Journal of emergency medicine case reports, Oct 1, 2011
Methyl alcohol is a toxic liquid that is a present in industrial paint, polish and many other pro... more Methyl alcohol is a toxic liquid that is a present in industrial paint, polish and many other products. Its toxic dose is between 20-250 ml and intoxication sings andsymptoms as brain and brainstem edema and necrosis in putamen are observed early in 12-24 hours. In this article, we present a case report of a patient with a infrequint finding of hemorrhage in the basal gangliae in magnetic resonance imaging (MRI) due to methyl alcohol intoxication.
Eurasian journal of emergency medicine, Jan 2, 2017
In the healthcare system, burnout is a frequent problem in professions, particularly in nursing, ... more In the healthcare system, burnout is a frequent problem in professions, particularly in nursing, where services are directly provided to individuals. Burnout has a personal nature, but it can lead to the loss of professional productivity, challenges in under taking professional responsibilities, and loss of institutional efficiency (1-4). Maslach defined burnout "as a syndrome seen in individuals who are exposed to intense emotional demands due to their occupation and are asked to work face-to-face with other individuals, which is caused by fatigue, long-term exhaustion, hopelessness, and desperate feelings being reflected out with negative behaviors shown toward occupation, life, and other people" (5). Emergency services in Turkey have very stressful and exhausting environments because simultaneous care is provided to patients with various health problems and critical decisions need to be made in a short time (2). Compared with other clinics of hospitals, emergency services are very crowded places where unplanned visits need to be made and various duties ranging from non-emergency procedures to resuscitation are performed (6). Additional factors such as the excessive number of patients, limited number of nurses, long working hours, shift work, provision of care for patients in need of extensive and immediate care, emotional stress linked to working conditions, insufficient wages, lack of appreciation by executives, and lack of support from colleagues may lead to exhaustion in emergency healthcare professionals, particularly in nurses (7-10).Accordingly, previous studies have reported that emergency nurses are more likely to experience burnout due to emotional exhaustion, depersonalization, and job-related stress because they face more challenging and life-threatening situations than nurses working in other services (1,9, 11,12). Work-related burnout may negatively affect nurses' understanding of and communication with patients and relatives, which in turn may result in not being fully able to meet patients' needs. Ultimately,
Ethical sensitivity is defined as sensitivity to ethical problems, which for nurses means being a... more Ethical sensitivity is defined as sensitivity to ethical problems, which for nurses means being acquainted with ethical values within a situation or situations concerning human health. As a nurse, having high ethical sensitivity not only leads to occupational professionalization, but it also directly influences the quality of nursing care provided to patients. This study was conducted in 2016 by 178 nurses working in a university hospital in the center of Samsun. The data was collected using an introductory information form and the Moral Sensitivity Questionnaire (MSQ). In this study, the median nurse's result on the Moral Sensitivity Questionnaire (MSQ) was 88 (52-187), whereas the median result on its sub-dimensions, such as autonomy, benevolence, holistic approach, experiencing conflict, practice and orientation, were 20 (8-45), 12 (4-25), 12 (5-35), 13 (5-21), 12 (4-25) and 7 (4-28), respectively. Nonetheless, it has been observed that MSQ median results change according to the working year, the number of patients and the work satisfaction level at any given institution; it has also been observed that the ethical sensitivity level is higher for nurses who have worked for 20 to 28 years, who care for 11-21 patients daily and who have a moderate work satisfaction level. This study suggests that MSQ score varies depending on some sociodemographic and professional characteristics such as income level, work life quality, professional satisfaction, length of service of nurses, whether or not they are satisfied with the service they work at, number of patients cared per day and total number of nurses at the service they work at.
Turkish Journal of Geriatrics-Turk Geriatri Dergisi, 2013
Introduction: The elderly population is rapidly growing in Turkey and in the world. The aim of ou... more Introduction: The elderly population is rapidly growing in Turkey and in the world. The aim of our study is to investigate the features of acute poisonings which is a major health problem among the elderly. Materials and Method: Medical files of patients aged 65 years and over admitted to the emergency department of a university hospital for acute poisonings between January 2005 and December 2011 were reviewed. The demographic characteristics of patients, causes and origins of poisonings were evaluated retrospectively. Results: Among 3106 patients who presented with acute poisoning, 126 (4.06%) were geriatric cases. The mean age of the patients was 73.36 ± 6.38. Sixty seven (53.2%) were male and 59 (46.8%) female. The most common causes of acute poisonings were as follows; 68 (54%) drug intoxication, 34 (27%) carbon monoxide and 16 (12.7%) pesticide poisoning. The origins of poisonings were as follows; 105 (83.3%) accidental, 16 (12.7%) suicidal. Fifty seven (45.2%) accidental poiso...
BACKGROUND: Recipients of hematopoietic stem cell transplantation (HSCT) are among the highest co... more BACKGROUND: Recipients of hematopoietic stem cell transplantation (HSCT) are among the highest consumers of allogeneic red blood cell (RBC) and platelet (PLT) components. The impact of patient blood management (PBM) efforts on HSCT recipients is poorly understood. STUDY DESIGN AND METHODS: This observational study assessed changes in blood product use and patient-centered outcomes before and after implementing a multidisciplinary PBM program for patients undergoing HSCT at a large academic medical center. The pre-PBM cohort was treated from January 1 through September 31, 2013; the post-PBM cohort was treated from January 1 through September 31, 2015. RESULTS: We identified 708 patients; 284 of 352 (80.7%) in the pre-PBM group and 225 of 356 (63.2%) in the post-PBM group received allogeneic RBCs (p < 0.001). Median (interquartile range [IQR]) RBC volumes were higher before PBM than after PBM (3 [2-4] units vs. 2 [1-4] units; p = 0.004). A total of 259 of 284 pre-PBM patients (91.2%) and 57 of 225 (25.3%) post-PBM patients received RBC transfusions when hemoglobin levels were more than 7 g/dL (p < 0.001). The median (IQR) PLT transfusion quantities was 3 (2-5) units for pre-PBM patients and 2 (1-4) units for post-PBM patients (p < 0.001). For patients with PLT counts of more than 10 × 10 9 /L, a total of 1219 PLT units (73.4%) were transfused before PBM and 691 units (48.8%) were transfused after PBM (p < 0.001). Estimated transfusion expenditures were reduced by $617,152 (18.3%). We noted no differences in clinical outcomes or transfusion-related adverse events. CONCLUSION: Patient blood management implementation for HSCT recipients was associated with marked reductions in allogeneic RBC and PLT transfusions and decreased transfusion-related costs with no detrimental impact on clinical outcomes. A llogeneic blood transfusion is the most common procedure performed in the United States, 1 but many transfusion episodes are inconsistent with evidence-based guidelines. With increased recognition of the potential for patient harm and excessive health care costs associated with inappropriate transfusion practices, many institutions have attempted to reduce non-evidencebased transfusion episodes. Formal, multidisciplinary programs for patient blood management (PBM), designed with the primary objective of optimizing patients' blood health, 2-11 have also been associated with reduced blood product use. In ABBREVIATIONS: HSCT = hematopoietic stem cell transplantation; ICU = intensive care unit; IQR = interquartile range; PBM = patient blood management.
Objective: Delirium is a neuropsychiatric syndrome characterized by acute onset and a fluctuating... more Objective: Delirium is a neuropsychiatric syndrome characterized by acute onset and a fluctuating course of globally altered mental status. It has been reported that the frequency of delirium among patients hospitalized with any disorder ranges from 2 to 30%. However, in the literature, few studies have evaluated the frequency of delirium in hospitalized patients, including those older than 65 years. According to our knowledge, this is the first study on adult patients in all age groups in an emergency department. We aimed to classify delirium according to its etiological causes and to compare the age groups for frequency and these causes. Material and Methods: Forty-three patients were included in the study; they had been diagnosed with delirium according to the Diagnostic and Statistical Manual of Mental Disorders (DSM)-IV in an emergency department from December 2002 to December 2003. The patients were divided into two groups (group I: age <65 years, group II: age ≥65 years). Following a detailed history, each patient underwent a physical and neurological examination. Additionally, the Mini-Mental State Examination was administered. Radiological and hematological examinations were conducted on all patients who had indications for such testing. Results: Of the patients with delirium, 18 were female and 25 were male. Mean age was 61.18 years (range 18 to 90 years). Of the 43 patients, 21 were in group I and 22 were in group II. The most common causes of delirium were metabolic disorders. There was no significant difference between group I and II for the frequency or etiological causes of delirium. Conclusion: In emergency departments, all patients with delirium should be evaluated for etiological factors, especially metabolic disorders, as treatment of the underlying cause is essential in delirium.
A Retrospective Evaluation of the Patients Who Admitted to Ondokuz Mayis University Emergency Dep... more A Retrospective Evaluation of the Patients Who Admitted to Ondokuz Mayis University Emergency Department The Emergency Deparment of the Ondokuz Mayis University Medical Faculty in Samsun was established in 1997 as an academic department with teaching staff members, specialists and resident asistants including auxiliary personnel. The department recieves emergency cases from a large interlancl covering the whole area of Middle Black Sea Region. The purpose of the present study was to evaluate statistically some of the parameters of patients admitted for several reasons to the Emergency Department in recent months. In this study 4387 patients who were admitted to Ondokuzmayis University Emergency Department between 1 July 1999 to 31 January 2000 were analyzed. The mode and the time of the admission to emergency department (ED), the diagnosis and management in ED, observation in ED, hospitalization rates to different clinics, mortality rates in ED and causalities were discussed. 2379 o...
Objective: Delirium is a neuropsychiatric syndrome characterized by acute onset and a fluctuating... more Objective: Delirium is a neuropsychiatric syndrome characterized by acute onset and a fluctuating course of globally altered mental status. It has been reported that the frequency of delirium among patients hospitalized with any disorder ranges from 2 to 30%. However, in the literature, few studies have evaluated the frequency of delirium in hospitalized patients, including those older than 65 years. According to our knowledge, this is the first study on adult patients in all age groups in an emergency department. We aimed to classify delirium according to its etiological causes and to compare the age groups for frequency and these causes. Material and Methods: Forty-three patients were included in the study; they had been diagnosed with delirium according to the Diagnostic and Statistical Manual of Mental Disorders (DSM)-IV in an emergency department from December 2002 to December 2003. The patients were divided into two groups (group I: age <65 years, group II: age ≥65 years). Following a detailed history, each patient underwent a physical and neurological examination. Additionally, the Mini-Mental State Examination was administered. Radiological and hematological examinations were conducted on all patients who had indications for such testing. Results: Of the patients with delirium, 18 were female and 25 were male. Mean age was 61.18 years (range 18 to 90 years). Of the 43 patients, 21 were in group I and 22 were in group II. The most common causes of delirium were metabolic disorders. There was no significant difference between group I and II for the frequency or etiological causes of delirium. Conclusion: In emergency departments, all patients with delirium should be evaluated for etiological factors, especially metabolic disorders, as treatment of the underlying cause is essential in delirium.
Poison hemlock (Conium maculatum) is one of the most poisonous plants in the world. Accidental in... more Poison hemlock (Conium maculatum) is one of the most poisonous plants in the world. Accidental ingestion of the plant could result in central nervous system depression, respiratory failure and even death. Airway and breathing management followed by fluid resuscitation is the mainstay of treatment. Poison hemlock poisoning is an important differential diagnosis for patients with impaired consciousness and respiratory failure after plant ingestion in areas of natural habitat for the plant. Early and proper diagnosis is vital for patients with poison hemlock poisoning. In this report, we present a case of life-threatening poisoning due to taking the poison hemlock mistaken for Helichrysum arenarium.
Surfactant protein D (SP-D) is a biomarker specific to the lungs. Our aim was to investigate the ... more Surfactant protein D (SP-D) is a biomarker specific to the lungs. Our aim was to investigate the relationship between clinical probability scores and the serum levels of SP-D to indicate the severity of lung injury that develops secondary to hypoxia in pulmonary embolism (PE). We included three groups in the study: non-massive PE (n = 20), sub-massive PE (n = 20), and the control group (n = 20), which consisted of healthy volunteers. The modified Geneva and Wells clinical probability scoring systems were performed for PE, and the patients were classified as low risk, moderate risk, and high risk. SP-D levels were determined by the enzyme-linked immunosorbent assay. For risk factors, the most significant were deep vein thrombosis (DVT) and immobilization. There was no significant difference in SP-D levels between the patients identified with risk factors and those without risk factors in either the Geneva or Wells scores. Atelectasis was the most common radiographic finding, while tricuspid valve regurgitation was predominant in echocardiography. There was no significant difference between the non-massive PE group and the control group, while SP-D levels of the sub-massive group were significantly higher than the control group. In our study, SP-D levels were significantly higher in the sub-massive PE group overall. However, further prospective studies are required with a larger number of cases, including patients with massive PE, in order to clarify the findings.
JPMA. The Journal of the Pakistan Medical Association, 2014
To evaluate the value of electroencephalography in patients with altered mental status in emergen... more To evaluate the value of electroencephalography in patients with altered mental status in emergency departments. Demographical characteristics, types and aetiologies of seizures, and clinical outcomes of the patients were recorded. Patients were divided into 4 groups according to the complaints of admission: findings and symptoms of seizure; stroke and symptoms of stroke-related seizures; syncope; and metabolic abnormalities and other causes of altered mental status. The electroencephalography findings were classified into 3 groups: epileptiform discharges; paroxysmal electroencephalography abnormalities; and background slowing. Electroencephalography abnormalities in each subgroup were evaluated. SPSS 21 was used for statistical analysis. Of the total 190 patients in the study, 117 (61.6%) had pathological electroencephalography findings. The main reason for electroencephalography in the emergency department was the presence of seizure findings and symptoms in 98 (51.6%) patients. ...
Background: Gastroesophageal reflux (GER) is a common clinical pathology detected in childhood. B... more Background: Gastroesophageal reflux (GER) is a common clinical pathology detected in childhood. Bile acids (BAs) are present in reflux and cause various pathologies in the esophagus, the larynx, and the lungs. Objective: We aimed to show if aminoguanidine (AG) contributes to the biochemical and histopathologic treatment of experimental aspiration pneumonitis induced by BAs. Methods: Twenty-eight female Sprague Dawley rats were used. There were 4 groups in the study: (1) group aspirated with 0.9% saline (n ϭ 7), (2) group aspirated with 0.9% saline and treated with AG (n ϭ 7), (3) group aspirated with a solution of 10 mg/kg taurocholic acid and 5 mg/kg taurochenodeoxycholate (n ϭ 7), and (4) group aspirated with BA and treated with AG (n ϭ 7). The saline and BA solutions were administered as 1 mL/kg intratracheally. The AG was administered intraperitoneally twice a day at a 150 mg/kg dose for 7 days. The different histopathologic and biochemical parameters were analyzed. Results: Clara cell protein 16 and malondialdehyde levels were found to be significantly higher in the BA group than in the group where saline was administered; however, they were significantly lower in the BA ϩ AG group than in the BA group. The total superoxide dismutase activity decreased significantly in the BA group compared with the group where saline was administered. A significant increase in superoxide dismutase activity was observed in the BA ϩ AG group when compared with the group where only BA was administered. When the group where BA was administered solely was compared with the group where saline was administered, peribronchial inflammatory cell infiltration, alveolar septal infiltration, alveolar histiocytes, interstitial fibrosis, and granuloma were significantly higher in the BA group than in the saline group. When the BA ϩ AG group was compared with the BA
Previous studies have revealed a relationship between the driving under the influence of alcohol ... more Previous studies have revealed a relationship between the driving under the influence of alcohol (DUIA) and/or driving under the influence drugs (DUID) and the increased risk of death and injury in traffic accidents. The aim of this study was to investigate of blood alcohol concentration (BAC) of drivers after involved in a traffic accident or for suspected for drunkenness in the roadside traffic control in the Turkey's four major cities. Methods: In this study, we retrospectively reviewed the laboratory registrations in university hospitals in four big cities of Turkey (Van, Manisa, Diyarbakır and Samsun) for BAC for five years (from 1 January 2015 to 31 December 2019) of the drivers. Results: In 342 cases (7.1%), BACs were above the cutoff value (0.01 g/100 mL). Of the cases sent for alcohol determination, 11.3% were women and 88.7% were men, and their mean age was 35.3±13.1. In 342 alcohol positive cases, BACs were above 0.101% in 58.8% of cases. BAC positivity of the cases was 9.4% in Manisa, 6.3% in Van, 5.3% in Samsun, and 5% in Diyarbakır. BAC was found to be positive in 4.4% (n=24) of females and 7.4% (n=318) of males (p<0.05). Conclusion: This study is one of the limited number of multicentre studies in this field; it was concluded in the study that zero tolerance should be for drunk driving in traffic, the deterrence of fines should be increased, and roadside screening tests should be used more widely.
Journal of Clinical and Experimental Investigations, 2017
Objective: Cardiopulmonary resuscitation (CPR) is a life-saving process in which many disciplines... more Objective: Cardiopulmonary resuscitation (CPR) is a life-saving process in which many disciplines are involved. In this study, our aim was to evaluate CPR knowledge of public health physicians and determine usefulness of education on this important topic. Methods: A total of 337 public health physicians were involved in an educational course and asked to answer a questionnaire both before and after the course. The questionnaire involved 26 questions and participants' personal identifiers were hidden. The results of two questionnaires were compared. Results: We achieved improvement in knowledge of 315 participants. In majority of the participants, the number of the right answers increased up to 6 to 10 points. We also determined that those who attended to a similar educational course before were more successful than those who did not. Conclusion: Education on CPR is essential for every discipline involved in medicine. Increasing the knowledge of physicians may decrease mortality and morbidity related to sudden cardiac arrest. Institutions must be encouraged for continuous educational organizations and participation of health care providers from different disciplines must be assured.
Journal of Experimental and Clinical Medicine, 2014
Retrobulbar haemorrhage is a rare emergency condition usually associated with trauma. Major clini... more Retrobulbar haemorrhage is a rare emergency condition usually associated with trauma. Major clinical features are loss of visual acuity, eye pain and increasing propitosis. Several spontaneous cases were also reported in literature. We present a 36 years old case of a spontaneus retrobulbar haemorrhage associated with subarachnoid haemorrhage. Patient underwent a lateral canthotomy and cantholysis (LCC) and intravenous corticosteroids, mannitol, topical timolol and acetazolamide were administered. The aim of this study was to increase the awareness of retrobulbar haemorrhage in emergency staff. This will prevent the delay in treatment that will lead to the situation whereby the patient is left permanently blind. Retrobulbar haemorrhage is an ophtalmic acute surgical emergency that emergency physicians have to be familiar with.
Trace elements are essential components of biological structures, but alternatively, they can be ... more Trace elements are essential components of biological structures, but alternatively, they can be toxic at concentrations beyond those necessary for their biological functions. Changes in the concentration of essential trace elements and heavy metals may affect acute hemorrhagic stroke. The aim of this study was to measure serum levels of essential trace elements [iron (Fe), zinc (Zn), manganese (Mn), copper (Cu), and magnesium (Mg)] and heavy metals [cobalt (Co), cadmium (Cd), and lead (Pb)] in patients with acute hemorrhagic stroke. Twenty-six patients with acute hemorrhagic stroke and 29 healthy controls were enrolled. Atomic absorption spectrophotometry (UNICAM-929) was used to measure serum Fe, Cu, Pb, Cd, Zn, Co, Mn and Mg concentrations. Serum Cd, Pb and Fe levels were significantly higher in patients with acute hemorrhagic stroke than controls (p \ 0.001), while serum Cu, Zn, Mg and Mn levels were significantly lower (all p \ 0.001). However, there was no significant difference between the groups with respect to serum Co levels (p [ 0.05). We first demonstrate increased Cd, Pb, and Fe levels; and decreased Cu, Zn, Mg, and Mn levels in patients with acute hemorrhagic stroke. These findings may have diagnostic and prognostic value for acute hemorrhagic stroke. Further studies are required to elucidate the roles of trace elements and heavy metals in patients with acute hemorrhagic stroke.
Journal of emergency medicine case reports, Oct 1, 2011
Methyl alcohol is a toxic liquid that is a present in industrial paint, polish and many other pro... more Methyl alcohol is a toxic liquid that is a present in industrial paint, polish and many other products. Its toxic dose is between 20-250 ml and intoxication sings andsymptoms as brain and brainstem edema and necrosis in putamen are observed early in 12-24 hours. In this article, we present a case report of a patient with a infrequint finding of hemorrhage in the basal gangliae in magnetic resonance imaging (MRI) due to methyl alcohol intoxication.
Eurasian journal of emergency medicine, Jan 2, 2017
In the healthcare system, burnout is a frequent problem in professions, particularly in nursing, ... more In the healthcare system, burnout is a frequent problem in professions, particularly in nursing, where services are directly provided to individuals. Burnout has a personal nature, but it can lead to the loss of professional productivity, challenges in under taking professional responsibilities, and loss of institutional efficiency (1-4). Maslach defined burnout "as a syndrome seen in individuals who are exposed to intense emotional demands due to their occupation and are asked to work face-to-face with other individuals, which is caused by fatigue, long-term exhaustion, hopelessness, and desperate feelings being reflected out with negative behaviors shown toward occupation, life, and other people" (5). Emergency services in Turkey have very stressful and exhausting environments because simultaneous care is provided to patients with various health problems and critical decisions need to be made in a short time (2). Compared with other clinics of hospitals, emergency services are very crowded places where unplanned visits need to be made and various duties ranging from non-emergency procedures to resuscitation are performed (6). Additional factors such as the excessive number of patients, limited number of nurses, long working hours, shift work, provision of care for patients in need of extensive and immediate care, emotional stress linked to working conditions, insufficient wages, lack of appreciation by executives, and lack of support from colleagues may lead to exhaustion in emergency healthcare professionals, particularly in nurses (7-10).Accordingly, previous studies have reported that emergency nurses are more likely to experience burnout due to emotional exhaustion, depersonalization, and job-related stress because they face more challenging and life-threatening situations than nurses working in other services (1,9, 11,12). Work-related burnout may negatively affect nurses' understanding of and communication with patients and relatives, which in turn may result in not being fully able to meet patients' needs. Ultimately,
Ethical sensitivity is defined as sensitivity to ethical problems, which for nurses means being a... more Ethical sensitivity is defined as sensitivity to ethical problems, which for nurses means being acquainted with ethical values within a situation or situations concerning human health. As a nurse, having high ethical sensitivity not only leads to occupational professionalization, but it also directly influences the quality of nursing care provided to patients. This study was conducted in 2016 by 178 nurses working in a university hospital in the center of Samsun. The data was collected using an introductory information form and the Moral Sensitivity Questionnaire (MSQ). In this study, the median nurse's result on the Moral Sensitivity Questionnaire (MSQ) was 88 (52-187), whereas the median result on its sub-dimensions, such as autonomy, benevolence, holistic approach, experiencing conflict, practice and orientation, were 20 (8-45), 12 (4-25), 12 (5-35), 13 (5-21), 12 (4-25) and 7 (4-28), respectively. Nonetheless, it has been observed that MSQ median results change according to the working year, the number of patients and the work satisfaction level at any given institution; it has also been observed that the ethical sensitivity level is higher for nurses who have worked for 20 to 28 years, who care for 11-21 patients daily and who have a moderate work satisfaction level. This study suggests that MSQ score varies depending on some sociodemographic and professional characteristics such as income level, work life quality, professional satisfaction, length of service of nurses, whether or not they are satisfied with the service they work at, number of patients cared per day and total number of nurses at the service they work at.
Turkish Journal of Geriatrics-Turk Geriatri Dergisi, 2013
Introduction: The elderly population is rapidly growing in Turkey and in the world. The aim of ou... more Introduction: The elderly population is rapidly growing in Turkey and in the world. The aim of our study is to investigate the features of acute poisonings which is a major health problem among the elderly. Materials and Method: Medical files of patients aged 65 years and over admitted to the emergency department of a university hospital for acute poisonings between January 2005 and December 2011 were reviewed. The demographic characteristics of patients, causes and origins of poisonings were evaluated retrospectively. Results: Among 3106 patients who presented with acute poisoning, 126 (4.06%) were geriatric cases. The mean age of the patients was 73.36 ± 6.38. Sixty seven (53.2%) were male and 59 (46.8%) female. The most common causes of acute poisonings were as follows; 68 (54%) drug intoxication, 34 (27%) carbon monoxide and 16 (12.7%) pesticide poisoning. The origins of poisonings were as follows; 105 (83.3%) accidental, 16 (12.7%) suicidal. Fifty seven (45.2%) accidental poiso...
BACKGROUND: Recipients of hematopoietic stem cell transplantation (HSCT) are among the highest co... more BACKGROUND: Recipients of hematopoietic stem cell transplantation (HSCT) are among the highest consumers of allogeneic red blood cell (RBC) and platelet (PLT) components. The impact of patient blood management (PBM) efforts on HSCT recipients is poorly understood. STUDY DESIGN AND METHODS: This observational study assessed changes in blood product use and patient-centered outcomes before and after implementing a multidisciplinary PBM program for patients undergoing HSCT at a large academic medical center. The pre-PBM cohort was treated from January 1 through September 31, 2013; the post-PBM cohort was treated from January 1 through September 31, 2015. RESULTS: We identified 708 patients; 284 of 352 (80.7%) in the pre-PBM group and 225 of 356 (63.2%) in the post-PBM group received allogeneic RBCs (p < 0.001). Median (interquartile range [IQR]) RBC volumes were higher before PBM than after PBM (3 [2-4] units vs. 2 [1-4] units; p = 0.004). A total of 259 of 284 pre-PBM patients (91.2%) and 57 of 225 (25.3%) post-PBM patients received RBC transfusions when hemoglobin levels were more than 7 g/dL (p < 0.001). The median (IQR) PLT transfusion quantities was 3 (2-5) units for pre-PBM patients and 2 (1-4) units for post-PBM patients (p < 0.001). For patients with PLT counts of more than 10 × 10 9 /L, a total of 1219 PLT units (73.4%) were transfused before PBM and 691 units (48.8%) were transfused after PBM (p < 0.001). Estimated transfusion expenditures were reduced by $617,152 (18.3%). We noted no differences in clinical outcomes or transfusion-related adverse events. CONCLUSION: Patient blood management implementation for HSCT recipients was associated with marked reductions in allogeneic RBC and PLT transfusions and decreased transfusion-related costs with no detrimental impact on clinical outcomes. A llogeneic blood transfusion is the most common procedure performed in the United States, 1 but many transfusion episodes are inconsistent with evidence-based guidelines. With increased recognition of the potential for patient harm and excessive health care costs associated with inappropriate transfusion practices, many institutions have attempted to reduce non-evidencebased transfusion episodes. Formal, multidisciplinary programs for patient blood management (PBM), designed with the primary objective of optimizing patients' blood health, 2-11 have also been associated with reduced blood product use. In ABBREVIATIONS: HSCT = hematopoietic stem cell transplantation; ICU = intensive care unit; IQR = interquartile range; PBM = patient blood management.
Objective: Delirium is a neuropsychiatric syndrome characterized by acute onset and a fluctuating... more Objective: Delirium is a neuropsychiatric syndrome characterized by acute onset and a fluctuating course of globally altered mental status. It has been reported that the frequency of delirium among patients hospitalized with any disorder ranges from 2 to 30%. However, in the literature, few studies have evaluated the frequency of delirium in hospitalized patients, including those older than 65 years. According to our knowledge, this is the first study on adult patients in all age groups in an emergency department. We aimed to classify delirium according to its etiological causes and to compare the age groups for frequency and these causes. Material and Methods: Forty-three patients were included in the study; they had been diagnosed with delirium according to the Diagnostic and Statistical Manual of Mental Disorders (DSM)-IV in an emergency department from December 2002 to December 2003. The patients were divided into two groups (group I: age <65 years, group II: age ≥65 years). Following a detailed history, each patient underwent a physical and neurological examination. Additionally, the Mini-Mental State Examination was administered. Radiological and hematological examinations were conducted on all patients who had indications for such testing. Results: Of the patients with delirium, 18 were female and 25 were male. Mean age was 61.18 years (range 18 to 90 years). Of the 43 patients, 21 were in group I and 22 were in group II. The most common causes of delirium were metabolic disorders. There was no significant difference between group I and II for the frequency or etiological causes of delirium. Conclusion: In emergency departments, all patients with delirium should be evaluated for etiological factors, especially metabolic disorders, as treatment of the underlying cause is essential in delirium.
A Retrospective Evaluation of the Patients Who Admitted to Ondokuz Mayis University Emergency Dep... more A Retrospective Evaluation of the Patients Who Admitted to Ondokuz Mayis University Emergency Department The Emergency Deparment of the Ondokuz Mayis University Medical Faculty in Samsun was established in 1997 as an academic department with teaching staff members, specialists and resident asistants including auxiliary personnel. The department recieves emergency cases from a large interlancl covering the whole area of Middle Black Sea Region. The purpose of the present study was to evaluate statistically some of the parameters of patients admitted for several reasons to the Emergency Department in recent months. In this study 4387 patients who were admitted to Ondokuzmayis University Emergency Department between 1 July 1999 to 31 January 2000 were analyzed. The mode and the time of the admission to emergency department (ED), the diagnosis and management in ED, observation in ED, hospitalization rates to different clinics, mortality rates in ED and causalities were discussed. 2379 o...
Objective: Delirium is a neuropsychiatric syndrome characterized by acute onset and a fluctuating... more Objective: Delirium is a neuropsychiatric syndrome characterized by acute onset and a fluctuating course of globally altered mental status. It has been reported that the frequency of delirium among patients hospitalized with any disorder ranges from 2 to 30%. However, in the literature, few studies have evaluated the frequency of delirium in hospitalized patients, including those older than 65 years. According to our knowledge, this is the first study on adult patients in all age groups in an emergency department. We aimed to classify delirium according to its etiological causes and to compare the age groups for frequency and these causes. Material and Methods: Forty-three patients were included in the study; they had been diagnosed with delirium according to the Diagnostic and Statistical Manual of Mental Disorders (DSM)-IV in an emergency department from December 2002 to December 2003. The patients were divided into two groups (group I: age <65 years, group II: age ≥65 years). Following a detailed history, each patient underwent a physical and neurological examination. Additionally, the Mini-Mental State Examination was administered. Radiological and hematological examinations were conducted on all patients who had indications for such testing. Results: Of the patients with delirium, 18 were female and 25 were male. Mean age was 61.18 years (range 18 to 90 years). Of the 43 patients, 21 were in group I and 22 were in group II. The most common causes of delirium were metabolic disorders. There was no significant difference between group I and II for the frequency or etiological causes of delirium. Conclusion: In emergency departments, all patients with delirium should be evaluated for etiological factors, especially metabolic disorders, as treatment of the underlying cause is essential in delirium.
Poison hemlock (Conium maculatum) is one of the most poisonous plants in the world. Accidental in... more Poison hemlock (Conium maculatum) is one of the most poisonous plants in the world. Accidental ingestion of the plant could result in central nervous system depression, respiratory failure and even death. Airway and breathing management followed by fluid resuscitation is the mainstay of treatment. Poison hemlock poisoning is an important differential diagnosis for patients with impaired consciousness and respiratory failure after plant ingestion in areas of natural habitat for the plant. Early and proper diagnosis is vital for patients with poison hemlock poisoning. In this report, we present a case of life-threatening poisoning due to taking the poison hemlock mistaken for Helichrysum arenarium.
Surfactant protein D (SP-D) is a biomarker specific to the lungs. Our aim was to investigate the ... more Surfactant protein D (SP-D) is a biomarker specific to the lungs. Our aim was to investigate the relationship between clinical probability scores and the serum levels of SP-D to indicate the severity of lung injury that develops secondary to hypoxia in pulmonary embolism (PE). We included three groups in the study: non-massive PE (n = 20), sub-massive PE (n = 20), and the control group (n = 20), which consisted of healthy volunteers. The modified Geneva and Wells clinical probability scoring systems were performed for PE, and the patients were classified as low risk, moderate risk, and high risk. SP-D levels were determined by the enzyme-linked immunosorbent assay. For risk factors, the most significant were deep vein thrombosis (DVT) and immobilization. There was no significant difference in SP-D levels between the patients identified with risk factors and those without risk factors in either the Geneva or Wells scores. Atelectasis was the most common radiographic finding, while tricuspid valve regurgitation was predominant in echocardiography. There was no significant difference between the non-massive PE group and the control group, while SP-D levels of the sub-massive group were significantly higher than the control group. In our study, SP-D levels were significantly higher in the sub-massive PE group overall. However, further prospective studies are required with a larger number of cases, including patients with massive PE, in order to clarify the findings.
JPMA. The Journal of the Pakistan Medical Association, 2014
To evaluate the value of electroencephalography in patients with altered mental status in emergen... more To evaluate the value of electroencephalography in patients with altered mental status in emergency departments. Demographical characteristics, types and aetiologies of seizures, and clinical outcomes of the patients were recorded. Patients were divided into 4 groups according to the complaints of admission: findings and symptoms of seizure; stroke and symptoms of stroke-related seizures; syncope; and metabolic abnormalities and other causes of altered mental status. The electroencephalography findings were classified into 3 groups: epileptiform discharges; paroxysmal electroencephalography abnormalities; and background slowing. Electroencephalography abnormalities in each subgroup were evaluated. SPSS 21 was used for statistical analysis. Of the total 190 patients in the study, 117 (61.6%) had pathological electroencephalography findings. The main reason for electroencephalography in the emergency department was the presence of seizure findings and symptoms in 98 (51.6%) patients. ...
Background: Gastroesophageal reflux (GER) is a common clinical pathology detected in childhood. B... more Background: Gastroesophageal reflux (GER) is a common clinical pathology detected in childhood. Bile acids (BAs) are present in reflux and cause various pathologies in the esophagus, the larynx, and the lungs. Objective: We aimed to show if aminoguanidine (AG) contributes to the biochemical and histopathologic treatment of experimental aspiration pneumonitis induced by BAs. Methods: Twenty-eight female Sprague Dawley rats were used. There were 4 groups in the study: (1) group aspirated with 0.9% saline (n ϭ 7), (2) group aspirated with 0.9% saline and treated with AG (n ϭ 7), (3) group aspirated with a solution of 10 mg/kg taurocholic acid and 5 mg/kg taurochenodeoxycholate (n ϭ 7), and (4) group aspirated with BA and treated with AG (n ϭ 7). The saline and BA solutions were administered as 1 mL/kg intratracheally. The AG was administered intraperitoneally twice a day at a 150 mg/kg dose for 7 days. The different histopathologic and biochemical parameters were analyzed. Results: Clara cell protein 16 and malondialdehyde levels were found to be significantly higher in the BA group than in the group where saline was administered; however, they were significantly lower in the BA ϩ AG group than in the BA group. The total superoxide dismutase activity decreased significantly in the BA group compared with the group where saline was administered. A significant increase in superoxide dismutase activity was observed in the BA ϩ AG group when compared with the group where only BA was administered. When the group where BA was administered solely was compared with the group where saline was administered, peribronchial inflammatory cell infiltration, alveolar septal infiltration, alveolar histiocytes, interstitial fibrosis, and granuloma were significantly higher in the BA group than in the saline group. When the BA ϩ AG group was compared with the BA
Previous studies have revealed a relationship between the driving under the influence of alcohol ... more Previous studies have revealed a relationship between the driving under the influence of alcohol (DUIA) and/or driving under the influence drugs (DUID) and the increased risk of death and injury in traffic accidents. The aim of this study was to investigate of blood alcohol concentration (BAC) of drivers after involved in a traffic accident or for suspected for drunkenness in the roadside traffic control in the Turkey's four major cities. Methods: In this study, we retrospectively reviewed the laboratory registrations in university hospitals in four big cities of Turkey (Van, Manisa, Diyarbakır and Samsun) for BAC for five years (from 1 January 2015 to 31 December 2019) of the drivers. Results: In 342 cases (7.1%), BACs were above the cutoff value (0.01 g/100 mL). Of the cases sent for alcohol determination, 11.3% were women and 88.7% were men, and their mean age was 35.3±13.1. In 342 alcohol positive cases, BACs were above 0.101% in 58.8% of cases. BAC positivity of the cases was 9.4% in Manisa, 6.3% in Van, 5.3% in Samsun, and 5% in Diyarbakır. BAC was found to be positive in 4.4% (n=24) of females and 7.4% (n=318) of males (p<0.05). Conclusion: This study is one of the limited number of multicentre studies in this field; it was concluded in the study that zero tolerance should be for drunk driving in traffic, the deterrence of fines should be increased, and roadside screening tests should be used more widely.
Journal of Clinical and Experimental Investigations, 2017
Objective: Cardiopulmonary resuscitation (CPR) is a life-saving process in which many disciplines... more Objective: Cardiopulmonary resuscitation (CPR) is a life-saving process in which many disciplines are involved. In this study, our aim was to evaluate CPR knowledge of public health physicians and determine usefulness of education on this important topic. Methods: A total of 337 public health physicians were involved in an educational course and asked to answer a questionnaire both before and after the course. The questionnaire involved 26 questions and participants' personal identifiers were hidden. The results of two questionnaires were compared. Results: We achieved improvement in knowledge of 315 participants. In majority of the participants, the number of the right answers increased up to 6 to 10 points. We also determined that those who attended to a similar educational course before were more successful than those who did not. Conclusion: Education on CPR is essential for every discipline involved in medicine. Increasing the knowledge of physicians may decrease mortality and morbidity related to sudden cardiac arrest. Institutions must be encouraged for continuous educational organizations and participation of health care providers from different disciplines must be assured.
Journal of Experimental and Clinical Medicine, 2014
Retrobulbar haemorrhage is a rare emergency condition usually associated with trauma. Major clini... more Retrobulbar haemorrhage is a rare emergency condition usually associated with trauma. Major clinical features are loss of visual acuity, eye pain and increasing propitosis. Several spontaneous cases were also reported in literature. We present a 36 years old case of a spontaneus retrobulbar haemorrhage associated with subarachnoid haemorrhage. Patient underwent a lateral canthotomy and cantholysis (LCC) and intravenous corticosteroids, mannitol, topical timolol and acetazolamide were administered. The aim of this study was to increase the awareness of retrobulbar haemorrhage in emergency staff. This will prevent the delay in treatment that will lead to the situation whereby the patient is left permanently blind. Retrobulbar haemorrhage is an ophtalmic acute surgical emergency that emergency physicians have to be familiar with.
Trace elements are essential components of biological structures, but alternatively, they can be ... more Trace elements are essential components of biological structures, but alternatively, they can be toxic at concentrations beyond those necessary for their biological functions. Changes in the concentration of essential trace elements and heavy metals may affect acute hemorrhagic stroke. The aim of this study was to measure serum levels of essential trace elements [iron (Fe), zinc (Zn), manganese (Mn), copper (Cu), and magnesium (Mg)] and heavy metals [cobalt (Co), cadmium (Cd), and lead (Pb)] in patients with acute hemorrhagic stroke. Twenty-six patients with acute hemorrhagic stroke and 29 healthy controls were enrolled. Atomic absorption spectrophotometry (UNICAM-929) was used to measure serum Fe, Cu, Pb, Cd, Zn, Co, Mn and Mg concentrations. Serum Cd, Pb and Fe levels were significantly higher in patients with acute hemorrhagic stroke than controls (p \ 0.001), while serum Cu, Zn, Mg and Mn levels were significantly lower (all p \ 0.001). However, there was no significant difference between the groups with respect to serum Co levels (p [ 0.05). We first demonstrate increased Cd, Pb, and Fe levels; and decreased Cu, Zn, Mg, and Mn levels in patients with acute hemorrhagic stroke. These findings may have diagnostic and prognostic value for acute hemorrhagic stroke. Further studies are required to elucidate the roles of trace elements and heavy metals in patients with acute hemorrhagic stroke.
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