Ambulans diversiyonu: Çözüm mü yoksa problem mi?

Aim: Ambulance diversion (AD) is defined as redirection of ambulance to an emergency department (ED) different from the initially intended ED with the purpose of both appropriate use of hospital sources for selected patients and relief of ED overcrowding. In the present study, the authors sought to perform a comprehensive analysis of ADs in Ankara, the capital city of Turkey. Materials and Methods: In this retrospective study, a comprehensive analysis of reasons for AD and the disposition data in the receiving hospital of patients diverted by ambulances of Ankara 112 Emergency Medical Service throughout 2014 (01 January-31 December 2014) was performed. Results: A total of 174.669 patients were transferred by ambulance to EDs and of those 1.300 ADs (0.74%) occured. The causes of AD were respectively lack of bed in intensive care unit (ICU), inpatient care ward or EDs (639 AD, 49.1%), shortage of on-call specialist doctors (242 AD, 18.6%), and insufficent radiology, laboratory equipment and other resources (174 AD, 13.3%). Conclusion: Unavailability of patient beds in EDs, ICUs or inpatient clinics are the most common causes of AD.Amaç: Ambulans diversiyonu (AD) acil servislerin (AS) aşırı yoğunluğunu hafifletmek ve hastane kaynaklarının en uygun şekilde kullanılması amacıyla ambulansla alandan nakledilen seçilmiş bazı hastaların başlangıçta götürülmesi planlanan hastane AS’den farklı bir hastanenin AS’e yeniden yönlendirilmesi olarak tanımlanır. Bu çalışmada Türkiye’nin Başkenti Ankara’da hastanelerin AS’lerinden yapılan AD’larının kapsamlı analizi yapıldı. Gereç ve Yöntem: Bu retrospektif çalışmada 1Ocak 2014-31 Aralık 2014 tarihleri arasında Ankara 112 Acil Sağlık Hizmetleri Ambulansları’yla başka hastane acil servisine yönlendirilen hastaları alan hastane sonuçları, AD nedenleri, tanı ve demografik özellikleri araştırıldı. Bulgular: Toplam 174.669 hasta ambulanslarla hastane AS’lerine nakledildi ve 1.300 (%0,74) AD’u yapıldı. Kadın hastaların sayısı 692 idi (%53,2). Başlıca hasta AD sebepleri yoğun bakımlarda, hastane servislerinde ve AS’lerinde yer olmaması (639 AD, %49,1), nöbetçi uzman doktorun olmaması (242 AD, %18,6), ve radyoloji, laboratuvar tetkikleri ve diğer kaynakların yetersizliğiydi (174 AD, %13,3). Sonuç: AS’lerde, yoğun bakımlarda ve hastane servislerinde yer olmaması AD’nun en sık nedenidir

Health care services in shopping centers: A routine mass-gathering event

Background:Shopping centers (SCs) are social areas with a group of commercial establishments which attract customers of numerous people every day. However, analysis of urgent health conditions and provided health care in SCs has not been performed so far.Objective:The aim of the study was to perform a comparative analysis of clients visiting SCs and demographics, complaints, and health care of patients admitted to Emergency Medical Intervention Units (EMIU) located in grand SCs in Ankara, Turkey.Methods:Customer and health care records of nine grand SCs in Ankara from January 1, 2018 through December 31, 2018 were evaluated retrospectively. Health care services in EMIUs of SCs were provided by employed medical staff. Data including demographic characteristics, complaints, treatment protocols, discharge, and referral to hospital of the patients were retrospectively analyzed from medical registration forms.Results:Medical records of nine grand SCs were analyzed. Number of customers could not be obtained in three SCs due to privacy issues and were not included in patient presentation rate (PPR) and transport-to-hospital rate (TTHR) calculation. Total number of customers in the remaining six SCs were 53,277,239. The total number of patients seeking medical care was 6,749. The number of patients seeking health care in six SCs with known number of customers was 4,498 and PPR ranged from 0.018 to 0.381 patients per 1,000 attendants. The median age of the recorded 4,065 patients (60.2%) was 28 (interquartile range [IQR]: 38-21), and 3,611 (53.5%) of the patients admitted to EMIUs were female. The number of patients treated in the SC was 4,634 (68.6%) and 189 patients (2.8%) were transferred-to-hospital by ambulance for further evaluation and treatment. Transportation to hospital was required in 125 patients who sought medical care in six SCs which provided total number of customers, and TTHR ranged from 0.000 to 0.005 patients per 1,000 attendants. No sudden cardiac death was seen. Medical conditions were the primary reasons for seeking health care. The most frequent causes of presentation were laceration and abrasions (639 patients, 9.4%).Conclusion:The PPR and TTHR in SCs are low. The most common causes of presentation are minor conditions and injuries. Majority of urgent medical conditions in SCs can be managed by health care providers in EMIUs

Evaluation of health care services provided in political public meetings in Turkey: A forgotten detail in politics

WOS: 000454206200008PubMed ID: 30428943Background: Political parties in Turkey execute political public meetings (PPMs) during their election campaign for members of the parliament (MoP). A great number of people attend these meetings. No guidelines exist regarding preparation and organization of health care services provided during these meetings. Furthermore, there is no study evaluating health care problems encountered in previous PPMs. Objective: Political parties arranged PPMs in 2015 during the election campaign for general election of MoP. The present study aimed to investigate the context of health care services, the distribution of assigned health staff, as well as the number and the symptoms of patients admitted in health care tents in these PPMs. Methods: Two general elections for MoP were done in Turkey on June 7, 2015 and November 1, 2015. Health care services were provided by the City Emergency Medical Services Department (CEMSD) in the cities. Demographic characteristics, symptoms, comorbid conditions, treatment, discharge, and hospital transfer of the patients were obtained from patient medical registration records. Information about the distribution and the number of the assigned staff was received from local CEMSDs. The impact of variables such as the number of attendees, heat index, humidity, and the day of the week on the number of patients and the patient presentation rate (PPR) were analyzed. Results: A total of 97 PPMs were analyzed. The number of total attendees was 5,265,450 people. The number of patients seeking medical help was 1,991. The PPR was 0.5 (0.23-0.91) patients per 1,000 attendees. Mean age of the patients was 40 (SD = 19) years old while 1,174 (58.9%) of the patients were female. A total of 1,579 patients were treated in the tents and returned to the PPM following treatment. Two-hundred and three patients were transferred to a hospital by ambulance. Transfer-to-hospital ratio (TTHR) was 0.05 (0.0-0.13) patients per 1,000 attendees. None of the patients suffered sudden cardiac death (SCD) or cardiac arrest. Medical conditions were the main cause for admission. The most common symptoms were dizziness, low blood pressure, fatigue, and hypertension, respectively. The most commonly used medical agents included pain killers and myorelaxants. The number of attendees, heat index, and weekend days were positively correlated with the number of the patients. Conclusion: The majority of medical conditions encountered in PPMs are easily treatable in health care tents settled in the meeting area. The number of attendees, heat index, and weekend days are factors associated with the number of patients

Determination of Energy Using Efficiency at Corn Production in Adana

Bu çalışmada, Adana koşullarında ana ürün mısır üretiminde enerji bilançosu ortaya konulmuştur. Çalışmada kullanılan aletKmakinelerin ekonomik ömürleri, iş başarısı, yakıt-yağ tüketimleri, makine ağırlıkları ile gübre, sulama, tohum miktarları gibi temel veriler, yapılan diğer çalışmalardan, çeşitli kaynak ve kataloglardan temin edilmiştir. Yapılan değerlendirmeler sonucunda mısır üretiminde enerji çıktı/girdi oranı 4.02, özgül enerji değeri 3.63 MJ/kg, net enerji üretimi 93094.19 MJ/ha olarak hesaplanmıştır. Mısır üretiminde toplam enerji girdileri içerisinde kullanım oranı en yüksek olanın % 50.41 ile gübre enerjisi olduğu bulunmuştur. Bunu sırasıyla % 17.98 ile yakıt-yağ enerjisi, % 15.45 ile sulama enerjisi takip etmiştir.In this study, energy balance in grown crop main crop corn was revealed in Adana. Main data used in this study, such as economical life, labor success, fuel-oil consumptions, machine weights of the tools and machines used in second crop sunflower and fertilizer, irrigation, seed amounts have been obtained from the other studies, various sources and catalogues. As a result of the evaluations energy output/input rate! was obtained as 4.02, the specific energy value was obtained 3.63, net energy production was obtained 93094.19 MJ/ha in grown corn. For the grown corn, fertilizer energy was the highest energy with 50.41 in total energy budget followed by fuel-oil energy and irrigation energy with 17.98% and 15.45% respectively

Diffusion tensor imaging can discriminate the primary cell type of intracranial metastases for patients with lung cancer

Purpose: Histopathological differentiation of primary lung cancer is clinically important. We aimed to investigate whether diffusion tensor imaging (DTI) parameters of metastatic brain lesions could predict the histopathological types of the primary lung cancer. Methods: In total, 53 patients with 98 solid metastatic brain lesions of lung cancer were included. Lung tumors were subgrouped as non-small cell carcinoma (NSCLC) (n = 34) and small cell carcinoma (SCLC) (n = 19). Apparent diffusion coefficient (ADC) and Fractional anisotropy (FA) values were calculated from solid enhanced part of the brain metastases. The association between FA and ADC values and histopathological subtype of the primary tumor was investigated. Results: The mean ADC and FA values obtained from the solid part of the brain metastases of SCLC were significantly lower than the NSCLC metastases (P 0.909 × 10-3 mm2/s for mean ADC (Sensitivity = 80.3, Specificity = 83.8, PPV = 89.1, NPV = 72.1) and > 0.139 for FA values (Sensitivity = 80.3, Specificity = 54.1, PPV = 74.2, NPV= 62.5) revealed in differentiating NSCLC from NSCLC. Conclusion: DTI parameters of brain metastasis can discriminate SCLC and NSCLC. ADC and FA values of metastatic brain lesions due to the lung cancer may be an important tool to differentiate histopathological subgroups. DTI may guide clinicians for the management of intracranial metastatic lesions of lung cancer