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  • Küçük Resim
    Öğe
    Acil Serviste Kan Ürünü İstemlerinin Değerlendirilmesi: Prospektif Gözlemsel Bir Çalışma
    (2024) Özdamar, Yasemin; Demir, Mehmet Cihat; Ağaçkıran, İlter; Aksu, Nalan Metin
    Amaç: Acil servis kan ürünü istemleri artıyor, ancak aşırı olup olmadığı belirsizdir. Acil hekimleri tarafından yapılan kan ürünü istemlerini ve kullanım oranlarını inceleyerek kan ürünleri istemlerinin aşırı olup olmadığını tespit etmeyi amaçladık. Gereç ve Yöntem: Bu prospektif, gözlemsel ve tek merkezli çalışma, beş ay içinde üçüncü basamak bir yetişkin acil servisine başvuran 18 yaş ve üzeri hastaların demografik verilerini, kan transfüzyonu endikasyonlarını ve transfüzyon oranlarını incelemiştir. Bulgular: Bin dört yüz yetmiş beş kan ürünü istemi (hasta başına ortalama 6,92 ünite) incelendi. Bu istemlerin %63,1’i kullanılmadı. Transfüzyon oranları eritrosit süspansiyonu için %40,89, trombosit süspansiyonu için %25,61 ve taze donmuş plazma için %44,34 idi. Kan ürünleri istemenin ana endikasyonları gastrointestinal kanama ve anemiydi. Gastrointestinal kanaması olan hastalarda spesifik olarak eritrosit süspansiyonlarının %30,04’ü, trombosit süspansiyonlarının %31,9’u ve taze donmuş plazmaların %60,56’sı kullanıldı. Travma hastalarında istenen eritrosit süspansiyonlarının %12,75’i, trombosit süspansiyonlarının %0,083’ü ve taze donmuş plazmaların %13,89’u kullanıldı. Sonuç: Acil serviste kan ürünlerine yönelik aşırı istemler, kaynakların yanlış kullanılmasına neden olabilir. Transfüzyon komitesi, gereksiz istekleri azaltmak ve kaynak kullanımını optimize etmek için özel stratejiler geliştirmeli ve hekim farkındalığını arttırmalıdır.
  • Küçük Resim
    Öğe
    Examination of Emergency Ophthalmologic Consultations in Terms of Urgency, Ophthalmic Pathology, and the Weekend Effect
    (2021) Demir, Mehmet Cihat; Boğan, Mustafa; Akçam, Hanife Tuba; Sultanoğlu, Hasan; Özdamar, Yasemin; Ağaçkıran, İlter
    Objective: To evaluate the urgency of ophthalmologyconsultations in the emergency department (ED) and thepresence of ophthalmic pathology. This study also aimedto determine whether the weekend phenomenon affectedemergency ophthalmologic consultation requests.Materials and Methods: Ophthalmology consultationsrequested by the emergency physician for patients whovisited the ED of a tertiary care hospital in Turkey fromJanuary to December 2019 were retrospectively investigated. Consultation requests were grouped as possibleemergent, unlikely to be emergent, and undetermined.Results: A total of 256 eligible patients were included.The top three reasons for ophthalmologic consultationswere blunt trauma (29.7%), foreign body (24.2%), andconjunctivitis (13.3%). 70.3% of the consultations werecategorized as a possible emergent, 18.4% as unlikely tobe emergent, and 11.3% undetermined. Most of the possible emergent consultations had ophthalmic pathology(p=0.001).Conclusion: Traumatic injuries are the most commoncause of ophthalmology consultation in the ED. Approximately one-fifth of patients are unlikely to be emergent.Early ophthalmology evaluation is required in possibleemergent category patients. The weekend effect does notinfluence ophthalmology consultations. Establishing eyeemergency services or having an available ophthalmologist is crucial in the emergency diagnosis and treatment ofpatients who require special practice skills.
  • Küçük Resim Yok
    Öğe
    The pandemic’s effect on discharge against medical advice from the emergency department
    (Selçuk BAŞAK, 2021) Demir, Mehmet Cihat; Ağaçkıran, İlter; Özdamar, Yasemin; Boğan, Mustafa
    Background/Aim: Reasons for discharge against medical advice (DAMA) may vary according to countries' conditions and environmental or individual factors. Patients who choose to leave the hospital against the doctors’ recommendations are at risk of inadequate treatment and increased rehospitalization risk. The COVID-19 disease has come to the fore with a pandemic and the atmosphere of fear and panic it creates. We aimed to investigate the effect of fear of the pandemic on DAMA. Methods: This study was conducted in the emergency department (ED) of a tertiary hospital in Turkey. The characteristics of all patients who were discharged against medical advice and their reasons over six months at the beginning of the pandemic were examined prospectively. Results: A total of 263 patients left the ED on various excuses against medical advice between February 6-August 31, 2020 (DAMA rate: 2.4‰). The most common complaint of patients discharged against medical advice was abdominal pain (27%). The top 3 most common causes of DAMA were the fear of being infected by COVID-19 (36.5%), the thought of being neglected (12.2%), and the month of Ramadan (11.4%). Conclusion: The pandemic is an important reason for DAMA. Patients leave the hospital against medical advice with an avoidance-avoidance conflict during the COVID-19 pandemic. Defining dirty and clean areas within the emergency services with sharp boundaries and informing patients may prevent DAMA due to the fear of being infected with COVID-19. Physicians do not ignore the risk of progression to worse clinical outcomes in patients who discontinue treatment due to the pandemic.