An Analysis of Referrals Done by Primary Care Centers to Tertiary Care Institutions.

Background and aim Primary care is an important element for every healthcare system around the world. Providing and optimizing the connection between the primary care centers and advanced clinical centers is a key concept for a well-functioning healthcare system. Our aim in this study was to analyze and review the referral data of primary care centers located in Ankara, Türkiye. Materials and methods We collected the entire referral data from the primary care centers, totaling 8,746 patients between January 1, 2019 and December 31, 2023 by using emergency medical services (EMS) transfer in Ankara. Demographic data, call reasons, transfer centers and transfer-related characteristics of the patients were recorded retrospectively, grouped by year, using EMS data. Results Our findings have shown that most of the referrals were made for Turkish citizens with 8,360 (95.6%) (p<0.001). Healthcare centers located in inner city had the most referrals made with 7,087 (81.0%) (p<0.001). Majority of the referrals were made by physicians in family healthcare centers with 6,583 (75.3%) (p<0.001) with chest pain being the most common diagnosis for referral initiation with 1,429 (16.3%) (p<0.001). This was followed by trauma, with 1,172 (13.4%) (p<0.001). Most common cause for trauma was falls with 613 (52.3%) (p<0.001). Conclusion Our data revealed important elements of local referral patterns. According to our data, majority of the referrals were made by inner city healthcare facilities. Family healthcare centers formed most of the referral requests. For this reason, strengthening these centers is important to prevent unnecessary resource use and delays.

The dome procedure: a new technique for the reconstruction of the umbilicus.

PURPOSE: The absence of the umbilicus is, in essence, an aesthetic deformity of the abdominal wall. The goal of reconstructing the umbilicus is to obtain a natural, three-dimensional appearance. In this study, we present a new technique called the "dome procedure" for the reconstruction of the umbilicus. METHODS: This procedure can be applied under local anaesthesia on an outpatient basis and the drawing of the design is simple. The technique was applied to six patients who presented with an absence of the umbilicus following repair of a large incisional and umbilical hernia. RESULTS: No major or minor complications were encountered. Patient satisfaction was high after surgical intervention. CONCLUSIONS: The dome procedure, which enables the umbilicus to have a natural appearance with sufficient depression and normal-appearing wrinkles, is simple, easy to perform, and safe.

Effectiveness of pericervical tourniquet by Foley catheter reducing blood loss at abdominal myomectomy.

OBJECTIVE: To evaluate effectivenes of pericervical tourniquet by Foley catheter reducing blood loss at abdominal myomectomy. MATERIALS AND METHODS: Retrospective chart review of 67 cases, with symptomatic myoma uteri and undertaken abdominal myomectomy, was performed. Myomectomy was performed in Group 1 (n = 34) by Foley catheter tourniquet around both uterin vessels and in Group 2 (n = 33) the tourniquet was not performed. RESULTS: The average blood loss during myomectomy was 286.4 +/- 137.5 ml for the tourniquet group and 673.8 +/- 172.3 ml for the control group. Postoperative blood transfusion was necessary in two patients from the control group. Technique significantly reduced the intraoperative blood loss and postoperative hemoglobin fall in patients. No serious complications occured on account of the tourniquet technique. CONCLUSIONS: The pericervical tourniquet by Foley catheter is a safe and effective method for reducing blood loss during abdominal myomectomy, although it should be evaluated in a randomized controlled trial.