Topical Ketoprofen Versus Placebo in Treatment of Acute Ankle Sprain in the Emergency Department.

BACKGROUND: Topical agents have been shown to be effective in soft tissue injuries and commonly used in outpatient clinics. However, the data regarding topical agents in the emergency department is insufficient, and they are not used often in the emergency department setting. The present study aimed to compare the effect of 2.5% topical ketoprofen (gel form) to placebo in patients presenting with ankle sprain to the emergency department. METHODS: Patients presenting with ankle sprain composed the study population. Study patients were randomized into 2 study arms: 2.5% ketoprofen gel and placebo administered over a 5-cm area locally. Pain alleviation was measured by visual analog scale at 15 and 30 minutes. A total of 100 patients were included in the final analysis. RESULTS: The median pain reduction in ketoprofen and placebo groups at 15 minutes was 27 (19.8-33.4) and 9 (7.6-17), respectively. The median pain reduction at 30 minutes for both groups was 42 (36-50.8) and 20 (17.6-24.4), respectively. Pain improvement either at 15 minutes (median difference: 16 [9-22]) or 30 minutes (median difference: 21 [15-27]) was better in the ketoprofen group than placebo. There were no adverse effects in either group. CONCLUSION: Ketoprofen gel was superior to placebo at 30 minutes in alleviating pain secondary to ankle sprain in the ED with a high safety profile. Further studies are needed concerning the effect of ketoprofen gel for long-term effects. LEVEL OF EVIDENCE: Level I, high quality prospective randomized study.

The Reliability of Turkish "Basic Life Support" and "Cardiac Massage" Videos Uploaded to Websites.

OBJECTIVE: In this study, the reliability of Turkish cardiac massage and Basic Life Support (BLS) videos, which have already been downloaded from three website such as YouTube, Google, Yahoo following the publication of 2010 cardiopulmonary resuscitation (CPR) guideline and their suitability to the same guideline were researched. MATERIALS AND METHODS: The videos uploaded to the three web-site to search videos on internet were queried by using the keywords "cardiac massage" and "basic life support". Videos that had been uploaded between January 2011 and July 2014 were analyzed and scored by two experienced emergency specialists. RESULTS: A total of 1126 videos were obtained. 1029 of the videos (91.4%) were excluded by researchers. 97 videos were detected to accord with study criteria. Despite most of the videos were found on Google website by keywords, the enormous part of videos proper to criteria were sourced from YouTube website (n=65, 67.0%). One fourth of the videos (24.7%) were observed to not be suitable for 2010 CPR guideline. AED usage was mentioned slightly in the videos (14.4%). Median score of the videos is 5 (IQR: 4-6). The rate and scores of the videos uploaded by official institution or association were significantly higher than others (p=0.007 and 0.006, respectively). Moreover, scores of the videos compatible with guidelines uploaded by official institution or association and medical personal were also found higher (p=0.001). CONCLUSION: Eventually, all the data obtained in this study support that Turkish videos were not reliable on the subject of BLS and cardiac massage. It is promising that videos with high follow-up rates also have been scored higher.

The reliability of national videos related to the kidney stones on YouTube.

OBJECTIVE: Kidney stones are one of the most common disorders of the urinary tract. With increasing awareness, a larger proportion of patients are seeking medical knowledge from the Internet. In present study, the features, reliability and efficacy of videos on YouTube related to the treatment of kidney stones were evaluated. MATERIAL AND METHODS: In December 2014, YouTube was searched using keywords "nephrolithiasis"; "renal calculi"; "renal stones"; and "kidney stones" for videos uploaded containing relevant information about the disease. Only videos in Turkish were included in the study. Two physician viewers watched each video and classified them as useful, partially useful and useless according to European Association of Urology (EAU) Guidelines. The source, length, number of views, number of favourable opinions, and days since uploaded date of the all videos were evaluated. RESULTS: A total of 600 videos were analysed The median length of videos was 6.7±10.4 (median: 3, IQR: 0.03-58) minutes. Each video was viewed at an average of 2368 (min: 11, max: 97133) times. Most of the videos (32.8%) were created by academicians and physicians. Nearly half (47.4%) of the videos were uploaded in 2014. The majority of the videos (62.5%) contained information for treatment. Percutaneous nephrolithotomy and ureterorenoscopy were the most common treatment modalities (32.8% and 28.0%, respectively ) in these videos. A statistically significant difference was not detected between view numbers and source of videos (p=0.87). However, there was a statistically significant difference between usefulness to the viewers and source of videos. Hospital -based videos were detected to be more useful (p=0.000). CONCLUSION: As a result, videos that would be prepared in internet environment by professional individuals or organizations in a way which would attract attention and be easily comprehended by the public could contribute to the knowledge and education of our society about the stone disease which is commonly seen in our country.

The Validity of YouTube Videos on Pediatric BLS and CPR.

BACKGROUND: There are few data regarding the validity of cardiopulmonary resuscitation (CPR) and basic life support (BLS) videos on YouTube in the medical literature, and those that do are only analyzing adult CPR videos. The present study aimed to determine the reliability and accuracy of pediatric CPR and BLS videos as to whether they are consistent with the 2010 CPR guidelines. MATERIALS AND METHODS: YouTube was scanned in January 2015 using the key words "Pediatric CPR Pediatric BLS" without any filters. The raw data collected in the study included sources that uploaded the videos, the record time, the number of viewers in the study period, and inclusion of human or mannequins. Furthermore, the contents of the videos were evaluated as to whether they are consistent with the 2010 resuscitation guidelines. All videos were seen by two independent researchers (emergency physicians) and scored between 0 and 8. RESULTS: In total, 1,200 videos were evaluated regarding the exclusion criteria, which yielded 232 eligible ones. Most of the videos were found to be uploaded by individuals with unspecified credentials (34.1%). Of the videos, 15.5% have content inconsistent with the 2010 guidelines. The median score of all the videos are not high enough (5 [interquartile range (IQR), 4-7]), and only one-third of the videos have optimal quality with scores of 7 or 8. The downloaded number of videos compatible with guidelines was significantly higher relative to the videos not compatible with the guidelines (15,389 [IQR, 881-31515] versus 477 [IQR, 108-3,797); p = 0.0001). The videos downloaded more than 10,000 times had a higher score than the others (median scores of 7 and 5, respectively; p = 0.0001). CONCLUSIONS: Moderate numbers of YouTube videos purporting to be about pediatric life support have optimal quality, and few of them are perfect. Furthermore, YouTube videos uploaded by news programs with an insufficient quality have the highest download rates.

Are YouTube videos accurate and reliable on basic life support and cardiopulmonary resuscitation?

OBJECTIVE: The objective of this study is to investigate reliability and accuracy of the information on YouTube videos related to CPR and BLS in accord with 2010 CPR guidelines. METHODS: YouTube was queried using four search terms 'CPR', 'cardiopulmonary resuscitation', 'BLS' and 'basic life support' between 2011 and 2013. Sources that uploaded the videos, the record time, the number of viewers in the study period, inclusion of human or manikins were recorded. The videos were rated if they displayed the correct order of resuscitative efforts in full accord with 2010 CPR guidelines or not. RESULTS: Two hundred and nine videos meeting the inclusion criteria after the search in YouTube with four search terms ('CPR', 'cardiopulmonary resuscitation', 'BLS' and 'basic life support') comprised the study sample subjected to the analysis. Median score of the videos is 5 (IQR: 3.5-6). Only 11.5% (n = 24) of the videos were found to be compatible with 2010 CPR guidelines with regard to sequence of interventions. Videos uploaded by 'Guideline bodies' had significantly higher rates of download when compared with the videos uploaded by other sources. Sources of the videos and date of upload (year) were not shown to have any significant effect on the scores received (P = 0.615 and 0.513, respectively). The videos' number of downloads did not differ according to the videos compatible with the guidelines (P = 0.832). The videos downloaded more than 10,000 times had a higher score than the others (P = 0.001). CONCLUSION: The majority of You-Tube video clips purporting to be about CPR are not relevant educational material. Of those that are focused on teaching CPR, only a small minority optimally meet the 2010 Resucitation Guidelines.

Intravenous paracetamol versus dexketoprofen in acute migraine attack in the emergency department: a randomised clinical trial.

OBJECTIVE: Migraine is a common form of headache that is a major burden for patients who often seek emergency care. The goal of this study was to compare the effectiveness of intravenous non-steroidal anti-inflammatory medication (dexketoprofen) with paracetamol (acetaminophen) in the treatment of an acute migraine attack. MATERIALS AND METHODS: This prospective, randomised, double blind, controlled study was conducted in a tertiary care emergency unit. Study patients were randomised into two groups to receive either 50 mg of dexketoprofen trometamol or 1000 mg of paracetamol intravenously by rapid infusion in 150 mL of normal saline. Pain reduction was measured at baseline, and after 15 and 30 min, using a Visual Analogue Scale (VAS)) as the primary outcome. VAS is a measurement tool ranging from 0 (no pain) to 100 mm (worst pain). RESULTS: 200 patients were included in the final analysis. Mean (SD) age of the study subjects was 30.1 ± 11 years and 81% (n=162) were women. Median reduction in VAS score at 30 min was 56 (IQR 30-78.5) for the paracetamol group and 55 (IQR 34-75) for the dexketoprofen group, with a difference of 1 mm (95% CI -7 to 10) between the two groups. CONCLUSIONS: Intravenous paracetamol and dexketoprofen appear to produce equivalent pain relief for migraine in the emergency department. CLINICALTRIALS.GOV NO: NCT01730326.

Intravenous paracetamol versus dexketoprofen versus morphine in acute mechanical low back pain in the emergency department: a randomised double-blind controlled trial.

STUDY OBJECTIVE: The objective of this study was to determine the analgesic efficacy and safety of intravenous, single-dose paracetamol versus dexketoprofen versus morphine in patients presenting with mechanical low back pain (LBP) to the emergency department (ED). METHODS: This randomised double-blind study compared the efficacy of intravenous 1 gm paracetamol, 50 mg dexketoprofen and 0.1 mg/kg morphine in patients with acute mechanical LBP. Visual analogue scale (VAS) was used for pain measurement at baseline, after 15 and after 30 min. RESULTS: A total of 874 patients were eligible for the study, and 137 of them were included in the final analysis: 46 patients from the paracetamol group, 46 patients in the dexketoprofen group and 45 patients in the morphine group. The mean age of study subjects was 31.5 ± 9.5 years, and 60.6% (n=83) of them were men. The median reduction in VAS score at the 30th minute for the paracetamol group was 65 mm (95% CI 58 to 72), 67 mm (95% CI 60 to 73) for the morphine group and 58 mm (95% CI 50 to 64) for the dexketoprophen group. Although morphine was not superior to paracetamol at 30 min (difference: 3.8 ± 4.9 (95% CI -6 to 14), the difference between morphine and dexketoprofen in reducing pain was 11.2 ± 4.7 (95% CI 2 to 21). At least one adverse effect occurred in 8.7% (n=4) of the cases in the paracetamol group, 15.5% (n=7) of the morphine group, and 8.7% (n=4) of the dexketoprophen group (p=0.482). CONCLUSIONS: Intravenous paracetamol, dexketoprofen and morphine are not superior to each other for the treatment of mechanical LBP in ED.

Causes and characteristics of work-related eye injuries in western Turkey.

OBJECTIVES: To analyze descriptive data and characteristics of work-related eye injuries (WREI) admitted into the emergency department (ED) and obtain information to utilize in planning measures to prevent WREI. MATERIALS AND METHODS: This prospective study recruited patients with WREI admitted to the center in the two-year study period. Only the casualties occurred at the workplace and while working constituted the sample. The data were collected via face-to-face contact in the ED. RESULTS: Males comprised the majority of the sample (95.3%, n = 778) and mean age of the patients was 28.1 ± 6.5 (range: 15-54) with the biggest percentage in between 25 and 34 years of age (46.2%, n = 377). Most patients were working in the metal and machinery sectors (66.4%, n = 542). Nearly half of the patients had less than 1 year of experience (50.4%, n = 411). The most common mechanism of WREI was noted to be exposures to welding light (26.9%, n = 219), followed by drilling/cutting injuries (21.1%, n = 172). "Carelessness" and "hurrying up" were the most commonly reported causes of WREIs among 'worker-related causes' (21.4% and 16.1%, respectively). Lack of protective measures ranked the highest among workplace-related causes (18.7%, n = 207). CONCLUSIONS: Programs to increase awareness on workplace safety and sound preventive strategies for both parties-employers and employees are to be pursued. Occupational safety efforts should include training on workplace eye safety and campaigns to raise knowledgeability on this disease among workers.

Intravenous paracetamol versus morphine for renal colic in the emergency department: a randomised double-blind controlled trial.

OBJECTIVE: To determine the analgesic efficacy and safety of intravenous single-dose paracetamol versus morphine in patients presenting to the emergency department with renal colic. METHODS: A randomised double-blind study was performed to compare the efficacy of intravenous paracetamol (1 g) and 0.1 mg/kg morphine in patients with renal colic. The efficacy of the study drugs was measured by a visual analogue scale and a verbal rating scale at baseline and after 15 and 30 min. The adverse effects and need for rescue medication (1 µg/kg intravenous fentanyl) were also recorded at the end of the study. RESULTS: 133 patients were eligible for enrolment in the study, with 73 patients included in the final analysis (38 in the paracetamol group and 35 in the morphine group). The mean±SD age of the subjects was 30.2±8.6 years and 51 (70%) were men. The mean reduction in scores at 30 min after study drug administration was 63.7 mm (95% CI 57 to 71) for paracetamol and 56.6 mm (95% CI 48 to 65) for morphine. The difference between pain reduction scores for the two groups at 30 min was 7.1 mm (95% CI -18 to 4), demonstrating no statistical or clinical significance. Two adverse events (5.3%) were recorded in the paracetamol group and five (14.3%) in the morphine group (difference 9%, 95% CI -7% to 26%). CONCLUSION: Intravenous paracetamol is effective in treating patients presenting with renal colic to the emergency department. CLINICAL TRIALS REGISTRATION NO: ClinicalTrials.gov ID number NCT01318187.