Objectives: Ultrasonography (US) has been shown to be helpful in diagnosing fractures in the emergency department (ED) setting. The aim of this study was to determine the diagnostic accuracy of US for fractures in patients presenting to the ED with foot and/or ankle sprain and positive Ottawa foot and ankle rules.Methods: This was a prospective study of consecutive patients aged 18 years and over were admitted to the ED with acute foot and/or ankle sprain and positive Ottawa foot and ankle rules. After the patients by were examined by bedside US, anteroposterior and lateral ankle radiographs were obtained, as well as anteroposterior and oblique foot radiographs. The films were evaluated by an orthopedic surgeon who was blinded to the US examination results. The orthopedic surgeon's evaluation was considered the criterion standard for diagnosing a fracture.Results: A total of 246 patients were included in the study. In 76 (30.9%) of the patients, a total of 79 fractures were detected by radiography. Ten false‐negative and nine false‐positive results were obtained by US examination. Only one patient, whose US showed a fracture but whose radiographs were normal, had a fracture detected by computed tomography (CT). The sensitivity and specificity of US scanning in detecting fractures were 87.3% (95% confidence interval [CI] = 77.5% to 93.4%) and 96.4% (95% CI = 93.1% to 98.2%), respectively.Conclusions: Ultrasound had good sensitivity and specificity for diagnosing fifth metatarsal, lateral, and medial malleolus fractures in the patients with foot and/or ankle sprain. However, sensitivity and specificity of US for navicular fractures were low.

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.

Objectives Ultrasonography is becoming increasingly common in the diagnosis of fracture in emergency medicine. The aim of our study was to investigate the diagnostic accuracy of sonographic examinations for diagnosing fifth metacarpal fractures. Methods A prospective study was performed of consecutive patients aged >14 years admitted to the emergency department with hand trauma and tenderness over the fifth metacarpal. Anteroposterior and oblique plain x-rays were taken on all patients. Emergency physicians performed bedside sonographic examination. The x-rays were reported by an orthopaedic surgeon who was blinded to the sonographic examination findings. The orthopaedic surgeon’s report was considered the gold standard unless a CT scan was performed. In the single case where this occurred, the CT scan report was considered the gold standard. Results Eighty one patients were included in the study, 39 of whom had fractures. Sonographic examination identified the fractures in 38 patients. One occult fracture undetected by plain radiography, later shown on CT scan, was identified by sonographic examination. There were three cases with false positive ultrasound findings. The sensitivity of the diagnosis of fifth metacarpal fractures by ultrasonography was 97.4% (95% CI 84.9% to 99.9%), specificity was 92.9% (95% CI 79.4% to 98.1%), positive likelihood ratio (LR) was 14 (95% CI 4.58 to 41), negative LR was 0.03 (95% CI 0.00 to 0.19), negative predictive value was 97.5% (95% CI 85.3% to 99.9%) and positive predictive value was 92.6% (95% CI 79% to 98.1%). Conclusions Sonographic examination can be used as an effective diagnostic tool in patients with fifth metacarpal trauma.

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.

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.