Evaluation of Emergency Interhospital Patient Transfers from Province of Mardin to Out-of-Province Hospitals in a Year

Abstract Objective: This study aimed to assess patients who were transferred from emergency services throughout the province of Mardin to out-of-province hospitals by ambulance in a year. Material and Methods: In this study, all patients transferred from emergency services in the province of Mardin to out-of-province hospitals via ambulances by the Patient Referral Assessment Committee, founded under the Provincial Directorate of Health, between the dates of December 31, 2010 and December 31, 2011 were evaluated retrospectively. No exclusion criteria were used. Patients were grouped and analyzed according to their demographic characteristics, transport properties, and reasons for referral. Results: The total number of the patients included in the study was 1518 (55.8% males, 41±27 mean age). Of all, 621 patients (40.9%) were transferred from the center of Mardin province, and the other patients were transferred from 8 district hospitals and two private hospitals. It was found that the patients were transferred to 37 hospitals in 8 provinces, and a total of 562 patients (37%) were transferred to private hospitals. Cardiology (23.3%), pediatrics (11.5%), and obstetrics and gynecology (8.8%) departments were the first three clinics that patients were transferred to frequently, respectively. In total, 274 patients (18.1%) were transferred inappropriately. There was a statistically significant difference between patients' transfer hospitals (state hospital/private hospital) and the age of the patients (younger than 18 years/18 years or older) (p<0.001). In addition, the rate of adult patients' transfers to tertiary healthcare centers was significantly higher (p<0.001). Conclusion: In Mardin, cardiology, pediatrics and obstetrics and gynecology patients are the most common group of emergency patients transferred by 112 ambulances to out-of-province hospitals. Approximately 40% of the patients were transferred to private hospitals. Inappropriate patient transfers seem to be a major problem in this study, as in other studies conducted in Turkey. (JAEM 2014; 13: 62-6

Evaluation of impact of fast track on emergency overcrowding

Giriş: ASK gün geçtikçe artan oranda AS lerin işleyişini olumsuz olarak etkilemektedir. ASK sorununun çözülmesine yönelik çeşitli çözüm önerileri mevcuttur. Bu önerilerden birisi de Fast Track (FT) -Hızlı Bakı Birimi uygulamasıdır. Bu çalışmada HBB uygulamasının ASK na olası etkisi araştırılmıştır. Asıl amaç bu olmakla birlikte, bu uygulamanın, hasta bekleme sürelerine, hastaların AS de toplam kalış sürelerine, muayeneden olmadan ayrılan hasta sayısına, hasta memnuniyetine, bedel-etkinliğe, hastaların konsülte edilip edilmeme oranlarına, morbidite ve mortaliyeteye etkileri de incelenmiştir. HBB uygulamasının ideal zaman aralığı da tespit edilmeye çalışılmış. Ayrıca AS çalışanlarının bu uygulamaya yönelik düşünceleri de anket yöntemiyle öğrenilmeye çalışılmıştır. Gereç ve Yöntem: Çalışma Ankara da Gazi Üniversitesi Hastanesi Erişkin AS de 17.09.2010-30.09.2010 tarihleri arasında yapılmıştır. Bir hafta süresince 24 saat HBB uygulaması yapılmış, diğer hafta ise HBB uygulaması yapılmamıştır. Bu iki haftadaki hastalar karşılaştırılarak HBB uygulamasının ASK na etkileri araştırılmıştır. HBB uygulamasına uygun hasta seçerken Kanada Triaj Skorlaması kullanılmış olup triaj skoru 4-5 olan hastalar çalışmaya dahil edilmiştir. Triaj skoru 1-3 olan diğer hastaların da yaş, cinsiyet, triajda bekleme süreleri de ayrıca değerlendirilmiştir. Tedavi süreci bitiminde, Kanada triaj skoru 4-5 olan hastalardan memnuniyet anketi doldurmaları istendi. Kabul eden hastalara memnuniyet anketi uygulanmış, soruların cevaplarında 5 li Likert yöntemi kullanılmıştır. Her iki hafta boyunca NEDOCS ölçümü yapılmış ayrıca AS çalışanlarının da NEDOCS tahmini yapmaları istenmiştir. AS de muayene olamadan ayrılan ambulans ve ayaktan hasta başvuran hasta sayıları da kaydedilmiştir. Bulgular: HBB uygulanan haftada diğer haftaya göre NEDOCS skoruna göre ASK istatistiksel olarak anlamlı şekilde daha az bulunmuştur. Hasta bekleme süreleri ve hastaların AS de toplam kalış süreleri ve muayene olmadan ayrılan hasta sayıları da yine HBB uygulanan haftada istatistiksel olarak anlamlı olarak daha az tespit edilmiştir. Çalışmada HBB uygulanan haftadaki HBB hastalarının memnuniyetleri de HBB uygulaması olmayan haftadaki hastalara göre istatistiksel olarak anlamlı olarak daha yüksek bulunmuştur. Hastaların ortalama maliyetlerine, konsülte edilme oranlarına, morbidite ve mortaliteye bakıldığında HBB uygulanan hafta ile uygulanmayan hafta arasında anlamlı fark saptanmamıştır. HBB nde değerlendirilen hastaların saat dilimlerine göre başvuru sıklığına bakıldığında saat 12:00-16:00 ve saat 20:00-24:00 arasında istatistiksel anlamlı şekilde daha çok hasta başvurusu olduğu tespit edilmiştir. Sonuç: HBB uygulaması ASK nı, hasta bekleme sürelerini, hastaların toplam AS de kalış sürelerini, muayene olmadan ayrılan hasta sayısını azaltmış, hasta memnuniyetlerini arttırmıştır.Background: Emergency department (ED) overcrowding is a ubiquitous problem with serious public health implications. The fast track area is a novel method which aims to reduce waiting time, patient dissatisfaction and emergency crowding. The study objective was to determine the impact of a fast track area on emergency crowding and both effectiveness measures (i.e. waiting times [WT] and length of stay [LOS]) and quality measures (i.e. Left without being seen (LWBS) rates and mortality rates) in non-urgent patients. Non-urgent patients were defined as whose Canadian Triage Acuity Scale (CTAS) was 4 and 5. The National Emergency Department Overcrowding Study (NEDOCS) was used to measure the ED overcrowding. Methods: The study took place in Ankara, at Gazi Univercity, Faculty of Medicine, Emergency Medicine Department. This study examined the impact of FT on a preintervention study group versus post-intervention control group. Results: NEDOCS skore of FT week was less than non-FT week. Patiens? saticfaction was higher in FT group. LWBS was decreased 53% and WT was decreased 54,9% in FT week. Morbidity and mortality rates remained unchanged. Conclusion: The FT decreased NEDOCS skore. It also improved ED effectiveness (WTs and LOS) and quality measures (LWBS rates, patient satisfaction)

Evaluation of impact of fast track on emergency overcrowding

ASK gün geçtikçe artan oranda AS‟lerin iŞleyiŞini olumsuz olarak etkilemektedir. ASK sorununun çözülmesine yönelik çeşitli çözüm önerileri mevcuttur. Bu önerilerden birisi de Fast Track (FT) -Hızlı Bakı Birimi uygulamasıdır. Bu çalışmada HBB uygulamasının ASK‟na olası etkisi araştırılmıştır. Asıl amaç bu olmakla birlikte, bu uygulamanın, hasta bekleme sürelerine, hastaların AS‟de toplam kalış sürelerine, muayeneden olmadan ayrılan hasta sayısına, hasta memnuniyetine, bedel-etkinliğe, hastaların konsülte edilip edilmeme oranlarına, morbidite ve mortaliyeteye etkileri de incelenmiştir. HBB uygulamasının ideal zaman aralığı da tespit edilmeye çalışılmış. Ayrıca AS çalışanlarının bu uygulamaya yönelik düşünceleri de anket yöntemiyle öğrenilmeye çalışılmıştır. Gereç ve Yöntem: Çalışma Ankara‟da Gazi Üniversitesi Hastanesi Erişkin AS‟de 17.09.2010-30.09.2010 tarihleri arasında yapılmıştır. Bir hafta süresince 24 saat HBB uygulaması yapılmış, diğer hafta ise HBB uygulaması yapılmamıştır. Bu iki haftadaki hastalar karşılaştırılarak HBB uygulamasının ASK‟na etkileri araştırılmıştır. HBB uygulamasına uygun hasta seçerken Kanada Triaj Skorlaması kullanılmış olup triaj skoru 4-5 olan hastalar çalışmaya dahil edilmiştir. Triaj skoru 1-3 olan diğer hastaların da yaş, cinsiyet, triajda bekleme süreleri de ayrıca değerlendirilmiştir. Tedavi süreci bitiminde, Kanada triaj skoru 4-5 olan hastalardan memnuniyet anketi doldurmaları istendi. Kabul eden hastalara memnuniyet anketi uygulanmış, soruların cevaplarında 5‟li Likert yöntemi kullanılmıştır. Her iki hafta boyunca NEDOCS ölçümü yapılmış ayrıca AS çalışanlarının da NEDOCS tahmini yapmaları istenmiştir. AS‟de muayene olamadan ayrılan ambulans ve ayaktan hasta başvuran hasta sayıları da kaydedilmiştir. Bulgular: HBB uygulanan haftada diğer haftaya göre NEDOCS skoruna göre ASK istatistiksel olarak anlamlı şekilde daha az bulunmuştur. Hasta bekleme süreleri ve hastaların AS‟de toplam kalış süreleri ve muayene olmadan ayrılan hasta sayıları da yine HBB uygulanan haftada istatistiksel olarak anlamlı olarak daha az tespit edilmiştir. Çalışmada HBB uygulanan haftadaki HBB hastalarının memnuniyetleri de HBB uygulaması olmayan haftadaki hastalara göre istatistiksel olarak anlamlı olarak daha yüksek bulunmuştur. Hastaların ortalama maliyetlerine, konsülte edilme oranlarına, morbidite ve mortaliteye bakıldığında HBB uygulanan hafta ile uygulanmayan hafta arasında anlamlı fark saptanmamıştır. HBB‟nde değerlendirilen hastaların saat dilimlerine göre başvuru sıklığına bakıldığında saat 12:00-16:00 ve saat 20:00-24:00 arasında istatistiksel anlamlı şekilde daha çok hasta başvurusu olduğu tespit edilmiştir. Sonuç: HBB uygulaması ASK‟nı, hasta bekleme sürelerini, hastaların toplam AS‟de kalış sürelerini, muayene olmadan ayrılan hasta sayısını azaltmış, hasta memnuniyetlerini arttırmıştır.Background: Emergency department (ED) overcrowding is a ubiquitous problem with serious public health implications. The fast track area is a novel method which aims to reduce waiting time, patient dissatisfaction and emergency crowding. The study objective was to determine the impact of a fast track area on emergency crowding and both effectiveness measures (i.e. waiting times [WT] and length of stay [LOS]) and quality measures (i.e. Left without being seen (LWBS) rates and mortality rates) in non-urgent patients. Non-urgent patients were defined as whose Canadian Triage Acuity Scale (CTAS) was 4 and 5. The National Emergency Department Overcrowding Study (NEDOCS) was used to measure the ED overcrowding. Methods: The study took place in Ankara, at Gazi Univercity, Faculty of Medicine, Emergency Medicine Department. This study examined the impact of FT on a preintervention study group versus post-intervention control group. Results: NEDOCS skore of FT week was less than non-FT week. Patiens‟ saticfaction was higher in FT group. LWBS was decreased 53% and WT was decreased 54,9% in FT week. Morbidity and mortality rates remained unchanged. Conclusion: The FT decreased NEDOCS skore. It also improved ED effectiveness (WTs and LOS) and quality measures (LWBS rates, patient satisfaction)

Analysis of Seismic Sloshing Displacements in Rectangular Liquid Storage Tanks with SPH Method

Bu çalışmada, yatay yönde yer sarsıntısına maruz kalan prizmatik bir tankta gerçekleşen çalkalanma modellemesi düzgünleştirilmiş parçacık hidrodinamiği yöntemiyle (SPH) gerçekleştirilmiştir. SPH yöntemi sonuçları bir deney ve ANSYS Fluent modeli sonuçlarıyla doğrulanmıştır. Deneyden ve Fluent modeliyle elde edilen çalkalanma profilleri burada ele alınan SPH yöntemi sonucuyla müthiş bir uyumluluk göstermektedir. Bu çalışma irdelenen SPH yöntemi, süreksizlikleri yakalama ve hareketli sınırları ele almada oldukça etkilidir.In this study, Smoothed Particle Hydrodynamics (SPH) method was used to model sloshing response of a rectangular tank subjected to horizontal earthquake base excitation. An experiment and a numerical study with ANSYS Fluent flow modeling software are performed to verify the outputs of the SPH model. The sloshing displacement profiles obtained from the SPH model closely matched the free surface displacements obtained from the experiment and the flow modeling software. The SPH model described in this study was highly efficient at capturing discontinuities and working with moving boundaries without having to re-mesh the model at each time step

The Role of the Government in Regional Development: An Empirical Analysis on Turkey

Bu çalışmanın amacı, Türkiye’de kamu yatırımları ve yatırım teşviklerinin bölgesel kalkınma üzerine etkisini panel veri yöntemiyle incelemektir. Bu amaçla bölgelerin ayrımında Türkiye’yi 26 farklı bölgeye ayıran İBBS (İstatistiki Bölge Birimleri Sınıflandırması) Düzey 2’den yararlanılmıştır. Çalışmada belirtilen bölgelerin 2004-2010 dönemine ilişkin verileri kullanılmıştır. Sabit Etkiler Modeliyle yapılan tahmin sonuçlarına göre çalışmanın iki temel sonucu bulunmaktadır. İlk olarak kamu yatırımlarının bölgesel kalkınma üzerinde pozitif etkisi bulunmaktadır. Detaylı olarak bakıldığında ise ulaşım ve eğitim alanında yapılan yatırımların bölgesel kalkınma üzerindeki etkisi, diğer kamu yatırımlarına göre yüksektir. İkinci olarak Türkiye’nin bölgesel kalkınmasında yabancı teşvikler pozitif etkiye sahipken yerli teşviklerin herhangi bir etkisi yoktur.The aim of this study is to analyze the effect of public investments and investment incentives on regional development in Turkey by using panel data method with the period of 2004-2010. For that purpose, the NUTS (Nomenclature of Territorial Units for Statistics) Level 2 which divides Turkey into 26 separate regions is used for division of regions. According to the results of the Fixed Effects Model regression, there are two main findings. The first one states that the public investments effect regional development positively. If it is considered in details, the positive effects of public investments on transportation and education is greater than the effects of other public investments. Secondly, the domestic investment incentives do not contribute to the regional development of Turkey while the foreign incentives have positive impact on regional development

Diagnostic and prognostic values of cerebral oxygen saturations measured by INVOS™ in patients with ischemic and hemorrhagic cerebrovascular disease

Objectives: In this study it was aimed to investigate whether measurement of potential changes of cerebral oxygenation saturations due to ischemic or hemorrhagic cerebrovascular diseases have an early diagnostic and prognostic value. Methods: Adult patients (≥18 years old) having acute ischemic or hemorrhagic stroke were included in the study. Patients under 18-year-old, those with incomplete data or suspicious diagnosis were excluded.The cerebral oxygen saturations of the patients were compared with the healthy subjects. Patients were also grouped according to their clinical outcomes; good clinical status (group 1) and poor clinical status (group 2). These groups were compared according to the patients’ cerebral oxygen saturations. Results: The mean oxygen saturation of the patients and healthy people were similar (59.48% ± 10.6 versus 58.44% ± 9.6). There was no difference between patients and healthy population according to cerebral oxygen saturations. Furthermore, mean oxygen levels were also similar between the hemisphere without lesion and with lesion in the patients group (59.8% ± 11.8 versus 59.2% ± 10.4).When the patients were grouped according to their clinical status, there were 30 patients in group 1 and 15 in group 2. The cerebral oxygen saturations of the hemisphere with lesion were similar between these groups and no statistical difference was observed (59.2% ± 9.3 versus 59.1% ± 12.6, p = 0.9). There was also no statistical difference between the groups when delta oxygen levels of the affected and unaffected hemispheres of the groups were calculated (0.9% ± 6.1 versus 0.13% ± 8.4, p = 0.7). Conclusion: Results of this study revealed that there was no difference in cerebral oxygen saturations measured by near-infrared cerebral oximetry system between the patients with cerebrovascular disease and healthy population. Furthermore, our results did not support that the cerebral oxygen saturations may be used for determining the prognosis of the patients with cerebrovascular disease. Keywords: Stroke, Cerebrovascular disorders, Diagnosis, Diagnosis emergency departmen

Intravenous Lipid Emulsion Therapy for Acute Synthetic Cannabinoid Intoxication: Clinical Experience in Four Cases

There is no specific antidote for intoxication with synthetic cannabinoids. In this case series, we considered the efficiency of intravenous lipid emulsion therapy in four cases, who presented to emergency department with synthetic cannabinoid (bonzai) intoxication. The first patient had a GCS of 3 and a left bundle branch block on electrocardiography. The electrocardiography revealed sinus rhythm with normal QRS width after the treatment. The second patient had bradycardia, hypotension, and a GCS of 14. After intravenous lipid emulsion therapy, the bradycardia resolved, and the patient’s GCS improved to 15. The third patient presented with a GCS of 8, and had hypotension and bradycardia. After the treatment, not only did the bradycardia resolve, but also the GCS improved to 15. The fourth patient, whose electrocardiography revealed accelerated junctional rhythm, had a GCS of 13. The patient’s rhythm was sinus after the treatment. Cardiovascular recovery was seen in all four cases, and neurological recovery was also seen in three of them. Based on the fact that intravenous lipid emulsion is beneficial in patients intoxicated with lipophilic drugs, unstable patients presenting to the emergency department with acute synthetic cannabinoid intoxication may be candidates for intravenous lipid emulsion treatment

Occipital epidermoid cyst of furuncular myiasis presenting with spontaneous bleeding: a case report.

A 77-year-old female patient was presented to the emergency department with swelling and bleeding in the occiput. It was learned from the patient that the soft tissue swelling on her head had been present for 1 year, and she had no history of trauma. The patient had diabetes mellitus and hypertension and a history of breast cancer 15 years ago. An epidermoid cyst, approximately 5x5 centimeter in size, bleeding in the form of leakage was observed on the patient's occipital scalp. There was no intracranial pathology in the brain computerized tomography. Wound debridement revealed that the cyst contained approximately 30 live larvae. All larvae were cleaned from the tissue defect. When looking from the outside, the larvae were 8-12 millimeters in size, yellow-white, spiral in shape, and were thought to be compatible with the larva of Lucilia sericata diptera. Myiasis is an ectoparasitic infection of diptera larvae by settling in human and animal tissues. When flies leave their larvae in the tissue, the larvae that invade and develop in that area cause infection. Cutaneous myiasis is the most common clinical form and can be seen on the scalp and cause furuncular myiasis. Immunosuppression, lack of self-care, travel to endemic areas and trauma have been reported as risk factors for myiasis. It was thought that the history of diabetes and old malignancy might be predisposing in our patient. In this case report, it is aimed to present a case of furuncular myiasis that settled down without any trauma to the occiput and presented with spontaneous soft tissue bleeding

Effect of the prognostic nutritional index and systemic immuneinflammatory index in predicting short-term mortality in geriatric patients with SARS-CoV-2 infection

Introduction and aim. We aimed to investigate whether systemic immune inflammatory index (SII) and prognostic nutritional index (PNI) were associated with short-term mortality in geriatric patients with SARS-CoV-2.Material and methods. Our study was designed retrospectively. The data of patients that presented to a single center. The primary outcome of the study was the diagnostic value of SII and PNI in predicting 28-day mortality in geriatric patients with SARS-CoV-2 pneumonia. Results. 272 geriatric patients with SARS-CoV-2 included. The median PNI was 42.5, and the median SII was 687.6 (430–1404.2). In univariant analysis, PNI and SII has a significant relationship with mortality (p40.1) and SII (<1.267) for 30-day mortality were determined as 1.12 , and 1. Conclusion. In conclusion, the blood tests used to calculate PNI and SII are routinely included in complete blood count and biochemistry tests that can be performed in every hospital. According to the results of the current study, the mortality group had significantly higher SII values and significantly lower