16 research outputs found
Influences of “do-not-resuscitate order” prohibition on CPR outcomes
No full textAbstractObjectivesThe aim of the study is to determine factors affecting the return of spontaneous circulation (ROSC) ratios, neurological outcomes at discharge, the ratio of living patients discharged from the hospital and due to Do not attempt resuscitation (DNAR) prohibition.Material and methodsThis is a retrospective observational study conducted on patients of cardiopulmonary resuscitation (CPR) performed in emergency department (ED) and intensive care units between February 2010 and February 2012.ResultsA total of 469 patients were evaluated, and 266 eligible patients who did not have DNAR orders were included in the study. Overall, 45.1% of the adult in-hospital cardiac arrest victims returned to spontaneous circulation, and 5.3% survived to hospital discharge. Of the patients who were discharged alive from the hospital, 33.3% were discharged in poor neurologic conditions of Cerebral Performance Category (CPC) score 3 or 4. The ROSC ratio was reduced for the patients with malignancies compared to the patients with other preexisting conditions (OR: 12.783; 95% CI 2.967–55.072; p = 0.000). None of the patients with malignancies were discharged alive from the hospital. Only one patient with end-stage disease was discharged alive from hospital, and this patient's CPC score was 4.Discussion and conclusionCPR has not increased the ROSC and alive discharge rates in patients with malignancy and end-state disease. DNAR order prohibition have been increased the futile CPR attempts. DNAR should be accepted as a human right that represents an honorable death option and whether a DNAR is order demanded should be specifically discussed with patients with malignancies and end-stage disease presenting to ED
Comparison of secure messaging application (WhatsApp) and standard telephone usage for consultations on Length of Stay in the ED
No full textSummary
Objective: Consultation, the process of an Emergency Physician seeking an opinion from other specialties, occurs frequently in the Emergency Department (ED). The aim of this study was to determine the effect of secure messaging application (WhatsApp) usage for medical consultations on Emergency Department Length of Stay (ED LOS) and consult time. Methods: We conducted a prospective, randomized controlled trial in the ED using allocation concealment over three months. Consultations requested in the ED were allocated into two groups: consultations requested via the secure messaging application and consultations requested by telephone as verbal. Results: A total of 439 consultations requested in the ED were assessed for eligibility and 345 were included in the final analysis: 173 consultations were conducted using secure messaging application and 172 consultations were conducted using standard telephone communications. The median ED LOS was 240 minutes (IQR:230-270, 95% CI:240 to 255.2) for patients in the secure messaging application group and 277 minutes (IQR:270-287.8, 95% CI:277 to 279) for patients in the telephone group. The median total ED LOS was significantly lower among consults conducted using Secure messaging application relative to consults conducted by telephone (median dif: -30, 95%CI:–37to-25, p<0.0001). The median consult time was 158 minutes (IQR:133 to 177.25, 95% CI:150 to 169) for patients in the Secure messaging application group and 170 minutes (IQR:165 to 188.5, 95% CI:170-171) for patients in the Telephone group (median dif: –12, 95%CI:-19 to-7,p<0.0001). Consultations completed without ED arrival was 61.8% in the secure messaging group and 33.1% in the Telephone group (dif: 28.7, 95% CI:48.3 to 66, p<0.001). Conclusions: Use of secure messaging application for consultations in the ED reduces the total ED LOS and consultation time. Consultation with secure messaging application eliminated more than half of in-person ED consultation visits.Gulacti U, Lok U. Comparison of secure messaging application (WhatsApp) and standard telephone usage for consultations on Length of Stay in the ED. Appl Clin Inform 2017; 8: 742–753 https://doi.org/10.4338/ACI-2017-04-RA-0064
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The Predictive Effect of the Neutrophil-to-Lymphocyte Ratio (NLR) on the Mortality of Acute Ischemic Stroke and its Subtypes: a Retrospective Cross-Sectional Study
No full textThe Damage of Penile Doppler Ultrasonoghraphy in Diagnosis of Penile Mondor's Disease: A Report of Two Cases
No full textAbstractPenile Mondor's disease is a thrombophlebitis of the superficial dorsal vein of the penis. It is a rare clinical diagnosis and generally resolves spontaneously. A simple physical examination is sufficient for diagnosis but color Doppler ultrasonography is often carried out as a further investigation. We describe two patients who developed priapism due to penile Doppler ultrasonography which was used for diagnosis of these patients. Now, in our opinion this examination was unnecessary
The ED use and non-urgent visits of elderly patients
No full textAbstractObjectiveTo evaluate the use of the emergency department (ED) by elderly patients, their non-urgent visits and the prevalence of main disease for ED visits.MethodsThis cross-sectional study was conducted on patients aged 65 years and over who visited the ED of a tertiary care university hospital in Turkey between January 2015 and January 2016 retrospectively.ResultsA total of 36,369 elderly patients who visited the ED were included in the study. The rate of ED visits by elderly patients was higher than their representation within the general population (p < 0.001). While the rate of elderly patients visiting polyclinics was 15.8%, the rate of elderly patients visiting the ED was 24.3% (p < 0.001). For both genders, the rates of ED visits for patients between 65 and 74 years old was higher than for other elderly age groups (p < 0.001). The prevalence of upper respiratory tract infection (URTI) was the highest within the elderly population (17.5%, CI: 17.1–17.9). The proportion of ED visits for non-urgent conditions was 23.4%. Most of the ED visits were during the non-business hours (51.1%), and they were highest in the winter season (25.9%) and in January (10.2%). The hospitalization rate was 9.4%, and 37.9% of hospitalized patients were admitted to intensive care units.ConclusionThe proportion of ED visits by elderly patients was higher than their representation within the general population. Elderly patients often visited the ED instead of a polyclinic. The rate of inappropriate ED use by elderly patients in this hospital was higher than in other countries
Predictive and prognostic role of mean platelet volume in patients with first-ever acute ischemic stroke
No full textEpidemiology of Cases with Rabies-Suspected Animal Contact and the Evaluation of Post Exposure Prophylaxis
No full textObjective: This study aims to evaluate the epidemiology of cases with rabies-suspected animal contact (RSAC) and the appropriateness of rabies post-exposure prophylaxis (RPEP). Material and Methods: This retrospective study was carried out at the emergency departments of two general hospitals between January 2010 and August 2011. The management charts of cases with RSAC who were admitted to the emergency room were reviewed. Statistical analysis of data was done using SPSS for Windows (version 16.0). Results: Of 616 study cases, 464 (75.3%) were male and 152 (24.7%) were female. Cases in the subgroup aged 6-15 years had the highest risk for RSAC. Four hundred and thirty one (70%) cases lived in an urban area, and most cases had presented in the spring (36.9%) and summer (31.3%). Dogs were the most common animal (66.9%) causing RSAC with statistical significance (p=0.001). Bite was the most common way of contact with 454(73.7%) cases reaching statistical significance (p=0.001). Of 616 animals responsible for RSAC, 336 (54.6%) had no owner, while the others (280, 45.4%) had owners. RPEP was considered inappropriate in 529 (85.9%) cases according to the Rabies Prevention and Control Guidelines of the Ministry of Health, with statistical significance (p=0.001). The most frequent inappropriate procedure was the lack of rabies immunoglobulin administration in 303 (57.3%) cases. Conclusion: RSAC is an important public health problem in our region. There are some problems in the application of Rabies Prevention and Control Guidelines of the Ministry of Health and this guideline should be updated. Routine training of healthcare workers may be an effective solution against rabies
