Fatma Ilknur Cinar

Living with scleroderma: patients’ perspectives, a phenomenological study

In this study, it is aimed to determine the daily life experiences of patients on the basis their own way of statement. Sixteen patients with scleroderma were enrolled to this qualitative study. Data were collected using both a demographic data form and a semi-structured interview form. Study was made on individual patient interview by face-to-face manner. Data were evaluated using Colaizzi’s phenomenological data analysis method. Data analysis revealed four categories and nine topics. These categories were (1) physical impact of disease, (2) emotional impact of disease, (3) social impact of disease and (4) patient behaviours for the cope with the disease. As emotional impact, patients imply that they have experienced disappointment, hope to get well and have fears about the future. In the physical impact category, tight skin, limitations of hand skills, swelling of the hands and feet, fatigue, swallowing difficulties and deformation of their bodies were the prominent features. In patients with recognizable disease, difficulty to join to social activities increases and eventually leads to isolation. There was also some evidence that patients who have been supported by their family and close relatives seem to be more optimistic about their disease. Most patients are not willing to communicate with other patients, particularly in an advanced stage. Scleroderma patients imply that they experience several difficulties regarding emotional, physical and social aspects. Individual abilities to cope with the disease were much more improved among patients who have a sustained social support. For advanced patients with apparent deformations, an effective social support system should be introduced.

AB0658 Cross-Cultural Adaptation, Reliability, and Validity of the Turkish Version of the Compliance Questionnaire on Rheumatology (CQR-T) in Patients with Behçet's Disease

Background Compliance to treatment can be defined as the degree to which patient behavior is consistent with the recommendations made by healthcare providers. Determining the level of the patients compliance will improve the management of a certain disease. Currently, the only self-reported questionnaire for assessing the compliance of patients with rheumatic disease is the 19-item Compliance Questionnaire on Rheumatology (CQR). Objectives The aim of this study was to examine the psychometric properties of the Turkish version of the Compliance Questionnaire on Rheumatology (CQR-T) for patients with Behçets disease (BD) Methods A sample of 105 Turkish patients with BD participated in this study. The scale was cross-culturally adapted through a process including translation, comparison with versions in other languages, back translation, and pretesting. Construct validity was evaluated by factor analysis, and criterion validity was evaluated using the Morisky Medication Adherence Scale (MMAS). Results The mean age of the study group was 30.87±8.06 years. The majority of the participants was male (89.5%). Mean disease duration was 5.67±4.68 years.Among the current medical treatment agents, colchicine and azathioprine were the most commonly used (79 and 50 patients, respectively). The CQR-T demonstrated acceptable internal consistency (Cronbachs alpha coefficient = 0.832), adequate test–retest reliability (intraclass correlation coefficient = 0.630), and correlations with MMAS scores (r=−0.389; p<0.001), indicating convergent validity. Conclusions The CQR-T was found to be a valid and reliable instrument for evaluating the compliance of Turkish BD patients with prescribed medications. The CQR-T might be a helpful tool in two ways: for determining the level of compliance of patients with BD and for adjusting their management and follow-up based on the results. References de Klerk, E., van der Heijde, D., Landewé, R., van der Tempel, H., & van der Linden, S. (2003). The compliance-questionnaire-rheumatology compared with electronic medication event monitoring: a validation study. The Journal of Rheumatology, 30, 2469-2475. de Klerk, E., van der Heijde, D., van der Tempel, H., & van der Linden, S. (1999). Development of a questionnaire to investigate patient compliance with antirheumatic drug therapy. The Journal of Rheumatology, 26, 2635–2641. Fialko, L., Garety, P.A., Kuipers, E., Dunn, G., Bebbington, P.E., Fowler, D., & Freeman, D. (2008). A large-scale validation study of the Medication Adherence Rating Scale (MARS). Schizophrenia Research,100, 53-59. Disclosure of Interest None declared

Cross-Cultural Adaptation, Reliability, and Validity of the Turkish Version of the Compliance Questionnaire on Rheumatology in Patients With Behçet’s Disease

Purpose: The aim of this study was to examine the psychometric properties of the Turkish versionof the Compliance Questionnaire on Rheumatology (CQR-T) for patients with Behçet’s disease (BD). Method:A sample of 105 Turkish patients with BD participated in this study. The scale was cross-culturally adapted through a process including translation, comparison with versions in other languages, back translation, and pretesting. Construct validity was evaluated by factor analysis, and criterion validity was evaluated using the Morisky Medication Adherence Scale. Results: The CQR-T demonstrated acceptable internal consistency (Cronbach’s α = .832), adequate test–retest reliability (intraclass correlation coefficient = .630), and correlations with Morisky Medication Adherence Scale scores (r = −.389, p< .001), indicating convergent validity. Conclusion:The CQR-T was found to be a valid and reliable instrument for evaluating the compliance of Turkish BD patients with prescribed medications. Implications for Practice: The CQR-T might be a helpful tool in two ways: for determining the level of compliance of patients with BD and for adjusting their management and follow-up based on the results.

Relationship between dialysis adequacy and sleep quality in haemodialysis patients.

AIM AND OBJECTIVES The aim of this study is to examine the relationship between dialysis adequacy and sleep quality in haemodialysis patients. BACKGROUND Sleep problems are common in haemodialysis patients. Dialysis adequacy is one of the factors associated with sleep quality. Studies evaluating the association between dialysis adequacy and sleep quality in haemodialysis patients present different results. DESIGN Descriptive and cross-sectional study. METHODS This study was performed with a total of 119 patients who had applied to dialysis centres for haemodialysis treatment between January and March 2014. The data collection form consists of socio-demographic and medical characteristics as well as laboratory parameters. A modified Post-Sleep Inventory was used to examine sleep quality in the research. RESULTS There were no statistically significant relationship between sleep quality and dialysis adequacy (p > 0·05). When the Post-Sleep Inventory scores were evaluated according to sleep quality, 63·0% of patients had poor sleep quality, and 37·0% had good sleep quality. Sleep quality was worse in unemployed patients (X(2) = 4·852; p = 0·025) and patients who smoked heavily (Z = 2·289; p = 0·022). CONCLUSIONS In this study, there is no statistically significant relationship between dialysis adequacy and sleep quality. However, it was found that the majority of haemodialysis patients had poor sleep quality. RELEVANCE TO CLINICAL PRACTICE Even if the dialysis adequacy of patients is at the recommended level, their sleep qualities may be poor. Therefore, evaluations of the sleep quality of haemodialysis patients during the clinical practice must be taken into consideration.

Investigation of the knowledge and attitudes of patients who are undergoing hemodialysis treatment regarding their arteriovenous fistula

Purpose The major cause of morbidity in hemodialysis patients is arteriovenous fistula deficiency. The patient should have adequate knowledge to ensure arteriovenous fistula patency. Our aim is to investigate the knowledge and attitude of the patients undergoing hemodialysis treatment regarding arteriovenous fistula. Methods This study was conducted on 335 patients who met the study criteria. Data collection forms evaluating the “Socio-Demographic and Medical Characteristics” and “Knowledge and Attitudes about arteriovenous fistula” of the patients were developed following a literature review by the investigators. Results The rules most known and implemented were “to not measure blood pressure” and “to not draw blood from arms with fistula”, while the least known and implemented were “to use blood vessels on the hands in arms without fistula for intravenous intervention” and “to know which situations cause hypotension”. Conclusions Hemodialysis patients with arteriovenous fistulas need to know that developing self-care behavior is a means to reconcile lifestyles with current health status. Accordingly, planned training in self-care should be provided to hemodialysis patients and their families, and nurses should repeat information to patients who demonstrate a lack of knowledge.

The effects of music on the cardiac resuscitation education of nursing students

PURPOSE The purpose of this study is to examine the effects of music on the appropriate performance of the rate and depth of chest compression for nursing students. METHODS This randomized controlled study was conducted in the School of Nursing in Turkey between November 2014 and January 2015. The studys participants were second-year nursing school students with no previous formal cardiac resuscitation training (n=77). Participants were randomly assigned to one of two groups: an intervention group with music and a control group without music. During practical training, the intervention group performed chest compressions with music. The outcomes of this study were collected twice. The first evaluation was conducted one day after CPR education, and the second evaluation was conducted six weeks after the initial training. RESULTS The first evaluation shows that the participants in the intervention group had an average rate of 107.33±7.29 chest compressions per minute, whereas the rate for the control group was 121.47±12.91. The second evaluation shows that the rates of chest compression for the intervention and control groups were 106.24±8.72 and 100.71±9.54, respectively. CONCLUSION The results of this study show that a musical piece enables students to remember the ideal rhythm for chest compression. Performing chest compression with music can easily be integrated into CPR education because it does not require additional technology and is cheap.

Analyzing the Correlation Between the Attitudes of Nursing Students Towards Using Computers in Health Care and Clinical Decision Making Skills

*** F İ Çınar, Doç. Dr. Sağlık Bilimleri Üniversitesi Gülhane Hemşirelik Yüksekokulu, Ankara ÖZ Amaç: Araştırma, hemşirelik öğrencilerinin bilgisayar kullanımına yönelik tutumları ile klinik karar verme becerileri arasındaki ilişkinin değerlendirilmesi amacıyla tanımlayıcı olarak planlanmıştır. Yöntem: Araştırma Şubat 2016 tarihinde bir hemşirelik yüksekokulunun 2., 3. ve 4. sınıfl arı ile yapılmıştır. Çalışma 140 öğrenci ile tamamlanmıştır. Verilerin toplanmasında; (1) Öğrencilerin sosyodemografi k ve bilgisayar kullanımına ilişkin özelliklerini inceleyen form, (2) Sağlık Bakımında Bilgisayar Kullanımına Yönelik Tutum Ölçeği, (3) Hemşirelikte Klinik Karar Verme Ölçeği kullanılmıştır. Verilerin istatistiksel analizinde SPSS 15.00 paket programı kullanılmıştır. Tanımlayıcı istatistikler sayı, yüzdelikler ve ortalama±standart sapma şeklinde gösterilmiştir. Karşılaştırmalı istatistikler için “Kruskal-Wallis” ve “Mann Whitney U” testleri, ölçek puanlarının nümerik parametreler ile ilişkilerinin değerlendirilmesinde “Spearman Korelasyon Analizi” kullanılmıştır. İstatistiksel anlamlılık düzeyi p<0.05 olarak kabul edilmiştir. Bulgular: “Hemşirelikte Klinik Karar Verme Ölçeği”nin “seçenek ve fi kirleri araştırmak” alt boyut puan ortalaması ikinci sınıf öğrencilerinde diğer sınıfl arda öğrenim gören öğrencilere göre istatistiksel olarak anlamlı derecede daha yüksek bulunmuştur (p<0.05). İki ölçek arasında toplam puanlar açısından pozitif yönde bir korelasyon saptanmıştır (r=0.570; p<0.001). Sonuç: Bilgisayar kullanımına yönelik tutum puanları yüksek olan öğrencilerde klinik karar verme becerisinin de yüksek olduğu görülmüştür. Bilgisayar kullanma becerisinin hemşirelik eğitimi süresince öğrencilere kazandırılarak, hasta bakımında kalitenin artırılmasına katkıda bulunulmalıdır.

AB0698 Complementary and alternative medicine usage and associated factors in ankylosing spondylitis: preliminary results of a cross-sectional study

Background Several surveys indicate that the complementary and alternative medicine (CAM) use is especially prevalent in patients with chronic painful conditions like ankylosing spondylitis (AS). Despite good treatment options such as tumor necrosis factor alpha (TNFα) inhibitors in AS, it is seen that patients have applied for CAM use for many reasons including local regulatory funding requirements, potential risks and accessibility of biological treatments. Few studies have examined the frequency of CAM use, and associations between demographic and disease-related factors of it in AS. Objectives To investigate the CAM usage of patients with AS and to determine the associated factors. Methods Total of 123 patients with AS, who were being followed in a tertiary rheumatology outpatient clinic, were included to the study. The demographic and clinical features along with the behaviors about the CAM usage of the patients agreeing to participate were recorded to the “Patient Assessment Form”. The activity of the disease were determined with doctor global assessment (numeric visual analog scale (nVAS; 0–10), and Routine Assessment of Patient Index Data (RAPID)-3 score. The treatment adherence of the patients was assessed with the Morisky Green Levine Scale. Results One hundred eleven patients (%90.2) were male, and mean age was 36.5±8.8 years. The mean disease duration and mean delay in diagnosis were 10.9±6.4, and 3.7±3.9 years, respectively. The mean RAPID3 score, doctor and patient global assessment were; 9.9±5.3, 2.8±1.9, and 4.6±2.7, respectively. While 79 patients (%64.2) were on anti-TNF treatment, 76 patients were receiving NSAIDs, and 35 patients (%28.5) reported an adverse event related with the treatment. Forty-five patients (%36.6) reported to use any CAM (previous or current) (Table1). The reasons reported by the patients for the usage of CAM; media in %13, recommendations from family members or relatives in %10.6. It has been found that in married patients, the ones with lower the Morisky Green Levine Scale score (high adherence), CAM usage was statistically high (p<0.05). Receiving NSAIDs or anti-TNF agents was not statistically associated with CAM usage. The underlying expectations for the usage of CAM were; considering it might be helpful in %27.6; considering it might heal in %17.9; to relieve the pain in %14.6; and preventing to deteriorate the disease status in %12.2.Table 1. Types of CAM use CAM Type n* % Plants and herbs 31 25.2 Massage 13 10.6 Spa 10 8.1 Praying/spiritual approach 6 4.9 Cupping 3 2.4 Imagining 2 1.6 Naturapati 2 1.6 Acupuncture 1 0.8 CAM, complementary and alternative medicine. *There are patients marked the method more than one. Conclusions In our study, we found that approximately one third of our AS patients were using CAM. When compared with the literature related with other diseases, CAM usage in AS patients was somewhat lower. Our results have demonstrated that treatment adherence was higher in those using concomitantly CAM in their therapy. Disclosure of Interest None declared

THU0583-HPR Living with Pain in Ankylosing Spondylitis: A Qualitative CASE Study

Background Pain, stiffness, fatigue and sleep problems are the most important symptoms of ankylosing spondylitis (AS) patients. Among these symptoms, inflammatory back pain is a major symptom reported by all AS patients. Although there are various quantitative studies reporting that pain is one of the most serious and prevalent problems during the course of AS, there are no detailed qualitative studies on how pain affects the AS patients physically, socially, emotionally, and economically. Objectives The aim of this study was to determine the pain experiences of patients with AS and the effect of pain on their lives by the method of direct interview. Methods This qualitative case study included 23 patients with AS. The data was collected by using both a demographic data form and a semi-structured interview form. Each patient was interviewed face-to-face. The data obtained was evaluated using a content analysis method. Results The data was analysed in 6 categories and 4 subcategories. The categories included the following: (1) pain as described by the patient, (2) the effect of pain on daily routine activities, (3) the effect of pain on social life, (4) the effect of pain on employment, (5) the effect of pain on family life, and (6) the emotional effects of pain. During periods of pain, patients indicated that they experienced difficulty in carrying out their daily routine activities and in meeting their personal needs. Pain also prevented them from fulfilling their responsibilities in the family, inhibited their social relations and caused trouble at their workplace. Due to the negative effects of pain in their lives, the patients felt helplessness, fear, stress, sadness, and unhappiness. Conclusions Besides being asked about the quantity of pain, patients with AS should also be questioned on how pain affects their lives. Such an approach would guide the health care workers in planning and applying health care specific for each individual patient. References Chorus AM, Miedema HS, Boonen A, Van Der Linden S: Quality of life and work in patients with rheumatoid arthritis and ankylosing spondylitis of working age. Ann Rheum Dis 2003; 62:1178-84. Hakkou J, Rostom S, Mengat M, Aissaoui N, Bahiri R, Hajjaj-Hassouni N: Sleep disturbance in Moroccan patients with ankylosing spondylitis: prevalence and relationships with disease-specific variables, psychological status and quality of life. Rheumatol Int 2013; 33(2):285-90 Özgül A, Peker F, Taskaynatan MA, Tan AK, Dincer K, Kalyon TA. Effect of ankylosing spondylitis on health-related quality of life and different aspects of social life in young patients. Clin Rheumatol 2006; 25: 168-174 Disclosure of Interest : None declared DOI 10.1136/annrheumdis-2014-eular.2407

FRI0444 Thoughts and perceptions about their medications of patients with ankylosing spondylitis using TNF inhibitors

Background Therapies for ankylosing spondylitis (AS) have entered a new era of optimism with the advent of TNF inhibitors (TNFis), which make remission as an achievable goal for most of the patients. Overall, data obtained from the clinical trials and post-marketing suggests that TNFis appear to be safe and well tolerated. However, risk of infections and malignancies stands as the major area of concern with these agents. Such concerns led to the development of recommendations and safety regulations for the rheumatologists, while these initiatives helped little to relieve the patients’ anxiety. Indeed, “word of mouth” uncertainty regarding some of the potential side effects of these agents is a major cause of reluctance among the patients using these agents. To overcome reluctance caused by uncertainty, it is important to gain an insight about the patients’ perceptions for these agents. Objectives To investigate the patients’ views about their treatments and the factors that influence patients’ treatment decisions in patients with AS who have been using TNFis. Methods This descriptive study was conducted in a single rheumatology unit between September 2011 and January 2012. AS patients who had been using TNFis at least 3 months were included to the study. Demographic and clinical characteristics of patients who accepted to participate in the study were recorded. Patients’ thoughts and perceptions about their treatment were evaluated with using a standard questionnaire given to the all patients. Results A total of 70 patients were recruited. The mean age was 35.9±7.1 (20-50) years, and 94.3% of them were male. The mean duration of illness was 8.8±5.6 (2-32) years. The mean BASDAI score was 3.2±2.3. The frequency of using etanercept, infliximab and adalimumab were 50.0%, 18.6%, and 31.4%, respectively. Patients described their feelings at the time of prescription as hopefulness (78.6%), anxiety (42.9%), fear (20%), desperate (12.9%), and hopeless (10%). The most significant determinant for acceptance of TNFis treatment was stated by patients as hope to heal (81.4%), trust in his/her physician (74.3%), recommendation by other patients (41.4%). After the information regarding TNFis were given through standard forms, patients described their feelings as, increase in anxiety (47.1%), psychologically wearisome (35.7%), and worrying to become worse in the future (28.6%). Following treatment with these agents, patients described their experience as “I recommend to other patients” (71.4%), “it saved my life” (64.3%), “I judge regulatory exams necessary” (77.1%), and “I feel secure by 3-monthly exams” (68.6%). Conclusions This study, to our knowledge, is the first in evaluating the attitudes of patients to TNFis, starting from the stage of informed consent to the stage of post-experience. We found that standard forms of informed consent causes an increase in the level of anxiety among new users of TNFis, while they are not supposed to do so. In this regard, wording of informed consents can be re-edited in a way to increase the knowledge about these agents without increasing the level of anxiety. In patients with a high level of concern about their disease and treatment options, patient support groups may help, since most of the patients have very good experiences related with this class of drugs. Disclosure of Interest None Declared