Prognostic value of troponin/creatinine ratio in patients with chest pain.

Background: The aim of this study was to investigate the prognostic value of the troponin/creatinine ratio in patients presenting with chest pain and to identify laboratory values affecting mortality. Methods: Between October 1st, 2016 and April 30th, 2019, a total of 5,079 patients (2,844 males, 2,235 females; median age: 65 years; range, 49 to 83 years) who presented to the emergency department with chest pain and whose troponin and creatinine measurements were done were retrospectively analyzed. Laboratory data and 28-day mortality rates were evaluated. The patients were divided into two groups according to 28-day mortality rates after the initial emergency department admission as survivors (n=4,793) and non-survivors (n=286). Results: There were statistically significant differences in the white blood cell count, C-reactive protein, creatinine, high-sensitivity troponin I, and troponin/creatinine ratio between the groups (p<0.05). The high-sensitivity troponin I ≥31.96 pg/dL, creatinine ≥1.11 mg/dL, C-reactive protein ≥43.94 mg/L, and troponin/creatinine ratio ≥25.12 were independent predictors of 28-day mortality (p<0.05). A C-reactive protein value of ≥43.94 mg/L was found to be more specific (81.14%) than the other markers for mortality. Conclusion: Troponin/creatinine ratio is a predictor of mortality in patients presenting to the emergency department with chest pain and high-sensitivity troponin I, creatinine, and C-reactive protein seem to be independent risk factors for 28-day mortality.

Effectiveness of Mesenchymal Stem Cell Therapy for COVID-19 Patients in the Intensive Care Unit: A Case-Control Study

Objective: Many methods are used in the treatment of coronavirus disease 2019 (COVID-19), which causes acute respiratory distress syndrome (ARDS), and there are conflicting reports in the literature regarding the results of mesenchymal stem cell (MSC) therapy, which is one of those methods. The aim of our study is to evaluate the effect of MSC treatment applied together with standard treatments on survival. Materials and Methods: This retrospective case-control study evaluates the survival effect of MSC treatment administered to patients treated in intensive care after the development of ARDS due to COVID-19 between March 2020 and March 2021. The age, gender, comorbid disease status, APACHE II score, and overall and comorbidity-based survival rates were compared between patients who received standard medical treatment (SMT) and patients who received MSC treatment together with SMT. Results: There were 62 patients in the group receiving only SMT and 81 patients in the group receiving SMT and MSC. No difference was observed between the groups in terms of age, gender, presence of comorbid diseases, or APACHE II scores. There were also no differences according to Kaplan-Maier analysis for the survival statuses of the groups. There was no serious adverse effect due to MSC treatment among these patients. Conclusion: Our study presents the largest case series in the literature, and it was observed that MSC treatment may not significantly affect overall survival or comorbid disease-based survival, in contrast to many other studies in the literature.

Communication skills training for emergency medicine residents.

OBJECTIVE: To determine the effects of a communication skills training program on emergency medicine residents and patient satisfaction. MATERIALS AND METHODS: Twenty emergency medicine residents attended a 6-week psychoeducation program that was intended to improve their communication skills. The first three sessions of the psychoeducation program consisted of theoretical education on empathy and communication. Other sessions covered awareness, active communication, and empathic skills on a cognitive behavioral basis using discussion, role play, and homework within an interactive group. The effects of the program were assessed using a communication skills scale, empathy scale, and patient satisfaction survey and were reflected by the reduction in the number of undesirable events between doctors and patients in the emergency department. RESULTS: The mean communication skills score increased from 178.7±19 to 189.2±16 after training (P<0.02). Empathy score also increased from 29.5±9 to 30.7±8, but this difference was not statistically significant (P=0.1). The patient satisfaction survey of 576 patients demonstrated increased scores on confidence in the doctor (88.2±14.6-93.6±10.3; P<0.01); the doctor's respect, kindness, and thoughtfulness (90.3±10.8-94.1±16.5; P<0.01); individualized attention (86.7±9.4-93.9±11.1; P<0.01); devotion of adequate time to listening (88.6±12.3-90.8±14.1; P=0.04); and counseling and information delivery (90.1±11.3-92.2±11.7; P=0.02). The number of undesirable events between doctors and patients decreased 75% from 12 to three. CONCLUSION: Participation in a communication skills training program was associated with improved communication skills of emergency medicine residents, increased patient satisfaction, and decreased complaints.

Communication skills training for emergency nurses.

OBJECTIVE: To determine the effects of a communication skills training program on emergency nurses and patient satisfaction. METHODS: Sixteen emergency nurses attended a 6-week psychoeducation program that was intended to improve their communication skills. The first 3 sessions of the psychoeducation program consisted of theoretical education on empathy and communication. Other sessions covered awareness, active communication, and empathic skills on a cognitive behavioral basis using discussion, role play, and homework within an interactive group. The effects of the program were assessed using a communication skills scale, empathy scale, and patient satisfaction survey and were reflected by the reduction in the number of undesirable events between nurses and patients in the emergency department. RESULTS: The mean communication skill score (177.8±20) increased to 198.8±15 after training (p=0.001). Empathy score also increased from 25.7±7 to 32.6±6 (p=0.001). The patient satisfaction survey of 429 patients demonstrated increased scores on confidence in the nurses (76.4±11.2 to 84.6±8.3; p=0.01); the nurse's respect, kindness, and thoughtfulness (72.2± 8.1 to 82.1 ± 6,5; p=0.01); individualized attention (71.3± 6.2 to 73.2 ± 9.8; p=0.2); devotion of adequate time to listening (84.6± 9.3 to 89.8 ± 7.6; p=0.03); and counseling and information delivery (71.1± 10.2 to 80.2 ± 9.7; p=0.01). The number of undesirable events and complaints during nurse-patient interactions decreased 66 % from 6 to 2. CONCLUSION: "Communication Skills Training" can improve emergency nurses' communication and empathy skills with a corresponding increase in patient satisfaction and reduction of the undesirable events and complaints during nurse-patient interactions.