Background:Post-earthquake engineering and epidemiologic assessments are important for the development of injury prevention strategies. This paper describes mortality and its relationship to building collapse patterns and initial medical responses following the 1992 earthquake in Erzincan, Turkey.Methods:The study consisted of: 1) background data collection and review; 2) design and implementation of a field survey; and 3) site inspection of building collapse patterns. The survey included: 1) national (n = 11) and local (n = 17) officials; 2) medical and search and rescue (SAR) workers (n = 38); and 3) a geographically stratified random sample of lay survivors (n = 105). The survey instruments were designed to gather information regarding location, injuries, initial actions and prior training of survivors and responders, and the location, injuries, and management of dead and dying victims. A case-control design was constructed to assess the relationship between mortality, location, and building collapse pattern.Results:There was extensive structural damage throughout the region, especially in the city where mid-rise, unreinforced masonry buildings (MUMBs) incorporating a “soft” first floor design (large store windows for commercial use) and one story adobe structures were most vulnerable to collapse. Of 526 people who died in the city, 87% (n = 456) were indoors at the time of the earthquake. Of these, 92% (n = 418) died in MUMBs. Of 54 witnessed deaths, 55% (n = 28) of victims died slowly, the majority of whom (n = 26) were pinned or trapped (p <0.05). Of 42 MUMB occupants identified through the survey, those who died (n = 25) were more likely to have been occupying the ground floor when compared with survivors (n = 28) (p <0.01). Official medical and search and rescue responders arrived after most deaths had occurred. Prior first-aid or rescue training of lay, uninjured survivors was associated with a higher likelihood of rescuing and resuscitating others (p <0.001).Conclusion:During an earthquake, MUMBs with soft ground floor construction are highly lethal, especially for occupants on the ground floor, suggesting that this building type is inappropriate for areas of seismic risk. The vulnerability of MUMBs appears due to a lack of lateral force resistance as a result of the use of glass store fiont windows and the absence of shear walls. The prevalence of this building type in earthquake-prone regions needs to be investigated further. A large portion of victims dying in an earthquake die slowly at the scene of injury. Prior public first-aid and rescue training programs increase participation in rescue efforts in major earthquakes and may improve survival.

Amaç: Hastaların çoğunda, ameliyat öncesi farklı derecelerde kaygı ve korku görülmektedir. Preoperatif dönemde anestezist tarafından yapılan görüşme ve bu görüşmede verilen bilgiler anksiyete seviyelerini düşürmek amacıyla uygulanan yöntemlerden biridir. Biz bu çalışmada STAI anksiyete skalası kullanarak ameliyat öncesi ve sonrası anksiyete düzeylerini ve preoperatif bilgilendirmenin, postoperatif anksiyete düzeyine etkisini değerlendirmeyi amaçladık.Yöntemler: Etik kurul onayı alındıktan sonra çalışmaya dahil edilen 107 hastaya preoperatif anksiyete düzeylerini ölçmek amacıyla birebir görüşme yöntemi kullanılarak hastaların durumsal kaygısını ölçmede kullanılan "STAI FORM TX-1" anket formu dolduruldu. Tüm hastalara ameliyat ve genel anestezi ile ilgili bilgiler verildikten sonra standart genel anestezi uygulandı. Postoperatif dönemde hastaların anksiyete düzeylerini belirlemek amacıyla postoperatif 4-6. saatleri arasında yine STAI FORM TX-1 anket formu tekrar dolduruldu. Bulgular: Preoperatif dönemde yapılan 1. Anket ile postoperatif dönemde yapılan 2. Anket testlerindeki anksiyete düzeyleri arasında istatistiksel olarak anlamlı bir düşme saptandı (p<0,05). Cinsiyetle STAI arasındaki ilişki incelendiğinde preoperatif dönemde, kadın hastaların Anket 1 değerlerinin, erkek hastaların Anket 1 değerlerinden yüksek olduğu, iki grup arasındaki bu farkında istatistiksel olarak anlamlı olduğu (p<0,05) tespit edildi. Postoperatif dönemde değerlendirilen Anket 2 değerleri ile cinsiyet arasındaki ilişki incelendiğinde kadınların anksiyete düzeylerinin, erkeklerden daha yüksek olduğu, ancak bu farkın istatistiksel olarak anlamlı olmadığı bulundu.Sonuç: Kadınlarda aileden ayrılmaya bağlı anksiyetenin daha yoğun yaşanmasından ve kadınların endişelerini daha rahat ifade edebilmelerinden dolayı kadın hastalarda preoperatif anksiyete düzeyleri erkeklerden daha yüksek olmaktadır. Ayrıca preoperatif bilgilendirme anksiyete düzeyini azaltmaktadır.Anahtar Kelimeler: Preoperatif anksiyete, State-Trait Anxiety Inventory test, preoperatif bilgilendirme, postoperatif anksiyete Objective: Different degrees of anxiety and fear are seen in the majority of pre-operative patients. An interview conducted by the anaesthesiologist during the preoperative period and the information given in this interview may reduce anxiety levels. In this study we aimed to evaluate the preoperative and postoperative anxiety levels and the impact of the preoperative information on the level of postoperative anxiety using the STAI anxiety scale. Methods:After approval of the ethics committee, the "STAI FORM TX-1" questionnaire, which is used to measure situational anxiety, was administered to 107 patients via an interview in order to measure their levels of preoperative anxiety. Standard general anaesthesiology was performed after all patients received information on the surgical operation and general anaesthesiology. In order to determine postoperative anxiety levels in patients in the postoperative period, the STAI FORM TX-1 questionnaire was repeated at postope...

We aimed to compare the effects of lidocaine and adrenaline with ibuprofen syrup (administered before adenotonsillectomy) on post-operative analgesia and initiation of oral feeding. One group of 20 children received 100 g/5 ml ibuprofen suspension (10 mg/kg) 1 h before anaesthesia; bleeding control was provided by pre-incisional administration of 1:200,000 adrenaline solution (10 ml). The same amount of 0.5% lidocaine solution plus 1:200,000 adrenaline was applied pre-incisionally in a similar manner in a second group of 20 children. No significant differences were observed between the two groups in terms of the duration of operation and anaesthesia, post-operative pain scores, paracetamol requirements, times to initiation of liquid and solid food intake, or adverse side-effects. We conclude that ibuprofen syrup applied pre-incisionally and local infiltration with lidocaine are equally effective for post-operative analgesia.

Rationale: Although the Basic Life Support (BLS) ability of a medical student is a crucial competence, poor BLS training programs have been documented worldwide. Better training designs are needed. This study aims to share detailed descriptions and the test results of two cognitive-constructivist training models for the BLS skills in the first year of medical curriculum.Method: A BLS skills training module was implemented in the first year curriculum in the course of 6 years (1997)(1998)(1999)(2000)(2001)(2002)(2003). The content was derived from the European Resuscitation Council Guidelines. Initially, a competence-based model was used and was upgraded to a cognitive apprenticeship model in 2000. The main performance-content type that was expected at the end of the course was: competent application of BLS procedures on manikins and peers at an OSCE as well as 60% achievement in a test consisting of 25 MCQ items. A retrospective cohort survey design using exam results and a self-completed anonymous student ratings' questionnaire were used in order to test models.Results: Training time for individual students varied from 21 to 29 hours. One thousand seven hundred and sixty students were trained. Fail rates were very low (1.0-2.2%). The students were highly satisfied with the module during the 6 years.Conclusion: In the first year of the medical curriculum, a competence-based or cognitive apprenticeship model using cognitive-constructivist designs of skills training with 9 hours theoretical and 12-20 hours long practical sessions took place in groups of 12-17 students; medical students reached a degree of competence to sufficiently perform BLS skills on the manikins and their peers. The cognitive-constructivist designs for skills training are associated with high student satisfaction. However, the lack of controls limits the extrapolation of this conclusion.

ÖzAnestezistler için oküler cerrahide birçok uygun anestezi tekniği mevcuttur. Günümüzde genel anestezi yöntemi bilinen temel ilaçları içermesine rağmen (intravenöz anestezikler ve inhalasyon anestezikleri, opiyoidler ve kas gevşeticiler) göz cerrahisinde daha az sıklıkla uygulanan anestezi yöntemidir. Genel anestezi; mental retarde, uyum sağlamada güçlüğü olan, yaşlı ve çocuk hastalar ile lokal anesteziyi reddeden hastalara uygulanmaktadır. Rejyonel veya genel anestezi yöntemi anestezistin deneyimine bağlıdır. Göz cerrahisi hasta grubunda artan yaş ve komorbitide, her tekniğin dikkatli yönetimini ve cerrah ile anestezistin iyi bir iletişimini gerektirir. Göz cerrahisinde uygulanan anestezi yöntemi ve yönetimi cerrahinin güvenliği ve başarısında kritik rol oynar.Anahtar Sözcükler: Oftalmik anestezi. Abstract Many anesthetic techniques are available in ocular surgery for the anestesiologists.Currently general anesthesia includes basic products (intravenous and inhalation anesthetics, opioids, and neuromuscular blockers) but less utilised in ophthalmology. General anaesthesia is indicated in debile, uncooperative or senile patients, in patients who refuse loco-regional procedures and in children. Regional or general anesthetic methods depends on the experience of the anesthetist. Increasing aging and comorbidity in the ophthalmic patient population needs careful management of each technique and therefore sufficient communication between anaesthesiologist and surgeon is essential.Ocular anesthetic techniques and managements play a critical role for the success and safety of ophthalmic surgery.