Person: KELEBEK GİRGİN, NERMİN
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KELEBEK GİRGİN
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Publication Knowledge, perception and prevention performance of intensive care unit nurses about medical device-related pressure injuries(Wiley, 2021-08-22) Dallı, Öznur Erbay; Girgin, Nermin Kelebek; ERBAY DALLI, ÖZNUR; KELEBEK GİRGİN, NERMİN; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Anesteziyoloji ve Reanimasyon Anabilim Dalı/Yoğun Bakım Bilim Dalı; 0000-0003-2282-0846; 0000-0002-5882-1632; ABI-1236-2020; GBC-7197-2022Aim and Objective To examine intensive care unit (ICU) nurses' knowledge, perceptions and prevention performance about medical device-related pressure injuries (MDRPIs). Background Prevention of MDRPIs has been an important part of nursing care, and there is a limited number of studies on nurses' level of knowledge or perception about MDRPIs. Design This study was designed as a cross-sectional survey and conducted according to STROBE Guidelines. Method The data of the study were collected with the Nurse Information Form and the MDRPI Knowledge Assessment Questionnaire. In the first phase, the psychometric properties of the questionnaire were evaluated (content validity, internal consistency and test-retest). A pilot study was conducted with 20 nurses for the test-retest phase. These nurses were excluded from the general sample. Results The study was conducted with 142 ICU nurses. The average percent knowledge score of ICU nurses on MDRPIs was 68.4%. In the survey, the highest rate of correct response was found in the expressions about MDRPIs skin assessment (83.6%), and the lowest was in those about follow-up (50.8%). There was no significant relationship between the total score and age, work experience and specialties (p > .05 for each). However, scores were significantly higher in females than males (65.5 vs. 47.8, p = .020) and in those with a postgraduate degree than those with a bachelor's degree (81.8 vs. 57.9, p = .008). Conclusions Our study demonstrated that nurses do not have sufficient perception of MDRPIs. The findings of the study can be used to improve nursing policies and practices in acute care settings. Additional studies will be needed with nurses and healthcare professionals working in different clinical settings. Relevance to the clinical practice This study demonstrates the nurses' need for more knowledge about MDRPIs and will help inform healthcare institutions and their management teams in developing programs and improving protocols to reduce the incidence of MDRPIs.Publication Are the tidal volumes used in intensive care units suitable for lung protective ventilation? Can training ensure compatibility?(Galenos Yayincilik, 2020-09-01) Kaya, Pınar Küçükdemirci; Sayan, Halil Erkan; Girgin, Nermin Kelebek; KELEBEK GİRGİN, NERMİN; Kaya, Murad; KAYA, MURAD; Bursa Uludağ Üniversitesi/Tıp Fakültesi; 0000-0002-5882-1632Objective: Low tidal volume (VT) and lung protective ventilation (LPV) are recommended to prevent lung injury associated with invasive mechanical ventilation (IMV). Present study aimed to determine the patients with risk of high VT application, whether VT calculated according ideal body weight (IBW) values are suitable for the recommended (6-8 mL/kg) and whether a questionnaire on the issue contributes to IMV suitable for LPV.Materials and Methods: Present study is conducted as a multicenter point - prevalence study in the intensive care units of three hospitals in Bursa. Non-ARDS patients receiving IMV and patients who were older than 18 years were included in the study. IMV parameters and demographic data of the patients were collected. Then, the physicians responsible of ventilatory management completed a questionnaire about LPV strategies and VT values required according to the IVA were shown. After 24 hours, mechanical ventilation parameters were re-collected. Body mass index (BMI), average tidal volume applied [VTmean = minute volume (MV)/respiratory rate (RR)] and VTmean for IBW (VTmean/IBW) values were calculated.Results: Fifty-six patients were included in the study. There were 33 male patients (58.9%) and the mean age of the patients was 65.43 +/- 18.87 years. The mean BMI of the patients was 27.84 +/- 7.0. The most commonly used ventilation mode was synchronized intermittent mandatory ventilation (75%). The VTmean was 549.32 +/- 151.00 mL (VTmean/IBW =9.31 +/- 3.07 mL/kg). According to VTmean/IBW, for the use of large VTs, being female (10.77 +/- 2.74 mL/kg) and having BMI >= 30 (10.82 +/- 3.80 mL/kg) posed significantly higher risk than being male (8.31 +/- 2.91 mL/kg) and having BMI <30 (8.67 +/- 2.47 mL/kg) (p=0.002, p=0.015 respectively). The results showed a significant decrease (p=0.026) in VTmean/IBW (8.81 +/- 3.49 mL/kg) values after the physicians completed LPV questionnaire and were shown the VT values (predicted by IBW).Conclusion: VTmean/IBW values were found to be higher than 6-8 mL/kg, the recommended value for LPV. Ventilation with high VT was associated with female gender and having a BMI of >= 30. Completing the LPV questionnaire and seeing the VT values (predicted by IBW) contributed to the number of the patients ventilated with VT values suitable LPV.Publication Reliability of CT angiography scoring systems used for brain death and the effect of cranial interventions on the results(Elsevier Science, 2021-04-19) Özpar, Rıfat; Tonkaz, Mehmet; Girgin, Nermin Kelebek; Bodur, Muhittin; Dinç, Yasemin; Kocaeli, Hasan; Hakyemez, Bahattin; ÖZPAR, RİFAT; TONKAZ, MEHMET; KELEBEK GİRGİN, NERMİN; BODUR, MUHİTTİN; DİNÇ, YASEMİN; KOCAELİ, HASAN; HAKYEMEZ, BAHATTİN; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Radyoloji Anabilim Dalı.; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Anesteziyoloji ve Reanimasyon Anabilim Dalı.; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Çocuk Nörolojisi Anabilim Dalı.; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Nöroloji Anabilim Dalı.; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Beyin Cerrahi Anabilim Dalı.; 0000-0001-6649-9287; 0000-0002-5882-1632; 0000-0002-2588-8195; 0000-0002-3425-0740; IUQ-6999-2023; JAN-9435-2023; AAH-5062-2021; AAH-2684-2021; DZJ-5260-2022; DTU-3148-2022; FDK-3229-2022; AAI-2318-2021Objective: To assess vascular opacifications, the efficiency, and interobserver agreement (IOA) of five different computed tomography angiography (CTA) brain death (BD) scoring systems in patients with and without cranial interventions, for determining alternative findings correctly supporting BD diagnosis by CTA even in cranial intervention presence. Methods: 45 patients clinically identified with BD and evaluated with CTA were included. IOA of five different scoring systems used for CTA BD diagnosis, the effect of intracranial interventions on scoring systems, and vascular opacification were evaluated. Results: IOA was almost perfect (Kappa = 0.843-0.911, p < 0.05) and substantial (Kappa = 0.771-0.776, p < 0.05) in all scoring systems. Significant relationships were observed between craniectomy presence and middle cerebral artery M4 segment and internal cerebral vein (ICV) opacification. No opacification was observed in straight sinus (SS) by observers in any of the craniectomized patients. Conclusion: IOA of CTA scoring systems is adequate. But a significant degree of false-negative results is observed due to ICV filling in craniectomy cases. Opacification presence in SS can give an idea of BD in these cases.Publication Therapeutic plasmapheresis therapy in patient with thyroid storm in the intensive care unit(Galenos Yayıncılık, 2020-01-15) Ertem, Aytül Coşar; Dağdelen, Melike Şeyda; Yıldız, Simge; Kahveci, Ferda Şöhret; Kelebek, Nermin; İsçimen, Remzi; COŞAR ERTEM, AYTÜL; Dağdelen, Melike Şeyda; Yıldız, Simge; KAHVECİ, FERDA ŞÖHRET; KELEBEK GİRGİN, NERMİN; İŞÇİMEN, REMZİ; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Anesteziyoloji ve Reanimasyon Anabilim Dalı.; 0000-0002-2767-1483; 0000-0003-2613-0084; 0000-0002-5882-1632; 0000-0001-8111-5958; 0000-0001-9020-5453; 0000-0003-4820-2288; AAI-8104-2021; HKP-2533-2023; ABE-2447-2020; DTR-4864-2022; CQC-3738-2022; IMY-6211-2023; GBC-7197-2022Thyroid storm is a rare clinical condition, and failure in management can lead to multiorgan failure and carries a high mortality. The comprehensive treatment approach is the administration of antithyroid drugs and radioactive iodine and thyroidectomy. The treatment option of therapeutic plasmapheresis (TP) should be considered as a stabilizing measure, especially when patients have failed or can not tolerate conventional treatment. This case report aimed to share that TP might be an alternative approach to be added to standard treatment methods in life-threatening conditions.Publication A retrospective evaluation of critically ill patients infected with H1N1 influenza A virus in Bursa, Turkey, during the 2009-2010 pandemic(Makerere Univ, 2015-01-01) Nermin, Kelebek Girgin; Remzi, İşçimen; Zeynep, Akoğul; İlker, Çimen; Meltem, Öner Torlar; Güven, Özkaya; Ferda, Kahveci; Halis, Akalın; KELEBEK GİRGİN, NERMİN; İŞÇİMEN, REMZİ; Akoğul, Zeynep; Çimen, İlker; Torlar, Meltem Öner; ÖZKAYA, GÜVEN; KAHVECİ, FERDA ŞÖHRET; AKALIN, EMİN HALİS; Uludağ Üniversitesi/Tıp Fakültesi/Anesteziyoloji ve Reanimasyon Anabilim Dalı.; Uludağ Üniversitesi/Tıp Fakültesi/Mikrobiyoloji ve Enfeksiyon Hastalıkları Anabilim Dalı.; Uludağ Üniversitesi/Tıp Fakültesi/Biyoistatistik Anabilim Dalı.; AAH-7250-2019; FTV-1495-2022; EIE-4319-2022; JOR-4047-2023; FMO-2967-2022; EZV-3846-2022; CPT-2668-2022; EZJ-5901-2022Background: H1N1 influenza A virus infections were first reported in April 2009 and spread rapidly, resulting in mortality worldwide. The aim of this study was to evaluate patients with H1N1 infection treated in the intensive care unit (ICU) in Bursa, Turkey.Methods: Demographic characteristics, clinical features, and outcome relating to H1N1 infection were retrospectively analysed in patients treated in the ICU.Results: Twenty-three cases of H1N1 infection were treated in the ICU. The mean age of patients was 37 years range: (1782). Fifteen patients were female (65.2%). The mean Acute Physiology and Chronic Health Evaluation (APACHE) II score was 19 range: (5-39). The most common symptoms were dyspnea (73.9%), fever (69.6%), and cough (60.9%). Mechanical ventilation was required for all patients. Oseltamivir and antibiotics were administered to all patients. Six (26.1%) patients died. APACHE II scores were higher in the deceased 28.5 range: [16-39] vs. 14 range: [5-28] in survivors; p = 0.013).Conclusion: When compared to the literature, the demographic, epidemiological, and clinical characteristics were similar in the cases we encountered. The mortality rate was high despite the use of appropriate treatment. We believe that the high mortality is related to higher APACHE II scores. The H1N1 virus should be considered in community acquired pneumonia, especially in younger patients presenting with severe pneumonia.Publication Acute kidney injury after orthotopic liver transplantation.(Wiley-blackwell, 2013-06-01) İŞÇİMEN, REMZİ; İşçimen, Remzi; Gülcü, Barış; Girgin, Nermin; KELEBEK GİRGİN, NERMİN; Sarkut, Pınar; Dündar, Ziya; DÜNDAR, HALİT ZİYA; Kaya, Ekrem; KAYA, EKREM; Bursa Uludağ Üniversitesi/Tıp Fakültesi; AAI-8104-2021; HKP-2533-2023; AAH-7250-2019; AAG-7319-2021Publication Aspergillus infections in intensive care units: Before and after the COVID-19 pandemic(Bilimsel Tıp Yayınevi, 2022-01-01) Tüzemen, Nazmiye Ülkü; Önal, Uğur; Akalın, Emin Halis; Kazak, Esra; Heper, Yasemin; İşçimen, Remzi; Kelebek Girgin, Nermin; Yılmaz, Emel; Özakın, Cüneyt; Şöhret Kahveci, Ferda; Ener, Beyza; TÜZEMEN, NAZMİYE ÜLKÜ; ÖNAL, UĞUR; AKALIN, EMİN HALİS; KAZAK, ESRA; HEPER, YASEMİN; İŞÇİMEN, REMZİ; KELEBEK GİRGİN, NERMİN; YILMAZ, EMEL; ÖZAKIN, CÜNEYT; KAHVECİ, FERDA ŞÖHRET; ENER, BEYZA; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Tıbbi Mikrobiyoloji Anabilim Dalı.; Bursa Uludağ Üniversitesi/Tıp Fakültesi/İnfeksiyon Hastalıkları ve Klinik Mikrobiyoloji Anabilim Dalı.; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Anestezi ve Reanimasyon Anabilim Dalı.; 0000-0003-3544-3509; 0000-0001-6194-3254; 0000-0001-7530-1279; 0000-0002-5882-1632; 0000-0002-3894-1231; ACQ-7832-2022; AAU-8952-2020; JCO-3678-2023; A-4290-2018; CTY-9474-2022; DWL-9897-2022; GBC-7197-2022; HJZ-6992-2023; JKC-3728-2023; IMY-6211-2023; CNK-0895-2022Introduction: Aspergillus species have begun to cause invasive pulmonary aspergillosis (IPA) with increasing frequency in patients with known risk factors in intensive care units (ICU). An international multicenter cohort study (AspICU) established criteria for diagnosis of invasive pulmonary aspergillosis (IPA) in intensive care units. In our study, patients with Aspergillus spp. growth in deep tracheal aspirate (DTA) samples in ICU were evaluated according to AspICU criteria.Materials and Methods: This study is a retrospective study. DTA samples were collected from the Pandemic and Reanimation ICU and performed in the Medical Microbiology Laboratory by separated two periods; pre-pandemic (1 March 2019-31 December 2019) and post-pandemic (1 March 2020-31 December 2020). Cases with Aspergillus spp. growth in the DTA samples in the Pandemic ICU were evaluated as COVID 19 associated pulmonary aspergillosis (CAPA) according to AspICU criteria.Results: While Aspergillus spp. was grown in the DTA of three patients in 2019 and five patients in 2020 in the Reanimation ICU, and 11 patients in the Pandemic ICU. Growths belonging to one patient from both Reanimation (2019) and Pandemic ICUs were considered as colonization. Other growths were interpreted as IPA according to AspICU criteria. When the incidence rates according to 10000 patient days were compared, the incidence rate increased significantly in 2020 (19.1) (p< 0.001) compared to 2019 (3.4); In 2020, it was determined that it increased significantly in the Pandemic ICU (40.4) (p< 0.001) compared to Reanimation ICU (9.2).Conclusion: It should not be forgotten that intensive care patients are also at risk for IPA, especially after viral infections (such as COVID-19, Influenza). Although the incidence of IPA was not very high, it was observed that it tended to increase according to our study. The diagnosis of IPA is problematic, therefore it is necessary to increase awareness and sample diversity and to use biomarkers more widely other than hematology patients.Publication Incidence, characteristics and risk factors of delirium in the intensive care unit: An observational study(Wiley, 2022-01-03) ERBAY DALLI, ÖZNUR; KELEBEK GİRGİN, NERMİN; Girgin, Nermin Kelebek; Kahveci, Ferda; KAHVECİ, FERDA ŞÖHRET; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Anestezi ve Reanimasyon Anabilim Dalı.; 0000-0003-2282-0846; 0000-0002-5882-1632; ABI-1236-2020Aims and Objective To investigate the incidence, characteristics and risk factors of delirium in the ICU. Background Identifying the risk factors of delirium is important for early detection and to prevent adverse consequences. Design An observational cohort study conducted according to STROBE Guidelines. Method The study was conducted with patients who stayed in ICU >= 24 h and were older than 18 years. Patients were assessed twice daily using the RASS and CAM-ICU until either discharge or death. Cumulative incidence was calculated. Demographic/clinical characteristics, length of stay and mortality were compared between patients with and without delirium. A logistic regression model was used to investigate risk factors. Results The incidence of delirium was 31.8% and hypoactive type was the most frequent (41.5%). The median onset of delirium was 3 days (IQR = 2) with a mean duration of 5.27 +/- 2.32 days. Patients with delirium were significantly older, had higher APACHE-II, SOFA and CPOT scores, higher blood urea levels, higher requirements for mechanical ventilation, sedation and physical restraints, longer stays in the ICU and higher mortality than those without delirium. The logistic regression analysis results revealed that a CPOT score >= 3 points (OR = 4.70, 95% CI: 1.05-20.93; p = .042), physical restraint (OR = 10.40, 95% CI: 2.75-39.27; p = .001) and ICU stay >= 7 days (OR = 7.26, 95% CI: 1.60-32.84; p = .010) were independent risk factors of delirium. Conclusions In this study, the incidence of delirium was high and associated with several factors. It is critical that delirium is considered by all members of the healthcare team, especially nurses, and that protocols are established for improvements. Relevance to the clinical practice Based on the results of this study, delirium could be decreased by preventing the presence of pain, prudent use of physical restraints and shortening the ICU stay.Publication Medical device-related pressure injury knowledge assessment for nurses: Development and psychometric validation of a multiple choice test(Ma Healthcare Ltd, 2023-06-01) Dallı, Öznur Erbay; ERBAY DALLI, ÖZNUR; Girgin, Nermin Kelebek; KELEBEK GİRGİN, NERMİN; Bursa Uludağ Üniversitesi/Sağlık Bilimleri Fakültesi/Hemşirelik Anabilim Dalı.; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Anestezi ve Reanimasyon Anabilim Dalı.; 0000-0003-2282-0846; 0000-0002-5882-1632; ABI-1236-2020Objective: This study aimed to develop a valid and reliable test to measure nurses' knowledge of medical device-related pressure injuries (MDRPIs). Methods: The data were collected between May and July 2022. An extensive literature review was performed to develop the instrument. Face and content validity were evaluated in a three-round e-Delphi procedure by an expert panel of 12, including: two wound care nurses; two medical professors; two academic professors/associate professors of nursing with at least 10 years of experience in pressure injuries (PIs) and their care in Turkey; two international professors/ associate professors of nursing who have been involved in the National Pressure Injury Advisory Panel and other wound care organisations; and nurses from each of four different fields. Results: A sample of 155 nurses and 108 nursing students participated to enable evaluation of the validity of the multiple-choice test items (item difficulty, discriminating index), and to construct validity, internal consistency and stability of the instrument. A 16-item test reflecting six themes was developed to assess MDRPI knowledge (MDRPI-KAT). The item difficulty index of the questions ranged from 0.36-0.84, while values for item discrimination ranged from 0.31-0.68. The one-week test-retest intraclass correlation coefficient (stability) was 0.82. The overall internal consistency reliability was 0.77. Group scores of nurses with a (theoretically expected) high level of expertise were found to be statistically significantly higher than those of participants with (theoretically expected) less expertise (p<0.05). Conclusions: The MDRPI-KAT showed acceptable psychometric properties, and can be used in research and practice to evaluate nurses' knowledge of MDRPIs. Declaration of interest: This research did not receive any specific grant from funding agencies in the public, commercial or not-forprofit sectors. The authors have no conflicts of interest to declare.Publication Is bispectral index monitoring reliable for determining sedation level in a tetanus patient?(Int Scientific Information, Inc, 2008-01-01) Girgin, Nermin Kelebek; KELEBEK GİRGİN, NERMİN; İşçimen, Remzi; İŞÇİMEN, REMZİ; Kutlay, Oya; Gurbet, Alp; GURBET, ALP; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Anestezi ve Reanimasyon Anabilim Dalı.; 0000-0002-6503-8232; AAI-8104-2021; A-7994-2018; HKP-2533-2023; AAH-7250-2019Background: Tetanus is an infectious disease characterised by increased muscle rigidity, muscle spasms, and, in severe cases, cardiovascular instability secondary to autonomic dysfunction. Sedation is an important part of the treatment of tetanus. Clinical scoring systems, although simple and inexpensive, are often inadequate in evaluating the patient level of sedation in the intensive care unit (ICU). The bispectral index (BIS), a variable derived from the electroencephalography, could assess sedation in the ICU. In the present study, we aimed to present our experience on the application of BIS monitoring during treatment of a patient with tetanus.Case Report: A 69-year-old man was admitted to intensive care unit with a diagnosis of tetanus. The patient was intubated, and mechanical ventilation (MV) therapy with pressure support ventilation mode was administered. Dexmedetomidine, midazolam and morphine were administered for sedation and analgesia. Sedation was titrated to maintain a Ramsay Sedation Score (RSS) of 5 or greater. The RSS was assessed once a minute during the loading dose of dexmedetomidine and once an hour in the first day. On the following days, the RSS was recorded every 2 hours. When the RSS evaluation was applied, BIS values were also recorded simultaneously. On the 7th day, BIS monitoring could not be continued due to technical reasons. Sedation was monitored by RSS. A total number of 107 Ramsay score determinations and BIS values were obtained in the follow-up period. The patient underwent percutaneous tracheostomy on the 8th day. The patient was totally disconnected from MV on the 31st day and discharged from the hospital on the 33rd day.Conclusions: In this case, we thought that RSS is still a reliable method in monitoring the sedation level in tetanus. The BIS monitoring is inferior to and discordant with the standard monitoring of the RSS, largely to the painful muscle spasms and rigidity inherent in the pathophysiology of the disease. Moreover, if the sedative drug dosage is elevated according to BIS values, excessive sedation may occur in these patients.