Background: Accurate electrocardiogram (ECG) interpretation is key to quickly providing attention to patients, and the first health staff who evaluate ECGs are nurses. Method: This was a prospective study with a pre–posttest design. The study test included 15 ECGs related to primary cardiac arrhythmias. After pretest nurses were instructed on arrhythmia interpretation using the Cardiac Rhythm Identification for Simple People (CRISP) method, posttests were completed. Results: There was a significant difference between the pretest scores of nurses who had postgraduate education on ECG interpretation and who did not ( p = .002). Median test score increased from 3 (interquartile range [ IQR ] = 2–5) to 7 ( IQR = 5–9) ( p < .001). Participants mostly missed questions about heart blocks and were most successful with questions about fatal arrhythmias after education. Conclusion: The CRISP method is an effective, simple, and easy method for accurate ECG interpretation by nurses. The posttest scores of the participants, especially accurate interpretation of fatal arrhythmias, increased significantly after training. [ J Contin Educ Nurs . 2020;51(12):574–580.]
Objective: The aim of this study is to investigate the relationship between procalcitonin (PCT) level and the severity of acute cholecystitis. Materials and Methods:This study included 200 patients diagnosed with acute cholecystitis. To diagnose and assess the severity of acute cholecystitis; physical examination and abdominal ultrasound findings were evaluated and blood samples were taken to determine white blood cell (WBC) count, erythrocyte sedimentation rate (ESR), and levels of coagulation factors, blood gas, C-reactive protein (CRP) and PCT. Patients were classified into three stages, namely, mild, moderate, and severe, according to the severity of acute cholecystitis using the Tokyo guidelines. The role of PCT level in the assessment of severity of acute cholecystitis and the correlation between the stages and PCT level were statistically analyzed.Results: Among patients with acute cholecystitis, 110 (55%) were classified as mild, 61 (30.5%) as moderate, and 29 (14.5%) as severe. Leukocytosis or leukopenia was positive in 48.5%, ESR elevation was found in 72.5%, CRP positivity in 55.5%, PCT elevation in 27%, and positive findings of ultrasonographic imaging in 54.5% of the patients. Serum WBC count, ESR, and CRP and PCT levels increased as the severity of disease increased (p<0.05). PCT could discriminate grade I from grade II-III with 95.45% sensitivity and 46.67% specificity at the best cut-off value of ≤0.52 (p<0.001). PCT could also discriminate grade III from grade I-II with 72.4% sensitivity and 90.06% specificity at the best cut-off value of >0.8 (p<0.001).Conclusion: PCT level may be considered to be a parameter that could be added to the assessment of the severity of acute cholecystitis in the Tokyo guidelines, although further studies are needed to support our findings.Keywords: Procalcitonin, acute cholecystitis, severity of illness index ÖZ Amaç: Bu çalışmanın amacı akut kolesistitin şiddeti ile prokalsitonin (PCT) seviyesi arasındaki ilişkiyi araştırmaktır.Gereç ve Yöntem: Bu çalışmaya akut kolesistit tanısı alan 200 hasta alındı. Tanıyı koymak ve akut kolesistitin şiddetini belirlemek için; fizik muayene ve abdominal ulltrasonografi bulguları değerlendirildi ve beyaz küre sayımı (BKS), eritrosit sedimentasyon hızı (ESH), koagülasyon faktörleri, kan gazı, C-reaktif protein (CRP) ve PCT düzeylerini belirlemek için kan örnekleri alındı. Hastalar akut kolesistitin şiddetine göre Tokyo klavuzu kullanılarak hafif, orta ve ağır olmak üzere üç evrede sınıflandırıldı. Akut kolesistitin şiddetini değerlendirmede PCT düzeylerinin yeri ve PCT düzeyi ile evreler arasındaki korelasyon istatiksel olarak analiz edildi.Bulgular: Akut kolesistitli hastaların; 110 (%55)'u hafif, 61 (%30,5)'i orta ve 29 (14,5)'u ağır olarak sınıflan-dırıldı. Hastaların %48,5'inde lökositoz veya lökopeni, %72,5'inde ESH yüksekliği, %55,5'inde CRP pozitifliği, %27' sinde PCT yüksekliği ve %54,5'inde pozitif ultrasonografi bulguları saptandı. Serum BKS, ESH, CRP ve PCT düzeyleri hastalığın şiddetiyle beraber artış gösterdi...
Objective: The aim of this study is to investigate the relationship between procalcitonin (PCT) level and the severity of acute cholecystitis. Materials and Methods:This study included 200 patients diagnosed with acute cholecystitis. To diagnose and assess the severity of acute cholecystitis; physical examination and abdominal ultrasound findings were evaluated and blood samples were taken to determine white blood cell (WBC) count, erythrocyte sedimentation rate (ESR), and levels of coagulation factors, blood gas, C-reactive protein (CRP) and PCT. Patients were classified into three stages, namely, mild, moderate, and severe, according to the severity of acute cholecystitis using the Tokyo guidelines. The role of PCT level in the assessment of severity of acute cholecystitis and the correlation between the stages and PCT level were statistically analyzed.Results: Among patients with acute cholecystitis, 110 (55%) were classified as mild, 61 (30.5%) as moderate, and 29 (14.5%) as severe. Leukocytosis or leukopenia was positive in 48.5%, ESR elevation was found in 72.5%, CRP positivity in 55.5%, PCT elevation in 27%, and positive findings of ultrasonographic imaging in 54.5% of the patients. Serum WBC count, ESR, and CRP and PCT levels increased as the severity of disease increased (p<0.05). PCT could discriminate grade I from grade II-III with 95.45% sensitivity and 46.67% specificity at the best cut-off value of ≤0.52 (p<0.001). PCT could also discriminate grade III from grade I-II with 72.4% sensitivity and 90.06% specificity at the best cut-off value of >0.8 (p<0.001).Conclusion: PCT level may be considered to be a parameter that could be added to the assessment of the severity of acute cholecystitis in the Tokyo guidelines, although further studies are needed to support our findings.Keywords: Procalcitonin, acute cholecystitis, severity of illness index ÖZ Amaç: Bu çalışmanın amacı akut kolesistitin şiddeti ile prokalsitonin (PCT) seviyesi arasındaki ilişkiyi araştırmaktır.Gereç ve Yöntem: Bu çalışmaya akut kolesistit tanısı alan 200 hasta alındı. Tanıyı koymak ve akut kolesistitin şiddetini belirlemek için; fizik muayene ve abdominal ulltrasonografi bulguları değerlendirildi ve beyaz küre sayımı (BKS), eritrosit sedimentasyon hızı (ESH), koagülasyon faktörleri, kan gazı, C-reaktif protein (CRP) ve PCT düzeylerini belirlemek için kan örnekleri alındı. Hastalar akut kolesistitin şiddetine göre Tokyo klavuzu kullanılarak hafif, orta ve ağır olmak üzere üç evrede sınıflandırıldı. Akut kolesistitin şiddetini değerlendirmede PCT düzeylerinin yeri ve PCT düzeyi ile evreler arasındaki korelasyon istatiksel olarak analiz edildi.Bulgular: Akut kolesistitli hastaların; 110 (%55)'u hafif, 61 (%30,5)'i orta ve 29 (14,5)'u ağır olarak sınıflan-dırıldı. Hastaların %48,5'inde lökositoz veya lökopeni, %72,5'inde ESH yüksekliği, %55,5'inde CRP pozitifliği, %27' sinde PCT yüksekliği ve %54,5'inde pozitif ultrasonografi bulguları saptandı. Serum BKS, ESH, CRP ve PCT düzeyleri hastalığın şiddetiyle beraber artış gösterdi...
Aim: Emergency department (ED) demand and overcrowding is increasing worldwide, and a significant portion of this overcrowding is caused by ''frequent users''. The aim of the study is to define the characteristics of this group of patients who contribute towards a disproportionate number of ED visits. Materials and Methods: All ED visits during a 1-year period between 01 January 2018 and 31 December 2018 were retrospectively investigated using the electronic registration system of the hospital. Patients who visited the ED ≥4 times in this period were considered as ''frequent users''. Social history, disease and care-related factors of frequent users were investigated. Results: A total of 335,457 ED visits made in a calendar year (2018) were investigated. Frequents users comprised 6.8% of all ED patient population and 22.9% of all ED visits. Female gender proportion was greater among frequent users, and frequent users were younger than occasional users. Yellow/red triage code ratio was higher and the median length of hospital stay was significantly longer in the frequent users group. The proportion of uninsured patients was two times higher in the frequent users group, and half of these patients were immigrants or refugees. Conclusion: Frequent users place a significant burden on the increasing patient volume in EDs. Welfare status was an important indicator for being a frequent user. However, frequent users are a very heterogeneous patient group and more research is needed to better understand the factors leading to frequent ED use and to develop effective strategies to meet patients' complex health care needs.
Objective: The objective of this study is to examine systemic inflammatory blood parameters measured in complete blood count of patients with carbon monoxide (CO) poisoning and to evaluate the relation between the parameters and the severity of poisoning. Material and Methods: Our study is a retrospective case control study. Data was obtained through hospital automation system. Patients who were detected to have 10% and above carboxyhemoglobin levels were included in the study. Patients' complete blood count parameters, red cell distribution width (RDW), neutrophil/lymphocyte ratios (NLR), platelet/lymphocyte ratios (PLR) and treatments were recorded. Results: When the control group was compared to patient group, WBC, leukocyte, neutrophil, platelet, NLR and PLR values were higher in the patient group and these differences were statistically significant (p <0.05). Patients were split into two groups in accordance with the severity of their poisoning. No significant differences were observed in terms of laboratory results (p >0.05). Conclusion: In patients with CO poisoning, values of NLO, PLO and RDW indicate inflammation. We consider that these values do not assume a role in determination of poisoning severity and in shaping of the treatment to be administered. Amaç: Bu çalışmada karbonmonoksit (CO) zehirlenmesi olan hastalarda tam kan sayımında bakılan sistemik inflamatuvar kan parametrelerinin irdelenmesi ve bu parametreler ile zehirlenme ciddiyeti arasındaki ilişkinin değerlendirilmesi amaçlanmıştır. Gereç ve Yöntemler: Çalışmamız retrospektif vaka kontrol çalışmasıdır. Veriler hastane otomasyon sisteminden elde edildi. Karboksihemoglobin düzeyi %10 ve üzerinde saptanan hastalar çalışmaya dahil edildi. Hastaların tam kan sayımı parametreleri, kırmızı küre dağılım genişliği (RDW), nötrofil/lenfosit oranı (NLO), platelet/lenfosit oranı (PLO) ve tedavileri kaydedildi. Bulgular: Hasta grubunda kontrol grubu ile karşılaştırıldığında WBC, lökosit, nötrofil, trombosit, NLO ve PLO değerleri daha yüksekti ve bu farklar, istatistiksel olarak anlamlıydı (p <0.05). Hastalar zehirlenme ciddiyetlerine göre iki gruba ayrıldı, gruplar arasında laboratuar sonuçları açısından anlamlı fark saptanmadı (p>0.05) Sonuç: NLO, PLO, RDW; CO zehirlenmesi olan hastalarda, inflamasyonu göstermekte olup, zehirlenme ciddiyetini belirlemede ve tedaviyi şekillendirme de rolü olmadığını düşünmekteyiz.
This study aimed to prevent unnecessary exposure to ionising radiation, and to exclude nonfracture cases in children admitted to the emergency department with a forearm trauma, by showing that forearm trauma could be assessed with ultrasonography (USG) as accurately and precisely as with direct radiography. Methods: A total of 105 patients (67 males and 38 females) were included in the study. Before performing radiography, the patients were assessed with USG and the results were recorded. The findings of USG and radiography were then compared. Results: A total of 58 (55%) patients had fractures detected with USG. When compared to X-ray, the sensitivity of USG in detecting forearm fractures was 98.3% (95% confidence interval [CI]: 90.7-100%), specificity was 95.8% (95% CI: 86.0-98.9%), negative likelihood ratio was 0.018, positive likelihood ratio was 23.58, negative predictive value was 97.9% (95% CI: 88.7-99.9%), and positive predictive value was 96.6% (95% CI: 88.1-99.6%). Conclusion: The use of USG on selected cases of paediatric patients may provide a more rapid evaluation so as to reduce exposure to ionising radiation. We believe that USG will be useful in excluding non-fracture cases.
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