Izmir Bozyaka Eğitim ve Araştırma Hastanesi

Background/Objectives: Non-invasive fibrosis scores are widely used for risk stratification in metabolic dysfunction-associated steatotic liver disease (MASLD); however, their performance in obese individuals remains controversial. The Fibrosis-4 (FIB-4) index is commonly recommended as a first-line tool, yet it may underestimate fibrosis risk in severe obesity. The BAST score, which incorporates metabolic and anthropometric parameters, has been proposed as an alternative. This study aimed to characterize both the degree and direction of discordance between FIB-4 and BAST in obese patients with MASLD. Methods: This predefined secondary analysis included 2950 adults with obesity (BMI ≥ 30 kg/m2) and MASLD from the multicenter OBREDI-TR cohort. Fibrosis risk categories were assigned using standard cut-offs for FIB-4 and BAST, and agreement was assessed using weighted Cohen's kappa. Associations among discordance patterns, obesity class, and the visceral adiposity index (VAI) were evaluated using chi-square tests and general linear models. Results: Overall agreement between FIB-4 and BAST was very poor (κ = 0.041, p < 0.001). Discordance was observed in 22.3% of patients and increased markedly with obesity severity. In class III obesity, discordance was predominantly driven by low-risk classification according to FIB-4 despite high-risk classification according to BAST. Patients with this discordant pattern exhibited significantly higher VAI values than concordant cases (p < 0.001), independently of the study center. Conclusions: In obese patients with MASLD, particularly those with morbid obesity, FIB-4 frequently classifies patients as low risk, while BAST identifies elevated fibrosis risk. This systematic discordance suggests that FIB-4 may underestimate fibrosis burden in the context of severe obesity and visceral adiposity, supporting the need for a phenotype-oriented, multimodal approach to fibrosis risk assessment.

Rapid Geriatric Assessment is a practical screening tool for common geriatric syndromes that can be administered in under five minutes, even by inexperienced healthcare professionals. The study aimed to validate the Turkish version of the Rapid Geriatric Assessment in hospitalized older adults. This cross-sectional study was conducted in the internal medicine inpatient unit of a university hospital among patients aged ≥65 years. 145 patients were evaluated. The Rapid Geriatric Assessment includes four brief instruments (FRAIL, SARC-F, Simplified Nutritional Appetite Questionnaire, and Rapid Cognitive Screen) plus two items on incontinence and constipation. Comparator measures included the Clinical Frailty Scale, Mini Nutritional Assessment-Short Form, Mini Mental State Examination, handgrip strength, Activities of Daily Living, Instrumental Activities of Daily Living, Patient Health Questionnaire-2, and Generalized Anxiety Disorder-2 . A total of 145 patients (57.9% women, 74.7 ± 7.9 years) were included. Rapid Cognitive Screen, Simplified Nutritional Appetite Questionnaire, and FRAIL showed strong significant positive correlations with Mini-Mental State Examination (0.822; p < .001), Mini Nutritional Assessment-Short Form (0.703; p < .001), and Clinical Frailty Scale (0.626; p < .001), respectively, while SARC-F correlated strongly and negatively with handgrip strength (-0.625; p < .001). Discriminant validity was demonstrated for the incontinence item, which was significantly associated with higher Patient Health Questionnaire-2 and Generalized Anxiety Disorder-2 scores and lower Activities of Daily Living and Instrumental Activities of Daily Living scores (all p < .001), constipation showed no associations. Convergent validity was supported by significant correlations of the frailty and sarcopenia domains with Instrumental Activities of Daily Living (r = 0.614 and r = -0.753, respectively; p < .001). The Turkish version of the Rapid Geriatric Assessment is valid and feasible for hospitalized older adults, supporting its use as a rapid screening tool for geriatric syndromes. Cite this article as: Çavdar, S., Kayhan Koçak, F. Ö., Çakmak, B., Altun, M. A., Bahadır, A., & Savaş, S. (2025). Validation of the Turkish version of rapid geriatric assessment in hospitalized older adults: a preliminary study. Florence Nightingale Journal of Nursing, 33, 0087, doi:10.5152/FNJN.2025.25087.

IntroductionIntrinsic capacity (IC), as defined by the World Health Organization, represents the composite of an individual’s physical and mental capacities and provides a multidimensional framework for assessing older adults’ functional reserve. It includes five domains: locomotion, vitality, cognition, psychological well-being, and sensory function. This study aimed to examine the associations between IC domains and common geriatric syndromes in hospitalized older adults.MethodsIn this retrospective observational study, 245 patients aged ≥ 60 years who underwent comprehensive geriatric assessment were included. IC was evaluated across five domains using standard tools: gait speed, self-reported sensory deficits, Standardized Mini-Mental State Examination (S-MMSE), Euro Quality of Life 5 Domain (EuroQOL-5D) and Mini Nutritional Assessment. The IC score ranges from 0 to 5, with higher scores indicating better intrinsic capacity, and a score ≤ 2 representing moderate–severe decline. Geriatric syndromes assessed were frailty, probable sarcopenia, falls, urinary incontinence, and functional impairments in Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL). Logistic regression models identified predictive IC domains, adjusting for age, sex, polypharmacy, and comorbidity.ResultsNearly 60% of participants had moderate to severe IC decline (score ≤ 2). Vitality and locomotor impairments were the most common. Cognitive and vitality impairments were strongly associated with both ADL and IADL disability (p < 0.001), while locomotor and vitality impairments predicted probable sarcopenia and frailty (p < 0.01). Cognitive impairment was linked to a nearly six-fold increased fall risk (OR = 5.86, 95% CI: 2.51–13.68, p < 0.001). The models showed good discrimination, with an area under the curve value of 0.723 for falls and 0.854 for ADL disability.ConclusionsIC impairments, particularly in cognition, vitality, and locomotion, are prevalent and predictive of major geriatric syndromes in hospitalized older adults. Routine IC assessment may help identify at-risk individuals and inform targeted interventions.

BackgroundFear of childbirth (FOC) is the most important feeling pregnant women experience about childbirth. It is also known that the fear of childbirth is affected by many factors. This study investigated the relationship between Fear of childbirth (FOC) and childbirth self-efficacy in low and high-risk pregnant women.MethodsThe research was designed in descriptive and correlational type. This study among 115 low-risk and 135 high-risk pregnant women who were recorded using a purposeful sampling.ResultsThe total W-DEQ-A values of high-risk pregnant women are substantially higher. It was determined that both groups had a moderate FOC. The W-DEQ-A and CBSEI-32 mean scores of low-risk pregnant women were significantly related. Their mean W-DEQ-A scores were negatively correlated with outcome expectancy sub-dimension (OE) scores and positively correlated with self-efficacy expectancy sub-dimension (EE) values.ConclusionThis is the first study to examine the relationship between FOC and childbirth self-efficacy in low and high-risk pregnant women. It is recommended that health professionals evaluate all pregnant women in terms of FOC and their childbirth self-efficacy for vaginal delivery.

The capillary refill time (CRT) is the time it takes for a capillary bed to regain its color after being subjected to pressure. Capillary refill time (CRT) is a bedside perfusion indicator. We examined CRT across emergency department (ED) triage categories and identified independent correlates of CRT and prolonged CRT (> 2 s). In this cross-sectional study (July–September 2024), adults presenting to a tertiary ED were assigned green/yellow/red triage. CRT was measured in triplicate on the index-finger pulp after 10-s blanching and the mean was analyzed. Vital signs (SpO₂, heart rate, systolic/diastolic blood pressure, body temperature, skin temperature at the measurement site, and respiratory rate) were recorded. Associations were assessed using correlation and multivariable regression (overall and stratified by triage). We included 313 patients (mean age 55.8 ± 20.9 years; 53.4% female). CRT repeatability was high (ICC = 0.972, 95% Cl). Mean CRT was 2.00 ± 0.94 s and was longer in the red vs. other triage groups (2.36 ± 1.01 s; p < 0.001). In stratified models, green: heart rate (β > 0, p = 0.031) and respiratory rate (β < 0, p < 0.001); yellow: age (β > 0, p = 0.001) and respiratory rate (β > 0, p = 0.039); red: age (β > 0, p = 0.001) and respiratory rate (β > 0, p = 0.026). In the overall model, age and heart rate were positively, and systolic blood pressure negatively, associated with CRT (all p < 0.05). CRT varies with ED triage acuity and behaves as a rapid, reproducible bedside perfusion indicator. Age, heart rate, respiratory rate and systolic blood pressure are independent correlates of CRT, supporting its utility in initial assessment. Prospective, multicenter validation and prediction-model performance reporting (AUC, calibration) are warranted. The present study has been registered with the Clinical Trials Protocol Registration and Results System (ClinicalTrials.gov) under the registration number NCT07054151. The registration date is 26/06/2025.

Objective: Given that Theory of Mind is a fundamental component of social cognition, impairments in this domain may contribute to interpersonal difficulties, impaired social functioning, and poor treatment adherence commonly observed in substance use disorder populations. The number of studies examining social cognitive functioning in children and adolescents with substance use disorder is insufficient in the literature. This study aims to compare the social cognitive functions of adolescents with substance use disorder to those of healthy controls.Methods: A total of 47 patients aged between 12 and 18 years who were diagnosed with substance use disorder according to Diagnostic and Statistical Manuel of Mental Disorders-5 criteria, and 45 healthy controls were included in the study. Sociodemographic data of the participants were collected, and the Affective Disorders and Schizophrenia for School-Age Children (K-SADS) was administered to assess comorbid psychiatric diagnoses. Theory of mind tests were applied to both groups to assess emotion recognition and mentalizing abilities. Results: The substance use disorder group had significantly higher rates of living in fragmented families and school dropout, and their fathers’ educational level was significantly lower compared to controls. The prevalence of psychiatric diagnoses, particularly current depressive disorders and Attention deficits / Hyperactivity Disorder identified via K-SADS, was significantly higher in the substance use disorder. The social cognition test results showed that performance on theory of mind tests was significantly lower in the substance-using group compared to the control group.Conclusion: In this study, the findings related to social cognitive impairments, comorbidpsychiatric conditions, family structure, and the level of mother/father education with SUD in adolescence may guide assessment, prevention, and intervention efforts in this field.

IntroductionJuvenile Systemic Lupus Erythematosus (jSLE) is a rare pediatric rheumatic disease characterized by systemic inflammation that can lead to organ damage. Compared to adults, it often has a more severe course in children. Both disease activity and treatments may result in temporary or permanent damage.ObjectivesTo evaluate risk factors associated with damage occurrence in patients with jSLE.MethodsThis multicenter, retrospective study included patients with jSLE followed for at least 12 months. Low-dose corticosteroid therapy was defined as prednisolone 0.01-0.03mg/kg/day (max 7.5mg/day). The annual cumulative steroid dose was calculated by dividing the total steroid intake by 365.25 times the number of follow-up years. Collected data included SLEDAI and SDI scores at initial and final visits, laboratory parameters, and flare characteristics.ResultsA total of 158 patients (86.7% female) from 17 centers were included. Median age at diagnosis was 13.8years, with a median follow-up of 35months. Organ damage was present in 14 patients at diagnosis and in 23 at final visit. Damage types included proteinuria, cognitive dysfunction (each 3.2%), and others such as cataracts, erosive arthritis, avascular necrosis, optic atrophy, and vertebral collapse. Patients with damage had significantly higher SLEDAI scores at both time points, delayed transition to low-dose steroids, and a lower rate of achieving Lupus Low Disease Activity State (LLDAS) (p = .006).ConclusionPersistent disease activity and delayed control are major contributors to organ damage in jSLE. Early and sustained disease suppression is critical to prevent long-term complications.

Objective: To compare the efficacy and safety of rituximab in patients with rheumatoid arthritis (RA) who were either biologic/targeted synthetic DMARD (bDMARD/tsDMARD)-naive or previously exposed. Methods: In this retrospective cohort study, 120 RA patients treated with rituximab between June 2020 and December 2023 were included. Patients were categorized as bDMARD/tsDMARD-naive (n=66) or -exposed (n=54). Clinical efficacy was assessed by change in Disease Activitity Score 28 (DAS28)-CRP and the proportion achieving low disease activity (LDA; DAS28-CRP &amp;lt;3.2) after treatment. Safety outcomes included infusion-related reactions (IRRs), infections, and hypogammaglobulinemia. Results: The naive group showed significantly greater improvement in disease activity (ΔDAS28-CRP: 2.5 vs. 1.9, p=0.001) and higher LDA achievement (62.1% vs. 46.2%, p=0.030) compared to the exposed group. Rates of IRRs (16.6% vs. 18.5%, p=0.820), infections (1.5% vs. 1.9%, p=0.880), and hypogammaglobulinemia were comparable between groups. Most IRRs were mild (grade 1–2); only one serious IRR occurred, with no cases requiring prolonged hospitalization. One patient in the exposed group experienced hepatitis B reactivation, managed effectively with antiviral therapy. Primary and secondary inefficacy were the most common reasons for rituximab discontinuation, with no significant differences between groups. Conclusion: Rituximab demonstrated superior efficacy in bDMARD/tsDMARD-naive RA patients, while maintaining a comparable safety profile to that in previously exposed patients. These findings support the potential benefit of using Rituximab earlier in the treatment sequence for selected RA patients.