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In reply to the letter to the editor regarding “Readability, understandability, and quality of online education materials and large language models for retrograde cricopharyngeal muscle dysfunction”
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Can Extended Focused Assessment with Sonography for Trauma safely rule out critical injury? A prospective diagnostic accuracy study versus computed tomography in adult blunt trauma
No full textObjective: The objective of this study is to evaluate the diagnostic accuracy of Extended Focused Assessment with Sonography for Trauma (E-FAST) performed by senior emergency medicine residents compared with computed tomography (CT) in patients with blunt thoracoabdominal trauma. Methods: This prospective observational diagnostic accuracy study was conducted at a Level 1 trauma center between December 2023 and June 2024. Adult patients presenting with isolated blunt thoracoabdominal trauma who underwent both E-FAST and thoracoabdominal CT were included. E-FAST examinations were performed at the bedside by senior emergency medicine residents certified in ultrasonography. CT served as the reference standard. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of E-FAST were calculated. Concordance between E-FAST and CT findings was analyzed using Fisher's exact test wherever appropriate. Results: A total of 170 patients were analyzed (124 males [72.9%] and mean age: 38.2 ± 14.7 years). E-FAST demonstrated a sensitivity of 100%, specificity of 98.7%, PPV of 88.2%, and NPV of 100% compared to CT. Concordance between E-FAST and CT findings was statistically significant for intra-abdominal free fluid, pneumothorax, and hemothorax (p < 0.001 for each). No pericardial effusion was detected by either modality. Conclusion: E-FAST performed by adequately trained emergency medicine residents is a rapid, reliable, and highly accurate diagnostic tool in the initial evaluation of blunt thoracoabdominal trauma. Incorporating E-FAST into standard trauma assessment protocols can enhance diagnostic efficiency and reduce unnecessary CT utilization
‘Gerekeni Asgari Düzeyde Yapmak': Hemşirelik Öğrencilerinin Sessiz İstifa Deneyimlerinin Karma Desen Yöntemiyle İncelenmesi
No full textDiş Hekimliğinde İleri Görüntüleme Yöntemleri
No full textModern diş hekimliği uygulamaları, klinisyenin tanı koyma ve tedaviplanlama sürecinde doğrudan belirleyici rol oynayan temel unsurlar arasındayer almaktadır. Geçmişte yaygın olarak kullanılan iki boyutlu konvansiyonelradyografi yöntemleri; süperpozisyon, görüntü distorsiyonu ve anatomikyapıların üst üste binmesi gibi önemli sınırlılıklar içermekteydi. Günümüzdeise bu yöntemlerin yerini, dijital ve hacimsel görüntüleme teknolojilerigiderek daha fazla almaktadır. Bu teknolojik gelişmeler sayesinde anatomikyapılar yalnızca şekilsel özellikleriyle değil; kemik kalitesi, yapısal özelliklerive çevre dokularla olan hassas ilişkileriyle birlikte daha kapsamlı ve gerçekçibir biçimde değerlendirilebilmektedir. Bunun yanı sıra dijitalleşme,görüntülerin arşivlenmesini ve farklı uzmanlar arasında paylaşılmasınıkolaylaştırarak klinik süreçlerin daha hızlı ve verimli yürütülmesine katkısağlamaktadır. Özellikle bilgisayarlı tomografi (BT) ve konik ışınlıbilgisayarlı tomografi (KIBT), maksillofasiyal bölgedeki sert dokuların üçboyutlu ve detaylı analizinde vazgeçilmez bir klinik standart haline gelmiştir.İmplantoloji, gömülü diş cerrahisi, ortodonti ve endodonti gibi pek çok alandasağladığı net uzaysal derinlik algısı, cerrahi riskleri minimize ederken tedavisüreçlerinin öngörülebilirliğini ve güvenilirliğini ciddi oranda artırmaktadır.Sert doku odaklı bu ileri yaklaşımlar, yumuşak doku patolojilerinin, siniryapılarının ve temporomandibular eklem rahatsızlıklarınındeğerlendirilmesinde üstün kontrast çözünürlüğü sunan manyetik rezonansgörüntüleme (MRG) ile kusursuz bir şekilde tamamlanmaktadır. Buna ekolarak, dokuların mikroskobik düzeyde incelenmesi için mikro bilgisayarlıtomografi (mikro-BT) teknolojisi ve lezyonların metabolik aktivitelerinisaptayan pozitron emisyon tomografisi (PET) ve tek foton emisyonlubilgisayarlı tomografi (SPECT) gibi radyonüklid yöntemler, patolojilerinkarakterizasyonunda kritik veriler sunmaktadır. İleri görüntülemetekniklerinin sağladığı geniş bakış açısı, klinik tanısal doğruluğunartırılmasına olanak tanırken; kanıta dayalı, minimal invaziv ve hastaya özgütedavi yaklaşımlarının geliştirilmesini desteklemektedir. Bu bölümde, dişhekimliğinde kullanılan görüntüleme yöntemlerinin modern klinikuygulamalardaki yeri, maliyet açısından sunduğu avantajlar ve tedavibaşarısına olan katkıları genel hatlarıyla ele alınacaktır. Modern dental practice relies on fundamental components that play a direct and decisive role in the clinician’s diagnostic and treatment-planning processes. In the past, two-dimensional conventional radiographic techniques were widely used; however, these methods were associated with significant limitations, including superimposition, image distortion, and overlap of anatomical structures. Today, these techniques are increasingly being replaced by digital and volumetric imaging technologies. Owing to these technological advancements, anatomical structures can now be evaluated in a more comprehensive and realistic manner, not only in terms of their morphological characteristics but also with respect to bone quality, structural properties, and their precise relationships with surrounding tissues. Furthermore, digitalization facilitates the archiving of images and their sharing among different specialists, thereby contributing to faster and more efficient clinical workflows. In particular, computed tomography (CT) and cone-beam computed tomography (CBCT) have become indispensable clinical standards for the three-dimensional and detailed analysis of hard tissues in the maxillofacial region. The clear spatial depth perception provided by these modalities in various fields—such as implantology, impacted tooth surgery, orthodontics, and endodontics—significantly enhances the predictability and reliability of treatment outcomes while minimizing surgical risks. These hard-tissue-oriented advanced approaches are seamlessly complemented by magnetic resonance imaging (MRI), which offers superior contrast resolution for the evaluation of soft tissue pathologies, neural structures, and temporomandibular joint disorders. In addition, micro-computed tomography (micro-CT), which enables microscopic-level assessment of tissues, as well as radionuclide imaging modalities such as positron emission tomography (PET) and single-photon emission computed tomography (SPECT), which detect the metabolic activity of lesions, provide critical data for the characterization of various pathologies. The broad perspective offered by advanced imaging techniques allows for improved diagnostic accuracy while supporting the development of evidence-based, minimally invasive, and patient-specific treatment approaches. This section aims to outline the role of imaging modalities used in dentistry within modern clinical practice, their cost-effectiveness, and their contributions to treatment success.</p
A survey-based assessment of emergency physicians’ proficiency in mechanical ventilator management
No full textLong-term effects of platelet-rich plasma administered with minced autologous fascia lata in the management of unilateral vocal fold paralysis
No full textAims: Autologous fascia lata (AFL) is a therapeutic option in the management of unilateral vocal fold paralysis (UVFP). However, the effect of platelet-rich plasma (PRP) administered with AFL is unknown. The aim of this study was to investigate the long-term effects of the combination of minced AFL and PRP in the treatment of UVFP. Methods: Between January 2015 and January 2021, a retrospective evaluation was made of 14 participants diagnosed with UVFP treated with minced AFL+PRP injection. Pre-treatment and postoperative 1-year evaluations were performed with videolaryngostroboscopy, the GRBAS scale, Turkish Voice Handicap Index (T-VHI-10), maximum phonation time (MPT), and acoustic analysis (%Jitter, %Shimmer, fundamental frequency (fo)). Findings: Half of the participants were males, with with a mean age of 42.0 ± 12.1 years. One-year post-intervention, the T-VHI-10 scores decreased significantly (32.1 to 13.8; p = 0.001), mean MPT increased significantly (from 6.57 s to 16.14 s; p = 0.001), and significant improvements were observed in %Jitter (0.8 to 0.3; p = 0.030) and %Shimmer (5.18 to 2.16; p = 0.001) values. No postoperative complications or donor site morbidity were reported in any participant. Conclusions: Combining PRP with minced AFL is a safe, long-acting option for treating UVFP with significant improvement in voice quality. The regenerative effects of PRP may contribute to permanent vocal improvement by increasing fascia fertility. This method can be considered a less invasive alternative to thyroplasty and may provide additional advantages in terms of the use of autologous material and permanence
Mortality prediction among ED patients with upper gastrointestinal bleeding: Comparison of NEWS-2 and conventional risk scores
No full textBackground: Upper gastrointestinal bleeding (UGIB) is a common, potentially life-threatening emergency. Early risk stratification is essential for effective triage and management. Although scores like AIMS65, Glasgow-Blatchford (GBS), and pre-endoscopic Rockall (PERS) are widely used, the roles of NEWS-2 and its lactate-enhanced version (NEWS-2 L) in UGIB have not been fully assessed. Objective: To compare the prognostic performance of NEWS-2 and NEWS2-L with conventional scoring systems in predicting in-hospital mortality in UGIB patients presenting to the ED. Methods: In this prospective observational study, adult patients admitted to the ED with clinically confirmed UGIB were enrolled. A total of 178 patients were included in the final analysis. For each patient, GBS, PERS, AIMS65, NEWS-2, and NEWS2-L scores were calculated at presentation. Receiver operating characteristic (ROC) curves were used to assess the predictive performance of each scoring system. Sensitivity (Sn), specificity (Sp), likelihood ratios (LR), and area under the curve (AUC) values were reported. Multivariate logistic regression was conducted to identify independent predictors of in-hospital mortality. Results: Mortality occurred in 20.2 % of patients. All scoring systems significantly predicted mortality. AIMS65 had the highest sensitivity and lowest negative LR, while NEWS-2 showed the highest specificity and strongest positive LR. NEWS2-L offered minimal improvement over NEWS-2. In multivariate analysis, AIMS65 and NEWS-2 remained independent predictors; lactate alone did not. Conclusion: Among patients with upper gastrointestinal bleeding, AIMS65 and NEWS-2 were both useful for mortality prediction. The lactate-augmented NEWS2-L provided modest additional benefit