Immunosuppressive therapy is the most crucial treatment of organ-transplanted patients. Both cyclosporin and tacrolimus have become a part of the standard immunosuppressive therapy for prevention of rejection. However, lower levels of these drugs are associated with insufficient therapy and eventually result in rejection of the organ, and, on the contrary, higher levels are associated with toxicity to certain organs such as liver and kidneys. Therefore, the levels of these drugs in body fluids should be monitored for the prevention of unwanted situations. In this retrospective study, the authors evaluated the 18-month profile of blood drug concentrations of cyclosporin and tacrolimus in patients admitted to the TDM Unit of the Marmara University Hospital (Istanbul, Turkey) between June 2000 and November 2001. A total of 578 blood samples (347 cyclosporin and 231 tacrolimus) from 134 patients (88 for cyclosporin, 46 for tacrolimus) were evaluated in this period. The therapeutic trough ranges were accepted as 100-350 ng/mL for cyclosporin and 5-20 ng/mL for tacrolimus, and levels below or above the identified levels were accepted to be subtherapeutic or toxic. Most of the results were found within the range of therapeutic levels (67.48% for cyclosporin and 82.71% for tacrolimus). Subtherapeutic levels were found in 19.92% of all cyclosporin and 10.53% of all tacrolimus assays, whereas toxic levels were seen in 12.60% and 6.77% of cyclosporin and tacrolimus results, respectively. In conclusion, this study gives information about the TDM practice in institutional clinical laboratory and also indicates the importance of critical information such as sampling time for individual decision making in dosage regiment.
Background: Emergency department (ED) overcrowding is among the biggest and most important problems experienced by ED staff. The number of ED visits is on the increase and remains an unresolved problem. Emergency department overcrowding has become an important problem for emergency care services worldwide. There is a relationship between overcrowding and patients' negative experiences of using ED and therefore reporting reduced patients' satisfaction. This study aimed to identify the causes of ED overcrowding, determine the reasons for people's use of EDs, and develop solutions for reducing ED overcrowding.Methods: This study used quantitative methods using a descriptive approach. The participants were patients who visited the ED. A questionnaire was administered to 296 participants between December 2021 and February 2022. The study included 5 different hospitals in Turkey. The data were analyzed using descriptive statistics.Results: This study identified the most common presenting medical problems in the ED and why patients used the ED. Reasons for using the ED included patients perceiving their condition as really urgent (62.8%), the ED being open for 24 hours (36.1%), and receiving faster care in the ED (31.4%). This study also developed recommendations for alleviating ED overcrowding.
Conclusion:This study identified causes of ED overcrowding and some solutions for alleviating the issue. Emergency department overcrowding should be perceived as an international problem, and initiatives for solutions should be implemented quickly.
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