Outcomes in 102 patients that present to the emergency department with chemotherapy- induced febrile neutropenia Kemoterapi kaynaklı febril nötropeni şikâyetiyle acil servise başvuran 102 hastanın sonuçları

Abstract Objective: Febrile neutropenia (FN) is a major toxic responseto chemotherapy requiring prompt medical attention. There are a limited number of reports on clinical outcome in patients with FN that present to emergency departments. Materials and Methods: We retrospectively evaluated clinical manifestations, therapeutic outcomes, and risk factors for FN in 102 adult patients that presented to the emergency department between 1 January 2006 and 31 March 2009. FN was defined as a body temperature>38°C and a neutrophil count >0.5×10 9 /L on the day of fever onset or the day after. Results: Mean age of the patients was 57 years. Mean absolute neutrophil count (ANC) was 436.8/mm 3 (range: 0-1000/mm 3 ). In all, 23 of the patients (22.5%) died due to complications related to FN. There were not a statistical difference in therapeutic outcome among tumor types, performance status, sex, depth of neutropenia, or time from emergency department presentationto initiation of antibiotic therapy. Age was an important prognostic factor for therapeutic outcome. Mean age of fatal cases was 65 years versus 56 years for non-fatal cases (p=0.016). Bacteremia was noted in 19 patients, 10 (53%) of which died. The mortality rate was significantly higher in thepatients with blood culture-proven bacteria than in those whose blood culture yielded no organism (p=0.013). Conclusion: FN patients that presented to the emergency department had a high mortality rate that increased with age. Given the increasing age of patients diagnosed with cancer as well as therapeutic interventions, the high mortality rate associated withchemotherapy-induced FN in elderly patients requires further study in order to reduce the risk of death. (Turk J Hematol 2011; 28: 193-7

Factors associated with satisfaction with pediatric emergency department services in Korea: analysis of Korea Health Panel Data 2010 to 2012

Objective We aimed to investigate the factors related to satisfaction with the pediatric emergency department service in Korea. Methods This study examined data from the Korea Health Panel Data from 2010 to 2012. Pediatric patients who visited the emergency department at least once between 2010 and 2012 in Korea were included. Data were collected on patient satisfaction with the emergency department service, and factors related to the patient characteristics, emergency department service process, and medical institution. We compared the dissatisfied and satisfied groups, and calculated the odds ratios for satisfaction according to each variable. Results A total of 1,505 emergency department visits from 947 pediatric patients during the 3-year period were analyzed. We estimated that about 79.5% of patients in the population were satisfied. The odds of expressing satisfaction were higher among males than in females, and among patients who were hospitalized after emergency department treatment compared to those who were transferred to another hospital. Conversely, the odds of expressing satisfaction were lower among patients who had a chronic disease, a financial source other than National Health Insurance, experienced hospitalization within 1 year. Conclusion Our study results might be helpful for establishing a satisfactory pediatric emergency medical service system. In the future, further prospective studies evaluating the causal relationships between the relevant factors and patient satisfaction are warranted

Use of smart glasses for ultrasound-guided peripheral venous access: a randomized controlled pilot study

Objective Smart glasses can provide sonographers with real-time ultrasound images. In the present study, we aimed to evaluate the utility of smart-glasses for ultrasound-guided peripheral venous access. Methods In this randomized, crossover-design, simulation study, 12 participants were recruited from the emergency department residents at a university hospital. Each participant attempted ultrasound-guided peripheral venous access on a pediatric phantom at intervals of 5 days with (glasses group) or without (non-glasses group) the use of smart glasses. In the glasses group, participants confirmed the ultrasound image through the lens of the smart glasses. In the non-glasses group, participants confirmed the ultrasound image through the display viewer located next to the phantom. Procedure time was regarded as the primary outcome, while secondary outcomes included the number of head movements for the participant, number of skin punctures, number of needle redirections, and subjective difficulty. Results No significant differences in procedural time were observed between the groups (non-glasses group: median time, 15.5 seconds; interquartile range [IQR], 10.3 to 27.3 seconds; glasses group: median time, 19.0 seconds; IQR, 14.3 to 39.3 seconds; P=0.58). The number of head movements was lower in the glasses group than in the non-glasses group (glasses group: median, 0; IQR, 0 to 0; non-glasses group: median, 4; IQR, 3 to 5; P<0.01). No significant differences in the number of skin punctures or needle restrictions were observed between the groups. Conclusion Our results indicate that smart-glasses may aid in ensuring ultrasound-guided peripheral venous access by reducing head movements

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Objective: Febrile neutropenia (FN) is a major toxic responseto chemotherapy requiring prompt medical attention. There are a limited number of reports on clinical outcome in patients with FN that present to emergency departments.Materials and Methods: We retrospectively evaluated clinical manifestations, therapeutic outcomes, and risk factors for FN in 102 adult patients that presented to the emergency department between 1 January 2006 and 31 March 2009. FN was defined as a body temperature>38°C and a neutrophil count >0.5×109/L on the day of fever onset or the day after.Results: Mean age of the patients was 57 years. Mean absolute neutrophil count (ANC) was 436.8/mm3 (range: 0-1000/mm3). In all, 23 of the patients (22.5%) died due to complications related to FN. There were not a statistical difference in therapeutic outcome among tumor types, performance status, sex, depth of neutropenia, or time from emergency department presentationto initiation of antibiotic therapy.Age was an important prognostic factor for therapeutic outcome. Mean age of fatal cases was 65 years versus 56 years for non-fatal cases (p=0.016). Bacteremia was noted in 19 patients, 10 (53%) of which died. The mortality rate was significantly higher in thepatients with blood culture-proven bacteria than in those whose blood culture yielded no organism (p=0.013).Conclusion: FN patients that presented to the emergency department had a high mortality rate thatincreased with age. Given the increasing age of patients diagnosed with cancer as well as therapeuticinterventions, the high mortality rate associated withchemotherapy-induced FN in elderly patientsrequires further study in order to reduce the risk of death

Status of Emergency Signal Functions in Myanmar Hospitals: A Cross-Sectional Survey

Introduction: Low- and middle-income countries (LMICs) have a large percentage of globalmortality and morbidity rates from non-communicable diseases, including trauma. Theestablishment and development of emergency care systems is crucial for addressing thisproblem. Defining gaps in the resources and capacity to provide emergency healthcare in LMICsis essential for proper design and operation of ECS (emergency care services) reinforcementprograms. Myanmar has particular challenges with road access for providing timely emergencymedical care, and a shortage of trained health workers. To examine the ECS capacity in Myanmar,we used the Emergency Care Assessment Tool (ECAT), which features newly developed toolsfor assessing sentinel conditions and signal functions (key interventions to address morbidity andmortality) in emergency care facilities.Methods: ECAT is composed of six emergent sentinel conditions and corresponding signalfunctions. We surveyed a total of nine hospitals in five states in Myanmar. A constructed surveysheet was delivered by e-mail, and follow-up interviews were conducted via messenger to clarifyambiguous answers.Results: We categorized the nine participating institutions according to predefined criteria:four basic-level hospitals; four intermediate-level; and one advanced-level hospital. All basichospitals were weak in trauma care, and two of 12 signal functions were unavailable. Half of theintermediate hospitals showed weakness in trauma care, as well as critical care such as shockmanagement. Only half had a separate triage area for patients. In contrast, all signal functions andresources listed in ECAT were available in the advanced-level hospital.Conclusion: Basic-level facilities in Myanmar were shown to be suboptimal in traumamanagement, with critical care also inadequate in intermediate facilities. To reinforce signalfunctions in Myanmar health facilities, stakeholders should consider expanding critical functionsin selected lower-level health facilities. A larger scale survey would provide more comprehensivedata to improve emergency care in Myanmar

Status of Emergency Signal Functions in Myanmar Hospitals: A Cross-Sectional Survey

Introduction: Low- and middle-income countries (LMICs) have a large percentage of globalmortality and morbidity rates from non-communicable diseases, including trauma. Theestablishment and development of emergency care systems is crucial for addressing thisproblem. Defining gaps in the resources and capacity to provide emergency healthcare in LMICsis essential for proper design and operation of ECS (emergency care services) reinforcementprograms. Myanmar has particular challenges with road access for providing timely emergencymedical care, and a shortage of trained health workers. To examine the ECS capacity in Myanmar,we used the Emergency Care Assessment Tool (ECAT), which features newly developed toolsfor assessing sentinel conditions and signal functions (key interventions to address morbidity andmortality) in emergency care facilities.Methods: ECAT is composed of six emergent sentinel conditions and corresponding signalfunctions. We surveyed a total of nine hospitals in five states in Myanmar. A constructed surveysheet was delivered by e-mail, and follow-up interviews were conducted via messenger to clarifyambiguous answers.Results: We categorized the nine participating institutions according to predefined criteria:four basic-level hospitals; four intermediate-level; and one advanced-level hospital. All basichospitals were weak in trauma care, and two of 12 signal functions were unavailable. Half of theintermediate hospitals showed weakness in trauma care, as well as critical care such as shockmanagement. Only half had a separate triage area for patients. In contrast, all signal functions andresources listed in ECAT were available in the advanced-level hospital.Conclusion: Basic-level facilities in Myanmar were shown to be suboptimal in traumamanagement, with critical care also inadequate in intermediate facilities. To reinforce signalfunctions in Myanmar health facilities, stakeholders should consider expanding critical functionsin selected lower-level health facilities. A larger scale survey would provide more comprehensivedata to improve emergency care in Myanmar

The characteristics of pediatric emergency department visits in Korea: An observational study analyzing Korea Health Panel data.

OBJECTIVE:We investigated the characteristics of pediatric emergency department (ED) patients in Korea and determined factors associated with hospital admission after ED treatment. METHODS:Korea Health Panel data from 2008 through 2013 were analyzed retrospectively; we included patients under 18 years old who visited the ED at least once. We collected patient and household epidemiologic data such as sex, age group, region of residence, disability, chronic disease, household income quintile, national health insurance type, use of private insurance, and annual frequency of ED visits. We also examined data related to each ED visit, such as reason for visit, medical service provided, and hospital size/ownership. We then investigated which factors were correlated with case disposition (discharge home or hospital admission) after ED treatment. RESULTS:In total, 3,160 pediatric ED visits occurred during the six-year period. Males (57.5%) and children aged 0-5 years (47.7%) made more visits than females and older children, respectively. The proportion of ED visits for disease (67.7%) was much higher than for injury or poisoning (32.2%), and 452 cases (14.3%) required hospital admission. For hospital admission, the odds ratio (OR) of females was 0.73 compared to males, and the OR of children aged 6-11 was 0.68 compared to children aged 0-5. The OR of capital residents was 0.69 compared to province residents, and the OR of the highest income quintile was 0.51 compared to the lowest quintile. The OR of children with private insurance coverage was 0.49 compared to those lacking private insurance, and the OR of ED visits due to disease was 1.82 compared to visits due to injury/poisoning. CONCLUSION:This analysis of clinical and demographic characteristics of pediatric ED visits and hospital admissions can serve as the foundation of future prospective studies required for establishing appropriate policies for the Korean pediatric emergency medical system

Association of Circulating Irisin Concentrations with Weight Loss after Roux-en-Y Gastric Bypass Surgery

Irisin is a myokine with potential anti-obesity properties that has been suggested to increase energy expenditure in obese patients. However, there is limited clinical information on the biology of irisin in humans, especially in morbidly obese patients undergoing bariatric surgery. We aimed to assess the association of circulating irisin concentrations with weight loss in obese patients undergoing bariatric surgery. This was a pilot, single-centre, longitudinal observational study. We recruited 25 morbidly obese subjects who underwent Roux-en-Y gastric bypass surgery (RYGBP), and blood samples from 12 patients were taken to measure serum irisin concentrations before, and one and nine months after surgery. Their clinical characteristics were measured for one year. The preoperative serum irisin concentration (mean 1.01 &#177; 0.23 &#956;g/mL, range 0.73&#8315;1.49) changed bidirectionally one month after RYGBP. The mean concentration at nine months was 1.11 &#177; 0.15 &#956;g/mL (range 0.92&#8315;1.35). Eight patients had elevated irisin levels compared with their preoperative values, but four did not. Elevations of irisin levels nine months, but not one month, after surgery, were associated with lower preoperative levels (p = 0.016) and worse weight reduction rates (p = 0.006 for the percentage excess weight loss and p = 0.032 for changes in body mass index). The preoperative serum irisin concentrations were significantly correlated with the percentage of excess weight loss for one year (R2 = 0.612; p = 0.04) in our study. Our results suggest that preoperative circulating irisin concentrations may be at least in part associated with a weight loss effect of bariatric surgery in morbidly obese patients. Further large-scale clinical studies are needed to ratify these findings

Systematic review and meta-analysis of initial management of pneumothorax in adults: Intercostal tube drainage versus other invasive methods

<div><p>Objectives</p><p>The ideal invasive management as initial approach for pneumothorax (PTX) is still under debate. The purpose of this systematic review and meta-analysis was to examine the evidence for the effectiveness of intercostal tube drainage and other various invasive methods as the initial approach to all subtypes of PTX in adults.</p><p>Methods</p><p>Three databases were searched from inception to May 29, 2016: MEDLINE, EMBASE, and the Cochrane CENTRAL. Randomised controlled trials that evaluated intercostal tube drainage as the control and various invasive methods as the intervention for the initial approach to PTX in adults were included. The primary outcome was the early success rate of each method, and the risk ratios (RRs) were used for an effect size measure. The secondary outcomes were recurrence rate, hospitalization rate, hospital stay, and complications.</p><p>Results</p><p>Seven studies met our inclusion criteria. Interventions were aspiration in six studies and catheterization connected to a one-way valve in one study. Meta-analyses were conducted for early success rate, recurrence rate, hospitalization rate, and hospital stay. Aspiration was inferior to intercostal tube drainage in terms of early success rate (RR = 0.82, confidence interval [CI] = 0.72 to 0.95, <i>I</i>^<i>2</i> = 0%). While aspiration and intercostal tube drainage showed no significant difference in the recurrence rate (RR = 0.84, CI = 0.57 to 1.23, I² = 0%), aspiration had shorter hospital stay than intercostal tube drainage (mean difference = -1.73, CI = -2.33 to -1.13, I² = 0%). Aspiration had lower hospitalization rate than intercostal tube drainage, but marked heterogeneity was present (RR = 0.38, CI = 0.19 to 0.76, I² = 85%).</p><p>Conclusion</p><p>Aspiration was inferior to intercostal tube drainage in terms of early resolution, but it had shorter hospital stay. The recurrence rate of aspiration and intercostal tube drainage did not differ significantly. The efficacy of catheterization connected to a one-way valve was inconclusive because of the small number of relevant studies.</p><p>(Registration of study protocol: PROSPERO, CRD42016037866)</p></div

Subgroup analysis of the studies that compared aspiration and intercostal tube drainage.

<p>The subgroupings were assigned according to the subtype of pneumothorax included in each study; i.e., first episode of primary spontaneous pneumothorax versus other types.</p