Arif Cimrin

Impact of Ramadan on demographics and frequencies of disease‐related visits in the emergency department

The objective of this study was to determine whether Ramadan is changing frequencies and demographics of visits due to certain diseases. Data obtained from the charts of the adult patients admitted into the emergency department (ED) due to 10 predetermined entities between 2000 and 2004 were analysed. Demographic variables analysed separately for certain entities visiting the ED in Ramadan were not found to be different from visits in other times of year. Visit frequencies for hypertension and uncomplicated headache in Ramadan were significantly higher than in non‐Ramadan months (χ2 test, p = 0.015 for hypertension, p < 0.001 for uncomplicated headache). Mean age of the patients admitted to the ED due to diabetes‐related conditions in Ramadan was significantly lower than in pre‐ and post‐Ramadan months (59.91 ± 14.60 and 62.11 ± 14.61, respectively) (Mann–Whitney U‐test, p = 0.032). The patients with diabetes presenting in Ramadan were found significantly younger than their peers in the rest of the year. For other diseases, Ramadan does not appear to be a risk factor.

Analysis of factors affecting satisfaction in the emergency department: A survey of 1019 patients

The objective of this study was to identify factors that affect overall satisfaction of patients admitted to the emergency department (ED). All consecutive adult patients in the ED during a 14-day period who could communicate well were enrolled into this cross-sectional analytic study. Patients’ demographic data, information on care, and level of satisfaction were recorded. Patients were asked to rate specific issues concerning their satisfaction (good and excellent) on a 5-point Likert scale. Response to the survey was obtained from 1019 (91.6%) of 1113 patients for analysis during the study. Satisfaction with physician experience, physician attitude, triage, explanation of health status and treatment, and discharge instructions were found to have significant impact on satisfaction (P<.001 for each). Satisfaction with physician experience level was the most important factor affecting overall satisfaction. Patient perception of the total time spent in the ED as “short” and “very short” was not demonstrated to be significantly related to overall satisfaction (P=.162). Temporal perceptions as “long” and “very long” were shown to be significantly related to overall satisfaction (P<.001). Behavioral characteristics of the healthcare providers and the hospital itself were the factors that had the greatest impact on overall satisfaction of the ED population evaluated.

Gait speed as a functional capacity indicator in patients with chronic obstructive pulmonary disease

AIM: Walking distance is generally accepted as a functional capacity determinant in chronic obstructive pulmonary disease (COPD). However, the use of gait speed in COPD patients has not been directly investigated. Thus, the aim of our study was to assess the use of gait speed as a functional capacity indicator in COPD patients. METHODS: A total 511 patients with mild-to-very severe COPD and 113 healthy controls were included. The lung functions (pulmonary function test), general health- and disease-related quality of life (Medical Outcomes Study 36-Item Short-Form of Health Survey, St Georges Respiratory Questionnaire), and gait speed (6-minute walk test) were assessed. RESULTS: The mean gait speed values were slower in moderate (75.7 ± 14.0 m/min), severe (64.3 ± 16.5 m/min), and very severe (60.2 ± 15.5 m/min) COPD patients than controls (81.3 ± 14.3 m/min). There were significant correlations between gait speed and age, dyspnea-leg fatigue severities, pulmonary function test results (FEV1, FVC, FVC%, FEV1/FVC ratio, PEF, PEF%), and all subscores of Medical Outcomes Study 36-Item Short-Form of Health Survey and activity, impact and total subscores of St Georges Respiratory Questionnaire in patients with moderate, severe, and very severe COPD. However, these correlations were higher especially in patients with severe and very severe COPD. CONCLUSIONS: As a conclusion, according to our results gait speed slows down with increasing COPD severity. Also, gait speed has correlations with age, clinical symptoms, pulmonary functions, and quality of life scores in COPD patients. Thus, we consider that gait speed might be used as a functional capacity indicator, especially for patients with severe and very severe COPD.

Sandblasting under Uncontrolled and Primitive Conditions in Turkey

Abrasive blasting involves forcefully projecting a stream of abrasive particles onto a surface, usually with compressed air or steam. Since silica sand is commonly used in this process, workers who perform abrasive blasting are often called sandblasters. A material with rough particles should be used in order to have a sufficient effect on resistant surfaces such as glass or metal. Mostly quartz (silicon dioxide=SiO 2 ) is forced by compressed air onto the target surface . Although the frequency of the procedure is declining, it is still applied in an uncontrolled fashion in small-scale workplaces (employing fewer than 10 workers). The application in narrow areas, the break up of the SiO 2 particles into smaller pieces when striking the surface and reuse of the same material, increase the respirable dust concentration and this leads to high risk of silicosis . In our country sandblasting is being done in smallscale workplaces, which would operate as contractors for bigger companies. The purpose of this procedure is to polish the surface of metal, which comes from foundries, and to make the glass dull. The structural features of all workplaces were similar to each other. Although they are in the framework of control mechanisms such as licensing procedures supervised by local public health centers and municipalities, data collection and occupational health & safety inspections and enforcements are not carried out effectively for smallscale companies, so that the actual magnitude of the occupational risks is not known. In view of these observations, this study was planned with the following aims: to evaluate the work environment and working conditions in small-scale sandblasting workplaces, and to detect the frequency of silicosis among these workers in Turkey. Methods

Increased micronucleus frequencies in surrogate and target cells from workers exposed to crystalline silica-containing dust.

Mining, crushing, grinding, sandblasting and construction are high-risk activities with regard to crystalline silica exposure, especially in developing countries. Respirable crystalline silica (quartz and cristobalite) inhaled from occupational sources has been reclassified as a human carcinogen in 1997 by the International Agency for Research on Cancer. However, the biological activity of crystalline silica has been found to be variable among different industries, and this has formed the basis for further in vivo/in vitro mechanistic research and epidemiologic studies. This study was conducted for genotoxicity evaluation in a population of workers (e.g. glass industry workers, sandblasters, and stone grinders) mainly exposed to crystalline silica in four different workplaces in Turkey. The micronucleus (MN) assay was applied both in peripheral blood lymphocytes (PBL) as a surrogate tissue and in nasal epithelial cells (NEC) as a target tissue of the respiratory tract. Our study revealed significantly higher MN frequencies in the workers (n = 50) versus the control group (n = 29) (P < 0.001) and indicated a significant effect of occupational exposure on MN induction in both of the tissues. For the NEC target tissue, the difference in MN frequencies between the workers and control group was 3-fold, whereas in peripheral tissue, it was 2-fold. Respirable dust and crystalline silica levels exceeding limit values and mineralogical/elemental dust composition of the dust of at least 70% SiO(2) were used as markers of crystalline silica exposure in each of the workplaces. Moreover, 24% of the current workers were found to have early radiographical changes (profusion category of 1). In conclusion, although the PBL are not primary target cells for respiratory particulate toxicants, an evident increase in MN frequencies in this surrogate tissue was observed, alongside with a significant increase in NEC and may be an indicator of the accumulated genetic damage associated with crystalline silica exposure.

Can Spirometry, Pulse Oximetry and Dyspnea Scoring Reflect Respiratory Failure in Patients with Chronic Obstructive Pulmonary Disease Exacerbation?

Objective: To evaluate the extent to which oximetry, spirometry and dyspnea scoring can reflect hypoxemia and hypercapnia among patients admitted to the emergency department (ED) with acute exacerbations of chronic obstructive pulmonary disease. Subjects and Methods: Spirometry, oxygen saturation by pulse oximetry (SpO2), arterial blood gas analysis and dyspnea scoring assessments were made in the ED. Correlations of these parameters were evaluated by means of Pearson’s test. Pulse oximetry cutoff values to express hypoxemia were demonstrated by receiver operating characteristic (ROC) curves. Results: 76 patients with a mean age of 68.0 years were included in the study. Mean spirometric values, expressed as percentages of predicted values, were forced expiratory volume in 1 s (FEV1) = 23.1 ± 9%; forced vital capacity (FVC) = 32.8 ± 11%, and mean FEV1/FVC = 72.4 ± 21.6%. While there was a positive correlation between the SpO2,SaO2 and PaO2 values (r = 0.91 and 0.80, respectively), a negative correlation (r = –0.74) was observed between PaCO2 and SpO2. In determining hypoxemia, both SpO2 and FEV1 were sensitive (83.9 and 90.3%, respectively) while dyspnea scoring was the most sensitive (93.5%). In the evaluation by means of an ROC curve, a saturation of 88.5% for the pulse oximeter was the best cutoff value to reflect hypoxemia (sensitivity 95.6%, specificity 80.6%). Conclusion: SpO2 alone appears to be as highly specific as a combination of other tests in the evaluation of hypoxemia. A cutoff value for SpO2 of ≤88.5% is proposed as a criterion in screening for hypoxemia.

First aid: level of knowledge of relatives and bystanders in emergency situations

Bystanders who are able to provide immediate first aid to patients who require emergency care can make a big difference in the outcome. Thus, first-aid training should be made available to as many people as possible. The aims of this study were to assess the level of first-aid knowledge among bystanders in emergency situations and to identify factors that affected this level of knowledge. At Dokuz Eylul University Emergency Service between February 1 and February 15, 2002, 318 bystanders were given a questionnaire. The first part of the questionnaire was concerned with demographic characteristics and factors that would affect first-aid knowledge level. The second part consisted of 16 multiple choice questions about first aid. Bystanders answered an average of 7.16±3.14 questions correctly. Bystanders who had graduated from a university, were health care personnel, had taken a first-aid course, had a first-aid certificate, or had a driver’s license were considered to be more successful.

Fungi and indoor conditions in asthma patients

This study was carried out with 127 asthmatic patients and 127 controls, which aimed to compare and evaluate the environmental conditions in the homes of asthmatic patients and the control group. Air samples were obtained by using an air sampler and the mean mould colony counts were established. Aspergillus and Penicillium were the most common isolated species. No significant difference was observed with regard to various house conditions and the mean mould colony counts between the houses of patients and controls. The mould colony counts were found to be lower in houses with wooden parquet flooring. The odds ratio for stone floors vs. wood floors was 2.3 (95% CI 1.08–4.98) for mould growth.

Airway disease risk from environmental tobacco smoke among coffeehouse workers in Turkey

Objectives: To examine the effect of ETS exposure on respiratory symptoms and pulmonary function and to compare workers in coffeehouses to those in other occupations in order to assess the risk of respiratory illness in this occupation. Design: Cross sectional study. Setting: The study area consisted of the three metropolitan districts of the city of Izmir, Turkey. 86 coffeehouses and 80 other small scale shops which had no known respiratory risk factor, located in the same area, were taken as the study group. Subjects: 207 workers were assessed. Main outcome measurements: Subjects answered a questionnaire about demographic and working characteristics, respiratory symptoms, and smoking behaviour. Physical examinations and spirometric measurements were carried out at the workplaces. Results: There was a significant increase in respiratory symptoms in coffeehouse workers. Working in a coffeehouse showed a significant risk for chronic bronchitis (odds ratio (OR) 4.3). In coffeehouse workers, forced expiratory volume in one second (FEV1) decreased 5.1%, forced vital capacity (FVC) 3.4%, FEV1/FVC 1.6%, peak expiratory flow (PEF) 6.45%, and forced expiratory flow (FEF25) 7.2%, FEF50 10%, and FEF25–75 9.8%. Among workers who were described as having an “airway disease”, coffeehouse workers were significantly greater in number. When age, body mass index, and smoking behaviour were controlled, working in a coffeehouse was strongly associated with “airway disease” compared to other workers (OR 5.35, 95% confidence interval 2.41 to 11.87). Conclusions: Workers in coffeehouses showed significant increases in respiratory symptoms and decreased pulmonary function. All workers need to gain an awareness of these occupational risks and working conditions should be improved immediately.

A model of standardized training in basic life support skills of emergency medicine residents.

This intervention study was designed to determine the current level of basic life support knowledge and skills of residents in a university-based emergency medicine residency program, and to investigate the potential benefit derived by these residents from a standardized theoretical and practical training session. All residents underwent tests before and after the training session. The residents were asked to perform basic life support on a recording cardiopulmonary resuscitation mannequin. Assessments were made using a 10-item checklist, with the highest score being 17. Each step performed by the resident was scored by an emergency physician for accuracy and effectiveness. Twenty-eight residents participated in the study. According to the modified Berden scale, the pretest and posttest scores were 11.2±2.9 and 15.6±1.0, respectively, and the mean difference was 4.36±2.9 (t test, P < .001). Only 11 residents (39.3%) were rated as “good” or “very good” in the pretest, whereas the corresponding figure in the posttest was 27 (96.4%) (P < .001). Skills, such as checking the airway patency (P < .001), checking breathing (P < .001), appropriate compression rate (P < .003), and delivering 2 effective breaths (P < .001), improved significantly. Depth of chest compression (P < .023) was improved significantly only in residents with fewer than 2 years of experience. The training process should comprise standardized courses to facilitate acquisition of the desired skills.