Browsing by Author "Gulalp, Betul"

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Comparison of Two Intraosseous Devices in Adult Patients in The Emergency Setting: A Pilot Study
(2016) Demir, Omer F.; Aydin, Kemal; Akay, Huriye; Erbil, Bulent; Karcioglu, Ozgur; Gulalp, Betul; https://orcid.org/0000-0002-2045-2771; 25075979; P-6931-2016
Objective To compare two intraosseous (IO) insertion devices in terms of safety and ease of use in patients who need urgent vascular access in the emergency setting following failed attempts for intravenous lines. Methods This prospective, randomized clinical study compared two different IO access devices in adults (>= 16 years of age or weighing > 40 kg) admitted to our emergency department with difficult peripheral venous access and in need of urgent intervention. The findings were compared in terms of the rates of successful insertion of spring-loaded impact-driven adult BIG and the battery-driven EZ-IO devices on the first attempt, difficulty of use, time taken to complete the insertion, and complication rates. Results A total of 52 patients were enrolled and randomized for the study. IO access was performed in 26 patients using the BIG device and in 26 patients using the EZ-IO device. The rates of successful insertion of BIG and EZ-IO devices on the first attempt were 92.3 and 84.6%, respectively (P=0.668). The time taken to complete the procedure was significantly greater in the EZ-IO group (5.2 +/- 2.2 s) compared with the BIG group (2.8 +/- 1.2 s) (P < 0.001). Difficulty of use was scored using the visual analogue scale, which yielded the mean visual analogue scale for EZ-IO and BIG (25.4 +/- 12.6 and 8.6 +/- 6.4 mm, respectively) (P < 0.001). No mechanical problems or technique-related complications were encountered in any of the groups. Conclusion Both EZ-IO and BIG are shown to be reliable and safe methods for insertion of intravascular access in emergency conditions.
Does measles immunization lead to immunization for COVID-19? Case series
(2021) Akkucuk, Mehmet Husamettin; Akalin, Nalan; Gulalp, Betul; https://orcid.org/0000-0003-4569-1143; https://orcid.org/0000-0002-2045-2771; AAJ-2828-2021; P-6931-2016
There are many studies on protective, preventive and treatment methods for about Covid-19 pandemic, which affects the whole world.The results of epidemiological studies also guide these researches. The studies of the scientists who are struggling with this pandemic worldwide reveal that the incidence of covid-19 is low in the child age group and the disease survived more mildly in childhood. There is an opinion about the reason why covid-19 disease is seen less frequently and milder in pediatric patients, that active immunization created with childhood vaccines. For this reason, we compared the Rubeola immunoglobulin levels formed aganist the measles vector, one of the childhood vaccines which has antigenic similarity with the SARS-CoV family, in patients diagnosed with covid-19 in our hospital and Rubeola immunoglobulin levels of screening performed in healthy individuals before pandemi. As a result , we found the measles IgG levels were statistically significantly higher in patients diagnosed with measles IgG covid-19 compared to the control group. According to this result, this significant increase in level after being infected with SARS-CoV2 in patients with measles immunization may have positive effects on the course of the disease. In addition. we saw that all our Covid-19 patients with high measles antibody recovered without serious mortality and morbidity , despite their age, gender and chronic diseases. Therefore , considering the completion process of vaccination studies, we think that measles vaccination can be applied to risky groups without contraindications to reduce the existing destructive effects of the disease.
Generalist versus Abdominal Subspecialist Radiologist Interpretations of Abdominopelvic Computed Tomography Performed on Patients with Abdominal Pain and its Impact on the Therapeutic Approach
(2020) Yesilagac, Hasan; Arer, Ilker Murat; Gulalp, Betul; Yabanoglu, Hakan; Karagun, Ozlem; Karadeli, Elif; 0000-0003-0681-8375; 0000-0002-2045-2771; 0000-0002-0352-8818; 0000-0002-1365-9256; 0000-0002-1161-3369; 32322789; U-4084-2017; P-6931-2016; AAK-5399-2021; AAJ-6068-2021; AAJ-7865-2021
Introduction: Abdominal pain is one of the most common patient complaints in the emergency department (ED) and abdominopelvic computed tomography (ACT) scan plays an important role in evaluation of these patients. Objective: The aim of this study was to determine the differences between interpretations by generalist radiologists and abdominal subspecialist radiologists regarding the abdominopelvic computed tomography (ACT) of patients who were admitted to the Emergency Department (ED) and to investigate its effect on the patients' therapeutic approach. Methods: The records of 16452 patients who were admitted to the emergency department with complaint of abdominal pain between January 2015 and April 2017 were reviewed, retrospectively. Out of these patients, 245 (1.5%) underwent ACT for differential diagnosis and among them, 137 (0.8%) patients had their ACT reports evaluated by generalist radiologists in 45 minutes and by abdominal subspecialist radiologist 8-12 hours later and were included in the study. Patients were divided into three groups according to the effect of ACT reports on the performed treatment. Group 1: no effect on planned treatment, group 2: minor effect on planned treatment, which did not result in a change in the treatment process and group 3: major effect on planned treatment approach, which resulted in a change in the treatment process. These changes included at least one of the two criteria: changing the indication of surgery from emergency surgery to elective surgery and/or discharge of the patient from the ED, when actually hospitalization was required. Results: Out of the 137 patients, 87 (63.5%) were male, 50 (36.5%) were female and the patients' mean age was 56 (27-93) years. There were 117 (85.4%) patients in group 1, 15 (10.9%) patients in group 2, and 5 (3.7%) patients in group 3. We determined minor inconsistency between the reports in group 2 and major inconsistency in group 3. Patients in group 3 suffered from delayed surgical intervention due to inconsistency of the CT reports resulting in prolonged hospital stay and increased morbidity. In 17 patients (four patients in Group 1 and 13 patients in Group 2) treatment plan was changed due to CT results; and while surgical treatment was planned for them prior to CT scan, they were discharged with medical treatment after that and overtreatment was prevented. Conclusion: Contribution of abdominal radiologists to evaluation of ACT images in the ED would reduce the inconsistency in ACT reports and prevent the patients from receiving insufficient treatment or overtreatment.
Investigation on Legal Problems Encountered by Emergency Medicine Physicians in Turkey
(2015) Kayipmaz, Afsin Emre; Kavalci, Cemil; Gulalp, Betul; Kocalar, Ummu Gulsum; Giray, Tufan Akin; Yesilagac, Hasan; Ozel, Betul Akbuga; Celikel, Elif; Karagun, Ozlem; 25992872
Background Medicine is a profession that carries certain risks. One risky area of practice is the emergency department. Emergency physicians diagnose and treat a high volume of patients, and are also responsible for preparing reports for forensic cases. In this study, we aim to investigate emergency physicians' legal-administrative problems and reveal their level of understanding on forensic cases. Methods An electronic questionnaire form was prepared after the approval of an ethical committee. This form was sent to the residents, specialists and academicians of emergency medicine by e-mail. The physicians were asked to fill out the form online. All the gathered data was analyzed. Descriptive statistics were presented as frequency percentages with mean and standard deviation. Chi-square tests were used to compare the groups. Correlation between number of complaint cases and age, sex, career, institution, and duration of service in emergency department were investigated. p<0.05 was considered statistically significant. Results 294 physicians participated in the questionnaire. According to the questionnaire, 170 of the physicians were reported to the patient communication units due to medical malpractice. Mean number of compliant reports was 3.20 +/- 3.5. 29 of the physicians received administrative penalties. 42 of the physicians were judged in the court for medical malpractice. 1 physician was fined 5000 Turkish Liras as a result of these judgments. Conclusion We found that the number of complaint reports is negatively correlated with duration of service in emergency medicine and age. There was a significant difference between number of complaint reports and career (p<0.05). The physicians' level of awareness on forensic cases was found to be insufficient. Lack of legislation knowledge may be an important cause of complaint reports concerning emergency physicians, who have a high load of patients. Thus, we think that increasing the frequency of post-graduate education sessions and periodical reviews might be beneficial.
Metoclopramide-induced acute dystonic reaction misinterpreted as conversion disorder and seizure
(2017) Ozel, Betul Akbuga; Aksel, Gokhan; Kilicli, Elif; Muratoglu, Murat; Kavalci, Cemil; Gulalp, Betul; Kayipmaz, Afsin Emre; 0000-0002-9586-7509; AAK-2079-2021; AAC-2597-2020
Metoclopramide, an antiemetic, is the most common cause of drug-induced dystonic reactions. 20-year-old female patient, complaining of involuntary bilateral upward medial deviation of the eyes, generalized muscle contractions and uncontrollable cry was brought into the emergency department(ED) by an ambulance. The diagnosis of the ambulance crew was conversion or seizure. The patient has all of dystonic reaction symptoms, including facial, neck, back, and extremity spasms, opisthotonus, oculogyric crisis, torticollis, trismus. The history revealed 40 mg of metoclopramide intake. Biperiden (5 mg) was infused in 100 ml saline. Symptoms were completely resolved. She was discharged from the ED. Drug-induced dystonic reactions can be confused with conversion, seizures, encephalitis, tetanus and hypocalcemic tetany. It is important for emergency physicians to know the drugs that may have dystonic reaction as potential side effects, recognize the clinical presentation of drug-induced dystonic reactions, and properly manage them in the ED.
What Can We Do to Improve Patient Satisfaction in the Emergency Department? A Prospective Study in a Turkish University Hospital
(2018) Karagun, Ozlem; Yesilagac, Hasan; Gulalp, Betul; Gokel, Yuksel; https://orcid.org/0000-0003-0681-8375; https://orcid.org/0000-0002-1365-9256; https://orcid.org/0000-0002-2045-2771; 31172104; U-4084-2017; AAJ-6068-2021; P-6931-2016
Introduction: In recent years, patients' satisfaction with emergency medical services provided to them has been one of the main criteria in the evaluation of the quality of these services. Objective: The goal of our study was to determine the factors that affect the satisfaction of patients admitted to the emergency department (ED) and to provide new regulations. Methods: This prospective and descriptive study included 341 patients who utilized the ED services of a university hospital between October 1, 2004, and June 30, 2005. The patients' demographic and visit characteristics, waiting times, and the total duration of stay in the ED were noted in the prepared questionnaire. In addition, all patients were asked to indicate their level of satisfaction with the care received in the ED based on a five-point Likert scale. The results were analyzed using ANOVA, chi-square, and logistic regression tests. Results: Of the 341 patients, 219 (64.2%) were satisfied with the care they had received in the ED. Factors such as doctor and nurse behavior, medical information, the frequency of doctors and nurses visits, the ease of access to personnel, the cleanliness of the ED, and the availability of technical equipment had a statistically significant effect on the overall satisfaction of the patients (p < 0.005). Conclusion: The quality of patient care provided and the features of the ED determine the patients' satisfaction with the ED services.