Response to winter pressures in acute services: analysis from the Winter Society for Acute Medicine Benchmarking Audit

Background There is increased demand for urgent and acute services during the winter months, placing pressure on acute medicine services caring for emergency medical admissions. Hospital services adopt measures aiming to compensate for the effects of this increased pressure. This study aimed to describe the measures adopted by acute medicine services to address service pressures during winter. Methods A survey of acute hospitals was conducted during the Society for Acute Medicine Benchmarking Audit, a national day-of-care audit, on 30th January 2020. Survey questions were derived from national guidance. Acute medicine services at 93 hospitals in the United Kingdom completed the survey, evaluating service measures implemented to mitigate increased demand, as well as markers of increased pressure on services. Results All acute internal medicine services had undertaken measures to prepare for increased demand, however there was marked variation in the combination of measures adopted. 81.7% of hospitals had expanded the number of medical inpatient beds available. 80.4% had added extra clinical staff. The specialty of the physicians assigned to provide care for extra inpatient beds varied. A quarter of units had reduced beds available for providing Same Day Emergency Care on the day of the survey. Patients had been waiting in corridors within the emergency medicine department in 56.3% of units. Conclusion Winter pressure places considerable demand on acute services, and impacts the delivery of care. Although increased pressure on acute hospital services during winter is widely recognised, there is considerable variation in the approach to planning for these periods of increased demand.

Geriatric epistaxis: Management of epistaxis in the geriatric patient group

OBJECTIVE: In this study, given the recent increases in the geriatric population and the consequent impacts on healthcare services, we examined the characteristics of geriatric patients admitted to the emergency department due to epistaxis. METHODS: This retrospective study included 55 patients (33 males, 22 females; mean age: 72±6.8 years; range, 65 to 93 years) with epistaxis admitted to the Cukurova University Emergency Medicine Department and University of Health Sciences Adana City Training and Research Hospital Otolaryngology Emergency Polyclinic between 01.05.2019-01.04.2020. The patients were divided into two groups according to age: Group 1 consisted of patients aged 65 to 75 years; Group 2 consisted of patients over 75. Postoperative bleeding and trauma history were excluded in all patients in the study. RESULTS: There were no significant differences between the two groups regarding the rate of hospital discharge (p=1.00). Patients with posterior hemorrhage and posterior nasal tampons required significantly more hospitalizations (p<0.001). CONCLUSION: The presence of comorbidities and drug use may cause persistent and recurrent epistaxis. It is necessary for physicians to be more cautious about the use of off-label antiaggregants and anticoagulants.

Evaluation of the Effect of Anatolian Propolis on Covid-19 in Healthcare Professionals

Background: No prophylactic treatment is available for individuals at high risk of developing COVID-19. This study, which was conducted between December 25, 2020 and January 25, 2021, is one of the first clinical studies to evaluate the efficacy of Anatolian propolis supplement against COVID-19. The aim was to obtain evidence on the prophylactic use of Anatolian propolis in individuals at high risk of developing COVID-19. Methods: This volunteer-based study was conducted in two centers. Study involved 209 healthcare professionals (physicians, nurses, medical secretaries) from Emergency Medicine Department of Medical Faculty of Ataturk University and Emergency Medicine Department of Rize Recep Tayyip Erdogan University. 209 participants meeting the study criteria were divided into two groups as experimental group and control group. The experimental group received 20 drops of BEE'O UP 30% Propolis Drops twice a day during a follow-up period of 1 month. The control group received no supplement but was followed up. Findings: The participants showing symptoms during the study and all the participants at the end the study were subjected to PCR testing. The evaluation of the results of PCR testing at the end of the study has shown that 14 participants from the control group and only 2 participants from the experimental group, who received Anatolian propolis supplement, were reported as positive cases. Interpretation: It has been found that a statistically significant protection was induced against COVID-19 infection in 98% of the experimental group, who received Anatolian propolis, compared to the control group.

Anomalous Facial Nerve in a Case of Atticoantral Chronic Otitis Media with Mastoid Abscess

An 18 years old female patient came to emergency medicine department on 3rd July 2020 in the evening hours with massive swelling extending in front, above and behind left ear. Associated with severe, throbbing, intermittent headache since past 4 days patient also had high grade fever. Patient also had a history of left ear foul smelling discharge, scanty in amount, non-blood tinged, not aggravated or relieved with upper respiratory tract infection (URTI), not relieved with medications and not associated with giddiness. Clinical examination revealed a swelling in left preauricular region extending to temporoparietal region displacing left pinna downwards and outwards. Bilateral periorbital swelling was present (Figure 2, 3). Mastoid tenderness was conspicuous. Whitish foul smelling, non-blood-tinged discharge was present in left external auditory meatus. Further ear examination was not possible due to oedema, swelling and thick discharge in external auditory canal (EAC). In view of extensive swelling with its epicenter in mastoid region, left unsafe chronic otitis media (COM) with complication was suspected and was admitted to ENT ward. General investigations were normal except leucocytosis. While patient was put on antibiotics, neurosurgical opinion was sought and magnetic resonance imaging (MRI) brain with contrast was planned to map the abscess. MRI (Figure 1) which was suggestive of left squamosal COM and mastoiditis with intracranial extradural abscess in left temporoparietal region. MRI also uncovered large subgaleal abscess in the left temporo-occipito-parietal region along the sternocleidomastoid (SCM) muscle with thrombosis of left transverse and sigmoid sinus. Neurosurgeons found no need for intervention from their side.

What Should We Focus on Sepsis Fluid Resuscitation? – a Research Based on Scientometrics and Visual Analysis

Background: Sepsis is a life-threatening condition and a global disease burden. Intravenous fluid therapy has been one of the cornerstones of sepsis treatment for decades. Many of the current views and programs are still controversial. With the rapid development of data science and bibliometrics, it is possible to comprehensively review and discover future research trends by analyzing the temporal evolution of topics. Methods: In this paper, bibliometric method was used to get a comprehensive review and quantitatively analyze the global development trend, regional distribution and discipline layout of fluid resuscitation in sepsis. VOSviewer and SciMAT were used to analyze the research hotspots, strategic layout and theme changes of fluid resuscitation in sepsis, and to explore the future research direction. Results: With the development of multi-disciplinary research on fluid resuscitation of sepsis, more attention has been paid to the early prediction and treatment in the emergency medicine department, and the number of basic research (effects of different components of resuscitation fluid) has a downward trend, but the role of albumin is still worthy of further study. The key points of fluid resuscitation in sepsis are the timing of fluid resuscitation, early intervention in the emergency medicine department, looking for accurate and timely indexes of microcirculation perfusion, fluid resuscitation volume in different resuscitation stages and its effect on respiration, kidney and abdominal cavity. Conclusion: The method can identify hotspots and detect future directions conveniently, quickly and effectively. The clinical research of fluid resuscitation in sepsis, especially “the early intervention” and “the precise resuscitation”, is paid more attention, and even the recommendations of the consensus and guidelines need to be further confirmed by “multi center research”, which may become the development direction in the future. Trial registration: it was not registered, because it is an bibliometric analysis based on the published articles.