The effect of thrombolytic therapy on QT dispersion in acute myocardial infarction and its role in the prediction of reperfusion arrhythmias

Purpose: We aimed to determine the effect of intravenous thrombolytic therapy on QT dispersion (QTd) and its role in the prediction of reperfusion arrhythmias.Materials and Methods: Twenty patients with acute myocardial infarction (MI) were enrolled in the study. Measurements of QTd were carried out  prior to thrombolytic therapy and before discharge. The patients were examined for ventricular arrhythmias with 24‑h Holter electrocardiography monitoring after treatment and the relationship between ventricular arrhythmias and the QTd values in the early phase of MI was investigated.Results: The values of QTd were significantly higher during the early phase of MI (60 ± 5.32 ms) than those in the late phase (53.35 ± 4.07 ms) (P = 0.032). There was no correlation between isolated, bigeminal, trigeminal and total ventricular premature beats, accelerated idioventricular rhythm (AIVR) with QTd values. However, the patients with sustained ventricular tachycardia (VT), prolonged VT and sustained AIVR had higher corrected QTd (92 ms1/2, 97.8 ms1/2, 81.7 ms1/2, respectively) than the patients without these arrhythmias (74 ms1/2, 56.3 ms1/2, 58.28 ms1/2,  respectively) (P = 0.022, 0.013, 0.018).Conclusion: The values of QTd may be significantly reduced in the 1st week of acute MI and measurement of QTd in the early phase of MI may have a correlation with the following reperfusion arrhythmias: Sustained VT, prolonged VT and AIVR.Key words: Arrhythmia, myocardial infarction, QT dispersion, reperfusion, thrombolytic therap

The effect of anesthesia type on stress hormone response: Comparison of general versus epidural anesthesia

Aim: The aim of this study was to investigate the effect of different types of anesthesia on stress hormones.Materials and Methods: The study was included 60 ASAI-II cases scheduled for major lower extremity surgery. The cases were randomized into 2  groups: The EA group was administered epidural anesthesia and the GA group was administered standard general anesthesia. In order to evaluate the surgical trauma - related stress response, CRP, TSH, cortisol, and fasting blood sugar(FBS) levels were measured preoperatively, 30 min after surgical incision, and 24 h post surgery.Results: Between-group comparisons; Preoperative values were not  significantly different between the groups.(P > 0,05) Pulse rate and cortisol values significantly higher in general group at 30 min. (P < 0,05), and the FBS values were significantly higher in the epidural group at 24 h.(P < 0,05) There were not found differences for other parameters at evaluation times.Conclusion: No differences were observed between the two anesthesia methods, in terms of minimizing the stress response due to surgical trauma during major low extremity surgery.Key words: Epidural anesthesia, general anesthesia, stress hormone

The training needs of Turkish emergency department personnel regarding intimate partner violence

<p>Abstract</p> <p>Background</p> <p>Violence against females is a widespread public health problem in Turkey and the lifetime prevalence of IPV ranges between 34 and 58.7%. Health care workers (HCW) sometimes have the unique opportunity and obligation to identify, treat, and educate females who are abused. The objective of this study was to evaluate the knowledge, attitudes, and experiences of the emergency department (ED) staff regarding intimate partner violence (IPV) at a large university hospital in Turkey.</p> <p>Methods</p> <p>A cross-sectional study was conducted in a large university hospital via questionnaire. The study population consisted of all the nurses and physicians who worked in the ED during a two month period (n = 215). The questionnaire response rate was 80.5% (41 nurses and 132 physicians). The main domains of the questionnaire were knowledge regarding the definition of IPV, clinical findings in victims of IPV, legal aspects of IPV, attitudes towards IPV, knowledge about the characteristics of IPV victims and abusers, and professional and personal experiences and training with respect to IPV.</p> <p>Results</p> <p>One-half of the study group were females, 76.3% were physicians, and 89.8% had no training on IPV. The majority of the nurses (89.5%) and physicians (71.1%) declared that they were aware of the clinical appearance of IPV. The mean of the knowledge scores on clinical knowledge were 8.84 ± 1.73 (range, 0–10) for acute conditions, and 4.51 ± 3.32 for chronic conditions. The mean of the knowledge score on legal procedures and the legal rights of the victims was 4.33 ± 1.66 (range, 0–7). At least one reason to justify physical violence was accepted by 69.0% of females and 84.7% of males, but more males than females tended to justify violence (chi square = 5.96; p = 0.015). However, both genders accepted that females who experienced physical violence should seek professional medical help.</p> <p>Conclusion</p> <p>The study participants' knowledge about IPV was rather low and a training program is thus necessary on this issue. Attention must be given to the legal aspects and clinical manifestations of IPV. The training program should also include a module on gender roles in order to improve the attitudes towards IPV.</p

Energy management modelling in production inventory systems

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A Heuristic Approach for Determining Lot Sizes and Schedules Using Power-of-Two Policy

We consider the problem of determining realistic and easy-to-schedule lot sizes in a multiproduct, multistage manufacturing environment. We concentrate on a specific type of production, namely, flow shop type production. The model developed consists of two parts, lot sizing problem and scheduling problem. In lot sizing problem, we employ binary integer programming and determine reorder intervals for each product using power-of-two policy. In the second part, using the results obtained of the lot sizing problem, we employ mixed integer programming to determine schedules for a multiproduct, multistage case with multiple machines in each stage. Finally, we provide a numerical example and compare the results with similar methods found in practice

Capacitated lot sizing with alternative routings and overtime decisions

Material requirements planning (MRP) is a basic tool for performing detailed material planning function in the manufacture of component parts and their assembly into finished items. MRP's managerial objective is to provide 'the right part at the right time' to meet the schedules for completed products. However satisfying end customer demands faster with lower inventories implies smarter scheduling which must simultaneously reflect actual capacity conditions. Therefore, the need is to schedule both capacity and materials simultaneously. Since MRP does not consider the availability of capacity resources to schedule production, consequently the schedules so developed are usually capacity infeasible. This paper proposes a three-step procedure to develop capacity feasible material and production schedules in a finite capacity environment. In the first step, an LP model produces capacity feasible but lot size relaxed planned order releases for all end products and assembly components which are then fed into a MRP processor, where a bill of material (BOM) explosion process generates material plans. Finally, these material plans are introduced to another LP model which assures that capacity feasibility is again restored. The mathematical models developed consider restrictions on lot sizes as well as alternative production routings and overtime decisions. A numerical example also is provided and some future research directions are outlined