Retrospective evaluation of patients with elevated digoxin levels at an emergency department

Objectives: We investigated the demographic characteristics, clinical and laboratory findings, treatment strategies and clinical outcomes of patients presenting at emergency department (ED) with digoxin levels at or above 1.2 ng/ml. Materials and methods: The demographic and clinical characteristics of patients with serum digoxin levels at or above 1.2 ng/ml admitted to an ED between January 2010 and July 2011 were investigated in this cross-sectional descriptive study. Patients with ECG and clinical findings consistent with digoxin toxicity and no additional explanation of their symptoms were evaluated for digoxin toxicity. Results: In this study 137 patients were included, and 68.6% of patients were women with mean age 76.1 ± 12.2. There was no significant difference between gender and digoxin intoxication. The mean age of intoxicated group was significantly higher than the non-intoxicated group (P = 0.03). The most common comorbidities were congestive heart failure (n = 91) and atrial fibrillation (n = 74). The most common symptoms were nausea, vomiting and abdominal pain. The levels of hospitalization and mortality in this group were significantly higher. Conclusion: Digoxin intoxication must be suspected in patients present in the ED, particularly those with complaints that include nausea and vomiting, as well as new ECG changes; serum digoxin levels must be determined. Keywords: Digoxin, Digoxin level, Intoxication, Emergency departmen

A New Model in Reducing Emergency Department Crowding: The Electronic Blockage System

SUMMARY: Objectives: Emergency department (ED) crowding is a growing problem across the world. Hospitals need to identify the situation using emergency department crowding scoring systems and to produce appropriate solutions. Methods: A new program (Electronic Blockage System, EBS) was written supplementary to the Hospital Information System. It was planned that the number of empty beds in the hospital should primarily be used for patients awaiting admission to a hospital bed at the ED. In the presence of patients awaiting admission at the ED, non-urgent admissions to other departments were blocked. ED overcrowded was measured in the period before initiation of EBS, the early post-EBS period and the late post-EBS period, of one-week's duration each, using NEDOCS scoring. Results: NEDOCS values were significantly lower in the early post-EBS period compared to the other periods (p≤0.0001). Although outpatient numbers applying to the ED and existing patient numbers at time of measurement remained unchanged in all three periods, the number of patients awaiting admission in the early post-EBS period was significantly lower than in the pre-EBS and late post-EBS periods (p=0.0001, p=0.001). Conclusions: EBS is a form of triage system aimed at preventing crowding and ensuring the priority admission of emergency patients over that of polyclinic patients. In hospitals with an insufficient number of total beds it can be used to reduce ED crowding and accelerate admissions to hospital from the ED. ÖZET: Amaç: Acil servis kalabalığı tüm dünyada giderek yaygınlaşan bir sorundur. Hastanelerin acil servis kalabalık ölçütlerini kullanarak durum tespiti yapması ve uygun çözüm önerileri üretmeleri gereklidir. Gereç ve Yöntem: Çalışmamızda Hastane Bilgi Yönetim Sistemine ek bir program (Elektronik Blokaj Sistemi, EBS) yazıldı. Buna göre hastanede bulunan boş yatakların öncelikli olarak acil serviste yatış bekleyen hastalar için kullanılması planlandı. Acil serviste yatış bekleyen hasta varken, ilgili servislere yapılacak acil olmayan poliklinik yatışları bloke edildi. EBS başlamadan önceki dönem, EBS sonrası erken dönem ve EBS sonrası geç dönemde birer hafta boyunca NEDOCS skorlaması ile acil servis kalabalıklığı ölçüldü. Bulgular: Elektronik blokaj sistemi sonrası erken dönemde diğer dönemlere göre NEDOCS değeri anlamlı olarak daha düşük bulundu (p≤0.0001). Her üç dönemde de acil servise başvuran günlük hasta sayısı ve ölçüm anında mevcut olan hasta sayısı değişmediği halde, acil servis içinde yatış bekleyen hasta sayısı EBS sonrası erken dönemde, EBS öncesi ve EBS sonrası geç döneme göre anlamlı olarak daha azdı (p=0.0001, p=0.001). Sonuç: Elektronik blokaj sistemi, acil hastaların poliklinik hastalarına göre öncelikli olarak hastaneye yatışını sağlayan, kalabalığı önlemeye yönelik bir çeşit yatış triajı sistemidir. Hastanedeki toplam yatak sayısının yeterli olmadığı hastanelerde, acil servis kalabalığını azaltmak için acil servisten hastaneye olan yatışları hızlandırmak amacıyla kullanılabilir. Key words: Emergency department, National Emergency Department Overcrowding Study, NEDOCS, overcrowding, Anahtar sözcükler: Acil servis, National Emergency Department Overcrowding Study, NEDOCS, kalabalı

A New Model in Reducing Emergency Department Crowding: The Electronic Blockage System.

Objectives: Emergency department (ED) crowding is a growing problem across the world. Hospitals need to identify the situation using emergency department crowding scoring systems and to produce appropriate solutions. Methods: A new program (Electronic Blockage System, EBS) was written supplementary to the Hospital Information System. It was planned that the number of empty beds in the hospital should primarily be used for patients awaiting admission to a hospital bed at the ED. In the presence of patients awaiting admission at the ED, non-urgent admissions to other departments were blocked. ED overcrowded was measured in the period before initiation of EBS, the early post-EBS period and the late post-EBS period, of one-week's duration each, using NEDOCS scoring. Results: NEDOCS values were significantly lower in the early post-EBS period compared to the other periods (p<0.0001). Although outpatient numbers applying to the ED and existing patient numbers at time of measurement remained unchanged in all three periods, the number of patients awaiting admission in the early post-EBS period was significantly lower than in the pre-EBS and late post-EBS periods (p=0.0001, p=0.001). Conclusions: EBS is a form of triage system aimed at preventing crowding and ensuring the priority admission of emergency patients over that of polyclinic patients. In hospitals with an insufficient number of total beds it can be used to reduce ED crowding and accelerate admissions to hospital from the ED

Agro-morphological and biochemical characteristics of european cranberrybush (Viburnum opulus L.)

The study aims to determine some agro-morphological (fruit weight, fruit flesh ratio, fruit skin colour, number of fruits per raceme, number of racemes per bush), and biochemicals (vitamin C, soluble solid content, organic acids, total phenol, total anthocyanin, total flavonoid and antioxidant capacity) in fruits of ten promising European cranberrybush (Viburnum opulus L.) genotypes grown in Erzurum province in Turkey. The results showed genotype-specific differences in most of the agro-morphological, biochemical and bioactive characteristics. The genotypes had fruit weight, number of fruits per raceme and number of racemes per bush between 0.58 and 0.80 g; 38.4 and 58.2 and 392 and 543, respectively. The vitamin C and soluble solid content were ranged from 33 to 42 mg per 100 g and 11.3 to 13.1%. Total phenol, total anthocyanin and total flavonoid content ranged from 703 to 911 mg gallic acid equivalent per 100 g fresh weight, 22–48 mg per 100 g expressed cyanidin-3-rutinoside, 187–302 mg routine equivalent per 100 g fresh weight. Genotype ERZ-08 had the highest antioxidant capacity as 32.70 µmol trolox equivalents per gramme based on FRAP assays. © 2018, Academic Publishing House. All rights reserved

Ischemia-Modified Albumin Levels in Essential Thrombocytosis

WOS: 000450536200014Objective: The aim of this study was to investigate the levels of ischemia-modified albumin (IMA) in people with essential thrombocytosis (ET). Methods: A total of 30 patients with ET patient group and 30 volunteers with no known disease control group (C group) were included in this study after the approval of ethics committee and written informed consent was obtained. Patients with a history of major thrombosis were excluded. IMA levels and independent variables were investigated and effects on thrombosis susceptibility were also studied. In addition to that; comorbid disease state, drug use and used drugs group were questioned in patient group and effects of them on IMA levels were studied. Results: In our study, when ET patient group and C group were compared, the mean serum IMA levels in ET patient group and C group was detected as 0,6726 (0,527-0,776) Absorbans Unite (ABSU) and 0,4342 (0,346-0,612) ABSU respectively and in ET patient group was significantly higher than C group (p<0,001). The glucose, total cholesterol and triglyceride values were significantly higher in ET patient group (p= 0,026, p= 0,058, p= 0,004, respectively). There is a correlation between IMA concentration and age (p= 0,042). Conclusions: In our study IMA levels were found significantly high in ET patient group, this supports increased risk of thrombosis in ET. The difference of metabolic parameters between the ET patient group and C group can be explained by insulin resistance and atherosclerosis background caused by chronic inflammation

The Effect of Haematological Parameters on Overall Survival in Advanced Stage Non Small Cell Lung Cancer

In this study, we aimed to evaluate the prognostic value of pretreatment blood count values, particularly WBC counts, in patients with advanced non-small cell lung cancer (NSCLC). The records of 186 patients with advanced stage (stage IIIB and IV) NSCLC were assessed retrospectively. Patients were divided into 3 subgroups according to WBC levels; 10000 and 15000/mm(3) as Group 3. Patient and tumor characteristics as well as outcomes in terms of overall survival (OS) were evaluated. Median OS was 13.3 months in the whole population, 25.7 months in stage IIIB and 8.9 months in stage IV patients. According to the pretreatment leukocyte values, median OS was 17.9 months in Group 1, 11.2 months in Group 2 and 8.4 months in Group 3 (p= 0.003). Median OS values in WBC groups according to stages IIIB and IV were significantly different (p< 0.001). In multivariate analyses, ECOG-PS 2 or 3, stage IV disease, anemia and high WBC levels were associated with poorer OS. In this study, higher pretreatment WBC levels were associated with poorer OS in patients with advanced stage NSCLC. Pretreatment WBC counts may represent a simple prognostic factor and may aid in tailoring treatment in patients with advanced NSCLC

The Amputation Endicated Extremity Can Be Recovered by Multidisciplinary Treatment: A Case Report and Review of Literature [Multidisipliner Yaklasimla Amputasyon Endikasyonu Olan Ekstremite Kurtarilabilir: Olgu Sunumu ve Literatur Derlemesi]

With the development of microsurgical techniques and successfull multidisciplinary approach; many injuries that requires amputation can be treated successfully by extremity preventing surgery. We present a case that admitted to our clinic with open fracture and although had amputation endication, treated with extremity reconstruction surgery. [Med-Science 2015; 4(2.000): 2281-8

A national survey of Turkish emergency physicians perspectives regarding family witnessed cardiopulmonary resuscitation

We investigated Turkish emergency physicians' views regarding family witnessed resuscitation (FWR) and to determine the current practice in Turkish academic emergency departments with regard to family members during resuscitation. A national cross-sectional, anonymous survey of emergency physicians working in academic emergency departments was conducted. Nineteen of the 23 university-based emergency medicine programs participated in the study. Two hundred and thirty-nine physicians completed the survey. Of the respondents, 83% did not endorse FWR. The most common reasons for not endorsing FWR was reported as higher stress levels of the resuscitation team and fear of causing physiological trauma to family members. Previous experience, previous knowledge in FWR, higher level of training and the acceptance of FWR in the institution where the participant works were associated with higher rates of FWR endorsement for this practice among emergency physicians