The Integration of Palliative Care into the Emergency Department

SUMMARY: Palliative care (PC) is a new and developing area. It aims to provide the best possible quality of life for patients with life-limiting diseases. It does not primarily include life-extending therapies, but rather tries to help patients spend the rest of their lives in the best way. PC patients often are admitted to emergency departments during the course of a disease. The approach and management of PC include differences with emergency medicine. Thus, there are some problems while providing PC in the ED. With this article, the definition, main features, benefits, and problems of providing PC are presented, with the primary aim of emphasizing the importance of PC integration into the ED. Key words: Emergency department, integration, palliative care, trainin

Ethical sensitivity of Emergency department employees and their views and knowledge levels on Palliative Care

Patients in need of Palliative Care (PC) often receive medical help from Emergency departments (ER) and sometimes due to healthcare system-related issues the time spent at the ER exceeds the expectations. In order to provide effective care, ER employees should have sufficient knowledge and skills about end-of-life care and PC in ER. This study aims to evaluate the knowledge levels of ER employees on PC, in addition to their educational background and their approach to PC and its possible relation with ethical sensitivity. The present study is a cross-sectional and descriptive study consisting of 100 emergency service employees working in the city centers of Tokat and Kayseri between August 2017 and May 2019. The data were collected using a questionnaire form containing sociodemographic characteristics of the ER employees and their views on PC in addition to the Ethical Sensitivity Questionnaire (ESQ). The sample of the study consisted of 100 ER workers; 52 (52%) female and 48 (48%) male. The mean age was 32.16±7.91 years. It was determined that the vast majority of the participants (63%) had not received PC training before. While the average score regarding knowledge levels on PC was found to be 49.10±8.25, the average total score of the Ethical Sensitivity Questionnaire was found to be 78.73±20.97. The participants had a higher ethical sensitivity and moderate knowledge levels about PC. There was no significant difference in the total ESQ scores of the ER employees according to the variables of "gender, education, occupation, palliative knowledge and in-service education in the institution" (p>0.05). In order to raise awareness of PC, there is a need for pre-graduation PC training and in-service training after graduation. These practices should be repeated at certain intervals to keep the knowledge up-to-date. [Med-Science 2022; 11(4.000): 1593-8

A case report of peripartum cardiomyopathy with a review of literature

Peripartum cardiomyopathy (PPCM) is a severe form of idiopathic dilated cardiomyopathy, which appears either in the last month of pregnancy or during the five months following delivery. This clinical entity leads to left ventricular dysfunction and eventually cardiac insufficiency. Left ventricle functions recover spontaneously in some patients with PPCM while left ventricular dysfunction persists to cause an indication for cardiac transplantation in some patients. This case report aims to increase the awareness of obstetricians about PPCM by describing an affected patient

The attitudes of emergency service workers towards attempted suicide cases and its relation to burnout and job satisfaction

Emergency healthcare is the first sight of intervention for suicide attempts. Therefore, the attitudes of emergency health personnel towards suicidal tendencies are of great importance. The aims of this study are; to determine the attitudes and behaviors of emergency service workers towards attempted suicide cases, which are frequently encountered in emergency services, and to determine whether they are influenced by job satisfaction and burnout. The sample of the descriptive correlational study consists of 282 healthcare professionals working in the emergency services of Tokat and its districts. The data were collected using a questionnaire method through a personal information form, a scale determining the attitudes of emergency health workers towards attempted suicide cases (SAEHS), occupational burnout inventory (OBI) and job satisfaction survey (JSS). A total of 282 healthcare personnel, 159 women and 123 men, participated in the study. The participants had a positive attitude towards patients who attempted suicide, and the results indicated that this was not affected by variables such as age, gender, level of education, profession, marital status, years of experience, weekly working hours and shift schedules. While there was a significant positive, moderate or weak correlation between SAEHS and its sub-groups; a negative correlation with very low significance was found between SAEHS and OBI. On the other hand, the results suggested that there was a positive correlation with very low significance between SAEHS and JSS. Although emergency service workers approach attempted suicide patients with a positive attitude, this can be improved with an increase in job satisfaction and a decrease in burnout. It would be beneficial to include healthcare professionals in pre and post-graduation training programs regarding suicide cases and to collaborate with psychiatric services. [Med-Science 2022; 11(4.000): 1680-5

The valuable effects of potent antioxidant curcumin in cisplatin induced liver and kidney injury

Amaç: Sisplatin (CIS) sıklıkla kullanılan oldukça güçlü bir anti kanser ajandır. Sisplatinin toksik etkileri kullanımını sınırlandırmaktadır. Sunulan bu deneysel çalışmada, sisplatinin nefrotoksik ve hepatotoksik yan etkilerine karşı kurkuminin (CUR) etkilerinin incelenmesi amaçlanmıştır.Yöntem: Sıçanlar her biri 7'şerli toplam 3 gruba ayrıldı. İlk grup, control grubu olarak, ikinci grup CIS (6 mg/kg, i.p)+ salin grubu ve 3. grup CIS (6 mg/kg, i.p) + CUR (100 mg/kg i.p) olarak belirlendi. Sisplatin tek doz olarak ve kurkumin ise 3 gün boyunca sıçanlara verildi. 3 gün sonra, karaciğer ve böbrek dokuları ve kan örnekleri histopatolojik ve biyokimyasal tekniklerle analiz edildi. Bulgular: Sisplatin+ kurkumin gurubunda BUN ve ALT değerleri sadece sisplatin uygulanan gruba göre daha düşük bulundu. Bunun yanında, SOD ve GSH düzeyleri sadece sisplatin verilen grupta CIS+CUR grubuna göre daha yüksekti. Karaciğer ve böbrek dokusunda histopatolojik olarak kurkuminin yararlı etkileri gözlendi. Sonuç: Sisplatin böbrek ve karaciğer dokuları üzerinde güçlü bir toksik etkiye sahiptir. Sunulan bu çalışma; kurkuminin, nefrotoksik ve hepatotoksik yan etkileri iyileştirmede önemli bir etkisi olduğunu öne sürmektedir.Objective: Cisplatin (CIS) is a potent anticancer drug that uses commonly. The toxic effects of CIS limit its usage. In the present experimental study, it is aimed to evaluate effects of curcumin (CUR) on CIS induced hepatotoxicity and nephrotoxicity. Method: The rats were separated into three groups as each composed of 7 rats. First one is control group, the second is the CIS (6 mg/kg, i.p) + saline group, and third is the CIS (6 mg/kg, i.p) + CUR (100 mg/kg i.p) group. CIS was given at single dose and CUR was given for 3 days. After 3 days, kidney, liver and blood samples were analyzed with histopathological and biochemical technics. Results: In CIS+ CUR group, there was decline in levels of Blood urea nitrogen (BUN), alanine aminotransferase (ALT) ALT and compared with CIS group. Besides, superoxide dismutase (SOD) and glutathione (GSH) levels were found increased as compared with CIS group. The ameliorating effects of CUR were presented with histopathological findings. Conclusions: CIS has serious toxicity on kidney and liver and oxidative stress play an important role on toxicity. The present study suggests that CUR has important healing effects on nephrotoxicity and hepatotoxicity of CIS

Beneficial effects of agomelatine in experimental model of sepsis-related acute kidney injury

WOS: 000374753400002PubMed ID: 27193977BACKGROUND: Sepsis-related acute kidney injury (AKI) is a serious complication of sepsis. Problems persist regarding early diagnosis and treatment of AKI. The aim of the present study was to evaluate the efficacy of agomelatine, which is primarily known for its positive effects on depressive and anxiety disorders in sepsis-related AKI. METHODS: Sepsis model was created with cecal ligation puncture (CLP). Rats were separated into 4 groups of 8 each: the control group, the sham-operated group, the CLP+saline group, and the CLP+agomelatine group. Agomelatine was administered intraperitoneally in doses of 20 mg/kg. RESULTS: In the agomelatine group, reductions were observed in levels of tumor necrosis factor alpha (TNF-alpha), malondialdehyde (MDA), blood urea nitrogen (BUN), and creatinine, as well as in histological kidney scores, compared to the non-treated group. In addition, it was demonstrated that agomelatine treatment had positive effect on sepsis-induced morphological damage to renal and tubular tissues. CONCLUSION: Agomelatine showed strong efficacy in sepsis-related AKI, demonstrated with histological and biochemical results in an experimental model. It is believed that antioxidant and pro-inflammatory effects of agomelatine are responsible for the improvement in kidneys

The importance of MTHFR C677T/A1298C combined polymorphisms in pulmonary embolism in Turkish population

Background and objective: Pulmonary embolism (PE) is an important cardiovascular emergency with high mortality. There are still problems related to the diagnosis of PE and genetic research may play a key role on diagnosis as well as determining risk stratification. In the present study, the aim was to evaluate MTHFR C677T and A1298C polymorphisms that play a role on folate metabolism in PE patients. Materials and methods: A total of 118 PE patients and 126 controls were enrolled in the current study. Genomic DNA was isolated and genotyped using polymerase chain reaction (PCR) analyses for the MTHFR C677T and A1298C polymorphisms. Results: There was no association between clinical and demographic characteristics of PE patients and both MTHFR C677T and A1298C polymorphisms. Allele frequencies showed a significant difference between patients and controls. T allele frequency was significantly higher in the patients\u27 group than the control group. There was an association between PE and combined MTHFR C677T and A1298C polymorphisms. Conclusion: We found an association between MTHFR C677T/A1298C combined mutations and PE in the Turkish population. Future genetic studies investigating combined mutations could be very helpful to identify risk population in PE