ABSTRACT
BACKGROUND: Emergency Medical Services (ES) are medical-surgical facilities where extremely ill patients, victims of accidents, intoxications and other urgent clinical situations should be rapidly and efficiently attended. However, a worldwide experience is that a large proportion of patients who require attention in an ES do not qualify as emergencies and they obstruct the possibilities of other patients that should be attended immediately. AIM: To evaluate the medical records in our ES and to assess whether patients understand what is a true emergency and which is the role of an ES. METHODS: Patients attended in the ES of Haydarpasa Military Teaching Hospital in 2001-2002 were classified according to their diagnosis. A random sample of patients and relatives were surveyed about why they required medical attention in the ES. RESULTS: 77,134 patients (39,327 female, 51%) were attended. The most common illness diagnosed was upper respiratory tract infection (18,423 patients, 23.9%). The true emergency condition rate in patients presenting to our ES was lower (44%) than the non-emergency condition rate. CONCLUSIONS: Improvements in public education are needed to solve this problem. Also, Primary Care facilities should be improved in order to reduce the demand for medical attention in ES by non-urgent patients.
Antecedentes: Los Servicios de Urgencia son unidades médico-quirúrgicas donde deberían atenderse rápida y eficientemente pacientes graves, víctimas de accidentes, intoxicaciones y otras situaciones clínicas urgentes. Sin embargo, es una experiencia mundial que una proporción importante de los consultantes en Servicios de Urgencia no califican como emergencias, pero dificultan las posibilidades de atención para otros pacientes que deberían ser atendidos de inmediato. Propósito: Evaluar las fichas clínicas en nuestro Servicio de Urgencia y averiguar si los pacientes comprenden cuál es una verdadera emergencia y cuál es la función de un Servicio de Urgencia. Métodos: Los pacientes atendidos en el Servicio de Urgencia del Hospital Clínico Militar Haydarpasa (Estambul, Turquía) en 2001-2002 fueron calificados retrospectivamente según sus diagnósticos. Una muestra al azar de pacientes y sus parientes acompañantes fueron encuestados sobre sus razones para solicitar atención en el Servicio de Urgencia. Resultados: Se atendieron 77.134 pacientes (39.327 del sexo femenino, 51%). El diagnóstico más frecuente correspondió a infección del tracto respiratorio (18.423 pacientes, 23,9%). La proporción de pacientes que calificaron como reales urgencias (44%) fue menor que los calificados como no-urgentes. Conclusiones: Para disminuir la demanda de atención en Servicios de Urgencia por pacientes no-urgentes se requiere mejorar la educación del público y aumentar la disponibilidad de policlínicas de atención primaria, ampliando su horario de atención.
Subject(s)
Humans , Male , Female , Child , Adult , Patient Acceptance of Health Care , Emergencies/epidemiology , Health Services Misuse/statistics & numerical data , Emergency Medical Services , Primary Health Care , Attitude to Health , Emergencies/psychology , Retrospective Studies , Hospitalization/statistics & numerical data , Triage/standardsABSTRACT
A single intra-muscular injection of 1.2 millions units of benzathine penicillin every 4 weeks is the most widely used method for the antibiotic prophylaxis of rheumatic fever. The aim of this study is to evaluate the effect of long-term benzathine penicillin on DNA in patients with rheumatic fever. Thirty children with confirmed rheumatic fever who were on the benzathine penicillin prophylaxis were enrolled in the study, and 30 similar normal children served as a control group. To detect any DNA damage, SCE analysis were performed in circulating lymphocytes of the subjects. A statistically significant increased frequency of SCE was observed in children on the benzathine penicillin prophylaxis (no = 30, mean SCEs/cell +/- SD 7.54 +/- 1.81) as compared to a control group (no = 30, mean SCEs/cell +/- SD 5.82 +/- 1.40). It has been suggested that the difference in the SCE frequencies was induced by the administration of the benzathine penicillin for a long time, and further investigations are needed to confirm this toxic effect.