What Can We Do to Improve Patient Satisfaction in the Emergency Department? A Prospective Study in a Turkish University Hospital.

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 < 0.05). CONCLUSION: The quality of patient care provided and the features of the ED determine the patients' satisfaction with the ED services.

Prognostic Factors Determining Morbidity and Mortality in Organophosphate Poisoning.

OBJECTIVE: Our aim in this retrospective study was to determine the factors affecting poor prognosis and mortality of organophosphate (OP) poisoning by reviewing patient data. We also reviewed present knowledge to make conclusions on certain longstanding debates in light of the literature. METHODS: In this retrospective descriptive study, patients who were admitted to and hospitalized in the emergency department (ED) or intensive care unit (ICU) of a university hospital with the diagnosis of OP poisoning between December 2010 and December 2015 were evaluated. All the data were obtained from electronic and manual patient files. A total of 80 patients were included in the study. RESULTS: The mean age of the study patients was 32.4±15.0 (13-94). Forty-nine (61.2%) patients were female. Twenty-two (27.5%) patients were seriously poisoned and needed mechanical ventilation (MV) support. Low pseudocholinesterase (PChE), high creatinine (Cr), low Glasgow Coma Scale (GCS) scores and long hospitalization durations were all found to be poor prognostics in MV patients. Low PChE and high Cr levels were found to be independent predictors of the hospitalization duration and high Cr was found to be an independent predictor of the intubation duration of MV patients in regression analyses. Ten (45.5%) of the MV patients were unresponsive to medical treatment and Therapeutic plasma exchange (TPE) was performed. Seven patients were discharged healthy. Three patients with low PChE levels and comorbidities died. CONCLUSIONS: Prolongation of respiratory depression necessitating MV support, comorbidities, long hospital stay, elevated creatinine, low GCS scores and low PcHE levels without regeneration in the first 48 hours of admission are all found to be poor prognostic factors for organophosphate (OP) poisoning.

Utilization of plasmapheresis in the management of bismuth intoxication with acute renal failure.

A 34-year-old female patient who ingested 2400 mg bismuth subcitrate in a suicide attempt was brought to the emergency department. She had mild encephalopathy and acute renal failure on admission. One session of plasmapheresis was performed to remove bismuth, and needed three sessions of hemodialysis and was discharged on the 24th day of hospitalization with the recovery of the renal function.

Serum IL-6, TNFα levels in snakebite cases occurring in Southern Turkey.

OBJECTIVE: The snake species Vipera ammodytes meridionalis and Vipera lebetina obtuse are often seen in Southern Turkey and have venom that causes serious systemic and tissue damage. The aim of our study is to assess the relationship between tumour necrosis factor α (TNFα) and interleukin 6 (IL-6) serum levels, and clinical and laboratory findings in the snakebite patients. METHODS: 26 patients who had received snakebites were included in a prospective study. Patients were grouped according to their clinical presentations in order to plan treatment. RESULTS: TNFα serum levels of most patients who went to the emergency room to receive treatment for snakebite were high. This increase was most likely to be related to the clinical severity of the snakebite and the length of time between the snakebite and their arrival at the hospital. In contrast to TNFα, there was no relationship between serum IL-6 levels and clinical and laboratory parameters. CONCLUSIONS: Snakebites from Vipera ammodytes meridionalis and Vipera lebetina obtuse lead to increased levels of serum TNFα. However, serum TNFα and IL-6 levels depend on various factors such as the kind of snake, the area the venom was injected into, the amount of venom and the body size of the patients.

Treatment of acute carbon-monoxide poisoning with therapeutic erythrocytapheresis: clinical effects and results in 17 victims.

Seventeen cases of acute carbon-monoxide poisoning were treated with therapeutic red cell-exchange. Glasgow Coma Scale score was used to evaluate the level of consciousness. The mean carboxyhemoglobin level decreased from 0.286 ± 0.1805 (28.6 ± 18.05%) to 0.0613 ± 0.0418 (6.13 ± 4.18%) and Glasgow Coma Scale score increased from 10 ± 3 to 13.76 ± 1.89. While 11 patients scored 15 at the end of the treatment, four scored 15 in an hour after the treatment. None of the patients died. Two victims (11.7%) experienced ischemic encephalopathy. Therapeutic red cell-exchange therapy can be an effective treatment in reducing mortality and morbidity in carbon-monoxide poisoning.

Trends in acute adult poisoning in a ten-year period in Turkey: factors affecting the hazardous outcome.

AIM: The aim of this study was to evaluate the trends in acute adult poisoning data during ten years in university emergency department and determine the factors of hazardous outcome such as severe clinical status, prolonged hospital stay and mortality. MATERIAL AND METHODS: Medical records of 4569 poisoned patients admitted to Emergency Department (ED) of Qukurova University, School of Medicine in Adana. RESULTS: The mean age of 2988 females (65.4% of the patients) was 24.5+/-10.1 years, whilst the mean age of 1581 male patients (34.6%) was 29.5+/-13.2 years (p=0.001). Of the poisonings 80.0% were suicidal; 69.4% of the women and 30.6% of the men committed suicide. The most common types of poisonings were ingestion of drugs (58.4%), organophosphates (23.9%) corrosives (3.4%), mushrooms (1.7%), methanol (2.4%), carbon monoxide (2.1%) and unknown (8.1%). Of the total 96.0% were discharged from emergency department, 1.4% transferred to IC and 2.6% died. CONCLUSIONS: Young people and women are high-risk groups for acute poisoning and drug poisoning was found to be the most common type of poisoning. The poisoning by psychoactive drugs is increasinging in the recent years and organophosphates poisoning seems to be still a serious problem in such an agricultural area. However, while the ratios of prolonged hospitalization and mortality are decreasing, suicidal poisoning is seriously increasing (Tab. 4, Fig. 2, Ref. 34). Full Text (Free, PDF) www.bmj.sk.

[Evaluation of the process and effectiveness of consultation system in the Department of Emergency Medicine]. / Acil Tip Anabilim Dali'nda konsültasyon sisteminin isleyisi ve etkinliginin degerlendirilmesi.

BACKGROUND: Triage, consultations, and radiological and laboratory test processes have different effects on the total waiting time in the emergency department (ED). Under these circumstances, the importance of the consultation system process and effectiveness of consultation becomes very clear. Our aim in this study was to verify the process of the consultation system. METHODS: This prospective and defining study was performed with 276 patients admitted to the ED. A total of 342 consultations were requested. These patients were classified as very urgent, urgent and non-urgent according to their problems, and a survey form was completed by the ED resident. RESULTS: The most frequently requested consultation was to the Department of Internal Medicine (72%). Mean time for reply to the consultation was 29+/-43 minutes. The earliest reply to the consultation was from Cardiology while the latest responders were the general surgeons. Timeline for replying to the consultation was shorter depending on the urgency of the case. CONCLUSION: In our study, we determined that the most important factor for the effectiveness of consultation was the definition of the urgency of the patients by the residents in the ED. Since the number of patients admitting to the ED will continue to increase in the future, more detailed prospective studies are needed about the efficiency of consultation in the ED.

The efficacy of low-dose antivenom therapy on morbidity and mortality in snakebite cases.

UNLABELLED: Similar to the cases seen around the world, snakebite causes mortality and morbidity in Turkey. The venom of different types of snake in the region of Cukurova causes serious systemic and local tissue damage. METHODS: We performed this prospective study on 45 patients who complained of snakebite. We grouped the patients according to their clinical presentations to facilitate treatment and follow-up period procedures. RESULTS: Whereas the patients with grade 1 envenomation did not receive any antivenom, grades 2 and 3 patients received 2.70 +/- 0.77 and 4.88 +/- 1.65 vials of antivenom, respectively. One of our patients had to undergo finger amputation but there were no deaths. Allergic reactions developed after antivenom therapy in 8 patients (17.8%). CONCLUSIONS: When we considered the cost and complications of the antivenom treatment, it was seen that low-dose antivenom treatment effectively treated the patients with venomous snakebite injuries in our region.

The effect of parathion-methyl and antidotes on parotid and pancreatic glands: a pilot experimental study.

The objective of this study is to investigate the functions of parotid and pancreatic glands in response to intoxication with parathion-methyl (PM) and the effects of treatment in rats. Seventy-five male Wistar rats were divided equally into five groups: Group I, control; group II, received atropine and pralidoxime (2-PAM) for 24 h, but no PM; group III, oral PM but no atropine and 2-PAM; group IV, PM and atropine for 24 h and 2-PAM; group V, PM and atropine for 96 h and 2-PAM. After the administration of the chemicals, blood samples were drawn to test for amylase, lipase, acetylcholinesterase (AChE), and butyrylcholinesterase (BChE), while pancreatic and parotid glands of each rat were removed for light microscopic examination. Amylase levels were found significantly elevated in groups II, III, IV, and V, whereas lipase levels were supranormal in groups III, IV, and V. The blood levels of AChE were decreased in groups III and IV and BChE were decreased in II, III, IV, and V. No evidence of pancreatitis and parotitis was identified in the histopathologic evaluation in any group in 96 h; however, hyperchromasia, irregularity in nuclei, and binuclear cells were observed in all parotid glands in group V. Parotitis and pancreatitis were not evident; however, hyperamylasemia and hyperlipasemia were found, whereas various histologic changes in parotid glands were documented in the groups that were administered organophosphate and treatment.

Clinical presentation and laboratory findings of organic phosphorus poisoning.

This study was conducted to evaluate the demographic, causative, and biologic characteristics of patients with organophosphate (OP) poisoning who were admitted to tertiary teaching and research hospitals at 2 different universities. All patients admitted to the emergency departments of Cukurova University Hospital in Adana, Turkey, between 2001 and 2003 and the Hospital of Mustafa Kemal University in Hatay, Turkey, between 2004 and 2006 were included. The study group consisted of subjects with a mean age of 28.5+/-14.1 y (range, 14-80 y), and the maximum number of cases in the second decade of life; the female-to-male ratio was 2.2:1. In all, 27 of 43 females and 16 of 20 males were married. Most subjects (n=55) had graduated from primary school; 3 were illiterate and 5 were highly educated. A total of 36 (57.1%) subjects belonged to lower socioeconomic groups. Fifty-three patients intended to commit suicide, and 10 cases were accidental. Mean arrival time of subjects to the hospital after poisoning was 9.9+/-16.1 h (range, 1-96 h); mean Glasgow Coma Scale score was 10.2+/-2.9 (range, 3-15). A total of 19 subjects were intubated, and 4 died. A total of 59 patients recovered completely. The mortality rate (6.3%) depended on various factors such as OP compound consumed, amount ingested, time interval before hospitalization, and patients' general health. Chances for recovery were greater when the patient was hospitalized at the earliest indication. In conclusion, OPs especially affected young single females, and most cases were due to attempted suicide. Because OP poisoning is an important cause of morbidity and mortality, therapy should be started immediately to avoid undesirable consequences.

Emergency hemodialysis in the management of intoxication.

Management of intoxicated patients has many aspects in a wide spectrum, beginning with decontamination processes and basic supportive care. The most logical therapeutic approach is probably the specific antidotes, when available and/or applicable. On the other hand, many chemicals and drugs, can be removed from the body by means of hemodialysis or hemoperfusion while treating vital sign abnormalities and electrolyte and acid-base disturbances of the patient. In this paper, we describe 11 cases of intoxication, 6 with methyl alcohol, 3 with lithium, and 2 with salicylate, admitted to emergency department and treated with hemodialysis between January 1, 2002 and December 31, 2004. We review their medical charts and detailed demographic data, medical history, type of exposure, clinical and laboratory presentations, duration of hemodialysis performed, and the outcome.

The sister-chromatid exchange and acetylcholine esterase enzyme levels among patients with insecticide intoxication in the Cukurova region, Turkey.

This study included 45 patients with intentional insecticide intoxication and 21 with accidental intoxication who were treated at the First-Aid and Emergency Department of Balcali Hospital at the Faculty of Medicine in the Cukurova University, Adana, Turkey, while the control group consisted of 25 people selected from university personnel known to be healthy. Patients with a history of X-ray exposure in the last 6 months or of any virus disease as well as continuous drug users and smokers were excluded, leaving a total of 49 patients. Acetylcholine esterase (Pseudocholinesterase) enzyme (AchE), sister-chromatid exchanges (SCE), the mitotic index (MI), and the replication index (RI) were evaluated. Blood samples were cultured for SCE evaluation and sera separated for AchE levels. Insecticide exposure was generally intentional for suicide in adolescents and at older ages, but accidental for children. AchE levels were found to be significantly lower in organophosphorus (OP) and carbamated (CB) insecticide poisoning groups in comparison with the control group (p<0.001), while the pyrethroid (PY) group was not statistically different for the AchE effect (p>0.05). SCE was found to be significantly higher in OP and CB groups (p<0.001), while the PY and control groups were statistically similar for SCE levels (p>0.05). This study showed an increase in SCE in response to orally ingested insecticides. These findings indicate that insecticide exposure results in cell abnormalities, with resulting impediments to the division and replication of cells, as suggested by MI decreases and RI increases, while the speed of the division cycles of stimulated cells increases.

Acute intoxication with doxazosin.

Experience with overdosage and toxicity with the alpha-adrenoreceptor antagonists remains very limited in the literature. In this paper, the second case in the literature with doxazosin overdosage is reported. Supportive treatment was given to the patient and the patient was discharged 48 hours after admission to the emergency department.

Subarachnoid hemorrhage and rhabdomyolysis induced acute renal failure complicating organophosphate intoxication.

Organophosphate is extremely uncommon cause of rhabdomyolysis. This article describe two cases with rhabdomyolysis induced acute renal failure complicating by monocrotophos, an organophosphate compound. First patient had rhabdomyolysis induced acute renal failure and subarachnoid hemorrhage. This is the first reported case of subarachnoid hemorrhage, which may be related with organophosphate intoxication in literature. Second patient described here had rhabdomyolysis induced acute renal failure after organophosphate overdose.

Parotitis due to organophosphate intoxication.

Acute pancreatitis due to pancreatic exocrine over-secretion induced by organophosphate poisoning has been previously reported but parotid gland involvement has not. This paper describes a case of acute organophosphate-induced parotitis in a patient with pre-existing sialolithiasis. The patient developed bilateral facial swelling in the pre-auricular area extending to the angle of the jaw and also developed elevated serum amylase on the second day of the poisoning. Serum lipase remained normal. Autopsy confirmed parotid gland inflammation and pre-existing ductal lithiasis. This case illustrates that organophosphate-induced parotitis can occur and should be considered in patients with organophosphate poisoning who have hyperamylasemia without elevation in serum lipase.

High-dose verapamil + trandolapril-induced thrombotic microangiopathy.

Thrombotic microangiopathy (TMA) is a syndrome characterized by microangiopathic haemolytic anaemia, thrombocytopenia, and several variable signs of organ damage due to the platelet thrombi in the microcirculation. This article reports a case with TMA which developed after ingestion of a high-dose combination of verapamil and trandolapril. To the authors' knowledge, no prior cases of TMA induced by trandolapril (an angiotensin-converting enzyme inhibitor) and verapamil (a calcium channel blocker) have been reported in the literature.

Chronic myeloid leukemia in a patient with colon adenocarcinoma.

A 62-year-old male patient who developed Philadelphia chromosome-positive chronic myeloid leukemia (CML) after cisplatin and 5-fluorouracil treatment for colon adenocarcinoma is reported. CML has been described after therapy for other malignancies, but no case of CML has been reported following treatment for colon carcinoma. It is not clear whether the development of CML after colon adenocarcinoma represents a therapy-related secondary malignancy, a coincidence, or an increased susceptibility to secondary malignancies due to the malignant process itself. Here we reported a case with colon adenocarcinoma and later developing CML which is not reported so far in according to our knowledge.