biological treatment responses of patients with late-onset asthma phenotype
No full textBackground: The data on subphenotypes and treatment responses to biologicals in late-onset asthma (LOA) is limited. This study aims to compare the clinical characteristics and treatment responses in severe asthma patients receiving biological treatments, categorized into early-onset asthma (EOA) and LOA groups. Methods: Patients treated with omalizumab or mepolizumab for at least six months at a tertiary care adult allergy clinic between December 2015 and December 2023 were included. Patients with persistent respiratory symptoms starting at age >= 40 years were categorized as LOA, while those with onset Results: Among 87 patients, 38 (43.7%) had LOA and 49 (56.3%) had EOA. Of these, 22 (25.3%) received omalizumab and 65 (74.7%) received mepolizumab, with a mean treatment duration of 24.7 (+/- 19.7) months. LOA patients had higher obesity rates and tobacco consumption compared to EOA patients (p = 0.041 and p = 0.024, respectively). There were no significant differences between LOA and EOA groups in ACQ scores, FEV1 percentage, the percentage change in FEV1 in liters and eosinophil counts (p = 0.531, p = 0.219, p = 0.632, p = 0.700, respectively). Within LOA patients, ACQ scores did not significantly differ between those treated with omalizumab and mepolizumab (p = 0.801). At 6 months, eosinophil counts significantly decreased with mepolizumab but not with omalizumab (p = 0.002). Conclusion: Biological treatment responses were similar between LOA and EOA groups. Omalizumab and mepolizumab showed comparable efficacy, with the exception of eosinophil count changes in LOA patients
Regorafenib Treatment for Recurrent Glioblastoma Beyond Bevacizumab-Based Therapy: A Large, Multicenter, Real-Life Study
No full textBackground/Objectives: In the REGOMA trial, regorafenib demonstrated an overall survival advantage over lomustine, and it has become a recommended treatment for recurrent glioblastoma in guidelines. This study aimed to evaluate the effectiveness and safety of regorafenib as a third-line treatment for patients with recurrent glioblastoma who progressed while taking bevacizumab-based therapy. Methods: This retrospective, multicenter study in Turkey included 65 patients treated between 2021 and 2023 across 19 oncology centers. The main inclusion criteria were histologically confirmed isocitrate dehydrogenase (IDH)-wildtype glioblastoma, progression after second-line bevacizumab-based treatment, and an Eastern Cooperative Oncology Group (ECOG) performance status score of <= 2. Patients received regorafenib 160 mg once daily for the first 3 weeks of each 4-week cycle. Results: The median age of the patients was 53 years (18-67 years), with a median progression-free survival of 2.5 months (95% Confidence Interval: 2.23-2.75) and a median overall survival of 4.1 months (95% CI: 3.52-4.68). The median overall survival was improved in patients who received subsequent therapy after regorafenib treatment compared with those who did not (p = 0.022). Progression-free survival was longer in patients with ECOG 0-1 than in those with ECOG 2 (p = 0.042). The safety profile was consistent with that of the REGOMA trial, with no drug-related deaths observed. Conclusions: Regorafenib shows good efficacy and safety as a third-line treatment for recurrent glioblastoma after bevacizumab-based therapy. This study supports the use of regorafenib and emphasizes the need for further randomized studies to validate its role and optimize treatment strategies
