To evaluate the analgesic effect of ultrasound-guided erector spinae plane (ESP) block in breast cancer surgery.
Randomized controlled, single-blinded trial.
Operating room.
Fifty ASA I–II patients ...aged 25–65 and scheduled for elective breast cancer surgery were included in the study.
Patients were randomized into two groups, ESP and control. Single-shot ultrasound (US)-guided ESP block with 20 ml 0.25% bupivacaine at the T4 vertebral level was performed preoperatively to all patients in the ESP group. The control group received no intervention. Patients in both groups were provided with intravenous patient-controlled analgesia device containing morphine for postoperative analgesia.
Morphine consumption and numeric rating scale (NRS) pain scores were recorded at 1, 6, 12 and 24 h postoperatively.
Morphine consumption at postoperative hours 1, 6, 12 and 24 decreased significantly in the ESP group (p < 0.05 for each time interval). Total morphine consumption decreased by 65% at 24 h compared to the control group (5.76 ± 3.8 mg vs 16.6 ± 6.92 mg). There was no statistically significant difference between the groups in terms of NRS scores.
Our study findings show that US-guided ESP block exhibits a significant analgesic effect in patients undergoing breast cancer surgery. Further studies comparing different regional anesthesia techniques are needed to identify the optimal analgesia technique for this group of patients.
•Erector spinae plane block is a new and promising technique for many indications.•Ultrasound guided erector spinae plane block is an effective modality of analgesia for breast surgeries.•Postoperative total morphine consumption in block group reduced by 65% in postoperative 24 h.•Ultrasound guided erector spinae plane block is a relatively easy and safe method for providing analgesia.
Strain energy from tectonic loading can be partly released through aseismic creep. Earthquake repeaters, repeatedly activated brittle fault patches surrounded by creep, indicate steady‐state creep ...that affects the amount of seismic energy available for the next large earthquake along a plate contact. The offshore Main Marmara Fault (MMF) of the North Anatolian Fault Zone represents a seismic gap capable of generating a M > 7 earthquake in direct vicinity to the mega‐city Istanbul. Based on a newly compiled seismicity catalog, we identify repeating earthquakes to resolve the spatial creep variability along the MMF during a 15‐year period. We observe a maximum of seismic repeaters indicating creep along the central and western MMF segments tapering off toward the locked onshore Ganos fault in the west, and the locked offshore Princes Islands segment immediately south of Istanbul in the east. This indicates a high degree of spatial creep variability along the Istanbul‐Marmara seismic gap.
Plain Language Summary
The relative motion of tectonic plates deforms these plates along their contact zone until the plate contact ruptures in an earthquake. However, some of this deformation can be released without earthquakes by so‐called aseismic creep in which the plates creep past each other. Within this creep zone, sometimes some brittle patches exist that interlock during the plate creep and rupture repeatedly in smaller earthquakes that are very similar. They are called earthquake repeaters. In the Sea of Marmara south of Istanbul lies the contact between the Eurasian and the Anatolian plates, the so‐called Main Marmara Fault (MMF). This plate contact did not rupture for a long time and thus a large magnitude event is expected here. We observe a large number of earthquake repeaters in the western offshore part of the MMF while no earthquake repeaters are found toward the east south of Istanbul or onshore toward the west. These areas seem to be locked and might accumulate deformation for a future large earthquake. The zones in between show an intermediate behavior with fewer earthquake repeaters indicating less creep. These results are important for the seismic risk and hazard assessment for the mega‐city of Istanbul.
Key Points
Earthquake repeaters along the Main Marmara Fault are identified based on a newly derived homogeneous earthquake catalog spanning 15 years
Seismic creep estimated from these repeaters is highly variable along‐strike with higher creep values along the western part
A repeating earthquake sequence showing accelerated activity after a nearby Mw 5.2 earthquake is observed
The aim of this randomized cross-over study was to compare one-minute and two-minute continuous chest compressions in terms of chest compression only CPR quality metrics on a mannequin model in the ...ED.
Thirty-six emergency medicine residents participated in this study. In the 1-minute group, there was no statistically significant difference in the mean compression rate (p=0.83), mean compression depth (p=0.61), good compressions (p=0.31), the percentage of complete release (p=0.07), adequate compression depth (p=0.11) or the percentage of good rate (p=51) over the four-minute time period. Only flow time was statistically significant among the 1-minute intervals (p<0.001). In the 2-minute group, the mean compression depth (p=0.19), good compression (p=0.92), the percentage of complete release (p=0.28), adequate compression depth (p=0.96), and the percentage of good rate (p=0.09) were not statistically significant over time. In this group, the number of compressions (248±31 vs 253±33, p=0.01) and mean compression rates (123±15 vs 126±17, p=0.01) and flow time (p=0.001) were statistically significant along the two-minute intervals. There was no statistically significant difference in the mean number of chest compressions per minute, mean chest compression depth, the percentage of good compressions, complete release, adequate chest compression depth and percentage of good compression between the 1-minute and 2-minute groups.
There was no statistically significant difference in the quality metrics of chest compressions between 1- and 2-minute chest compression only groups.
Purpose
This study was conducted to examine the experiences of nursing students in holistic nursing clinical practice.
Design
Twenty senior nursing students participated in this study. Data were ...collected through focus group interviews with a qualitative approach followed by thematic data analysis.
Findings
Four themes were obtained holistic care, barriers to holistic care, the contributions of holistic nursing internship, and students' expectations.
Practice Implications
The participants stated that they believe that physical care is sufficient enough in the care they provide to patients and their families in clinical practice and that they only provide physical care. However, they stated that they became aware of the importance of holistic care with this practice and gained better insights into their professional requirements.
Synthetic pyrethroid cypermethrin is commonly used in agriculture, veterinary, and household insects management. It has been found to be a newer insectiside poisoning reported in Turkey. Acute severe ...poisoning of cypermethrin is a rare event. Here we report a case of a 25-year-old woman presented with features of cypermethrin poisoning in intensive care unit. Management of acute rare poisoning is discussed in this case with literature review.
This study aimed to determine the sociodemographic factors affecting the depression-anxiety-stress levels and coping strategies of parents with babies treated in neonatal intensive care units during ...the COVID-19 pandemic.
and Methods: This descriptive cross-sectional study was conducted between March and October 2021. The sample consisted of 93 parents. Data were collected using a descriptive questionnaire, the Depression Anxiety Stress Scale (DASS- 42), and Coping Style Scale (CSS).
Participants had mean DASS “depression,” “anxiety,” and “stress” subscale scores of 13.69 ± 8.86, 12.11 ± 8.37, and 19.09 ± 9.24, respectively. They had mean CSS “self-confident,” “optimistic,” “helpless,” “submissive coping,” and “seeking of social support” subscale scores of 2.71 ± 0.65, 2.57 ± 0.59, 2.29 ± 0.62, 2.25 ± 0.49, and 2.38 ± 0.52, respectively. Fathers had lower mean CSS “helpless” and “submissive” subscale scores than mothers. Participants who were briefed about their babies' condition by nurses had lower mean CSS “helpless” and “submissive” subscale scores than others. Participants with higher education had lower mean CSS “helpless” and “submissive” subscale scores than others. Participants with spouses with bachelor's or higher degrees had a higher median CSS “optimistic” subscale score than those with literate spouses or spouses with primary school degrees. Participants who were worried about the “no visitors” policy had a lower median CSS “self-confident” subscale score than those who were not.
Parents who are not allowed to see their babies due to the “no visitors” policy during the COVID-19 pandemic experience more psychosocial problems. Though not a result of the present study, the “no visitors” policy seems to affect the mother-infant attachment adversely.
Healthcare professionals should brief parents about what a neonatal intensive care unit is like. They should also warn them that they may not be too happy about how their baby looks before seeing them. Therefore, they should use therapeutic communication techniques to talk to them and explain the situation in a way they can understand. Moreover, they should provide parents with psychological empowerment training programs to help them adopt active coping strategies to deal with challenges in times of crisis.
•Parents are worried about the “no visitors” policy during the COVID-19 pandemic.•Mothers use passive coping strategies more often than fathers.•Mothers have higher depression-anxiety levels than fathers.
A review on the historical evolution of seismic hazard maps in Turkey is followed by summarizing the important aspects of the updated national probabilistic seismic hazard maps. Comparisons with the ...predecessor probabilistic seismic hazard maps as well as the implications on the national design codes conclude the paper.
Based on the earthquake event data accumulated by the Turkish National Seismic Network between 2007 and 2013, the local magnitude (Richter, Ml) scale is calibrated for Turkey and the close ...neighborhood. A total of 137 earthquakes (Mw > 3.5) are used for the Ml inversion for the whole country. Three Ml scales, whole country, East, and West Turkey, are developed, and the scales also include the station correction terms. Since the scales for the two parts of the country are very similar, it is concluded that a single Ml scale is suitable for the whole country. Available data indicate the new scale to suffer from saturation beyond magnitude 6.5. For this data set, the horizontal amplitudes are on average larger than vertical amplitudes by a factor of 1.8. The recommendation made is to measure Ml amplitudes on the vertical channels and then add the logarithm scale factor to have a measure of maximum amplitude on the horizontal. The new Ml is compared to Mw from EMSC, and there is almost a 1:1 relationship, indicating that the new scale gives reliable magnitudes for Turkey.
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