Person: KELEBEK GİRGİN, NERMİN
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KELEBEK GİRGİN
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Publication Sepsis episodes caused by pressure injuries in critical illness: A retrospective observational cohort study(Hmp, 2023-11-01) Kaya, Pınar Küçükdemirci; Kaya, Murad; Girgin, Nermin Kelebek; Kahveci, Ferda S.; Akalın, Emin Halis; İsçimen, Remzi; KÜÇÜKDEMİRCİ KAYA, PINAR; KAYA, MURAD; KELEBEK GİRGİN, NERMİN; KAHVECİ, FERDA ŞÖHRET; AKALIN, EMİN HALİS; İŞÇİMEN, REMZİ; Tıp Fakültesi; 0000-0002-8428-8245; 0000-0002-5882-1632; JGB-6637-2023; CYJ-4124-2022; DTU-3148-2022; IMY-6211-2023; AAU-8952-2020; DWL-9897-2022BACKGROUND: Critically -ill patients (CIPs) with pressure injuries (PIs) may develop bloodstream infections (BSIs). PURPOSE: To identify predisposing factors and discuss diagnosis and management of sepsis -related PIs in CIPs. METHODS: The records of CIPs in the intensive care unit (ICU) between January 1, 2014, and January 1, 2020, with PI with sepsis -diagnoses and with different site cultures that were positive concurrent with bloodstream -cultures were retrospectively reviewed. RESULTS: Ninety-one sepsis episodes were included in the study. Low albumin level ( U = 382.00, P = .006), renal failure (odds ratio [OR], 0.108 [95% CI, 0.015-0.783]; P = .025), and length of ICU stay ( U = 130.00, P < .001) were identified as risk factors of BSIs due to PIs. The probability of BSI during a sepsis episode was lower in CIPs with PIs with higher C -reactive protein levels ( U = 233.00, P < .001) and whose injury resulted from trauma or surgery (OR, 0.101 [95% CI, 0.016-0.626]; P = .014). The mortality was higher in CIPs with PI -induced BSIs (OR, 0.051 [95% CI, 0.008-0.309]; P = .001). CONCLUSIONS: Pressure injury -induced sepsis was associated with a high risk of 28 -day mortality. The findings suggest that CIPs with PI are at increased risk of BSIs if they have low albumin levels, renal -failure, and prolonged ICU stay during sepsis episodes.Publication A retrospective analysis of causes for readmission to hospital and intensive care unit in patients discharged from intensive care units(Galenos Yayıncılık, 2022-06-01) Ulusaloğlu, Ceyda; Ceylan, İlkay; Girgin, Nermin Kelebek; İsçimen, Remzi; Kahveci, Ferda Şöhret; KELEBEK GİRGİN, NERMİN; İŞÇİMEN, REMZİ; KAHVECİ, FERDA ŞÖHRET; Tıp Fakültesi; Anesteziyoloji ve Reanimasyon Ana Bilim Dalı; GBC-7197-2022; DWL-9897-2022; IMY-6211-2023Objective: Intensive care unit (ICU) readmission is a common and unwanted situation. Mortality rates, length of stay in ICU and treatment expenses are also higher in readmitted patients. This study aimed to examine the hospital/ICU readmission rates and risk factors among patients discharged from the ICU.Materials and Methods: Patients older than 18 years who were hospitalised in the ICU between January 1, 2012 and October 31, 2016 and were re-admitted to the hospital/ICU within 30 days after discharge were retrospectively analysed.Results: A total of 510 patients met the inclusion criteria, of whom 91 (17.84%) patients were readmitted to the ICU. The average age was higher (p=0.002) among the readmitted patients. The acute physiology and chronic health evaluation-II and sequential organ failure assessment scores at admission and discharge, stability and workload index for transfer (SWIFT) scores at discharge and comorbid disease rates were higher among readmitted patients (p<0.05 for all). Patients discharged with mechanical ventilation support had higher readmission rates (p=0.041). In our risk analysis model, factors that increased the risk of readmission were identified as age [odds ratio (OR), 1.02; 95% confidence interval (CI), 1.01-1.03] and presence of renal disease (OR, 5.72; 95% CI, 2.81-11.65) among patient-related reasons.Conclusion: High acute physiology and chronic health evaluation and SWIFT scores during discharge as well as presence of comorbidities can predict hospital/ICU readmission.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; Tıp Fakültesi; Anesteziyoloji ve Reanimasyon Ana Bilim 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 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; Tıp Fakültesi; Mikrobiyoloji ve Enfeksiyon Hastalıkları Ana Bilim 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 Antibiotic usage policies(Galenos Yayincilik, 2007-01-01) Kelebek-Girgin, Nermin; KELEBEK GİRGİN, NERMİN; Kurhan-Erari, Gülhan; Tıp Fakültesi; Anestezi ve Reanimasyon Ana Bilim DalıPublication Current statement of intensive care units in Turkey: Data obtained from 67 centers(Bilimsel İpucu Yayınevi, 2018-10-01) Ediboğlu, Özlem; Mocin, Özlem Yazıcıoğlu; Özyılmaz, Ezgi; Saltürk, Cüneyt; Onalan, Tuğba; Seydaoğlu, Gülşah; Çelikel, Turgay; Arıkan, Hüseyin; Ataman, Sena; Kıraklı, Cenk; Özçelik, Zerrin; Kultufan, Sema; Kara, İskender; Kara, Atilla; Dağlı, Emine; Bülbül, Selma Duru; Kahveci, Kadriye; Dinçer, Metin; Şenoğlu, Nimet; Özkarakaş, Hüseyin; Bahar, İlhan; Cengiz, Melike; Ramazanoğlu, Atilla; Çelik, Burcu; Gaygısız, Ümmugülsun; Kır, Gülay; Bindal, Ahmet; Akan, Belgin; Turan, Işil Özkoçak; Yıldırım, Fatma; Basarık, Burcu; Ulukan, Zeliha Arslan; Efe, Serdar; Sungur, Murat; Temel, Şahin; İzdeş, Seval; Hoşgün, Derya; Karadeniz, Nurhan; Tuncay, Eylem; Göksenoğlu, Nezihe Çiftarslan; Irmak, İlim; Datlı, Utku; Zerman, Avşar; Akdağ, Devrim; Özdemir, Levent; Elay, Gülşeren; Karaçayır, Yücel; Topeli, Arzu; Hancı, Pervin; Kaya, Esat Kıvanç; Güven, Pınar; Sazak, Hilal; Aydemir, Semih; Aygencel, Gülbin; Aydemir, Yusuf; Doğanay, Zahide; Kömurcü, Özgür; Hancı, Volkan; Karakoç, Emre; Sozutek, Didem; Coşkun, Güven; Ateş, Güngor; Tiryaki, Civan; Soytürk, Ayşe Nur; Girgin, Nermin Kelebek; Çalışkan, Gülbahar; Bıyıklı, Oben; Gökmen, Necati; Koca, Uğur; Çiledağ, Aydın; Suner, Kezban Özmen; Cinel, İsmail; Arslantaş, Mustafa Kemal; Gül, Fethi; Ergün, Recai; Yılmaz, Nafiye; Altıntaş, Defne; Talan, Leyla; Yalçınsoy, Murat; Güllü, Mehmet Nezir; Özcan, Perihan Ergin; Orhun, Günseli; Savran, Yusuf; Tokur, Murat Emre; Akpınar, Serdar; Şen, Pelin; Gürsel, Gül; Şerifoğlu, İrem; Gedik, Ender; Balbay, Öner Abidin; Akbaş, Türkay; Cesur, Sinem; Yolacan, Hülya; Sağmen, Seda Beyhan; Ekren, Pervin Korkmaz; Bacakoğlu, Feza; Ergan, Begüm; Günay, Ersin; Sarıaydın, Muzaffer; Sağlam, Dursun Ali; Karakurt, Sait; Eryüksel, Emel; Öztuna, Funda; Murtezaoğlu, Emine Sevil Ayaydın; Cinemre, Hakan; Nalbant, Ahmet; Yağmurkaya, Öznur; Mandal, Tuğba; İkidağ, Belgin; Soytürk, Ayşe Nur; KELEBEK GİRGİN, NERMİN; Çalışkan, Gülbahar; Tıp Fakültesi; Hastanesi Yoğun Bakım Ünitesi; 0000-0002-0053-9087; FZE-6902-2022; AAH-7250-2019; ABR-7846-2022OBJECTIVES: We aimed to obtain information about the characteristics of the ICUs in our country via a point prevalence study.MATERIAL AND METHODS: This cross-sectional study was planned by the Respiratory Failure and Intensive Care Assembly of Turkish Thoracic Society. A questionnaire was prepared and invitations were sent from the association's communication channels to reach the whole country. Data were collected through all participating intensivists between the October 26, 2016 at 08:00 and October 27, 2016 at 08:00.RESULTS: Data were collected from the 67 centers. Overall, 76.1% of the ICUs were managed with a closed system. In total, 35.8% (n=24) of ICUs were levels of care (LOC) 2 and 64.2% (n=43) were LOC 3. The median total numbers of ICU beds, LOC 2, and LOC 3 beds were 12 (8-23), 14 (10-25), and 12 (8-20), respectively. The median number of ventilators was 12 (7-21) and that of ventilators with non-invasive ventilation mode was 11 (6-20). The median numbers of patients per physician during day and night were 3.9 (2.3-8) and 13 (9-23), respectively. The median number of patients per nurse was 2.5 (2-3.1); 88.1% of the nurses were certified by national certification corporation.CONCLUSION: In terms of the number of staff, there is a need for specialist physicians, especially during the night and nurses in our country. It was thought that the number of ICU-certified nurses was comparatively sufficient, yet the target was supposed to be 100% for this rate.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; Tıp Fakültesi; Anestezi ve Reanimasyon Ana Bilim 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.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; Tıp Fakültesi; Anestezi ve Reanimasyon Ana Bilim 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 Mixed fungal infection in early period after kidney transplantation: A case report(Turk Nefroloji Diyaliz Transplantasyon Dergisi, 2015-01-01) Işıktaş Sayılar, Emel; Ersoy, Alparslan; ERSOY, ALPARSLAN; Akalın, Halis; AKALIN, EMİN HALİS; Ayar, Yavuz; Girgin, Nermin Kelebek; KELEBEK GİRGİN, NERMİN; CEYLAN, İLKAY; DEMİR, UYGAR LEVENT; Ener, Beyza; ENER, BEYZA; Tıp Fakültesi; Anestezi ve Reanimasyon Ana Bilim Dalı; 0000-0003-4607-9220; 0000-0001-7530-1279; 0000-0003-3306-3107; AAU-8952-2020; AAH-5054-2021; O-9948-2015; AAH-7250-2019; GSE-0029-2022; AGF-0767-2022; AAG-8523-2021Invasive fungal infections have a rapid and frequently fatal course in patients with solid organ transplantations. Mostly Aspergillus spp., Mucorales spp., Candida spp. and Cryptococcus neoformans are causal pathogens for opportunistic infections. Aspergillus spp. and Mucorales spp. especially lead to invasive fungal infections at rhino-cerebral area; they show similar radiological and clinical signs and they lead to invasive fungal co-infections. In case of any doubt about invasive fungal infections, antifungal treatment should be initiated as soon as possible and immunosuppressive treatment should be considered. This case presentation is about a patient at 51 years of age who developed invasive rhino-cerebral mixed fungal infection in 4 weeks following renal transplant.Publication Reliability and validity of the Turkish version of pressure ulcer knowledge assessment tool-updated version (pukat 2.0)(Elsevier Sci Ltd, 2022-02-08) Yıldırım, Yasemin; Çalışkan, Gülbahar; Dallı, Öznur Erbay; ERBAY DALLI, ÖZNUR; Girgin, Nermin Kelebek; KELEBEK GİRGİN, NERMİN; Tıp Fakültesi; Anestezi ve Reanimasyon Ana Bilim Dalı; 0000-0003-2282-0846; 0000-0002-5882-1632; ABI-1236-2020Objective: This study aimed to determine the reliability and validity of the Turkish version of the measurement tool developed and updated by Manderlier et al. to evaluate the nurses' evidence-based knowledge about pressure ulcers. Materials and methods: A methodological study design was used. The instrument was translated to Turkish and back-translated to English. A group of faculty members, including physicians and nurses who are experts in the subject area, evaluated the content validity of the tool with the Lawshe technique. A group of 240 nurses who met the inclusion criteria were reached, and then a pilot study was conducted with 35 nurses by using the testretest method to determine the invariance of the tool over time. The nurses in the pilot study were excluded from the overall sample, and the evaluations were performed with 205 nurses. Item difficulty index and discrimination index were used for the validity of the items since they were multiple-choice items; Kuder-Richardson 20 analysis was used to determine the internal consistency. Results: The translated and modified instrument demonstrated acceptable psychometric properties as follows: 1) overall content validity index was 0.90, 2) overall test-retest reliability was 0.83 (0.70-0.92 for the sub-themes), 3) item difficulty indexes were 35-75%, 4) discrimination indexes were 0.44-0.92, and 5) overall Cronbach's alfa for the internal consistency was 0.72. Conclusions: Similar to the earlier version, the Turkish version of PUKAT 2.0 was demonstrated to be a valid and reliable tool to evaluate the nurses' knowledge of evidence-based current information about pressure ulcers.