The Effects of Interventions During Pregnancy to Improve Breastfeeding Self‐Efficacy: Systematic Review and Meta‐Analysis

Introduction Breastfeeding self‐efficacy can be increased through effective interventions to improve breastfeeding rates and promote maternal and infant health. Improving breastfeeding self‐efficacy in the prenatal period is important for successful breastfeeding and sustainable breastfeeding practices after birth. Although randomized controlled trials have shown that antenatal and postnatal interventions can boost breastfeeding self‐efficacy, evidence is lacking on which interventions are most effective and on the key characteristics of such interventions. The purpose of this review was (1) to examine the effects of various antenatal interventions on breastfeeding self‐efficacy and (2) to identify the most effective intervention. Methods In this meta‐analysis, randomized controlled trials and experimental studies were searched using 5 search engines in accordance with the Preferred Reporting Items for Systematic Reviews and Meta‐Analysis protocols declaration guidelines. In total, 34 studies were identified, which included 4698 participants. A random effects model, subgroup analysis, and meta‐regression analysis were used to pool the results. Results During pregnancy, all types of interventions except model‐based counseling provided without prior education and simulation methods have been effective in increasing breastfeeding self‐efficacy ( P <.05). Intervention type was the only intervention characteristic that showed statistically significant differences in effect size using the between‐group heterogeneity statistic (Q B , 13.888; P = .016). A meta‐regression analysis found a significant effect of differences in intervention types across studies (heterogeneity: τ 2 , 0.672; Q value = 662.100; df = 33; P < .001; I 2 = 95.016%; test for overall effect: z, 7.020; P = .001), and this difference was found to be due to model‐based education and counseling, which had the largest effect size in increasing breastfeeding self‐efficacy. Intervention type explained 16% of the relationship between interventions to increase breastfeeding self‐efficacy during pregnancy and breastfeeding self‐efficacy ( r 2 = 0.16). Discussion There is a relationship between the types of interventions for breastfeeding during pregnancy and breastfeeding self‐efficacy. To increase breastfeeding self‐efficacy during pregnancy, it is recommended that health care professionals primarily develop programs that include model‐based education and counseling.

Expression patterns of aquaporin 9 in umbilical cord and fetal membranes in women with pregestational and gestational diabetes

Abstract Aim Aquaporins (AQPs) play crucial roles in the fetal development process. We aimed to investigate the expression patterns of AQP‐9 in the umbilical cord and fetal membranes in pregnancies complicated by gestational diabetes mellitus (GDM) and pregestational diabetes mellitus (PGDM) compared to normoglycemic pregnancies. Methods Samples of umbilical cord and fetal membranes were collected from women with GDM ( n  = 6), PGDM with nephropathy (White Class F) ( n  = 6). Histomorphologic evaluation was performed using hematoxylin–eosin staining. AQP‐9 expression was analyzed by immunohistochemistry and quantitative real‐time PCR (qPCR). Results Histologically, the GDM group showed increased umbilical cord diameter with edematous changes in Wharton's jelly, while the PGDM group exhibited decreased umbilical cord diameter. Immunohistochemical evaluation revealed significantly increased AQP‐9 protein expression in vascular endothelium and amnion of both umbilical cord and fetal membranes in diabetic groups compared to controls, with the PGDM group showing the most intense immunoreactivity. qPCR demonstrated significantly decreased AQP‐9 gene expression in umbilical cord of diabetic groups compared to controls ( p  = 0.026), while no significant differences in mRNA levels were found in fetal membranes between groups ( p  = 0.980). Conclusion AQP‐9 exhibits significantly increased protein expression in both umbilical cord and fetal membranes of diabetic pregnancies, while mRNA levels are decreased only in the umbilical cord of diabetic patients with no changes in fetal membranes. This tissue‐specific discrepancy between protein upregulation and gene expression suggests complex post‐transcriptional regulatory mechanisms in diabetes‐affected pregnancies, providing novel insights into the molecular pathophysiology of maternal‐fetal complications in diabetes.

Artificial Intelligence Literacy Levels of Perioperative Nurses: The Case of Türkiye

ABSTRACT Artificial intelligence (AI) experience among nurses in perioperative settings is crucial for effective healthcare delivery. This study aimed to assess AI literacy levels and associated characteristics among perioperative nurses in Türkiye. This cross‐sectional study was conducted between March 15 and April 15, 2024, and included 505 perioperative nurses. Data were collected online using the “Nurse Information Form” and “AI Literacy Scale.” Snowball sampling technique was used to enlist individuals. The mean literacy score was 44.35 ± 5.88, which means moderate proficiency. Key elements associated with high literacy levels included being male, familiarity with and use of AI applications, youth, seeing AI as a tool to alleviate workload, and using information technology tools. The results show that although perioperative nurses have a moderate level of AI literacy, their use of AI tools is minimal. The findings underline the need for professional development in AI integration and the inclusion of relevant materials in nursing education programs.

Development of the Critically Ill Patient Eye Assessment Scale: A study of validity and reliability

Abstract Background Eye care and assessment of the eye are critical for intensive care patients to prevent ocular complications like dry eye and corneal abrasion. However, there is no measurement tool developed for intensive care patients that examines the risks of ocular complications. Aim This study aims to develop a valid and reliable tool, the Critically Ill Patient Eye Assessment Scale (CIPEAS), for assessing the risk of ocular complications and determining the frequency of eye care. Study design This study is an instrument development study. This methodological study was conducted with 151 intensive care patients in Turkey between March 2022 and March 2023. Data were collected with the Patient Information Form and the CIPEAS. The data were evaluated using SPSS 23 statistical software. AMOS 21 was used to verify the structure obtained with CFA. Exploration and confirmatory factor analyses were performed to determine the scale's factorial structure. Results As a result of exploratory factor analysis, a six‐item scale consisting of a single dimension was obtained, explaining 59.993% of the total variance. The fit indices of the scale were found to be χ 2 /SD = 2.653, GFI = 0.954, RMSEA = 0.075, NFI = 0.949 and CFI = 0.967. Cronbach's alpha of the scale was found to be 0.862. Conclusion The CIPEAS was found to be a valid and reliable assessment tool. Relevance to Clinical Practice The Critically Ill Patient Eye Assessment Scale is a valid and reliable tool for Turkish society for assessing the risk of ocular complications. It is recommended for various national and international studies with different patients in intensive care units.

Skin tears in older patients in intensive care units: A multicentre point prevalence study

Abstract Background With the ageing of the global population, it is predicted that the population of older adult patients in hospitals and intensive care units (ICUs) will increase. Because of health conditions, care practices and ageing‐related skin changes, older adult ICU patients are prone to skin integrity problems, including skin tears (STs). Aim To determine the prevalence of STs and associated factors in older patients hospitalized in ICUs. Study Design The study is a regional, multicentre, point prevalence study conducted in five centres in the five largest cities in terms of population in the Central Anatolia Region of Türkiye. Data were collected simultaneously in each centre on the same day. The list of patients hospitalized in the ICUs on the day of data collection was drawn up, and 200 patients who were 65 years of age or older, were hospitalized in ICUs and agreed to participate in the research were included. The researchers formed an “ST chart” to record patient demographic characteristics, clinical variables and skin assessment. Results STs were detected in 14.5% of patients in ICUs, with 72.5% of them having stage 1 ST. A significant relationship was found between individuals' average body mass index (BMI) ( p  = .043), age ( p  = .014), length of stay in the ICU ( p  = .004) and having ST. There was also a statistically significant relationship between skin temperature ( p  = .002), skin turgor ( p  = .001) and ST. More STs were observed in patients with cold skin and low turgor. The prevalence of ST was higher in individuals with a history of ST. Additionally, there was a statistically significant relationship between consciousness ( p  = .014), incontinence ( p  = .006), the Braden score ( p  = .004), the Itaki fall risk score ( p  = .006) and ST. Conclusions In this multicentre point prevalence study, the prevalence of ST in older patients in ICUs was 14.5%, and many factors associated with ST have been identified. Relevance to Clinical Practice Given the insufficient information and attention to STs in older adults, the study emphasizes the importance of addressing STs. The impact of STs includes increased treatment costs, length of stay and risk of complications. Therefore, understanding the global extent of STs in ICUs and developing effective interventions for prevention and management are crucial.

Dentoalveolar and Skeletal Effects of an Anterior Open Bite Treatment Protocol Using Zygomatic Anchorage

ABSTRACT Objective Primary aim was to analyse dentoalveolar and skeletal effects induced by an anterior open bite (AOB) treatment protocol for intrusion of maxillary buccal segment. Secondary aim was to investigate whether a subsequent change occurred in hyoid position. Materials and Methods Study group included 28 non‐growing subjects treated in academic setting for correction of AOB. All patients received same appliance that included bilateral acrylic bite‐blocks covering posterior dentition. Intrusive force was applied between buccal bars of appliance and zygomatic multipurpose implants. Lateral cephalograms taken at pre‐treatment (T0) and after intrusion (T1) were analysed using NemoCeph software. Eight skeletal, 9 dental, 6 soft tissue and 5 hyoid parameters were measured and evaluated statistically. Results Mean open bite was −3.2 ± 2.1 mm at T0. T1–T0 duration was 9.6 ± 1.9 months. Increase in SNB (1.1° ± 2.1°) and the decrease in ANB (−1.1° ± 1.3°), Y‐axis (−0.5° ± 3.5°), SN‐GoGn (−2.0° ± −2.5°) and lower facial height (−1.4 ± 2.1 mm) were significant, indicating mandibular counter‐clockwise rotation. Overjet and open bite decreased significantly (−1.8 ± 2.3 mm and 4.2 ± 2.1 mm, respectively). Maxillary molars intruded (U6‐PP: −3.1 ± 1.3 mm) and distalised (ΔU6‐TVL: −1.5 ± 2.7 mm) significantly. Mean change in L6‐MP was significant (0.9 ± 1.4 mm) showing mandibular molar eruption. Lower lip‐true vertical line (TVL) showed significant forward movement of lower lip (−1.8 ± 2.3 mm). Mean changes in hyoid parameters were not significant. Conclusion Significant maxillary buccal segment intrusion was achieved in a relatively short period. AOB was corrected while facial profile and smile aesthetics were improved. Distalisation of maxillary molar suggests that intrusive force vector can be modified to achieve simultaneous intrusion and distalisation.

The Role of Multiple Peripheral Nerve Blockades in the Treatment of Hemicrania Continua

Critical Care Outcomes in Pediatric Hematopoietic Stem Cell Transplantation: A Single‐Center Pediatric Intensive Care Unit Experience

ABSTRACT Background Hematopoietic stem cell transplantation (HSCT) has become an essential curative strategy for various malignant and non‐malignant pediatric diseases. However, HSCT recipients remain highly vulnerable to complications, often requiring pediatric intensive care unit (PICU) admission. Identifying key risk factors and predictors of mortality is crucial for improving patient outcomes. This study aims to evaluate the clinical characteristics, risk factors, and outcomes of pediatric HSCT patients requiring PICU admission, focusing on organ failure, respiratory and cardiovascular dysfunction, and the impact of supportive therapies. Methods This retrospective, single‐center study included pediatric HSCT recipients admitted to a tertiary PICU between August 2019 and October 2023. Patients with PICU stays shorter than 24 h were excluded. Clinical and demographic characteristics, HSCT‐related parameters, PICU admission criteria, and patient outcomes were analyzed. Logistic regression models were applied to identify independent risk factors associated with mortality. Results Among 40 HSCT recipients requiring PICU admission, the overall mortality rate was 80%, exceeding previously reported rates. Sepsis, respiratory failure, and multiple organ dysfunction were the primary reasons for admission. Elevated PELOD scores were strong predictors of mortality. All patients requiring mechanical ventilation, inotropic support, or renal replacement therapy died ( p  < 0.001), whereas all patients managed with non‐invasive ventilation survived, underscoring the importance of early and appropriate respiratory support. Conclusion Organ failure significantly impacts mortality in pediatric HSCT recipients, emphasizing the need for early intervention and proactive monitoring. Structured post‐HSCT surveillance, particularly for patients with prior PICU admissions, is critical for identifying early signs of organ dysfunction and optimizing intensive care management.

Life Satisfaction, Self‐Care Ability, and Loneliness in Older Adults: A Descriptive and Correlational Survey

ABSTRACT Objective This study aimed to determine the relationship between life satisfaction, self‐care ability, and loneliness in older adults. Materials and Methods This descriptive‐correlational study was conducted on voluntary participants aged 65 years and above who lived in North Cyprus. Personal information form, loneliness scale for elderly, satisfaction with life scale and exercise of self‐care agency scale were used for data collection. Results Older adults in our study had moderate levels of life satisfaction and self‐care ability and the level of loneliness was at acceptable levels. Besides, the life satisfaction of the participants was positively correlated with self‐care ability and negatively correlated with the level of loneliness. Conclusion The psychosocial needs of older adults might be evaluated, and social support systems might be enhanced within the context of primary healthcare services. Besides, nurses might play an effective role in planning elderly care by taking the importance of multidisciplinary approaches into consideration.

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