This study was designed to determine the reasons for vaccine rejection in patients who applied for the coronavirus disease-2019 (COVID-19) polymerase chain reaction (PCR) test but did not receive the vaccine. The study was conducted prospectively in the emergency department of a tertiary hospital between 31.01.2022 and 31.05.2022. 1000 patients who applied for the COVID-19 PCR test and refused to be vaccinated were included. The COVID-19 status of the participants, reasons for their application, number of PCR tests, methods of obtaining information about the vaccine, and reasons for the rejection of the vaccine were questioned. 54.6% of the participants were male and 45.4% were female. 60.7% of the patients applied for testing due to symptoms, 25.4% due to contact with people with symptoms, and 23.9% due to travel. 43.3% of the cases had COVID-19 infection; 53.6% of them had tested an average of 2-5 times in the last year. Most of the information about the vaccine was taken from social media, television, medical publications, and people around, respectively. Of the participants, 62.0% believed that COVID-19 vaccines had side effects, 47.3% believed that it had no protection, and 30.9% believed that there was not enough study on the subject. As the age grew, the rate of learning information from social media increased. The most common reasons for COVID-19 vaccine rejection were vaccine side effects, doubtful vaccine protection, and concerns about the lack of sufficient studies on the vaccine. The higher the education level, the higher the vaccine rejection rate.

INTRODUCTION Cerebral infarction is defined as an acute neurological injury stroke that occurs as a result of intracerebral hemorrhage (ICH) and subarachnoid hemorrhage (SAH). 80-85% of stroke cases are ischemic group. Hemorrhagic stroke is responsible for approximately 10-30% of these cases. Studies have shown that the inflammatory response that occurs exacerbates ischemic brain injury and neurological dysfunction. MATERIALS AND METHODS Patients who were admitted to a tertiary state hospital in Istanbul in the last six months and diagnosed with stroke were retrospectively analyzed. Blood samples taken at the time of admission of 116 patients with stroke diagnosed in the study were examined and neutrophil and lymphocyte values in the complete blood count were used in the study. Neutrophil/Lymphocyte ratios (NLR) were calculated by subtracting these values. Hospitalization times of the patients were recorded. The correlation of NLR values of the cases with the length of hospital stay was examined. RESULTS Of the 116 patients included in the study, 100 had ischemic stroke and 16 had hemorrhagic stroke. Of the cases examined, 63 were male and 53 were female. The mean age was 71.6±11.6 years. There was no statistically significant difference between hemorrhagic stroke and ischemic stroke groups in terms of age and gender. We examined the correlation between the length of hospital stay and NLR values of the patients. We found that there was no statistically significant correlation between length of stay and NLR in ischemic stroke and hemorrhagic stroke patient groups. Likewise, when we examined the length of hospitalization and NLR levels, we showed that there was no weak and statistically significant correlation. CONCLUSION Although there are many studies in the literature showing that high neutrophil and low lymphocyte values have a negative effect on mortality and morbidity, there are also studies that have not been shown to have an effect as in our study.

Objective: In this study we studied the calls to 112 command and control center in 2012-2013 years in our province and we aimed the evaluation of use of the emergency ambulance service in our province. Methods: By evaluating emergency call forms that is taken 112 command and control center head physician’s office, a descriptive study was done retrospectively. SPSS 17 program is used for the statistical analysis in this study. Results: It is identified that 51.8% of 1176126 emergency service applicants was male in 2012, 52.3% of 1185019 emergency service applicants was female in 2013. Ambulance service utilization was highest in summer (27%) and the peak value was in august. It is detected that 94% of the calls was unnecessary. The ambulance service utilization by the patients age 65 and over was 30% in 2012 and 2013. It is also identified that the mean ambulance arrival time to the patients was 8.6 min. in 2012 and 9.1 min. in 2013. As we determined, most of the reasons of emergency calls were medical diseases (72%) and traffic accidents (12%). In the patient’s classification according to their pre-diagnosis, the biggest patient group was trauma cases. In 2012 the trauma cases have had 23,3% rate among the pre-diagnosis reasons and in 2013 the value was 22,2%. In our study, the highest rate of ambulance exists is hospital transfer (64.2% in 2012, 63.1% in 2013). Most of the cases which are transported with ambulance have been gone to Denizli State Hospital (32.4%). Conclusion: The high rate of unnecessary calls to command and control center (95,5%) is a serious problem for the quality of service. Because of the fact that these kind of calls make 112 KKM busy unnecessarily; patients, which must have a priority to access to emergency services because of their severe illnesses, don’t arrive on time. So education programs or public spotlights should be performed to improve the public’s knowledge.

Management of Patients with Severe Acidosis in the Emergency Department - Eurasian Journal of Emergency Medicine

Background/Objectives: Medical Malpractice Stress Syndrome (MMSS) describes the psychological and behavioral consequences of malpractice-related concerns and may contribute to defensive medicine practices. Emergency medicine physicians are particularly vulnerable to medicolegal risk because of the high-acuity and time-sensitive nature of their work. This study aimed to evaluate MMSS awareness, malpractice-related stress, and defensive medicine practices among emergency medicine specialists in Türkiye. Methods: A national cross-sectional web-based survey was conducted among emergency medicine specialists practicing in Türkiye between 1 April and 1 June 2026 and was distributed through professional emergency medicine networks and congress-related channels; because the survey was disseminated through multiple open professional platforms, an exact response rate could not be determined. The questionnaire assessed demographic characteristics, MMSS awareness, malpractice-related experiences and anxiety, and defensive medicine behaviors. Defensive medicine practices were evaluated using the validated Turkish version of the Defensive Medicine Attitude Scale. Associations between malpractice-related anxiety and defensive medicine behaviors were analyzed using Spearman correlation analysis. Results: A total of 128 emergency medicine specialists completed the survey. Malpractice-related anxiety was highly prevalent and frequently influenced professional attitudes and clinical decision-making. Defensive medicine practices were common, with assurance-type behaviors being substantially more frequent than avoidance-type behaviors. Malpractice-related anxiety demonstrated a significant positive correlation with assurance defensive medicine behaviors (r = 0.383, p < 0.001) but not with avoidance behaviors (r = 0.139, p = 0.118). Assurance and avoidance defensive medicine scores were positively correlated (r = 0.575, p < 0.001). Conclusions: MMSS and malpractice-related anxiety are highly prevalent among emergency medicine physicians in Türkiye and are associated with widespread defensive medicine practices. Malpractice-related anxiety appears to primarily promote assurance-type defensive medicine behaviors rather than avoidance behaviors. These findings suggest that medicolegal stress may influence clinical decision-making and contribute to increased healthcare utilization in emergency medicine.