Non-urgent patients are one of the important causes of emergency department (ED) overcrowding. In this study, it is aimed to identify the characteristics of these patients and the reasons why they prefer the ED. This study was conducted during regular office hours. The characteristics of non-urgent patients, their complaints, the frequency of visits to family physicians (FPs), the frequency of using the Central Hospital Appointment System (CHAS) and reasons for preferring the ED were questioned by a questionnaire. This study was conducted on 624 patients. Among them, 326 (52.2%) were male. The mean age was 38.4 years (SD: 14.4). It was identified that 80.3% of the patients had no chronic disease and that 97.4% had health insurance. The most common complaints at presentation were musculoskeletal system pain (25.2%) and upper respiratory tract infections symptoms (19.7%). It was identified that 28.7% of the patients did not prefer to visit their FPs and that 48.6% did not use the CHAS. The reasons of preferring ED were as follows: rapid physical examination (36.4%), not being able to book an earlier appointment at alternative health facilities (30.9%), being close to the facility (12.8%) and being at the hospital for a different reason (12.3%). Among the patients, 20.2% did not express any particular reason. Non-urgent patients who admitted to the ED are mostly middle-aged patients with no chronic disease. They usually visit the ED for preventable reasons. The use of alternative health facilities and CHAS should be encouraged.

Occupational stress is an undesired factor causing discomfort for healthcare workers. Stressors in work can lead to dissatisfaction and in turn, this may affect patient care adversely. The aim of this study was to evaluate the occupational stress among residents and faculty physicians of various medical specialties working night shifts. Residents and faculty physicians working night shifts in the emergency departments, medical and surgical wards were questioned with Swedish Demand Control Support Questionnaire. Also, various factors (specialty, marital status, sex, number of patients during a typical shift, number of night shifts per month, decision about career making in that specialty, having chronic disease and/or sleep problem) originated from social life or working conditions were investigated that could affect the demand, job-control and job strain model. Of the 108 participants, the mean age was 31 ± 6 years, 40.7 % were female, and 78.7 % were residents. Job strain was similar among the three physician groups (p > 0.05). Job control and social support was found to be lower among residents while job stress was higher. The social support-scores were lower in residents who were responsible for more than 60 patients, and who had a chronic disease. The demand-scores were lower in faculty physicians who worked 1 to 4 night shifts per month. Job strain was higher in residents with respect to faculty physicians. Stress and psychosocial risk factors are considered critical issues in the field of occupational health. Workload and job stress are stated as predictors of workers' health, productivity, and motivation. We found a few job stressors by physician working night shifts such as number of taken care of patient, having chronic disease. But, these physicians were significantly residents, due to their high workload sense. Interestingly, job stress was not more by emergency physicians than others. Job strain was found to be higher among the residents as compared to the faculty physicians. Job strain was not significantly different among the physicians of emergency medicine than the physicians of the other specialties working night shifts.

Increase of methemoglobin level is named as methemoglobinemia characterized by functional anemia and tissue hypoxia. Methemoglobinemia can be congenital, but acquired form are more often caused by various drugs and toxins. Methylene blue is the most effective antidote for acquired methemoglobinemia. When methylene blue is not available, alternative treatments such as ascorbic acid and hyperbaric oxygen can be useful. In this paper we presented a case of methomoglobinemia due to dapsone overdose.

Background. Warfarin is a commonly used oral anticoagulant agent. The most common adverse effects of warfarin are bleeding complications.Methods. We performed a 1-year retrospective chart review of emergency department patients using warfarin. A total of 65 patients with bleeding disorder (study group) and 63 patients without bleeding (control group) were included, making up a total of 128 subjects. Demographic data, frequency of international normalized ratio (INR) checks, and routine blood results were extracted. Logistic regression analysis was used to determine which factors were most closely associated with bleeding complications.Results. Median age was62.0±14.4and61.9±14.5for study group and control group, respectively. Educational status and frequency of INR checks were similar in both groups (P=0.101andP=0.483, resp.). INR levels were higher in the study group (5.45±3.98versus2.63±1.71,P<0.001). Creatinine levels were also higher in the study group (1.14±0.57 mg/dL versus0.94±0.38 mg/dL,P=0.042). Acetylsalicylic acid use was more frequent in the study group and was associated with a 9-fold increase in bleeding complications(P<0.001).Conclusions. High INR levels, high creatinine levels, and acetylsalicylic acid use were associated with bleeding complications in ED patients using warfarin.

Objective: As with other people, sleep quality has an impact on a physician’s work safety. Aim of this study is determine the sleep quality among medical specialists whose working night shifts, and detect other independent factors that affect their sleep quality. This is essential for improving the physician health and their daily performance for patient care.Methods: A qualitative study was design with a cross-sectional method. Sampling was conducted with stratification among night shift physicians who work in the emergency, internal medicine and surgical departments at an education and research hospital. Scores on the Pitts burgh Sleep Quality Index (PSQI) and the Swedish Demand-Control-Support Questionnaire (DCSQ) were assessed. Results: One hundred eight physicians who worked night shifts responded to the questionnaire. The average age of the physicians was 31.3±5.9, and 40.7% were women. The average PSQI score in male participants was significantly higher (8.1±3.7 vs. female 7.6±3.9; p=0.014). The majority of physicians (83.3%) had high PSQI values, i.e., scores of 5 or more. No significant difference was found in the average PSQI values between the emergency and internal medicine physicians and surgeons (p>0.05). The most important factors that affected physicians’ sleep quality were the number of night shifts per month, age, gender and the existence of a chronic disease.Conclusion: The sleep quality of medical specialists who work night shifts is equally low. The existence of a chronic disease, age, gender and higher numbers of night shifts affect sleep quality as powerful independent factors.

The C-reactive protein (CRP) velocity (CRPv) is an indicator of the change in CRP over time. In individuals with sepsis, the second values of CRP and CRPv have been shown to have more importance than the first CRP value measured at admission. This study examined the importance of CRPv for mortality among individuals who were hospitalized in the intensive care unit (ICU). The study was conducted between January 2021 and December 2022. CRPv was calculated according to the change in the second CRP value compared to the first. The median age of the patients was 79 years (interquartile range (IQR), 69–85 years), and 53.2 % were male. The in-hospital mortality rate was 45.5 %. The presence of diabetes increased the odds of mortality by 2.17 times (confidence interval (CI): 1.06–4.4, p=0.032). Each increase in CRPv by 1 mg/dl/hour increased the odds of mortality by 1.07 times (CI: 1.01–1.14, p=0.015), while each one-point increase in the Sequential Organ Failure Assessment (SOFA) score increased the odds of mortality by 1.21 times (CI: 1.07–1.35, p=0.002). The SOFA score had the highest area under the curve (AUC) value for in-hospital mortality (AUC = 0.699 p=7, its sensitivity in predicting mortality was 46.7 %, and its specificity was 85.1 %. The AUC value of CRPv in predicting mortality was 0.629 (p=0.006). When CRPv was >0.75, its sensitivity in predicting mortality was 68.2 %, and its specificity was 57 %. CRPv performed well in predicting mortality and had satisfactory discriminative ability. Additionally, diabetes, SOFA score, and CRPv elevation were significant risk factors for mortality.