{"id":451,"date":"2022-12-14T10:22:25","date_gmt":"2022-12-14T07:22:25","guid":{"rendered":"https:\/\/tatd.org.tr\/geriatri\/?p=451"},"modified":"2022-12-14T10:32:48","modified_gmt":"2022-12-14T07:32:48","slug":"geriatrik-aciller-son-5-yilin-en-cok-atif-alan-makaleleri","status":"publish","type":"post","link":"https:\/\/tatd.org.tr\/geriatri\/genel\/geriatrik-aciller-son-5-yilin-en-cok-atif-alan-makaleleri\/","title":{"rendered":"Geriatrik Aciller: Son 5 Y\u0131l\u0131n En \u00c7ok At\u0131f Alan Makaleleri<\/em><\/strong>"},"content":{"rendered":"\n

Yeni bir yaz\u0131 dizimizle t\u00fcm okuyucular\u0131m\u0131za merhaba;<\/p>\n\n\n\n

Geriatri \u00e7al\u0131\u015fma grubu olarak bu ay ki yaz\u0131 dizimizin konusu \u2018\u2019Geriatrik aciller konusunda son 5 y\u0131lda en \u00e7ok at\u0131f alan yay\u0131nlar\u0131n derlemesi\u2019\u2019<\/em><\/strong>\u00a0ile sizlerleyiz. Bu konuda beklentilerim ile kar\u015f\u0131la\u015ft\u0131klar\u0131m a\u00e7\u0131k\u00e7as\u0131 benim ad\u0131ma yeni ufuklar a\u00e7t\u0131. \u0130lk olarak ara\u015ft\u0131rmaya geni\u015fletilmi\u015f literat\u00fcr taramas\u0131 ile ba\u015flad\u0131\u011f\u0131mda, ilk dikkatimi \u00e7eken asl\u0131nda geriatrik acillerde pandemi d\u00f6nemindeki k\u0131s\u0131tl\u0131l\u0131klara ra\u011fmen geni\u015f bir say\u0131da akademik makalenin mevcut olmas\u0131yd\u0131. Y\u0131llara g\u00f6re paralel oranda makale ba\u015f\u0131na at\u0131f say\u0131s\u0131ndaki art\u0131\u015f da dikkat \u00e7ekici bir d\u00fczeydeydi. Son 5 y\u0131lda yay\u0131nlanan geriatrik acillerde makale say\u0131s\u0131 ve at\u0131f say\u0131lar\u0131n\u0131n \u00f6zet tablosu \u015fekil- 1\u2019de verilmi\u015ftir.<\/p>\n\n\n\n

\"\"<\/figure>\n\n\n\n

\u015eekil-1: <\/strong>Y\u0131llara g\u00f6re yay\u0131nlanm\u0131\u015f makale ve at\u0131f say\u0131lar\u0131.<\/p>\n\n\n\n

Mevcut makaleler at\u0131f say\u0131s\u0131na g\u00f6re d\u00fczenlenerek toplamda 3500 akademik \u00e7al\u0131\u015fma incelendi ve 1000 at\u0131f\u0131n \u00fczerinde olan 2500 \u00e7al\u0131\u015fma i\u00e7erisinde en y\u00fcksek at\u0131f alan ve klinik i\u015fleyi\u015fimizde \u00f6nemli olan 52 makalenin sonu\u00e7lar\u0131n\u0131 sizler i\u00e7in derledik. Bu makalelerin ilgi alanlar\u0131 incelendi\u011finde, mevcut d\u00f6nemde en fazla yay\u0131n\u0131n\u00a0mortalite, taburculuk ve takip kriterleri ile travma alan\u0131nda<\/em><\/strong>\u00a0oldu\u011fu ilk g\u00f6ze \u00e7arpan \u00f6nemli noktalardand\u0131 (\u015eekil-2). \u00d6ncelikle pandemi d\u00f6neminde \u00e7al\u0131\u015fmalar\u0131n daha \u00e7ok Covid-19 \u00fczerine oldu\u011fu beklenen bir durumdu. Bu alanda \u00e7ok konu\u015fuldu\u011fu ve pandemi etkilerinin gerileme e\u011filiminde olmas\u0131 nedeniyle 1 \u00e7al\u0131\u015fma d\u0131\u015f\u0131nda Covid-19 ile ilgili \u00e7al\u0131\u015fmalar\u0131 kapsam d\u0131\u015f\u0131 b\u0131rakt\u0131\u011f\u0131m\u0131z\u0131 \u00f6nceden belirtelim. Sonu\u00e7lar\u0131 inceledi\u011fimizde, \u00f6zellikle pandeminin etkisi ile karantina d\u00f6neminde evden takip ve taburculuk \u00fczerine olan \u00e7al\u0131\u015fmalar\u0131n y\u00fcksek olmas\u0131 kendi ad\u0131ma \u015fa\u015f\u0131rt\u0131c\u0131 bir sonu\u00e7 olmad\u0131. Bu alan\u0131n d\u0131\u015f\u0131nda geriatrik travmalar\u0131n en \u00e7ok ara\u015ft\u0131rma konusu oldu\u011fu bir ba\u015fka sonu\u00e7 olarak kar\u015f\u0131m\u0131za \u00e7\u0131kmaktad\u0131r.<\/p>\n\n\n\n

\"\"<\/figure>\n\n\n\n

\u015eekil-2: <\/strong>Geriatrik acillerde yay\u0131nlanan y\u00fcksek at\u0131fl\u0131 makalelerin da\u011f\u0131l\u0131m\u0131.<\/p>\n\n\n\n

Gelin birlikte bu makaleleri birlikte inceleyelim;<\/em><\/p>\n\n\n\n

K\u0131r\u0131lganl\u0131k<\/em><\/strong><\/p>\n\n\n\n

\u0130lk olarak literat\u00fcr\u00fc tarad\u0131\u011f\u0131m\u0131zda en \u00e7ok kar\u015f\u0131m\u0131za geriatrik hastalarda \u2018\u2019k\u0131r\u0131lganl\u0131k<\/strong>\u2019\u2019 terimi \u00e7\u0131kmaktad\u0131r. K\u0131r\u0131lganl\u0131k, \u201cfizyolojik rezerv kayb\u0131 ve strese direnme yetene\u011fi\u201d olarak tan\u0131mlanan \u00e7ok boyutlu bir sendromdur, geriatrik pop\u00fclasyonlarda yayg\u0131nd\u0131r ve y\u00fcksek oranda d\u00fc\u015fme, sakatl\u0131k, hastaneye yat\u0131\u015f ve \u00f6l\u00fcm riskine yol a\u00e7ar. K\u0131r\u0131lganl\u0131\u011f\u0131n sonu\u00e7lar\u0131 s\u0131kl\u0131kla \u00f6l\u00fcm, hastal\u0131k ve hastaneye yat\u0131\u015fla \u00f6l\u00e7\u00fcl\u00fcr. K\u0131r\u0131lganl\u0131\u011f\u0131n ayr\u0131ca diyabet, kardiyovaskuler, b\u00f6brek fonksiyon bozuklu\u011fu ve depresif ruh hali i\u00e7in bir risk fakt\u00f6r\u00fc oldu\u011fu kabul edilmi\u015ftir. Zhu ve ark\u2019n\u0131n yapt\u0131\u011f\u0131 \u2018\u2019Akut b\u00f6brek hasar\u0131 (ABH\u2019nin ya\u015fl\u0131 pop\u00fclasyonda k\u0131r\u0131lganl\u0131kla ili\u015fkisi: sistematik bir g\u00f6zden ge\u00e7irme ve meta-analiz\u2019\u2019<\/em> konulu sistematik inceleme ve meta-analizin amac\u0131, k\u0131r\u0131lganl\u0131\u011f\u0131 olan ya\u015fl\u0131 ki\u015filerde ABH riskini de\u011ferlendirmek ve hafif ve orta-\u015fiddetli k\u0131r\u0131lganl\u0131\u011f\u0131 olanlarda ilgili risk tahminlerini incelemekti. \u00c7al\u0131\u015fman\u0131n ana sonucu olarak kontrol grubu ile kar\u015f\u0131la\u015ft\u0131r\u0131ld\u0131\u011f\u0131nda, k\u0131r\u0131lgan grup \u00f6nemli \u00f6l\u00e7\u00fcde ABH ile ili\u015fkili bulunmu\u015ftur (Odds Ratio1\u204442,05; %95 GA: 1,23\u20133,43). Orta-\u015fiddetli k\u0131r\u0131lgan grup, hafif k\u0131r\u0131lgan gruba g\u00f6re ABH riskinde art\u0131\u015fa sahip saptanm\u0131\u015ft\u0131r. Bildi\u011fimiz kadar\u0131yla, bu \u00e7al\u0131\u015fma ya\u015fl\u0131 pop\u00fclasyonda k\u0131r\u0131lganl\u0131\u011f\u0131n ABH \u00fczerindeki etkilerini inceleyen ilk sistematik inceleme ve meta-analizdir. \u00c7al\u0131\u015fma sonu\u00e7lar\u0131, k\u0131r\u0131lganl\u0131\u011f\u0131 olan ya\u015fl\u0131 hastalarda ABH riskinin artt\u0131\u011f\u0131 ve k\u0131r\u0131lganl\u0131k derecesi artt\u0131k\u00e7a ABH riskinin artt\u0131\u011f\u0131 hipotezini desteklemektedir. Yazarlar taraf\u0131ndan k\u0131r\u0131lganl\u0131k ve ABH aras\u0131ndaki ili\u015fkinin ayr\u0131nt\u0131lar\u0131 hakk\u0131nda daha fazla bilgi sa\u011flamak i\u00e7in daha b\u00fcy\u00fck \u00f6l\u00e7ekli prospektif \u00e7al\u0131\u015fmalara ihtiya\u00e7 oldu\u011fu belirtilmi\u015ftir ki, bu sonu\u00e7ta yeni \u00e7al\u0131\u015fmalar planlayan akademisyenlere \u0131\u015f\u0131k tutmaktad\u0131r. <\/p>\n\n\n\n

Pandemide her derde deva; D vitamini bir mucize mi, yoksa \u015fehir efsanesi mi?<\/em><\/strong><\/p>\n\n\n\n

Pandemi d\u00f6neminde a\u011f\u0131rl\u0131kl\u0131 olarak solunum yollar\u0131 enfeksiyonlar\u0131n\u0131n \u00f6nlenmesinde D vitamini kullan\u0131m\u0131nda art\u0131\u015f g\u00f6zlendi. Peki D vitamini ger\u00e7ekten solunum yolu enfeksiyonu geli\u015fiminin \u00f6nlenmesinde etkili mi? Bu konuda Carlos ve ark\u2019n\u0131n yapt\u0131\u011f\u0131 Yeni Zelanda’da 5000’den fazla ya\u015fl\u0131 yeti\u015fkin \u00fczerinde yap\u0131lan randomize \u00e7ift k\u00f6r plasebo kontroll\u00fc bir \u00e7al\u0131\u015fmada, ayl\u0131k y\u00fcksek doz D vitamini takviyesinin akut solunum yolu enfeksiyonunu \u00f6nlemedi\u011fini buldular. \u00d6zetle g\u00fcnl\u00fck prati\u011fimizde profilaktik D vitamini kullan\u0131m\u0131n\u0131n etkinli\u011fi mevcut de\u011fildir. <\/p>\n\n\n\n

Geriatrik hastay\u0131 taburcu ettik, peki ya sonra?<\/em><\/strong><\/p>\n\n\n\n

Acil servisten taburcu edilen geriatrik hastalar\u0131n taburculuk sonras\u0131 durumlar\u0131n\u0131n de\u011ferlendirildi\u011fi \u00e7al\u0131\u015fmalar pandeminin sonucu olarak son d\u00f6nemde y\u00fcksek at\u0131fl\u0131 makaleler aras\u0131nda yerini ald\u0131. Laila ve ark\u2019n\u0131n bu konuda yapt\u0131\u011f\u0131 ve acil servisten taburcu edilen ya\u015fl\u0131 hastalarda telefonla takip ve taburcu talimat\u0131na uyulmas\u0131 konusundaki \u00e7al\u0131\u015fmada sonu\u00e7 olarak telefonla takip, ya\u015fl\u0131larda taburcu etme talimatlar\u0131na uyulmad\u0131\u011f\u0131n\u0131 belirleyebilir. Ancak \u015fu anda uyumu iyile\u015ftirdi\u011fini g\u00f6steren hi\u00e7bir kan\u0131t\u0131n olmad\u0131\u011f\u0131n\u0131 belirtmi\u015flerdir.<\/p>\n\n\n\n

Geriatrik hastada a\u011fr\u0131 tedavisinde yeni model: \u201cTele Bak\u0131m\u201d<\/strong><\/strong><\/p>\n\n\n\n

Geriatrik acil servis hastalar\u0131nda kas-iskelet a\u011fr\u0131s\u0131n\u0131n erken ayaktan tedavisi i\u00e7in bir e\u011fitim videosu ile tele bak\u0131m\u0131n kar\u015f\u0131la\u015ft\u0131r\u0131ld\u0131\u011f\u0131 randomize kontroll\u00fc pilot \u00e7al\u0131\u015fmada, kas-iskelet sistemi a\u011fr\u0131s\u0131 olan 50 ya\u015f ve \u00fcst\u00fc acil servis hastalar\u0131 (1) ola\u011fan bak\u0131m, (2) yaln\u0131zca k\u0131sa bir e\u011fitim videosu veya (3) k\u0131sa bir e\u011fitim videosu art\u0131 bir doktordan protokol k\u0131lavuzlu\u011funda takip eden bir telefon g\u00f6r\u00fc\u015fmesi olarak randomize edildi. Birincil sonu\u00e7, acil servis ziyaretinden \u00f6nceki ortalama a\u011fr\u0131 \u015fiddetinden, acil servis ziyaretinden bir ay sonra de\u011ferlendirilen son haftadaki ortalama a\u011fr\u0131 \u015fiddetine ge\u00e7i\u015fti. A\u011fr\u0131, \u201c0-10 say\u0131sal derecelendirme \u00f6l\u00e7e\u011fi\u201d kullan\u0131larak de\u011ferlendirildi. Ola\u011fan bak\u0131m, video ve video art\u0131 tele bak\u0131m gruplar\u0131 i\u00e7in ba\u015flang\u0131\u00e7 a\u011fr\u0131 skorlar\u0131 7,3, 7,1 ve 7,5 idi. Bir ayda a\u011fr\u0131 skorlar\u0131 s\u0131ras\u0131yla-1,5,-2.2 ve -3,0’l\u0131k ortalama d\u00fc\u015f\u00fc\u015flere kar\u015f\u0131l\u0131k gelen 5,8, 4,9 ve 4,5 idi. M\u00fcdahale gruplar\u0131 aras\u0131ndaki ikili kar\u015f\u0131la\u015ft\u0131rmada, video art\u0131 tele bak\u0131m grubunda a\u011fr\u0131da normal bak\u0131ma k\u0131yasla 1,7 puan (%95 GA 1,2, 2,1) daha fazla azalma ve video grubunda 1,1 puan (%95 GA 0,6, 1.6) ba\u015flang\u0131\u00e7 a\u011fr\u0131s\u0131, ya\u015f ve cinsiyet i\u00e7in d\u00fczeltme yap\u0131ld\u0131ktan sonra normal bak\u0131ma k\u0131yasla a\u011fr\u0131da daha fazla azalma saptand\u0131. Bir ayda, analjezik yan etkiler, devam eden opioid kullan\u0131m\u0131 ve fiziksel i\u015flev a\u00e7\u0131s\u0131ndan video ile birlikte tele bak\u0131m ve ola\u011fan bak\u0131m gruplar\u0131 aras\u0131nda klinik olarak \u00f6nemli farkl\u0131l\u0131klar da g\u00f6zlendi. Sonu\u00e7 olarak bu pilot \u00e7al\u0131\u015fman\u0131n sonu\u00e7lar\u0131, acil servise kas-iskelet a\u011fr\u0131s\u0131 ile ba\u015fvuran ya\u015fl\u0131 yeti\u015fkinler i\u00e7in sonu\u00e7lar\u0131 iyile\u015ftirmek i\u00e7in bir e\u011fitim videosu ile birlikte tele bak\u0131m\u0131n potansiyel de\u011ferini g\u00f6stermektedir.<\/p>\n\n\n\n

\u2018\u2019Acil Servisten Eve Taburcu Edilen Ya\u015fl\u0131lar \u0130\u00e7in Telefonla Takip: Pragmatik Randomize Kontroll\u00fc \u00c7al\u0131\u015fma\u2019\u2019 da e\u011fitimli bir hem\u015firenin acil servisten taburcu olduktan sonra ya\u015fl\u0131 bir yeti\u015fkin ile yaz\u0131l\u0131 bir metinle telefon g\u00f6r\u00fc\u015fmesi, 30 g\u00fcn i\u00e7inde acil serviste veya hastaneye d\u00f6n\u00fc\u015f oranlar\u0131n\u0131 veya \u00f6l\u00fcm\u00fc azaltmad\u0131. Benzer \u015fekilde Maurice ve ark\u2019n\u0131n yapt\u0131\u011f\u0131 \u2018\u2019Danimarka\u2019da Tek Takipli Ev Ziyaretinin Bir Grup K\u0131r\u0131lgan Ya\u015fl\u0131 Hastada Yeniden Yat\u0131\u015f \u00dczerindeki Etkisi- Randomize Bir Klinik \u00c7al\u0131\u015fma\u2019\u2019 da Hastaneden taburcu edilen bir grup k\u0131r\u0131lgan ya\u015fl\u0131 hastada yeniden yat\u0131\u015f \u00fczerinde tek bir takip ev ziyaretinin etkisi olmam\u0131\u015ft\u0131r. <\/p>\n\n\n\n

Ya\u015fl\u0131 Aktivite Performans M\u00fcdahalesi<\/em><\/strong><\/em><\/strong><\/p>\n\n\n\n

\u2018\u2019Acil Serviste K\u0131sa S\u00fcreli Bir \u00dcniteden Ya\u015fl\u0131 Hastalar\u0131n Taburcu Edilmesinde \u2018Ya\u015fl\u0131 Aktivite Performans\u0131 M\u00fcdahalesinin\u2019 Etkinli\u011fi; Yar\u0131 Deneysel Bir \u00c7al\u0131\u015fma\u2019\u2019 isimli \u00e7al\u0131\u015fmada acil serviste k\u0131sa s\u00fcreli takip sonras\u0131 \u00fcniteden taburcu edilen ya\u015fl\u0131 hastalarda yeniden yat\u0131\u015f riskini azaltmada Ya\u015fl\u0131 Aktivite Performans\u0131 M\u00fcdahalesinin etkinli\u011fini incelemeyi ama\u00e7lam\u0131\u015flar. \u00c7al\u0131\u015fma randomize olmayan, yar\u0131 deneysel bir \u00e7al\u0131\u015fma olarak y\u00fcr\u00fct\u00fclm\u00fc\u015ft\u00fcr. 375 ya\u015fl\u0131 hasta dahil edilmi\u015f ve Ya\u015fl\u0131 Aktivite Performans M\u00fcdahalesine (n=144) veya ola\u011fan uygulamaya (n=231) g\u00f6re kategorize edilmi\u015ftir. M\u00fcdahale; 1) Hastalar\u0131n g\u00fcnl\u00fck aktivitelerinin performans\u0131n\u0131n de\u011ferlendirilmesinden, 2) \u0130leri rehabilitasyona sevkten ve 3) Taburcu olduktan sonraki g\u00fcn takip ziyaretinden olu\u015fuyordu. Birincil sonu\u00e7, 26 hafta i\u00e7inde yeniden kabul (evet\/hay\u0131r) idi. \u00c7al\u0131\u015fman\u0131n sonu\u00e7lar\u0131na bak\u0131ld\u0131\u011f\u0131nda; yeniden yat\u0131\u015fta gruplar aras\u0131nda fark bulunmam\u0131\u015ft\u0131r. Genel olarak m\u00fcdahale grubundaki hastalar\u0131n %44’\u00fc ve ola\u011fan uygulama grubundaki hastalar\u0131n %42’si 26 hafta i\u00e7inde yeniden kabul edilmi\u015ftir. Sonu\u00e7 olarak \u2018Ya\u015fl\u0131 Aktivite Performans\u0131 M\u00fcdahalesi\u2019, acil serviste k\u0131sa s\u00fcreli bir \u00fcniteden taburcu edilen ya\u015fl\u0131 hastalarda yeniden yat\u0131\u015f riskini azaltmada hi\u00e7bir etkinlik g\u00f6stermedi\u011fi bulunmu\u015ftur.<\/p>\n\n\n\n

Acil serviste tekrarlayan ba\u015fvurular<\/em><\/strong><\/p>\n\n\n\n

Acil servislerde kalabal\u0131\u011f\u0131n en \u00f6nemli etkenlerinden birisi de \u00f6zellikle ya\u015fl\u0131 hasta grubunda tekrarlayan ba\u015fvurular olmaktad\u0131r. Acil servis a\u015f\u0131r\u0131 kullan\u0131m\u0131 ABD’de 38 milyar dolara mal olmaktad\u0131r. Ya\u015fl\u0131 hastalar di\u011fer ya\u015f gruplar\u0131na k\u0131yasla %20-40 aras\u0131ndaki oranlarla daha s\u0131k kullanmaktad\u0131r. Acil servis ba\u015fvurusunda daha ya\u015fl\u0131 yeti\u015fkinler, gen\u00e7 yeti\u015fkinlere k\u0131yasla daha \u00e7ok komorbid duruma ve karma\u015f\u0131k t\u0131bbi ge\u00e7mi\u015fe sahiptir. Bu durum genellikle daha pahal\u0131 ve uzun acil servis tan\u0131 testlerini gerektirir. Sa\u011fl\u0131k sigortas\u0131, 1.basamak hekime sahip olmamalar\u0131, zay\u0131f okur yazarl\u0131k, bili\u015fsel bozukluk ve sosyal destek eksikli\u011fi acil servise tekrar ba\u015fvurularda \u00f6nemli etkenler oldu\u011fu tan\u0131mlanm\u0131\u015ft\u0131r. Baz\u0131 risk fakt\u00f6rleri literat\u00fcrde yayg\u0131n olarak ortaya \u00e7\u0131km\u0131\u015ft\u0131r. Bu fakt\u00f6rler aras\u0131nda artan ya\u015f, erkek cinsiyet, belirli tan\u0131lar (kar\u0131n a\u011fr\u0131s\u0131, travmatik yaralanmalar ve solunum \u015fikayetleri), psikososyal fakt\u00f6rler (depresyon, kayg\u0131, zay\u0131f sosyal destek ve s\u0131n\u0131rl\u0131 sa\u011fl\u0131k okuryazarl\u0131\u011f\u0131) ve k\u00f6t\u00fc genel sa\u011fl\u0131k (bili\u015fsel sa\u011fl\u0131k ve fiziksel) yer al\u0131r. Tan\u0131mlanan risk fakt\u00f6rlerinin \u00e7o\u011fu kolayca de\u011fi\u015ftirilemez ve etkili m\u00fcdahale stratejileri geli\u015ftirme ve uygulama aray\u0131\u015f\u0131nda \u00f6nemli bir zorluk te\u015fkil eder. <\/p>\n\n\n\n

Travmatik Beyin Hasar\u0131 Ve Tai Chi Egzersizi<\/em><\/strong><\/p>\n\n\n\n

\u201cTravmatik Beyin Hasar\u0131 (TBH) Olan Ya\u015fl\u0131 Yeti\u015fkinlerde Bilgisayarl\u0131 Bili\u015fsel E\u011fitim (BBE) ve Tai Chi’nin Bili\u015fsel Performans \u00dczerindeki Etkileri\u201d<\/em> konulu ilgin\u00e7 bir \u00e7al\u0131\u015fmada Tai Chi egzersizi, bili\u015fsel olarak sa\u011fl\u0131kl\u0131 ya\u015fl\u0131 insanlarda ve hafif bili\u015fsel bozuklu\u011fu olanlarda bili\u015fsel i\u015flevleri geli\u015ftirebilir. Tai Chi fiziksel, bili\u015fsel ve meditatif bile\u015fenleri bir dizi duru\u015fla b\u00fct\u00fcnle\u015ftiren bir zihin-v\u00fccut egzersizidir ve derin nefes alma ve her v\u00fccut hareketinin bilin\u00e7li kontrol\u00fcn\u00fc vurgular. Tai Chi uygulamas\u0131, fiziksel ve zihinsel egzersizin bir kombinasyonu olarak d\u00fc\u015f\u00fcn\u00fclebilir ve dolay\u0131s\u0131yla di\u011fer egzersiz bi\u00e7imlerinden daha fazla bili\u015fsel fayda sa\u011flayabilir. Buna g\u00f6re yap\u0131lan \u00e7al\u0131\u015fmada, ya\u015fl\u0131 eri\u015fkinlerde TBH’n\u0131n bili\u015fsel sekellerinin Tai Chi uygulayarak iyile\u015ftirilebilece\u011fini tahmin etmi\u015fler. Hem BBE hem de Tai Chi, daha ya\u015fl\u0131 travmatik beyin hasar\u0131 hastalar\u0131nda genel bili\u015fi ve farkl\u0131 spesifik bili\u015fsel alanlar\u0131 geli\u015ftirebilir; Tai Chi’nin etkisi en az 6 ay daha s\u00fcrebilece\u011fi sonucu ortaya \u00e7\u0131km\u0131\u015ft\u0131r.<\/p>\n\n\n\n

Ya\u015fl\u0131larda d\u00fc\u015fmeyi \u00f6nlemeye y\u00f6nelik program: \u201cRESPOND\u201d<\/em><\/strong><\/p>\n\n\n\n

Acil servise d\u00fc\u015fme ile ba\u015fvuran ya\u015fl\u0131larda d\u00fc\u015fmeleri \u00f6nlemeye y\u00f6nelik hasta merkezli bir program olan RESPOND’un de\u011ferlendirilmesinde; randomize kontroll\u00fc bir \u00e7al\u0131\u015fmada RESPOND de\u011ferlendirmesinin temelinde YANIT \u015fu basamaklardan olu\u015fuyordu: (1) ev tabanl\u0131 risk de\u011ferlendirmesi; (2) 6 ayl\u0131k telefon temelli e\u011fitim, ko\u00e7luk, hedef belirleme ve kan\u0131ta dayal\u0131 risk fakt\u00f6r\u00fc y\u00f6netimi deste\u011fi ve (3) mevcut hizmetlere ba\u011flant\u0131lar. Bu \u00e7al\u0131\u015fmada, telefon tabanl\u0131, hasta merkezli bir d\u00fc\u015fme \u00f6nleme program\u0131 sa\u011flanmas\u0131, acil servise d\u00fc\u015fme ile ba\u015fvuran ya\u015fl\u0131 ki\u015filerde d\u00fc\u015fmeleri azaltt\u0131\u011f\u0131, ancak d\u00fc\u015fme yaralanmalar\u0131n\u0131 azaltmad\u0131\u011f\u0131 saptanm\u0131\u015ft\u0131r. \u0130kincil sonu\u00e7lar aras\u0131nda sadece k\u0131r\u0131klar\u0131n azald\u0131\u011f\u0131 g\u00f6r\u00fclm\u00fc\u015ft\u00fcr. D\u00fc\u015fmelerin \u00f6nlenmesi i\u00e7in hasta merkezli stratejileri rutin klinik uygulamaya uyarlamak, acil servise ba\u015fvuran hastalarda sonu\u00e7lar\u0131 iyile\u015ftirmek ve d\u00fc\u015fmeleri azaltmak i\u00e7in bir f\u0131rsat sunabilir.<\/p>\n\n\n\n

Geriatrik Hastalarda K\u00fcnt G\u00f6\u011f\u00fcs Travmas\u0131<\/em><\/strong><\/p>\n\n\n\n

Bir di\u011fer s\u0131k kar\u015f\u0131la\u015f\u0131lan durumda ya\u015fl\u0131 hastalarda k\u0131r\u0131lgan yap\u0131 ile birlikte k\u00fcnt g\u00f6\u011f\u00fcs travmalar\u0131 yer almaktad\u0131r. K\u00fcnt g\u00f6\u011f\u00fcs duvar\u0131 travmas\u0131 olan ya\u015fl\u0131 eri\u015fkinlerde olumsuz sonu\u00e7lar i\u00e7in risk fakt\u00f6rlerini \u00f6zel olarak inceleyen ilk sistematik derlemeyi inceledik. K\u00fcnt g\u00f6\u011f\u00fcs travmas\u0131 ge\u00e7iren ya\u015fl\u0131 eri\u015fkinlerde olumsuz sonu\u00e7lar i\u00e7in 26 risk fakt\u00f6r\u00fc bildiren 13 \u00e7al\u0131\u015fma belirlenmi\u015ftir. \u00c7al\u0131\u015fmalar aras\u0131nda risk fakt\u00f6r\u00fc ve sonu\u00e7 \u00f6l\u00e7\u00fcm\u00fcnde \u00f6nemli farkl\u0131l\u0131klar oldu\u011fu ve bildirilen ya\u015f ve kot k\u0131r\u0131klar\u0131 d\u0131\u015f\u0131nda, ili\u015fkiler bir veya iki \u00e7al\u0131\u015fma ile s\u0131n\u0131rl\u0131 oldu\u011fu g\u00f6r\u00fclm\u00fc\u015ft\u00fcr. Bu nedenle bir meta-analiz ger\u00e7ekle\u015ftirilememi\u015ftir. Dikkat \u00e7ekici bir \u015fekilde, \u00e7o\u011fu \u00e7al\u0131\u015fma, \u00f6nceki ara\u015ft\u0131rmalara dayanmak yerine k\u00fc\u00e7\u00fck veri k\u00fcmelerini kullanarak yeni ili\u015fkiler bulmaya odaklanm\u0131\u015ft\u0131r. T\u00fcm bu k\u0131s\u0131tl\u0131l\u0131klara ra\u011fmen ortak sonu\u00e7 olarak; >65 ya\u015f, \u00fc\u00e7 veya daha fazla kot k\u0131r\u0131\u011f\u0131, \u00f6nceden var olan kardiyopulmoner hastal\u0131k ve pn\u00f6moni geli\u015fiminin mortalite ile ili\u015fkili oldu\u011fu ileri s\u00fcr\u00fclm\u00fc\u015ft\u00fcr.<\/em><\/p>\n\n\n\n

Geriatrik Hastalarda Mortalite De\u011ferlendirilmesi<\/em><\/strong><\/p>\n\n\n\n

Geriatrik hastalar\u0131n mortalite de\u011ferlendirmesi son d\u00f6nemlerde \u00e7ok fazla \u00e7al\u0131\u015fmaya y\u00f6n vermektedir. Bu konuda yap\u0131lan en kapsaml\u0131 de\u011ferlendirmede acil serviste potansiyel kullan\u0131m i\u00e7in risk de\u011ferlendirme modellerinin, k\u0131sa vadeli mortalite i\u00e7in orta ya\u015fl\u0131lara k\u0131yasla ya\u015fl\u0131 hastalarda daha d\u00fc\u015f\u00fck \u00f6ng\u00f6r\u00fc yetene\u011fi vard\u0131r. Hayati belirtiler veya rutin biyobelirte\u00e7ler, 7 g\u00fcnl\u00fck mortaliteyi tahmin etmek i\u00e7in en iyi modelleri olu\u015fturdu ve geleneksel triyaj modelinden daha iyi bulunmu\u015ftur. Bu nedenle k\u0131sa vadeli mortalite i\u00e7in mevcut risk de\u011ferlendirmesini g\u00fc\u00e7lendirilebilir, ancak acil serviste yeni risk de\u011ferlendirme modelleri olu\u015fturulurken ya\u015fa g\u00f6re de\u011fi\u015fiklikler dikkate al\u0131nmal\u0131d\u0131r. 42.452 akut hastay\u0131 kapsayan bu \u00e7al\u0131\u015fmada, ya\u015famsal belirtilere ve rutin biyobelirte\u00e7lere dayal\u0131 risk de\u011ferlendirme modellerinin, test edilen di\u011fer risk de\u011ferlendirme modellerine k\u0131yasla en iyi \u00f6ng\u00f6r\u00fc yeteneklerine sahip oldu\u011funu belirtmektedirler. Ayr\u0131ca, bu \u00e7al\u0131\u015fmaya dahil edilen be\u015f risk de\u011ferlendirme modelinin t\u00fcm\u00fc, 7 g\u00fcnde hayatta kalanlar ve hayatta kalmayanlar aras\u0131nda ayr\u0131m yapma konusunda orta-iyi performans g\u00f6stermi\u015f olup, ancak daha ya\u015fl\u0131lar i\u00e7in daha d\u00fc\u015f\u00fck sensitivite ve spesiviteye sahip oldu\u011funu g\u00f6stermi\u015flerdir.<\/p>\n\n\n\n

A\u011fr\u0131y\u0131 Dindirme Sanat\u0131<\/em><\/strong><\/em><\/strong><\/p>\n\n\n\n

A\u011fr\u0131 ile ilgili her ya\u015f grubunda bir\u00e7ok \u00e7al\u0131\u015fma alan\u0131 mevcut iken \u00f6zellikle geriatrik hastalarda a\u011fr\u0131 kontrol\u00fc ila\u00e7 etkile\u015fimleri, komorbiditeler vb gibi nedenlerle zor olmas\u0131 ile paralel olarak bu hasta grubunda \u00e7al\u0131\u015fmalar s\u0131n\u0131rl\u0131 ancak \u00e7o\u011funlukla de\u011ferli olmaktad\u0131r. Literat\u00fcrde bu konuda meta-analiz ya da randomize \u00e7ift k\u00f6r \u00e7al\u0131\u015fmalar s\u0131n\u0131rl\u0131d\u0131r. Son d\u00f6nemde yay\u0131nlanan y\u00fcksek at\u0131fl\u0131 \u201cAkut \u015eiddetli A\u011fr\u0131s\u0131 Olan Ya\u015fl\u0131 Yeti\u015fkinler \u0130\u00e7in Analjezik Yard\u0131mc\u0131 Olarak IV Asetaminofenin Randomize Klinik \u00c7al\u0131\u015fmas\u0131\u201d nda akut \u015fiddetli a\u011fr\u0131s\u0131 olan 65 ya\u015f ve \u00fcst\u00fc uygun yeti\u015fkinler, 0,5 mg IV hidromorfon ve 1 gr IV asetaminofen veya 0,5 mg IV hidromorfon ve 100 cc normal salin plasebo olarak randomize edilmi\u015ftir. Birincil sonu\u00e7, 60. dk\u2019da NRS a\u011fr\u0131 skorlar\u0131n\u0131n iyile\u015ftirilmesinde gruplar aras\u0131ndaki farka bak\u0131lm\u0131\u015ft\u0131r. IV asetaminofen kolundaki 80 hasta ve plasebo kolundaki 79 hasta analiz i\u00e7in yeterli veriye sahip bulunmu\u015ftur. 60 dk\u2019da, hidromorfon + IV asetaminofen grubundaki hastalar 5,7 NRS birimi, hidromorfon + plasebo grubundakiler 5,2 NRS birimi iyile\u015firken, iki grup aras\u0131nda 0.6 NRS birimlik bir fark (%95 GA -0,4-1,5) saptanm\u0131\u015ft\u0131r. Hidromorfon + IV asetaminofen grubundaki hastalar\u0131n %28,7’si, hidromorfon + plasebo grubunda %29.1\u2019i 60 dk\u2019da daha fazla ek analjezi ihtiyac\u0131 olmu\u015ftur. Bu farkl\u0131l\u0131klar ne klinik olarak ne de istatistiksel olarak anlaml\u0131 bulunmam\u0131\u015ft\u0131r. G\u00fcvenlik profilleri her iki grupta da benzer bulunmu\u015ftur. Bu randomize klinik \u00e7al\u0131\u015fmada, ya\u015fl\u0131 eri\u015fkinlerde akut, \u015fiddetli a\u011fr\u0131 i\u00e7in ek analjezik olarak IV hidromorfona IV asetaminofen eklenmesinin tedavinin ilk saatinde tek ba\u015f\u0131na hidromorfonla kar\u015f\u0131la\u015ft\u0131r\u0131ld\u0131\u011f\u0131nda, ne klinik olarak ne de istatistiksel olarak \u00fcst\u00fcn a\u011fr\u0131 giderme sa\u011flamam\u0131\u015ft\u0131r. Bu \u00e7al\u0131\u015fman\u0131n bizim i\u00e7in hidromorfon ula\u015f\u0131m\u0131n\u0131n zorlu\u011fundan dolay\u0131 k\u0131s\u0131tl\u0131 oldu\u011funu hat\u0131rlatmak yerinde olacakt\u0131r.<\/p>\n\n\n\n

EACEM 2022\u2019de a\u011fr\u0131 kursu ile tan\u0131\u015ft\u0131\u011f\u0131m\u0131z Motov\u2019un yapt\u0131\u011f\u0131 \u201cAcil Servisteki Geriatrik Hastalarda Akut A\u011fr\u0131 i\u00e7in Morfin’e Kar\u015f\u0131 \u0130ntraven\u00f6z Subdissosiyatif Doz Ketamin (SDK): Randomize Kontroll\u00fc Bir \u00c7al\u0131\u015fma\u201d<\/em> orta ila \u015fiddetli akut kar\u0131n, yan, kas-iskelet sistemi veya maligniteye sekonder a\u011fr\u0131 ya\u015fayan 65 ya\u015f ve \u00fcst\u00fc acil servis hastalar\u0131n\u0131 de\u011ferlendiren prospektif, randomize, \u00e7ift k\u00f6r bir \u00e7al\u0131\u015fmaya g\u00f6re; hastalar 15 dk\u2019l\u0131k k\u0131sa iv inf\u00fczyon yoluyla 0.3 mg\/kg SDK veya 0.1 mg\/kg morfin alacak \u015fekilde randomize edilmi\u015ftir. De\u011ferlendirmeler 15, 30, 60, 90 ve 120. dakikalarda yap\u0131lm\u0131\u015ft\u0131r. Birincil sonu\u00e7, 30 dk \u2018da a\u011fr\u0131da azalma \u015feklinde olmu\u015ftur. \u0130kincil sonu\u00e7lar, genel yan etki oranlar\u0131n\u0131 ve kurtarma analjezisi insidans\u0131n\u0131 i\u00e7ermektedir. 0.3 mg\/kg’da 15 dk\u2019da uygulanan SDK, geriatrik acil servis hastalar\u0131nda akut a\u011fr\u0131n\u0131n k\u0131sa s\u00fcreli tedavisi i\u00e7in morfine benzer analjezik etkinlik sa\u011flar, ancak daha y\u00fcksek psiko-alg\u0131sal yan etki oranlar\u0131yla sonu\u00e7land\u0131\u011f\u0131n\u0131 ortaya koymaktad\u0131r.<\/p>\n\n\n\n

Geriatrik Hastalarda Maliyet Etkinlik<\/em><\/strong><\/em><\/strong><\/p>\n\n\n\n

\u201cA\u011f\u0131r K\u0131r\u0131lgan Ya\u015fl\u0131 Hastalar \u0130\u00e7in Akut Hastane Bak\u0131m\u0131nda K\u0131sa Vadeli Kaynak Kullan\u0131m\u0131 ve Maliyet Etkinli\u011fi Kapsaml\u0131 Geriatrik De\u011ferlendirmede \u00d6nlemler\u201d <\/em>konulu \u00e7al\u0131\u015fman\u0131n birincil sonucu, 3 ayl\u0131k takipte kontrolle kar\u015f\u0131la\u015ft\u0131r\u0131ld\u0131\u011f\u0131nda m\u00fcdahaleyle ili\u015fkili d\u00fczeltilmi\u015f art\u0131ml\u0131 maliyet etkililik oran\u0131 \u015feklinde bulunmu\u015ftur. Sonu\u00e7 olarak hastane, birinci basamak ve belediye bak\u0131m maliyetleri ve etkileri dahil olmak \u00fczere regresyon analizleriyle ayarlanan maliyet etkililik analizi yap\u0131lm\u0131\u015ft\u0131r. 3 ayda gruplar aras\u0131nda kazan\u0131lan ortalama d\u00fczeltilmi\u015f kaliteye g\u00f6re ayarlanm\u0131\u015f ya\u015fam y\u0131l\u0131 fark\u0131 0.0252 idi [%95 g\u00fcven aral\u0131\u011f\u0131 (GA): 0,0082-0,0422]. Artan maliyet, yani gruplar aras\u0131ndaki fark 3226 ABD dolar\u0131 olarak bulunmu\u015ftur (%95 CI: 6167 ila 285). Sonu\u00e7lar akut hasta k\u0131r\u0131lgan ya\u015fl\u0131 hastalar i\u00e7in bir geni\u015fletilmi\u015f geriatrik bak\u0131m \u00fcnitesindeki bak\u0131m\u0131n, 3 ay sonra konvansiyonel bak\u0131ma k\u0131yasla muhtemelen maliyet etkin oldu\u011funu g\u00f6stermektedir. <\/p>\n\n\n\n

Kalp yetmezli\u011finde taburculukta troponin seviyelerinin tekrar ba\u015fvuru ya da klinik iyile\u015fme takibinde etkisi<\/em><\/strong><\/p>\n\n\n\n

D\u00fc\u015f\u00fck ejeksiyon fraksiyonlu kalp yetmezli\u011fi nedeniyle hastaneye yat\u0131r\u0131lan hastalarda taburculuk \u00f6ncesi ve erken taburculuk sonras\u0131 troponin y\u00fckselmesi: ASTRONAUT \u00e7al\u0131\u015fmas\u0131ndan elde edilen bulgularda hastanede yatan bu KY pop\u00fclasyonunda, hastaneye yat\u0131\u015f s\u0131ras\u0131nda ve 1 ayl\u0131k takipte troponin I y\u00fckselmesi yayg\u0131n g\u00f6r\u00fclmektedir. 1. ayda y\u00fckselmi\u015f troponin I seviyesi, -ancak taburculuk \u00f6ncesi de\u011fil- 12. ayda artan klinik olaylar\u0131n ba\u011f\u0131ms\u0131z bir g\u00f6stergesi olarak saptanm\u0131\u015ft\u0131r. Erken taburculuk sonras\u0131 troponin I \u00f6l\u00e7\u00fcm\u00fc pratik bir risk arac\u0131 sunabilir. Bu \u00e7al\u0131\u015fma yatan hastalar \u00fczerinde yap\u0131lan bir \u00e7al\u0131\u015fma olup, gelecekte acil serviste taburculuk \u00f6ncesi troponin de\u011ferlerinin mortalite ya da yeniden ba\u015fvuru \u00fczerine etkisinin ara\u015ft\u0131r\u0131lmas\u0131 i\u00e7in klinisyenlere yol g\u00f6sterebilir.<\/p>\n\n\n\n

Atriyal Fibrilasyonu Olan Geriatrik Hastalarda Varfarin mi, Yeni ku\u015fak Oral Antikoag\u00fclanlar (YOAK) m\u0131?<\/em><\/strong><\/p>\n\n\n\n

Atriyal fibrilasyonu olan ya\u015fl\u0131 hastalarda oral antikoag\u00fclanlar\u0131n etkinli\u011fi ve g\u00fcvenli\u011fi: sistematik bir g\u00f6zden ge\u00e7irme ve meta-regresyon analizinde ya\u015fl\u0131 AF hastalar\u0131nda inme\/TE riskini azaltmada varfarin kullan\u0131m\u0131 varfarin kullan\u0131lmamas\u0131na, aspirine ve antitrombotik tedavi uygulanmamas\u0131na g\u00f6re daha \u00fcst\u00fcn bulunmu\u015f, ancak maj\u00f6r kanamada olas\u0131 bir art\u0131\u015f g\u00f6r\u00fclm\u00fc\u015ft\u00fcr. YOAK’lar inme\/TE’yi \u00f6nlemede varfarinden daha \u00fcst\u00fcn saptanm\u0131\u015f ve maj\u00f6r kanama riskini azaltm\u0131\u015ft\u0131r. <\/p>\n\n\n\n

Geriatrik hastalarda \u00f6nemli bir t\u0131bbi sorun: \u201cDeliryum\u201d<\/em><\/strong><\/p>\n\n\n\n

Akut olarak hastaneye yat\u0131r\u0131lan riskli ya\u015fl\u0131 hastalarda deliryumun \u00f6nlenmesi i\u00e7in plaseboya kar\u015f\u0131 haloperidol: \u00e7ok merkezli, \u00e7ift k\u00f6r, randomize, kontroll\u00fc bir klinik \u00e7al\u0131\u015fmada<\/em> profilaktik d\u00fc\u015f\u00fck doz oral haloperidol akut olarak hastanede yatan ya\u015fl\u0131 hastalarda deliryum insidans\u0131n\u0131 azaltmad\u0131\u011f\u0131 g\u00f6r\u00fclm\u00fc\u015ft\u00fcr. Bu nedenle, bu pop\u00fclasyonda profilaktik haloperidol kullan\u0131m\u0131 \u00f6nerilmemektedir. Ya\u015fl\u0131larda deliryumun tan\u0131s\u0131nda serum biyobelirte\u00e7lerinin etkinli\u011finin ara\u015ft\u0131r\u0131ld\u0131\u011f\u0131 metaanalizde<\/em> 32 \u00e7al\u0131\u015fmada 7610 hastada \u00e7al\u0131\u015f\u0131lan 44 farkl\u0131 biyobelirte\u00e7 taranm\u0131\u015ft\u0131r. Yeterli m\u00fcdahale arac\u0131 olmad\u0131\u011f\u0131 s\u00fcrece, de\u011fi\u015fen biyobelirte\u00e7 d\u00fczeylerinin klinik uygulamada herhangi bir de\u011fi\u015fiklik ba\u015flatmas\u0131 olas\u0131 de\u011fildir. \u015eimdiye kadar, deliryum insidans\u0131n\u0131, \u015fiddetini veya s\u00fcresini azaltacak tedavi stratejilerinin geli\u015ftirilmesini sa\u011flayacak hi\u00e7bir biyobelirte\u00e7 tan\u0131mlanmam\u0131\u015ft\u0131r. Yararl\u0131 bir biyobelirte\u00e7, maliyet etkin olurken hedefe y\u00f6nelik tedaviyi m\u00fcmk\u00fcn k\u0131lmak i\u00e7in kolayca tan\u0131mlanabilir ve g\u00fcvenilir olmal\u0131d\u0131r. Bu kriterler, bu literat\u00fcr incelemesinde bulunan herhangi bir biyobelirte\u00e7 i\u00e7in ge\u00e7erli de\u011fildir. Sonu\u00e7 olarak, belirli bir deliryum biyobelirte\u00e7inin uygulanmas\u0131 i\u00e7in \u00e7\u0131\u011f\u0131r a\u00e7an bir \u00f6neri sunmamaktad\u0131r. \u0130nflamatuvar biyobelirte\u00e7ler ve metabolizman\u0131n biyobelirte\u00e7leri, deliryum tan\u0131s\u0131nda ve deliryum riskinin de\u011ferlendirilmesinde yard\u0131mc\u0131 olabilir. Uzman g\u00f6r\u00fc\u015fleri, \u00f6zellikle hipoaktif formun, deliryum tan\u0131s\u0131 koymak i\u00e7in yerle\u015fik ara\u00e7lar kullan\u0131ld\u0131\u011f\u0131nda bile s\u0131kl\u0131kla tan\u0131 konamad\u0131\u011f\u0131n\u0131 belirtmektedir. Bu biyobelirte\u00e7lerin deliryum de\u011ferlendirme ara\u00e7lar\u0131nda uygulanmas\u0131 yeni bir yakla\u015f\u0131m\u0131 temsil edebilir. Ancak yazarlar, deliryum risk fakt\u00f6rleri olarak tutarl\u0131 bir \u015fekilde bildirilmeyen inflamatuvar biyobelirte\u00e7ler bulmu\u015flard\u0131r. Kan\u0131t d\u00fczeyleri \u00f6ncelikle bir meta-analizde ara\u015ft\u0131r\u0131lmal\u0131d\u0131r.<\/p>\n\n\n\n

Acil Servisten Palyatif Bak\u0131ma<\/em><\/strong><\/em><\/strong><\/p>\n\n\n\n

\u201cAcil Serviste Ya\u015fam Sonu Bak\u0131m\u0131, Palyatif Bak\u0131m Kons\u00fcltasyonu ve Palyatif Bak\u0131m Y\u00f6nlendirmesi: Sistematik Bir \u0130nceleme\u201dde<\/em> dahil edilmek \u00fczere se\u00e7ilen 13 makale ile 3091 \u00f6zet ve 98 tam metin makaleyi taranm\u0131\u015ft\u0131r. \u0130ki makale tek bir RK\u00c7’nin sonu\u00e7lar\u0131n\u0131 bildirirken, geri kalan 11 \u00e7al\u0131\u015fma tan\u0131mlay\u0131c\u0131 veya yar\u0131 deneysel kohort \u00e7al\u0131\u015fmalar oldu\u011fu g\u00f6ze \u00e7arpmaktad\u0131r. \u00c7al\u0131\u015f\u0131lan pop\u00fclasyonlar ya\u015fl\u0131 eri\u015fkinleri, ilerlemi\u015f malignitesi olan hastalar\u0131 ve kar\u015f\u0131lanmam\u0131\u015f palyatif bak\u0131m ihtiya\u00e7lar\u0131 a\u00e7\u0131s\u0131ndan pozitif tarama yapan acil servis hastalar\u0131n\u0131 i\u00e7ermektedir. M\u00fcdahalelerin \u00e7o\u011fu, huzurevleri veya palyatif bak\u0131ma sevki veya do\u011frudan acil serviste sa\u011flanan palyatif bak\u0131m\u0131 i\u00e7ermektedir. Normal bak\u0131mla kar\u015f\u0131la\u015ft\u0131r\u0131ld\u0131\u011f\u0131nda; Acil Servis-Palyatif Bak\u0131m (AS-PB) m\u00fcdahaleleri ya\u015fam kalitesini iyile\u015ftirdi\u011fi g\u00f6zlemnlenmi\u015f, ancak bu iyile\u015fme AS-PB ile yatan hasta-PB’si kar\u015f\u0131la\u015ft\u0131r\u0131l\u0131rken g\u00f6zlemlenmemi\u015ftir. AS-PB m\u00fcdahaleleri, PB kons\u00fcltasyonunu h\u0131zland\u0131rm\u0131\u015f; \u00e7o\u011fu \u00e7al\u0131\u015fma hastanede kal\u0131\u015f s\u00fcresinde e\u015fzamanl\u0131 bir azalma ve huzurevleri kullan\u0131m\u0131nda bir art\u0131\u015f bildirmi\u015f, ancak baz\u0131 verilerin \u00e7eli\u015fkili oldu\u011fu g\u00f6r\u00fclm\u00fc\u015ft\u00fcr. T\u00fcm \u00e7al\u0131\u015fmalarda k\u0131sa vadeli \u00f6l\u00fcm oranlar\u0131 y\u00fcksek iken, AS-PB m\u00fcdahalelerinin ola\u011fan bak\u0131ma k\u0131yasla sa\u011f kal\u0131m s\u00fcresini azaltmad\u0131\u011f\u0131 saptanm\u0131\u015ft\u0131r.<\/p>\n\n\n\n

Sonu\u00e7 olarak; mevcut veriler acil serviste PB’\u0131n uygulanabilir oldu\u011funu, ya\u015fam kalitesini iyile\u015ftirebilece\u011fini ancak sa\u011f kal\u0131m\u0131 etkilemedi\u011fini g\u00f6stermektedir.<\/p>\n\n\n\n

Covid-19\u2019da Evde Takipte Kullan\u0131labilecek Ya\u015fl\u0131 Hasta Odakl\u0131 Aplikasyonlar<\/em><\/strong><\/p>\n\n\n\n

\u201cCOVID-19 Pandemisi S\u0131ras\u0131nda Tecrit Halinde Ya\u015fl\u0131 Yeti\u015fkinlerin Kullanabilece\u011fi 15 Ak\u0131ll\u0131 Telefon Uygulamas\u0131<\/em>\u201d refah, sa\u011fl\u0131k ve sosyal ba\u011flant\u0131n\u0131n s\u00fcrd\u00fcr\u00fclmesi ya\u015fl\u0131 yeti\u015fkinler i\u00e7in \u00e7ok \u00f6nemlidir ve 2019 koronavir\u00fcs hastal\u0131\u011f\u0131 (COVID-19) salg\u0131n\u0131 s\u0131ras\u0131nda d\u00fcnyan\u0131n b\u00fcy\u00fck bir k\u0131sm\u0131 tecritle kar\u015f\u0131 kar\u015f\u0131ya kald\u0131\u011f\u0131 i\u00e7in bir tart\u0131\u015fma konusu haline gelmi\u015ftir. \u015eiddetli akut solunum sendromu korona vir\u00fcsten ciddi komplikasyonlar geli\u015ftirme a\u00e7\u0131s\u0131ndan daha y\u00fcksek risk alt\u0131nda olduklar\u0131 i\u00e7in ya\u015fl\u0131 hastalara kendilerini izole etmeleri \u00f6nerilmi\u015ftir. Ek olarak, \u00fclke \u00e7ap\u0131ndaki huzurevleri ve yard\u0131ml\u0131 ya\u015fam tesisleri, sakinlerini korumak i\u00e7in kap\u0131lar\u0131n\u0131 ziyaret\u00e7ilere kapatm\u0131\u015ft\u0131r. Uygulamalar gibi mobil teknolojiler, ailelerin ba\u011flant\u0131da kalmas\u0131na yard\u0131mc\u0131 olmak ve ya\u015fl\u0131 hastalar\u0131n hareketlili\u011fi s\u00fcrd\u00fcrmelerine yard\u0131mc\u0131 olmak ve onlar\u0131 fiziksel ve zihinsel refah\u0131 te\u015fvik eden kaynaklara ba\u011flamak i\u00e7in de\u011ferli bir ara\u00e7 sa\u011flayabilir. Uygulamalar bili\u015fsel, g\u00f6rsel ve i\u015fitme bozukluklar\u0131n\u0131 ele alabilir. Ama\u00e7lar\u0131, fiziksel ve bili\u015fsel s\u0131n\u0131rlamalar\u0131 ele alan ve \u00f6zellikle sosyal mesafe veya kendi kendine karantina s\u0131ras\u0131nda ya\u015fl\u0131 hastalar\u0131n ya\u015fam kalitesini iyile\u015ftirme potansiyeline sahip 15 uygulama \u00f6zetlenmektir (\u015eekil-3).<\/p>\n\n\n\n

\"\"<\/figure>\n\n\n\n

\u015eekil-3:<\/strong> Ya\u015fl\u0131 hastalar\u0131n evde kullanabilece\u011fi 15 aplikasyon.<\/p>\n\n\n\n

Bu uygulamalar ucuz ve eri\u015filebilir olup, ara\u015ft\u0131rma ya\u015fl\u0131 hastalar\u0131n olanaklar sa\u011fland\u0131\u011f\u0131nda ak\u0131ll\u0131 telefonlar\u0131 kullanabilece\u011fini g\u00f6stermi\u015ftir. Uygulamalar tam olarak y\u00fcz y\u00fcze bak\u0131m\u0131n yerine ge\u00e7emese de, baz\u0131 durumlarda y\u00fcz y\u00fcze bak\u0131mlar\u0131 tamamlayabilir veya ikame edebilir.<\/p>\n\n\n\n

Sonu\u00e7 olarak n\u00fcfus ya\u015flanmaya devam ettik\u00e7e, ya\u015fl\u0131 yeti\u015fkinler gen\u00e7 gruplara g\u00f6re orant\u0131sal olarak daha y\u00fcksek yan etki oranlar\u0131na sahip oldu\u011fundan geriatrik hastalar\u0131n bak\u0131m\u0131 daha fazla ilgi g\u00f6rmektedir. Ya\u015fl\u0131 yeti\u015fkinler di\u011fer hastalardan \u00e7e\u015fitli \u015fekillerde farkl\u0131l\u0131k g\u00f6sterebilir. Ayr\u0131ca, acil servisin h\u0131zl\u0131 tempolu, hedefe y\u00f6nelik ortam\u0131, genellikle daha akut, karma\u015f\u0131k veya atipik hastal\u0131k sunumlar\u0131 olan ya\u015fl\u0131 hastalar\u0131n tedavisine her zaman elveri\u015fli de\u011fildir, bu da davran\u0131\u015f veya sistem de\u011fi\u015fikli\u011fine olan ihtiyac\u0131 vurgular.<\/p>\n\n\n\n

Kaynaklar<\/em><\/strong><\/p>\n\n\n\n

    \n
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  20. Banskota S, Healy M, Goldberg EM. 15 Smartphone Apps for Older Adults to Use While in Isolation During the COVID-19 Pandemic. West J Emerg Med. 2020 Apr 14;21(3):514-525. doi: 10.5811\/westjem.2020.4.47372. <\/li>\n<\/ol>\n","protected":false},"excerpt":{"rendered":"

    Yeni bir yaz\u0131 dizimizle t\u00fcm okuyucular\u0131m\u0131za merhaba; Geriatri \u00e7al\u0131\u015fma grubu olarak bu ay ki yaz\u0131 dizimizin konusu \u2018\u2019Geriatrik aciller konusunda son 5…<\/p>\n","protected":false},"author":1185,"featured_media":452,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"inline_featured_image":false,"_lmt_disableupdate":"","_lmt_disable":"","footnotes":""},"categories":[1,10014],"tags":[10018],"class_list":["post-451","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-genel","category-akademik-blog-yazisi","tag-geriatri"],"acf":[],"_links":{"self":[{"href":"https:\/\/tatd.org.tr\/geriatri\/wp-json\/wp\/v2\/posts\/451","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/tatd.org.tr\/geriatri\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/tatd.org.tr\/geriatri\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/tatd.org.tr\/geriatri\/wp-json\/wp\/v2\/users\/1185"}],"replies":[{"embeddable":true,"href":"https:\/\/tatd.org.tr\/geriatri\/wp-json\/wp\/v2\/comments?post=451"}],"version-history":[{"count":0,"href":"https:\/\/tatd.org.tr\/geriatri\/wp-json\/wp\/v2\/posts\/451\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/tatd.org.tr\/geriatri\/wp-json\/wp\/v2\/media\/452"}],"wp:attachment":[{"href":"https:\/\/tatd.org.tr\/geriatri\/wp-json\/wp\/v2\/media?parent=451"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/tatd.org.tr\/geriatri\/wp-json\/wp\/v2\/categories?post=451"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/tatd.org.tr\/geriatri\/wp-json\/wp\/v2\/tags?post=451"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}