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Öğe Association between peripheral perfusion index and five vital signs in patients admitted to the emergency department Association between perfusion index and vital signs(Bayrakol Medical Publisher, 2021) Arslan, Banu; Saracoglu, Gulcim; Topaçoğlu, HakanAim: Mental status, skin temperature and color, urine output, mean arterial pressure, lactate levels, and capillary refill time are widely used in the evaluation of peripheral perfusion. However, reliable, simple, and objective tests are needed. The peripheral perfusion index (Pt), derived from the pulse oximeter signal, has been lately suggested for providing fast, continuous, bedside, and affordable clinical data. This study aimed to investigate the association between the perfusion index and five vital parameters in a large emergency medicine patient population. Material and Methods: A single-center, prospective, cross-sectional study was carried out on 2330 adult patients who were admitted to the emergency department during five consecutive days. Patients who required emergency operation and cardiopulmonary resuscitation, and were unable to communicate with were excluded from the study. PI was measured at the 4th finger of the non-dominant hand by using Masimo RDS-7 puke oximeter. Simultaneously, vital signs were taken. Results: The mean PI, independent of diagnosis and the severity of a disease, was calculated as 3.71 +/- 2,83. The mean PI was found to be significantly higher in males than females, respectively 4,03 +/- 3,04 and 3,36 +/- 2,56 (p<0.001). A significant difference in the mean PI levels was detected across four age groups. PI was positively correlated with SBP, DBP, and MAR Moreover, it correlated negatively with heart rate and body temperature (p<0,001). The correlation between the PI and respiratory rate and oxygen saturation was not statistically significant. Discussion: Even though PI cannot replace clinical assessment in assessing peripheral perfusion, it has great potential to be a useful toot in recognizing poor peripheral perfusion at the triage level and lead to improved outcomes of emergency department patients.Öğe Cancer, platelet distribution width, and total protein levels as predictors of rebleeding in upper gastrointestinal bleeding(Peerj Inc, 2022) Tatliparmak, Ali Cankut; Dikme, Ozlem; Dikme, Özgür; Topaçoğlu, HakanBackground: Rebleeding is associated with poor outcomes in upper gastrointestinal bleeding (UGIB). Identifying predictors of rebleeding can assist in risk assessment. The aim of the study is to investigate the factors affecting rebleeding in patients with UGIB admitted to the emergency department.Methods: This retrospective, observational, cross-sectional study was conducted on patients with UGIB presented to the emergency department. Patients who did not arrest in the first 24 h, who were not diagnosed with GI malignancy, and who were clinically diagnosed with UGIB were included in the study. Patient demographic characteristics, hemodynamic parameters, patient parameters, and bleeding that may affect rebleeding were evaluated. The primary endpoint was rebleeding within 7 days.Results: The study included 371 patients. A total of 55 patients (14.8%) had rebleeding within 7 days, and 62 patients (16.7%) presented without bleeding manifestations. Rebleeding rates were higher in those who presented with bloody or coffee-ground vomitus, had a diagnosis of cancer, had blood in their nasogastric tube, and had peptic ulcers due to endoscopy. Mean cell hemoglobin concentration, lymphocyte, albumin, and total protein values of patients with rebleeding were low; red blood cell distribution width, neutrophil count, platelet distribution width (PDW), and neutrophil lymphocyte ratio were high. In-hospital mortality and 30-day mortality values of patients with rebleeding were significantly increased. In the multivariate analysis, cancer, PDW, and total protein levels were statistically significant.Conclusion: The presence of cancer, low total protein level, and high PDW are effective parameters in predicting 7-day rebleeding in patients with UGIB admitted to the emergency department.Öğe İstanbuldaki Eğitim ve Araştırma Hastanelerinde Çalışan Acil Tıp Asistanlarının Piper Yorgunluk Ölçeği ve Epworth Uykululuk Ölçeği İle Yorgunluk ve Uykululuk Değerlerinin Ölçülmesi ve Etkileyen Faktörlerin Değerlendirilmesi(2019) İz, Mehmet; Topaçoğlu, Hakan; Dikme, Özlem; Bayıl, Erhan; Layık, Mehmet Emin; İz, Fatma Betül Ay; Dikme, ÖzgürAmaç: Bu çalışmada İstanbul?daki eğitim ve araştırmahastanelerinde çalışan acil tıp asistanlarında uykululuk veyorgunluk düzeyinin belirlenmesi ve etkileyen faktörlerindeğerlendirilmesi amaçlanmıştır.Gereç ve Yöntem: Çalışma prospektif, kesitsel bir anketçalışması olarak düzenlendi. İstanbul?daki eğitim ve araştırmahastanelerinde 2013 yılında çalışmakta olan acil tıp asistanlarıüzerinde yapıldı. Çalışmanın yapıldığı dönemde toplam 240 aciltıp asistanı olduğu saptandı. Çalışmaya katılımda gönüllük esasıalındı. Çalışmaya katılan acil tıp asistanlarına ankete dayalı formdağıtıldı. Çalışmada yorgunluk ve uykululuk ölçümünde PiperYorgunluk Ölçeği ve Epworth Uykululuk Ölçeği kullanıldı.Katılımcılar ayrıca bazı sosyodemografik faktörlere ait anketicevaplandırdı.Bulgular: Çalışmaya yaş ortalamaları 29.8±3.7yıl olan 130(%67.4) erkek, 63 (%32.6) kadın toplam 193 acil tıp asistanıdahil edildi (Katılım oranı %80.4). Piper yorgunluk ölçeğindeacil tıp asistanlarının genel yorgunluk süresi en sık %55.4 ileaylar olarak saptandı. Acil tıp asistanlarının %12.4?ü yorgunlukhissetmediğini belirtmiştir. Piper yorgunluk ölçeğinde genelyorgunluk süresi ile acil tıp asistanlarının yaş ortalamaları,cinsiyet, medeni hal, çocuk, kronik hastalık varlığı ilaç kullanımı,kullandığı ilaç tipi, sigara kullanımı, asistanlık süresi, meslektekitoplam süresi, nöbet saati, aylık çalışma süresi ve pratisyenlikteacil serviste çalışma durumu arasında istatistiksel olarak anlamlıfark saptanmamıştır. Epworth uykululuk ölçeğine göreasistanların %66.8?inde normal gündüz uykululuk hali,%26.4?ünde artmış gündüz uykululuk hali, %6.7?sinde şiddetligündüz uykululuk hali saptanmıştır.Sonuç: Acil tıp asistanları arasında özellikle ağır çalışmakoşulları, yoğun ve vardiyalı iş temposu, eşlik eden stresfaktörleri uykululuk ve yorgunluk düzeyini arttırmaktadır.Öğe A systematic review of safety and adverse effects in the practice of therapeutic hypothermia(W B Saunders Co-Elsevier Inc, 2018) Karcıoğlu, Özgür; Topaçoğlu, Hakan; Dikme, Özlem; Dikme, ÖzgürObjective: To carry out a systematic review to estimate the rate and magnitude of adverse effects following therapeutic hypothermia (TH) procedure in patients resuscitated from out-of-hospital cardiac arrest (OHCA) and highlight the specific complications seen after the procedure. Methods: A systematic review of currently published studies was performed following standard guidelines. Online database searches were performed for controlled trials for the last twenty years. Papers were examined for methodological soundness before being included. Data were independently extracted by two blinded reviewers. Studies were also assessed for bias using the Cochrane criteria. The adverse effects attributed to TH in the literature were appraised critically. Results: The initial data search yielded 78 potentially relevant studies; of these, 59 were excluded for some reason. Themain reason for exclusion (n= 43, 55.8%) was that irrelevance to adverse effects of TH. Finally, 19 underwent full-text review. Studies were of high-to-moderate (n= 12, 63%) to low-to-very low (n= 7, 37%) quality. Five studies (27.7%) were found to have high risk of bias, while 8 (42.1%) had low risk of bias. Interpretation: Although adverse effects related to the practice of TH have been studied extensively, there is substantial heterogeneity between study populations and methodologies. There is a considerable incidence of side effects attributed to the procedure, e.g., from life-threatening ventricular arrhythmias to self-limited consequences. Most studies analyzed in this systematic review indicated that the procedure of TH has not caused severe adverse effects leading to significant alterations in the outcomes following resuscitation from OHCA. (C) 2018 Elsevier Inc. All rights reserved.Öğe A systematic review of the pain scales in adults: Which to use?(W B Saunders Co-Elsevier Inc, 2018) Karcıoğlu, Özgür; Topaçoğlu, Hakan; Dikme, Özgür; Dikme, ÖzlemObjective: The study analysed the Visual Analogue Scale (VAS), the Verbal Rating Scale (VRS) and the Numerical Rating Scale (NRS) to determine: 1. Were the compliance and usability different among scales? 2. Were any of the scales superior over the other(s) for clinical use? Methods: A systematic review of currently published studies was performed following standard guidelines. Online database searches were performed for clinical trials published before November 2017, on the comparison of the pain scores in adults and preferences of the specific patient groups. A literature search via electronic databases was carried out for the last fifteen years on English Language papers. The search terms initially included pain rating scales, pain measurement, pain intensity, VAS, VRS, and NRS. Papers were examined for methodological soundness before being included. Data were independently extracted by two blinded reviewers. Studies were also assessed for bias using the Cochrane criteria. Results: The initial data search yielded 872 potentially relevant studies; of these, 853 were excluded for some reason. The main reason for exclusion (33.7%) was that irrelevance to comparison of pain scales and scores, followed by pediatric studies (32.1%). Finally, 19 underwent full-text review, and were analysed for the study purposes. Studies were of moderate (n = 12, 63%) to low (n = 7, 37%) quality. Conclusions: All three scales are valid, reliable and appropriate for use in clinical practice, although the VAS is more difficulties than the others. For general purposes the NRS has good sensitivity and generates data that can be analysed for audit purposes. (C) 2018 Elsevier Inc. All rights reserved.
