Nebivolol in preventing atrial fibrillation following coronary surgery in patients over 60 years of age

Objective: Postoperative atrial fibrillation is a common complication after cardiac surgery, with an incidence as high as 20-50%. Increased age is associated with a significant increase in postoperative atrial fibrillation risk. This common complication is associated with higher morbidity and mortality rates. The aim of this study was to assess the efficacy of nebivolol in preventing atrial fibrillation following coronary artery bypass surgery in patients over 60 years of age. Methods: In this prospective randomized study, 200 patients who were candidates for elective coronary artery bypass surgery were divided into two groups. The first group was administered with nebivolol and the second group was administered with metoprolol. Treatment was initiated four days prior to surgery, and patients were monitored for atrial fibrillation until discharge. Forty-one patients recieved 50 mg metoprolol succinate daily, which was initiated minimum 4 days before surgery. Results: Demographic data were similar in both groups. The incidence of postoperative atrial fibrillation in both groups was similar, with no significant difference being identified [n=20 (20%); n=18 (18%), P=0.718; respectively]. There were not any mortality at both groups during study. Inotropic agent requirement at ICU was similar for both groups [n=12 (12%), n=18 (18%), P=0.32]. Conclusion: We compared the effectiveness of nebivolol and metoprolol in decreasing the incidence of postoperative atrial fibrillation, and determined that nebivolol was as effective as metoprolol in preventing postoperative atrial fibrillation at patients. Nebivolol may be the drug of choice due to its effects, especially after elective coronary artery bypass surgery

Analysis of the Process of Consultations in the Emergency Department

Çalışmamızda Acil Servise başvuran ve herhangi bir bölüme konsültasyonu yapılan hastaların epidemiyolojik özelliklerinin belirlenmesi ve konsültasyon sürecinin incelenmesi amaçlanmıştır. Çalışmaya 2013 hasta dahil edildi. Hastaların yaş ve cinsiyet özellikleri, ön tanı/tanıları, hastaneye yatış veya sevk ve mortalite oranları gibi epidemiyolojik özellikleri ile konsülte edildiği bölümler, acil serviste kalış süreleri ve konsültasyon süreçleri araştırıldı. Hastaların 521 (%25.9)'i 16:00-19:59 saatleri arasında başvurmuş olup, en sık başvuru saatlerinin de bu saatler arasında olduğu saptandı. Acil serviste en sık konsültasyon isteme nedenleri; basit travma(%33.5) ve kardiyo-vasküler hastalıklardı (%9.5). Hastaların %58.6'sı acil servisten taburcu edilirken, %27.9'u değişik kliniklere yatırıldı ve %9.1'i başka bir sağlık kuruluşuna sevk edildi. Acil serviste 8 saatten uzun süre kalan hasta sayısı 407(%20.21) idi. Konsültasyon süresini uzatan nedenler arasında; en sık herhangi bir bölüm tarafınca uygulanan ek tedavi veya tanısal girişimlerin (%2.8) olduğu görüldü. Hastaların yaşı ile konsültasyon istenme sayısı ve hastaların acil servise başvurduğu saat ile konsültasyon istenme sayısı arasında anlamlı ilişki saptandı (p<0.05). Acil servislerin işleyişinde konsültasyonlar önemli yer tutmaktadır. Hızlı ve etkin bir konsültasyon işleyiş sistemi için acil servis hekimi ve konsültan hekimin işbirliği gerekli olup, bu süreç içerisinde rol alan tüm etkenlerin hasta yararına odaklı olması sağlanmalıdır.In this study, we aimed to evaluate the epidemiological characteristics of the patients who are admitted to Emergency Department (ED) and the process of consultations. 2013 patients were included in the study. The epidemiological characteristics of patients such as age and gender, prediagnosis/diagnosis, hospitalization or referring to other hospital and mortality rates and the consulted departments, stay length in ED and process of consultation were investigated. 521 (25.9%) of patients applied to hospital between 16:00-19:59 hours and these were the most common appeal hours. The most frequent reasons of consultation requests were,not-complicated traumas (33.5%), cardio-vascular diseases (9.5%) in ED.58.6% of patients were discharged from ED, 27.9% of the patients were hospitalized to different clinics, %9.1 of the patients were referred to another health center. 407 (20.21%) patients stayed in the ED longer than 8 hours. Additional therapies or diagnostic interventions (2.8%) which were performed by any department increased the lenght of consultation. There was a significant relationship between the number of consultation request and the patients age and time of the admission to the ED (p<0.05). Consultations in the emergency department is very important. The emergency physician and the consultant physician cooperation is necessary for a fast and effective consultation system, and all factors involved in process should work for the benefit of the patient