Wos İndeksli Açık & Kapalı Erişimli Yayınlar
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Item Intrahospital critical patient transport from the emergency department(2020) Salt, Omer; Akpinar, Metin; Sayhan, Mustafa Burak; Ors, Fatma Betul; Durukan, Polat; Baykan, Necmi; Kavalci, Cemil; 32190144Introduction: Although intrahospital transportation of critical patients from the emergency department (ED) is inevitable, it could also result in life-threatening situations. These situations, referred to as unwanted or unexpected events, mainly happen during the transportation of patients for diagnostic imaging or invasive procedures and result in a wide spectrum from vital condition changes, mental condition changes to cardiopulmonary arrest and death. Emergency departments have a high risk of facing such situations because these units are the first admission door of critical patients. Material and methods: This cross-sectional study was conducted prospectively, after interviewing the doctors who work in the ED actively, and by filling out the forms which were already prepared by the participants. Statistical analysis was performed according to the data received, and results were compared to the literature. Results: Three hundred and forty-seven doctors from 52 hospitals were included in the study. 59.4% (n = 206) of them were working at EDs which had more than 500 patients admitted. 51.9% (n = 180) of doctors stated that they performed 10 or more critical patients' transport every day from their ED. 86.7% (n = 301) of the participants stated that usage of control checklists would decrease the rate of unwanted situations and stated that they wanted to use them. Conclusions: Intrahospital transportation of critical patients from the emergency room is a subject that should require attention by emergency room doctors, and using educated personnel, proper equipment, standardized protocols and control checklists will decrease the frequency of unwanted situations effectively.Item Why USB-endoscope laryngoscopy is as effective as video laryngoscopy(2020) Findik, Meliha; Kayipmaz, Afsin E.; Kavalci, Cemil; Sencelikel, Tugce; Muratoglu, Murat; Akcebe, Aysegul; Gungorer, Bulent; Kavalci, Gulsum; 0000-0002-9586-7509; 32593274; AAK-2079-2021Purpose: To compare the efficacy of a low-cost custom-made universal serial bus (USB) endoscope laryngoscope for intubation with a direct laryngoscope and a high-cost video laryngoscope in a mannequin study. Methods: We used one intubation simulator model (mannequin) in our study. A USB endoscope was mounted to the direct laryngoscope as a custom-made USB endoscope laryngoscope (USB-L). We used a video laryngoscope (Glidescope(R), Verathon, USA) and a direct laryngoscope (Macintosh) for comparison. Intubation time and the correct placement of the tube were measured. Intubations were performed by two operators and results were compared. Results: We found a statistically significant difference between the video and direct laryngoscope groups (p < 0.001), as well as between the USB-L and direct laryngoscope groups (p = 0.001) for Operator 1. For Operator 2, there was a statistically significant difference between the video laryngoscope group and the direct laryngoscope group (p = 0.022); however, we did not find a significant difference between the USB-L group and the direct laryngoscope group (p = 0.154). Furthermore, there were no significant differences between the USB-L and video laryngoscope groups for either operator (p=0.347 for Operator 1 and p>0.999 for Operator 2). Conclusion: Our study showed that USB endoscope laryngoscope provided similar intubation time to video laryngoscopy at a fraction of the cost; and both had superior times in comparison with direct laryngoscopy.Item The red cell distribution width to platelet ratio predicts 30-day mortality of acute pulmonary embolism patients(2019) Findik, Meliha; Kavalci, Cemil; Kayipmaz, Afsin Emre; Muratoglu, Murat; Kilicli, Elif; AAC-2597-2020Objective: To specify the clinical and sociodemographic characteristics, risk factors, factors affecting mortality including hematologic parameters, and red blood cell distribution width to platelet ratio (RPR) in patients with pulmonary thromboembolism, and to reduce the mortality. Methods: The archive records of patients diagnosed with pulmonary embolism were retrospectively examined. The histories, risk factors, physical examination findings, arterial blood gas analysis, X-rays, laboratory, and computed tomography reports of all cases were obtained via the hospital information system. Logistic regression analysis was performed to determine the independent variables affecting early mortality. Results: A total of 146 patients with a definitive diagnosis of pulmonary thromboembolism were included. Thirteen point seven percent (n=20) of the deceased patients died at early term. Ninety percent of patients with early mortality was 65 years or older. There were significantly differences in age, RPR, D-dimer, creatinine, lymphocyte, pH, and body temperature between patients with and without early mortality (P=0.017, P<0.001, P=0.019, P=0.025, P=0.042, P=0.013, P=0.017, respectively). Logistic regression analysis showed that RPR was a statistically significant and independent risk factors of mortality [P=0.026, OR: 0.254., 95% CI (0.326-5.056)]. In addition, there was a significant difference in pulmonary embolism severity index classification between patients with and without early mortality(P<0.034). Conclusions: RPR is an independent risk factor of mortality of pulmonary embolism patients and may help emergency physician to stratify mortality risks of pulmonary embolism patients.Item Compliance to guidelines in in-hospital cardiopulmonary resuscitation interventions: single-center experience(2019) Caliskan, Nail; Durukan, Polat; Baykan, Necmi; Kaymaz, Neslij Dogan; Elmali, Ferhan; Kavalci, CemilPurpose: The aim of this study was to investigate standard of knowledge about adult cardiopulmonary resuscitation according to current guidelines and affecting factors among clinicians working at the Hospital of Erciyes University, Medicine School. Materials and Methods: The study conducted on residences and subspecialty residences who accepted to participate and complete the survey. Overall 303 clinicians who accepted to participate and were accessible for completion of survey were recruited to the study. The survey included 2 sections. The first section included data regarding demographic characteristics and the second part included 20 multiple-choice items with one correct answer prepared based on 2010 American Heart Association Cardiopulmonary Resuscitation and Emergency Cardiovascular Care.. Results: Age, total duration of medical practice and residency positively affected standard of knowledge. Higher number of cardiopulmonary resuscitation performed within prior 6 months and defibrillation performance during cardiopulmonary resuscitation positively affected standard of knowledge. Post-graduate theoretical and practical training positively affect standard of knowledge. Conclusion: Cardiopulmonary resuscitation trainings aiming clinicians should be standardized and updated as well as education during employment should be scheduled to provide access to such programs.Item Neutrophil/lymphocyte ratio and Red blood cell distribution width are independent risk factors for 30-day mortality in Gastrointestinal system bleeding patients(2019) Altinbilek, Ertugrul; Ozturk, Derya; Kavalci, CemilBackground. In this study, we aimed to examine demographic and endoscopic features of patients with GI bleeding to determine the factors affecting 30-day mortality. Method. Patient's demographic features, laboratory outcomes, comorbidities, drug use, endoscopy outcomes, Glasgow-Blatchford scores, and mortality status were examined. The factors affecting 30-day mortality were investigated. Results. The mean age of the patients was 58.2 +/- 17.4 years, and 72.1% were male patients. 30-day mortality rate was found to be 14.4%. The mean age of patients who died was high (p<0.05). The incidence of mortality was high in the presence of comorbidity, malignancy, and cirrhosis (p<0.05). Systolic blood pressure was low in the patients who died (p<0.05). No significant correlation was found between mortality and gender, symptoms, predisposing factors, lesion type and Forrest score, diastolic blood pressure and heart rate (p>0.05). Urea, neutrophils, red blood cell distribution width / platelet ratio, neutrophil / lymphocyte ratio and RDW levels were high, and hemoglobin level was significantly low in patients with a mortal progression (p<0.05). No significant correlation was found between mortality, and platelet and lymphocyte levels (p>0.05). Glasgow-Blatchford score was significantly higher in patients who died (p<0.05). Conclusion. Many factors affect 30-day mortality in GI bleeding. It should be remembered that follow-up of patients with an advanced age who have comorbidity and impaired hemodynamics should be kept for long, and that these patients are at a high risk for mortality. According to our results, NLR and RDW are independent factors that determine the 30-day mortality in upper GI bleeding.Item Analysis of geriatric patients with minor spinal trauma admitted to the emergency department of a university hospital(2019) Giray, Tufan Akin; Kayipmaz, Afsin Emre; Sonmez, Erkin; Haberal, Kemal Murat; Yilmaz, Cem; Kavalci, Cemil; Oguzturk, HakanObjective: To retrospectively analyze patients aged 65 years and over, who were admitted to a level II trauma center in Turkey due to minor spinal trauma in a period of 4 years. Methods: The study included 64 patients aged 65 years and over, who were admitted to the Emergency Department of Baskent University Ankara Hospital between January 2011 and January 2015 and diagnosed with vertebral trauma. The information of the patients was obtained from the medical records. The clinical characteristics of patients including localizations and types of fracture, presence of additional system injuries and treatment options were investigated. Results: The most common cause was fall, accounting for 51 (79.7%), with 7 (10.9%) due to intra-vehicle traffic accident, and 6 (9.4%) due to out-of-vehicle pedestrian injury. The most common site of trauma was the lumbar region. Of the fractures, 46.9% (n=30) were in the lumbar region, 37.5% (n=24) in the thoracic region and 15.6% (n=10) were in the cervical vertebra region. Fourteen (21.9%) patients had an additional injury. Given the fracture types, 47 fractures (74.6%) were compression, 14 fractures (22.2%) were spinous process and 2 fractures (3.2%) were burst fractures. Twenty patients (31.2%) had multilevel vertebral fractures. Conclusions: The results of our study demonstrated the importance of vertebral fractures in the geriatric age group. In this age group, falls and motor vehicle accidents are the leading causes of vertebral traumas. Taking the necessary measures to prevent the risk factors which increase with aging is the most important step in preventing the mortality and morbidity that may occur as a result of vertebral fracture.Item Importance of Neutrophil Gelatinase-Associated Lipocalin in Differential Diagnosis of Acute and Chronic Renal Failure(2014) Ozkan, Seda; Durukan, Polat; Kavalci, Cemil; Duman, Ali; Sayhan, Mustafa Burak; Salt, Omer; Ipekci, Afsin; 24764742Background: Neutrophil Gelatinase-associated Lipocalin (NGAL) protein is easily detected in the blood and urine soon after acute renal injury NGAL gains features of an early, sensitive and noninvasive biomarker for acute renal injury Recent evidences suggest that its expression is also increased in CRF reflecting the severity of disease. Objectives: In the present study, we aimed to investigate whether blood NGAL level plays a role in the differential diagnosis of acute and chronic renal failure. Patients and Methods: This was a prospective case-control study. Fifty patients presented to emergency department with acute renal failure (ARF), 30 with chronic renal failure (CRF) and 20 healthy individuals as control group were included in this study Blood pH, HCO3(-), BUN, creatinine and potassium values were evaluated in all patients. Blood NGAL values were evaluated in all groups. BUN, serum creatinine and NGAL values were statistically compared between patients and controls. Results: Median NGAL levels in patients was 304.50 (29), and 60 (0) in control, which was statistically significant between the two groups (Z = -6.477, P < 0.001). The median NGAL values were 261.50 +/- 291 in ARF group and 428.50 +/- 294 in CRF group. There was a significant difference in NGAL level between ARF and CRF groups (Z = -2.52, P = 0.012). Median BUN values were 153.46 +/- 82.47 in ARE group and 169.40 +/- 93.94 in CRF group. There was no significant difference in BUN value between ARF and CRF groups (P > 0.05). Median creatinine values were 2.84 +/- 2.95 in ARF group and 4.78 +/- 4.32 in CRF group. In serum creatinine values, a significant difference was found between ARF and CRE groups (P <0.05). Conclusions: Serum NGAL levels of ARE and CRF patients were significantly higher than healthy individuals. In addition, NGAL values of patients with CRF were significantly higher than those of ARE. Serum NGAL values can be used to detect renal injury and differentiate ARE and CREItem Epidemiological and Cost Analysis of Self-Poisoning Cases in Ankara, Turkey(2014) Kavalci, Gulsum; Ethemoglu, Filiz Banu; Batuman, Asli; Kumral, Dilber; Emre, Cengizhan; Surgit, Meltem; Akdikan, Alev; Kavalci, Cemil; 25763203Background: Poisoning is a global public health problem. Self-poisoning has potentially serious consequences. Follow-up studies have found that 3-10% of self-harm patients eventually succeed. Objectives: This study was designed to investigate the epidemiological, clinical and economical aspects of deliberate self-poisoning patients admitted to Yenimahalle State Hospital Intensive Care Unit. Patients and Methods: The study was carried out retrospectively in Ankara Yenimahalle State Hospital. It included Seventy-one patients over 16 years of age who were admitted to the hospital due to poisoning during 2012. Exposed poisons were classified into one of three categories; pharmaceuticals, pesticides, and alcohols. Cost account was based on the medical invoices at patient discharge. Data were compared using Student's T test and chi-square test. A P value of less than 0.05 was considered significant. Results: The female/male ratio was 2.55. The mean age of the 71 poisoned patients was 28.92 +/- 11.51 years. Most of the poisoning agents were pharmaceuticals (68 cases). Among the pharmaceuticals, antidepressants were involved most often, followed by analgesics. There was no statistically significant difference between pharmaceutical agents in terms of hospital cost (P > 0.05). The mean length of hospital stay was 6.4 +/- 4.3 days. There was a statistically significant difference between the lengths of stay of patients in terms of hospital cost (P < 0.05). Conclusions: The patient cost increased as the length of stay increased due to the policy of bundle pricing.Item Analysis of the correlation between blood glucose level and prognosis in patients younger than 18 years of age who had head trauma(2015) Danisman, Bahadir; Yilmaz, Muhittin Serkan; Isik, Bahattin; Kavalci, Cemil; Yel, Cihat; Solakoglu, Alper Gorkem; Demirci, Burak; Inan, Selim; Karakilic, M.Eyvah; 25741378Objective: To analyze the correlation between early-term blood glucose level and prognosis in patients with isolated head trauma. Methods: This study included a total of 100 patients younger than 18 years of age who had isolated head trauma. The admission blood glucose levels of these patients were measured. Age at the time of the incident, sex, mode of occurrence of the trauma, computed tomography findings, and GCSs were recorded. Kruskall Wallis test was used compare of groups. A p value less than 0.05 was considered statistically significant. Results: The median age of the study population was 7 years and the median GCS was 11. There was a significant negative correlation between blood glucose level and GCS (p < 0.05). A significant correlation in the negative direction was observed between GCS and blood glucose level (r = -0.658, p < 0.05). Seventy-seven percent of the patients were admitted to hospital, while 6% died in ED. Conclusion: The results of the present study suggest that hyperglycemia at an early stage and a low GCS may be reliable predictors of the severity of head trauma and prognosis. A higher blood glucose level may be an ominous sign that predicts a poor prognosis and an increased risk of death.Item 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; 25992872Background 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.
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