Publications by authors named "Ata Elvan"

11 Publications

  • Page 1 of 1

Evaluation of the Use of Diverse Mental Health Simulation in Nursing Students' Learning Experience: An International Multisite Study.

Nurse Educ 2021 Mar 30. Epub 2021 Mar 30.

Clinical Assistant Professor (Dr Ozkara San), NYU Rory Meyers College of Nursing, New York; and Associate Professor (Dr Dikec) and Assistant Professor (Dr Ata), Department of Psychiatric Nursing, and Professor (Dr Sendir), Department of Fundamental Nursing, Hamidiye Faculty of Nursing, University of Health Sciences, Istanbul, Turkey.

Background: Simulated patients (SPs) in mental health nursing education provide a unique approach to assist student development in complex assessment skills.

Purpose: The purpose of this international multisite study was to evaluate the use of two diverse mental health SP simulation scenarios on nursing students' satisfaction and self-confidence in learning to care for patients with mental health disorders in the United States (n = 70) and Turkey (n = 90).

Methods: A multisite cross-sectional study design was used. Outcome measures included the Student Satisfaction and Self-confidence in Learning Scale and the adapted Simulation Effectiveness Tool-Modified. Results were analyzed using independent t tests.

Results: While students in the United States reported higher perceived self-confidence and satisfaction in learning, both student populations found the intervention effective to their learning (P < .05).

Conclusion: Using SPs in mental health education allow students to practice their assessment skills learned in classroom and transfer them to the clinical area.
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http://dx.doi.org/10.1097/NNE.0000000000001007DOI Listing
March 2021

Reliability of Different Clinical Techniques for Assessing Foot Posture.

J Manipulative Physiol Ther 2020 Nov - Dec;43(9):901-908. Epub 2020 Aug 20.

School of Physical Therapy and Rehabilitation, Dokuz Eylul University, Izmir, Turkey.

Objective: The aim was to determine the interrater and intrarater reliability of navicular drop (NDP), navicular drift (NDT), and the Foot Posture Index-6 (FPI-6), and test-retest reliability of the static arch index (SAI) and dynamic arch index (DAI).

Methods: Sixty healthy individuals were assessed for intrarater and test-retest reliability. From 60 participants, 30 individuals were assessed for interrater reliability. A digital caliper was used to measure NDP and NDT. Electronic pedography was used to calculate SAI and DAI. The FPI-6 was also performed. All assessments were performed on the dominant foot. The NDP, NDT, SAI, and DAI were repeated 3 times. The NDP and NDT were analyzed separately using both first measurement and the average, but the SAI and DAI were analyzed using only the average. The NDP, NDT, and FPI-6 were conducted by 2 raters to determine interrater reliability and were repeated by a single rater after 5 days from initial assessment to determine intrarater reliability. The SAI and DAI were also repeated after 5 days to determine test-retest reliability.

Results: Intrarater intraclass correlation coefficients (ICCs) were 0.934 and 0.970 for NDP, 0.724 and 0.850 for NDT, and 0.945 for FPI. Interrater ICCs were 0.712 and 0.811 for NDP, 0.592 and 0.797 for NDT, and 0.575 for FPI. Test-retest ICCs of the SAI and DAI were 0.850 and 0.876, respectively.

Conclusion: Navicular drop is relatively more reliable than other traditional techniques. Also, the FPI-6 has excellent intrarater reliability, but only moderate interrater reliability. The results can provide clinicians and researchers with a reliable way to implement foot posture assessment.
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http://dx.doi.org/10.1016/j.jmpt.2020.02.002DOI Listing
August 2020

The impact of side effects on schizophrenia and bipolar disorder patients' adherence to prescribed medical therapy.

Perspect Psychiatr Care 2020 Jul 9;56(3):691-696. Epub 2020 Feb 9.

Giresun University Prof. Dr. A İlhan Özdemir Training and Research Hospital, Giresun University, Giresun, Turkey.

Purpose: Our study aims to investigate how antipsychotic drugs' side effects impact schizophrenia and bipolar disorder patients and how this affects their adherence to prescribed medical therapy.

Design And Methods: The study sample consists of 47 bipolar disorder and 45 schizophrenic patients. Data were collected using the Medication Adherence Rating Scale (MARS) and Liverpool University Neuroleptic Side Effect Rating Scale (LUNSERS).

Findings: The mean total LUNSERS scores showed that bipolar disorder patients had more significant side effects compared with schizophrenic patients (P < .05). There was a moderate negative correlation between the mean MARS scores and mean LUNSERS scores of bipolar disorder patients (P < .05).

Practice Implications: Nursing care actions and strategies should be planned and implemented to promote adherence to treatment.
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http://dx.doi.org/10.1111/ppc.12483DOI Listing
July 2020

Investigation of the effects of flat cushioning insole on gait parameters in individuals with chronic neck pain.

Acta Bioeng Biomech 2019 ;21(2):135-141

School of Physical Therapy and Rehabilitation, Dokuz Eylul University, Izmir, Turkey.

Purpose: Individuals with chronic neck pain (CNP) walk with a stiffer spine known to cause an increase in dynamic loading on the spine. They also exhibit altered spatiotemporal gait variables, however, it is still unclear whether flat cushioning insole, which reduces dynamic loading on the musculoskeletal system by absorbing the ground reaction force, affects gait parameters in individuals with CNP. The aim of this work was to investigate the effects of flat cushioning insole on neck pain during walking and gait parameters in individuals with CNP.

Methods: Twenty-one individuals with CNP and 21 asymptomatic controls were included. Assessments of gait parameters and pain were conducted in two sessions, standard shoe only and standard shoe with flat cushioning. In both sessions, all participants performed the 10-meter walk test in two walking conditions: preferred walking, walking at maximum speed. The force sensitive insoles and the video analysis method were used to assess plantar pressure variables and spatiotemporal gait variables, respectively. Pain was assessed using the Visual Analogue Scale.

Results: Our results indicated that flat cushioning reduced the maximum force and force-time integral in both groups (p < 0.05). Flat cushioning increased walking speed and step length in both walking conditions and reduced neck pain during walking at maximum speed in individuals with CNP (p < 0.05). In asymptomatic individuals, no difference was found in spatiotemporal gait variables between two sessions (p > 0.05).

Conclusions: These results have suggested that the use of flat cushioning insole may improve neck pain during walking and spatiotemporal gait variables in individuals with CNP.
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April 2020

Pelvic floor muscle function and symptoms of dysfunctions in midwifes and nurses of reproductive age with and without pelvic floor dysfunction.

Taiwan J Obstet Gynecol 2019 Jul;58(4):505-513

School of Physiotherapy, Dokuz Eylul University, Izmir, Turkey. Electronic address:

Objectives: This study aims to compare pelvic floor muscle (PFM) functions in midwifes and nurses of reproductive age with and without pelvic floor dysfunction (PFD) and investigate the relationship between PFM function and the number, type and symptoms of PFDs.

Materials And Methods: 82 midwifes and nurses of reproductive age with (n = 51) and without PFD (n = 31) participated in the study. PFM function was assessed by digital palpation using PERFECT scale. Gynecological examination, ultrasonography, disease-specific questionnaires, questions and tests were used to assess symptoms of PFD. PFD was assessed in terms of risk factors, urinary incontinence, fecal incontinence, pelvic organ prolapse (POP), pelvic pain and sexual dysfunctions.

Results: Power parameter of PERFECT scheme was significantly lower in subjects with PFD compared to Non-PFD group (p = 0.002). 41% of the subjects with Power 5 PFM strength in PFD group were diagnosed as stage 1 POP, 5.8% as stage 2 POP, 15.7% of urge incontinence, 23.3% of stress incontinence and 10.5% of mixed incontinence. Both urinary incontinence and POP were detected in 15.7% of them. Among all subjects, incontinence symptoms decreased whereas POP and sexual function did not change as PFM increased. PFM strength was negatively correlated with the number of PFD (p = 0.002, r = -0.34). The type of dysfunction did not correlate with PFM strength (p > 0.05).

Conclusion: PFM strength only affects of urinary incontinence sypmtoms among all PFDs in midwifes and nurses of reproductive age. PFM strength may not be the main factor in the occurrence of PFDs as pelvic floor does not consist solely of muscle structure. However, it strongly affects the number of dysfunctions. Therefore, PFM training should be performed to prevent the occurrence of extra dysfunctions in addition to the existing ones even if it does not alter the symptoms.
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http://dx.doi.org/10.1016/j.tjog.2019.05.014DOI Listing
July 2019

Effect of Different Insole Materials on Kinetic and Kinematic Variables of the Walking Gait in Healthy People.

J Am Podiatr Med Assoc 2018 Sep;108(5):390-396

Background: There is a lack of data that could address the effects of off-the-shelf insoles on gait variables in healthy people.

Methods: Thirty-three healthy volunteers ranging in age from 18 to 35 years were included to this study. Kinematic and kinetic data were obtained in barefoot, shoe-only, steel insole, silicone insole, and polyurethane insole conditions using an optoelectronic three-dimensional motion analysis system. A repeated measures analysis of variance test was used to identify statistically significant differences between insole conditions. The alpha level was set at < .05.

Results: Maximum knee flexion was higher in the steel insole condition ( < .0001) compared with the silicone insole ( = .001) and shoe-only conditions ( = .032). Reduced maximum knee flexion was recorded in the polyurethane insole condition compared with the shoe-only condition ( = .031). Maximum knee flexion measured in the steel insole condition was higher compared to the barefoot condition ( = .020). Higher maximum ankle dorsiflexion was observed in the barefoot condition, and there were significant differences between the polyurethane insole ( < .0001), silicone insole ( = .001), steel insole ( = .002), and shoe conditions ( = .004). Least and highest maximum ankle plantarflexion were detected in the steel insole and silicone insole conditions, respectively. Maximum ankle plantarflexion in the barefoot and steel insole conditions ( = .014) and the barefoot and polyurethane insole conditions ( = .035) were significant. There was no significant difference between conditions for ground reaction force or joint moments.

Conclusions: Insoles made by different materials affect maximum knee flexion, maximum ankle dorsiflexion, and maximum ankle plantarflexion. This may be helpful during the decision-making process when selecting the insole material for any pathological conditions that require insole prescription.
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http://dx.doi.org/10.7547/16-175DOI Listing
September 2018

Gait speed and gait asymmetry in individuals with chronic idiopathic neck pain.

Musculoskelet Sci Pract 2019 06 7;41:23-27. Epub 2019 Mar 7.

School of Physical Therapy and Rehabilitation, Dokuz Eylul University, Balcova, Izmir, Turkey.

Background: Recent studies have shown that individuals with chronic idiopathic neck pain (CINP) exhibit altered spatiotemporal gait parameters. Problems arising from the neck joints and related soft tissues, and most mechanical neck pain appear asymmetric. However, whether individuals with CINP have an asymmetric gait has not been clarified.

Objectives: The aim was to investigate if there was a significant difference in gait speed (GS) and gait asymmetry (GA) between individuals with CINP and healthy controls.

Design: Case-Control Study.

Method: Twenty individuals with CINP and 20 healthy controls were included. All participants performed the 10-m walking test in three walking conditions: preferred walking (PW), preferred walking with head rotation and walking at maximum speed (MAXW). The timing gate system and pressure sensitive insoles were used to calculate GS and GA, respectively. GA was calculated using the difference between right and left swing durations.

Results/findings: Individuals with CINP had slower GS in all walking conditions compared to controls (p < 0.05). In PW and MAXW conditions, gait was found to be asymmetric in individuals with CINP compared to controls (p < 0.05). There was no difference in GA between the walking conditions in either group (p > 0.05).

Conclusions: Individuals with CINP had a slower and more asymmetrical gait. GA should be evaluated as a part of the routine gait analysis since it has potential to cause asymmetric loading on joints which could cause other musculoskeletal problems in the long-term. Also, future research is needed to clarify the reasons why gait is more asymmetric in individuals with CINP.
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http://dx.doi.org/10.1016/j.msksp.2019.03.001DOI Listing
June 2019

Association of quadriceps angle with plantar pressure distribution, navicular height and calcaneo-tibial angle.

Acta Orthop Traumatol Turc 2019 Mar 9;53(2):145-149. Epub 2019 Jan 9.

School of Physical Therapy and Rehabilitation, Dokuz Eylül University, Izmir, Turkey.

Objective: The aim of study was to analyze the association between Quadriceps Angle (QA) and plantar pressure, navicular height (NH), and calcaneo-tibial angle (CTA).

Methods: A total of 64 volunteers (mean age: 22.25 ± 2.54 (range:19-33)) participated in this cross sectional study. EMED-m (Novel GmbH, Germany) electronic pedobarograph was employed for dynamic plantar pressure measurement using two step protocol. The angle between the vertical axis of calcaneus and the long axis of Achilles tendon for CTA. The height of navicular tubercle from the ground was measured while the subject was standing on both feet for NH. QA was measured while the subject was standing in a relaxed posture where both feet bearing equal weight.

Results: There were significant negative correlations between QA and maximum force (MxF) under the 4th. metatarsal head (MH4). The QA was also significantly correlated with MxF and force-time integral (FTI) under the bigtoe (BT). FTI under the 3rd. metatarsal head (MH3), MH4 and 5th. metatarsal head (MH5) were significantly negatively correlated with QA. Pressure-time integral (PTI) under the MH4 and MH5 were found to be significantly negatively correlated with QA. A significant correlation was also found between QA and NH (p < 0.0001), whilst there was no correlation between QA and CTA. Regression analysis showed that NH was appeared as the major contributor for the QA (β = -0.49, p < 0.001) in the dynamic condition, followed by BT-FTI (β = 0.37, p < 0.001) and MH5-MxF (β = -0.21, p < 0.037).

Conclusion: These findings may imply that the NH which can at least be controlled by appropriate shoe inserts may affect QA. This way, loading pattern of both plantar region and whole lower extremity may be altered.

Level Of Evidence: Level III, Diagnostic Study.
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http://dx.doi.org/10.1016/j.aott.2018.12.008DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6506805PMC
March 2019

Generalized hypermobility syndrome (GHS) alters dynamic plantar pressure characteristics.

J Back Musculoskelet Rehabil 2019 ;32(2):321-327

School of Physical Therapy and Rehabilitation, Dokuz Eylül University, Izmir, Turkey.

Background: In the relevant literature generalized hypermobility syndrome (GHS) has been shown to alter the kinetic and kinematic patterns of the human movement system. Although GHS affects the general body biomechanics of individuals, the body of knowledge in plantar pressure distribution in GHS is far from sufficient.

Objective: The aim of this study was to determine whether individuals with joint hypermobility syndrome have abnormal plantar pressure distribution during normal gait compared to healthy individuals.

Methods: A total of 37 participants (mean age: 22.16 ± 2.58 years) diagnosed with GHS and 37 aged-matched participants (mean age: 23.35 ± 2.85 years) without GHS were included in the study. Dynamic plantar pressure distribution was obtained as each participant walked in barefoot at a self-selected pace over EMED-m system (Novel GmbH, Munich, Germany). Correlations between hypermobility score (HS) (Beighton score) and plantar pressure variables, and between group differences in peak pressure (PP), pressure-time integral (PTI), average pressure (AP) and maximum force (MxF) were computed for 10 regions under the sole.

Results: HS was significantly correlated with peak pressure under the mid-foot (MF) (r= 0.24, p= 0.043), 5th metatarsal head (MH5) (r= 0.33, p= 0.001), big toe (BT) (r= 0.44, p< 0.001), and second toe (ST) (r= 0.38, p= 0.001). A similar trend was observed for pressure-time integrals under hindfoot (HF) (r= 0.24, p= 0.04), MF (r= 0.30, p= 0.009), MH5 (r= 0.25, p= 0.033), BT (r= 0.37, p= 0.001) and ST (r= 0.34, p= 0.003). The only significant MxF detected was under the ST (r= 0.23, p= 0.048), and AP was determined to be significantly higher as HS increases indicated by APs under MH5 (r= 0.24, p= 0.042), BT (r= 0.32, p= 0.005) and ST (r= 0.40, p< 0.001). Peak pressure values under HF were significantly higher in the hypermobile group (p= 0.023), MH5 (p= 0.001), BT (p< 0.001) and ST (p= 0.003). AP and PTI were also found to be significantly higher in the hypermobile group under MH5 (p= 0.009), BT (p= 0.037), and ST (p= 0.003). MxF was higher only under MF5 (p= 0.029) and SF (p= 0.041) in the hypermobile group.

Conclusion: The forefoot regions received a higher load in GHS during gait. This could be useful in clinical evaluation of the foot in GHS, preventing potential injuries of lower extremity, and also in processes related to decision making for foot orthotics and/or rehabilitation protocols.
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http://dx.doi.org/10.3233/BMR-170973DOI Listing
May 2019

The Effect of a Brief Cognitive Behavioural Stress Management Programme on Mental Status, Coping with Stress Attitude and Caregiver Burden While Caring for Schizophrenic Patients.

Arch Psychiatr Nurs 2018 Feb 14;32(1):112-119. Epub 2017 Oct 14.

Nursing Department, Faculty of Healty Science, Üsküdar University, Üsküdar, İstanbul, Turkey. Electronic address:

This experimental study was carried out using a pre-test/post-test control group model to evaluate the effect of a "Brief Cognitive Behavioural Stress Management Programme" (BCBSMP) on mental status, coping with stress attitude, and caregiver burden while caring for patients with schizophrenia. A total of 61 caregivers who provided care for schizophrenia patients at a community mental health centre were included in the study. Caregivers were matched according to gender and scale scores and were assigned to either the study or the control group. Before and after the programme, caregivers in both groups were given the "Demografic Data Form", "Zarit Caregiver Burden Scale", "Coping Attitude Evaluation Scale", "Stress Indicators Scale", and the "General Health Survey-28". Caregivers in the study group were taken to a BCSMP one session per week (each session lasted 120min) for seven weeks. We determined that the stress indicators, the risk of developing a psychological disorder, and caregiver burden decreased and skills related to both the problem-oriented and emotion-oriented aspects of stress increased in the study group after the programme.
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http://dx.doi.org/10.1016/j.apnu.2017.10.004DOI Listing
February 2018

Effects of lavender scent on patients' anxiety and pain levels during gynecological examination.

Complement Ther Clin Pract 2017 Aug 13;28:65-69. Epub 2017 May 13.

Department of Obstetrics and Gynecology, Faculty of Medicine, Cumhuriyet University, 58140 Sivas, Turkey. Electronic address:

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http://dx.doi.org/10.1016/j.ctcp.2017.05.006DOI Listing
August 2017