Sezgin Sarikaya

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.

CLINICAL EFFICACY OF DEXAMETHASONE FOR ACUTE EXUDATIVE PHARYNGITIS

The objective of this study was to investigate whether treatment with single-dose dexamethasone can provide relief of symptoms in acute exudative pharyngitis. A prospective, randomized, double-blinded, placebo-controlled clinical trial was undertaken over a 3-month period in a university-based Emergency Department. The study included all consecutive patients between 18 and 65 years of age presenting with acute exudative pharyngitis, sore throat, odynophagia, or a combination, and with more than two Centor criteria. Each patient was empirically treated with azithromycin and paracetamol for 3 days. The effects of placebo and a fixed single dose (8 mg) of intramuscular injection of dexamethasone were compared. The patients were asked to report the exact time to onset of pain relief and time to complete relief of pain. After completion of the treatment, telephone follow-up regarding the relief of pain was conducted. A total of 103 patients were enrolled. Thirty patients with a history of recent antibiotic use, pregnancy, those who were elderly (>65 years of age) and patients who failed to give informed consent were excluded. Forty-two patients were assigned to the placebo group and 31 were assigned to the intramuscular dexamethasone group (8-mg single dose). Time to perceived onset of pain relief was 8.06+/-4.86 h in steroid-treated patients, as opposed to 19.90+/-9.39 h in the control group (p=0.000). The interval required to become pain-free was 28.97+/-12.00 h in the dexamethasone group, vs. 53.74+/-16.23 h in the placebo group (p=0.000). No significant difference was observed in vital signs between the regimens. No side effects and no new complaints attributable to the dexamethasone and azithromycin were observed. Sore throat and odynophagia in patients with acute exudative pharyngitis may respond better to treatment with an 8-mg single dose of intramuscular dexamethasone accompanied by an antibiotic regimen than to antibiotics alone.

Paramedics and triage: Effect of one training session on triage in the emergency department

This 3-stage intervention study enrolled all adult patients referred to a universitybased emergency department (ED) during randomly assigned 1-week preeducation or posteducation periods. Triage decisions recorded by ED paramedics (n=8) both before and after an educational training session were compared to decisions made by emergency physicians (EPs). Triage decisions of paramedics and EPs in the preeducation phase showed poor consistency (κ =0.317, κ=0.388). Triage decisions in the posteducation phase increased slightly but were still found to be low. On the other hand, consistency between the triage assessments recorded by paramedics and EPs of the general appearance of patients increased from low in the preeducation phase to moderate in the posteducation phase (κ =0.327, κ=0.500, respectively). The training session was associated with a slight increase in the consistency of triage decisions recorded by paramedics and EPs.

Factors affecting pain in intravenous catheter placement: role of depression illness

The aim of the study was to examine factors affecting pain during intravenous (IV) catheter placement in an emergency department.

Rare and Emergency Gastric Bleeding Cause – Dieulafoy's Lesion

Gastrointestinal bleeding is among the most common causes of emergency admissions. Having high mortality rates, high diagnosis and treatment costs, this condition constitutes a clinical problem that requires a multidisciplinary approach. Extra-varicose bleeding of the upper gastrointestinal system has still been frequent and it usually stops spontaneously. However, recurrent bleeding is the most important cause of mortality and morbidity. (Erickson & Glick, 1986; Rivkin & Lyakhovetskiy, 2005; Pfau et al., 2004) Any remarkable cause could not be demonstrated in approximately 4-9% of massive upper gastrointestinal hemorrhage. (Cotton et al., 1973; Palmer, 1969). Bleeding and anemia might be associated with gastrointestinal vascular malformations. Some epidemiological studies suggest that symptomatic vascular anomalies may be present in approximately 1/10000 individuals (Hodgson et al., 2001). Dieulafoys lesion is a rarely found vascular malformation in symptomatic vascular anomalies group of disease. It is commonly located in the proximal aspect of the stomach. Dieulafoys lesion constitutes 1% to 5.8% of nonvariceal bleeds and is more common in men than in women (2:1) (Garg, 2007). Pathogenesis is still unknown, but it is assumed that it might be a congenital lesion (Regula et al.,2008). The typical lesion is generally located in the submucosa and described as a large tortuous vessel and a small defect in the overlying mucosal surface (Ekci et al., 2010; Vats et al., 2006). (Fig 1 & 2 & 3). In 1884, Gallard first described this lesion, but it was attributed to a French surgeon Dieulafoy in literature (Alva et al., 2006). This medical condition usually presents with a large tortuous arteriole in the stomach wall that erodes and bleeds. In addition, this lesion is generally located at the lesser curvature of the stomach within 6 to 10 cm of the esophagogastric junction (Stojakov et al., 2007). It consists of a single large tortuous arteriole that does not exert normal branching or has a branch 1–5 mm in diameter(Fig 2 & 3). This size is more than the normal diameter of mucosal capillaries. The most common location of the lesion is the body of stomach, followed by the cardia and the esophagus, but they have also been reported in the esophagus, small and large bowel (Ekci et al., 2010; Turan et al., 2008). This condition is commonly seen in elder males (Schmulewitz & Baillie, 2001; Stark et al, 1992). Large majority of patients having Dieulafoys lesion might present with comorbidity