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Medical Assessment (medical + assessment)
Selected AbstractsCancer risk from diagnostic radiology in a deliberate self-harm patientACTA PSYCHIATRICA SCANDINAVICA, Issue 5 2010L. J. Norelli Norelli LJ, Coates AD, Kovasznay BM. Cancer risk from diagnostic radiology in a deliberate self-harm patient. Objective:, Patients who engage in recurrent deliberate self-harm (DSH) behaviours have increased morbidity and mortality and use emergency services more than others. Unrecognized iatrogenic injury may play a role. Specifically, we call attention to the potential danger of cumulative radiation exposure. Method:, Case presentation and discussion. Results:, A 29-year-old woman with multiple episodes of deliberate foreign body ingestion received over 400 diagnostic radiology examinations during a 12 year period. The patient's calculated total radiation dose reached an average of 20.5 mSv per year, a dose comparable to atomic bomb survivors and nuclear industry workers, populations in which there is a significant excess cancer risk. Conclusion:, Patients with recurrent self-injurious behaviours, frequent users of healthcare services who often undergo repeated medical assessment and treatment, are likely at higher risk for iatrogenic adverse events. Multiple diagnostic radiology examinations have recently come under scrutiny for causing increased lifetime risk of cancer. Healthcare providers, in particular psychiatrists and emergency department physicians, should consider the cumulative risks of radiological procedures when assessing and treating patients with DSH. [source] Emergency nurse practitioner care and emergency department patient flow: Case,control studyEMERGENCY MEDICINE AUSTRALASIA, Issue 4 2006Julie Considine Abstract Objective:, The present study aimed to compare ED waiting times (for medical assessment and treatment), treatment times and length of stay (LOS) for patients managed by an emergency nurse practitioner candidate (ENPC) with patients managed via traditional ED care. Methods:, A case,control design was used. Patients were selected using the three most common ED discharge diagnoses for ENPC managed patients: hand/wrist wounds, hand/wrist fractures and removal of plaster of Paris. The ENPC group (n = 102) consisted of patients managed by the ENPC who had ED discharge diagnoses as mentioned above. The control group (n = 623) consisted of patients with the same ED discharge diagnoses who were managed via traditional ED care. Results:, There were no significant differences in median waiting times, treatment times and ED LOS between ENPC managed patients and patients managed via traditional ED processes. There appeared to be some variability between diagnostic subgroups in terms of treatment times and ED LOS. Conclusion:, Patient flow outcomes for ENPC managed patients are comparable with those of patients managed via usual ED processes. [source] Contemporary referral of patients from community care to cardiology lack diagnostic and clinical detailINTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 5 2006S. Bodek Summary The quantity of referrals to secondary care is increasing. That the quality of medical referrals is decreasing is a common allegation yet has rarely been assessed. We report a time-limited, cross-sectional survey evaluating cardiological referral information quality. Referral letters (n = 218, excluding direct access pro formas) from GPs to the Cardiology Department at City Hospital, Birmingham, were collated and analysed over 2 months. A subset (n = 49) of these patients completed questionnaires assessing their knowledge and patient communication of the referral. Information quality was poor (length, diagnosis, expectation, prior treatment and investigation) with almost half of all letters containing only outline symptomatic complaints without diagnosis. The majority of patients referred had not been investigated or treated in any way before referral. Despite lack of understanding of the reason for referral, typically the majority of patients expressed themselves as satisfied with the process. Given most referrals are seen as appropriate, information exchange between secondary and primary care is crucial. By contrast, the standard of even basic clinical assessment communicated between primary care and secondary care was severely limited. The reason(s) why medical assessment is lacking are unclear but must be explored to give more support to primary care to complete basic medical task particularly if investment is to flow into this source. [source] Measuring the opinions of memory clinic users: patients, relatives and general practitionersINTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 9 2001H. P. J. van Hout Abstract Background The opinions of memory clinic users are important to assess the value of memory clinics. Objective To measure the quality of care of an outpatient memory clinic for the elderly as perceived by patients, their relatives and general practitioners (GPs). Methods An observational study was conducted to measure the opinions of the users of a typical outpatient memory clinic. Opinions on five aspects were measured: (1) communication of the results, (2) provision of diagnostic information, (3) attitude of the clinicians, (4) usefulness of the medical assessment, and (5) information and advice to relatives. Patients and relatives were both interviewed with a dementia care satisfaction questionnaire. The GPs' opinions were derived with a self-constructed questionnaire. Results On 105 consecutive assessments, 101 opinions of GPs, 81 of caregivers and 31 of patients were recorded. Positive opinions were recorded on the way the results were communicated, the usefulness of the assessment and attitude of the clinicians. In contrast to GPs and relatives, patients were less positive about the clarity of the diagnostic information received. Both relatives and GPs were negative on information and advice to relatives. Conclusions Patients, caregivers and GPs had positive opinions about the diagnostic value of the memory clinic. Quality improvement could focus on the clarity of the diagnostic information for patients and on better advice to relatives. Copyright © 2001 John Wiley & Sons, Ltd. [source] Plasma Carboxymethyl-Lysine, an Advanced Glycation End Product, and All-Cause and Cardiovascular Disease Mortality in Older Community-Dwelling AdultsJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 10 2009Richard D. Semba MD OBJECTIVES: To determine whether older adults with high plasma carboxymethyl-lysine (CML), an advanced glycation end product, are at higher risk of all-cause and cardiovascular disease (CVD) mortality. DESIGN: Prospective cohort study. SETTING: Population-based sample of adults aged 65 and older residing in Tuscany, Italy. PARTICIPANTS: One thousand thirteen adults participating in the Invecchiare in Chianti study. MEASUREMENTS: Anthropometric measures, plasma CML, fasting plasma total, high-density and low-density lipoprotein cholesterol, triglycerides, glucose, creatinine. Clinical measures: medical assessment, diabetes mellitus, hypertension, coronary heart disease, heart failure, stroke, cancer. Vital status measures: death certificates and causes of death according to the International Classification of Diseases. Survival methods were used to examine the relationship between plasma CML and all-cause and CVD mortality, adjusting for potential confounders. RESULTS: During 6 years of follow-up, 227 (22.4%) adults died, of whom 105 died with CVD. Adults with plasma CML in the highest tertile had greater all-cause (hazard ratio (HR)=1.84, 95% confidence interval) CI)=1.30,2.60, P<.001) and CVD (HR=2.11, 95% CI=1.27,3.49, P=.003) mortality than those in the lower two tertiles after adjusting for potential confounders. In adults without diabetes mellitus, those with plasma CML in the highest tertile had greater all-cause (HR=1.68, 95% CI=1.15,2.44, P=.006) and CVD (HR=1.74, 95% CI=1.00,3.01, P=.05) mortality than those in the lower two tertiles after adjusting for potential confounders. CONCLUSION: Older adults with high plasma CML are at higher risk of all-cause and CVD mortality. [source] Prevalence of vision, hearing, and combined vision and hearing impairments in patients with hip fracturesJOURNAL OF CLINICAL NURSING, Issue 21 2009Else Vengnes Grue Aims and objectives., To examine the prevalence of hearing and vision impairments in 65+ year-old patients with hip fractures. Background., Many older people believe sensory problems are inevitable and thus avoid medical assessment and assistance. Furthermore, health professionals often overlook sensory problems, though it is known that sensory impairments can increase the risk of falling and sustaining hip fractures. Design., A prospective, observational study. Methods., We admitted 544 consecutive patients to an orthogeriatric ward from October 2004,July 2006; 332 were screened for study inclusion with the Resident Assessment Instrument for Acute Care (InterRAI-AC) and a questionnaire (KAS-Screen). We conducted patient interviews, objective assessments, explored hospital records and interviewed the family and staff. Impairments were defined as problems with seeing, reading regular print or hearing normal speech. Results., Sixteen per cent of the patients had no sensory impairments, 15·4% had vision impairments, 38·6% had hearing impairments and 30·1% had combined sensory impairments. Among the impaired, 80·6% were female, the mean age was 84·3 years (SD 6·8), 79·9% were living alone, 48·0% had cognitive impairments, 89·6% had impaired activities of daily living, 70·6% had impaired instrument activities in daily living, 51·0% had bladder incontinence and 26·.8% were underweight. Comorbidity and polypharmacy were common. Delirium was detected in 17·9% on day three after surgery. Results showed the prevalence of combined sensory impairments was: 32·8% none; 52·2% moderate/severe; and 15·1% severe. Conclusion., Patients with hip fractures frequently have hearing, vision and combined impairments. Relevance to clinical practice., We recommend routine screening for sensory impairments in patients with hip fractures. Most sensory problems can be treated or relieved with environmental adjustments. Patients should be encouraged to seek treatment and training for adapting to sensory deficiencies. This approach may reduce the number of falls and improve the ability to sustain independent living. [source] Emotional response to the ano-genital examination of suspected sexual abuseJOURNAL OF FORENSIC NURSING, Issue 3 2009Gail Hornor RNC Abstract Introduction: Concerns have arisen among professionals working with children regarding potential emotional distress as a result of the ano-genital examination for suspected child sexual abuse. The purpose of this study was to describe and compare children's anxiety immediately preceding and immediately following the medical assessment of suspected child sexual abuse, including the ano-genital exam, and to examine demographic characteristics of those children reporting clinically significant anxiety. Method: In this descriptive study, children between the ages of 8 to 18 years of age requiring an ano-genital examination for concerns of suspected sexual abuse presenting to the Child Assessment Center of the Center for Child and Family Advocacy at Nationwide Children's Hospital were asked to participate. The Multidimensional Anxiety Scale for Children (MASC-10) was utilized in the study. The MASC-10 was completed by the child before and after the physical exam for suspected sexual abuse. Results: Although most (86%) children gave history of sexual abuse during their forensic interview, the majority (83%) of children in this study did not report clinically significant anxiety before or after the child sexual abuse examination. Children reporting clinically significant anxiety were more likely to have a significant cognitive disability, give history of more invasive forms of sexual abuse, have a chronic medical diagnosis, have a prior mental health diagnosis, have an ano-genital exam requiring anal or genital cultures, and lack private/public medical insurance. Discussion: A brief assessment of child demographics should be solicited prior to exam. Children sharing demographic characteristics listed above may benefit from interventions to decrease anxiety regardless of provider ability to detect anxiety. [source] Death and International Travel,The Canadian Experience: 1996 to 2004JOURNAL OF TRAVEL MEDICINE, Issue 2 2007Douglas W. MacPherson MD, FRCPC, MSc(CTM) Background Death during international travel concerns several levels of the travel industry. In addition to the immediate effects for the traveler, their family and friends, the nature of travel-related mortality has important implications for pretravel health advisors and providers of medical care services. Methods The Consular Affairs Bureau, Foreign Affairs Canada provides information and assistance to Canadian civilians abroad. Beginning in 1995, the Consular Management and Operations System tracked Canadian deaths abroad notifications. The annual data for 1996 to 2004 was extracted for sex, age, and cause of death by location for all reports received. Results There were 2,410 reported deaths in Canadians abroad; reported sex was 32% female and 68% male, average age of 61.7 and 60.4 years, respectively. Recorded causes of death: natural (1,762), accidental (450), suicide (92), and murder (106). Country of death reflected the pattern of Canadian international travel for recreation, business, and ancestral linkages. Average age of natural death (66 years) distinguished it from all other causes of death: accidental (45), suicide (41), and murder (43). Conclusion Natural causes and suicide deaths may be anticipated or planned to occur abroad. The risk of death may be mitigated through personal knowledge and medical assessment and prevention strategies. Deaths due to vaccine-preventable diseases, exotic and infectious diseases were rare in this population. Consular services may be able to provide various types of support. Local laws and customs, as well as international regulations in health and quarantine govern other responsibilities such as funeral services and repatriation of the deceased to Canada. [source] Home safety assessment in the prevention of falls among older peopleAUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH, Issue 5 2000Nancye Peel Objective:Home safety assessment was examined as part of a randomised trial of falls prevention interventions among older community dwellers. Method:Falls prevention strategies, including education and awareness-raising, exercise, home modifications and medical assessment, were trialled with 252 members of the National Seniors Association. Falls outcomes were monitored using a daily calendar diary during intervention and follow-up periods. Results:The home assessment group was significantly more likely to modify their home environment than the controls (p<0.0001). Participants, regardless of group allocation, reported a significant reduction in concern about falling (p<0.0001). During the intervention, the home assessment group had lower incidence rates for falls and injuries than the control group, although differences were not significant. The lowered rates were sustained post-intervention. Conclusions:While the effect on falls incidence of a home safety intervention on its own could not be demonstrated, other benefits, including improved confidence attributable to awareness of such falls prevention measures, were recorded. Implication:The null effects of home modifications on falls prevention in this study may indicate that the program is more appropriate for the frail aged. [source] Intraoral condition in children with juvenile idiopathic arthritis compared to controlsINTERNATIONAL JOURNAL OF PAEDIATRIC DENTISTRY, Issue 6 2008EVA LEKSELL Aims. The aims of this study were to compare the periodontal conditions in children and adolescents with juvenile idiopathic arthritis (JIA) in comparison to age-matched healthy individuals, and to describe intraoral health in relation to medical assessments. Design. Forty-one JIA patients, 10,19 years old, were compared to 41 controls. Plaque, calculus, probing depth, bleeding on probing, clinical attachment loss, as well as mucosal lesions were registered. Marginal bone level was recorded on radiographs. A questionnaire was included. Data were analysed with chi-squared test, Fisher's exact test, and Mann,Whitney U -test (P < 0.05). Results. The JIA patients reported pain from jaws (P = 0.001), hands (P = 0.001), and oral ulcers (P = 0.015) more often than controls. They avoided certain types of food because of oral ulcers (P = 0.037). The frequencies of sites with plaque (32% vs. 19%, P = 0.013), calculus (11% vs. 5%, 5 = 0.034), bleeding on probing (26% vs. 14%, P < 0.01), and probing depth 2 mm (32% vs. 2%, P < 0.001) were higher among JIA patients. No sites with attachment loss or reduced marginal bone level were observed. Conclusions. These obtained results are probably because of joint pain, making it difficult to perform oral hygiene as well as the use of medication and general disease activity. [source] The Medical Assessment of Migrants: Current Limitations and Future PotentialINTERNATIONAL MIGRATION, Issue 2 2001V.P. Keane Attempts to control the importation of infectious diseases through the medical screening and evaluation of immigrants and refugees represent the modern application of some of the earliest recorded public health interventions. States with long-standing immigration programmes continue to require the medical examination and screening of migrants for certain diseases. In some instances, the public health effectiveness of these immigration medical assessments is of questionable value when considered from a population health basis. This article reviews current practices and describes recent studies where more modern and epidemiologically based immigration medical interventions have been undertaken. A more effective immigration medical assessment process is proposed through the use of results of this more empirical approach to immigration medical screening. [source] Evaluating Co-primary Endpoints Collectively in Clinical Trials,BIOMETRICAL JOURNAL, Issue 1 2009Qian H. Li Abstract Often a treatment is assessed by co-primary endpoints so that a comprehensive picture of the treatment effect can be obtained. Co-primary endpoints can be different medical assessments angled at different aspects of a disease, therefore, are used collectively to strengthen evidence for the treatment effect. It is common sense that if a treatment is ineffective, the chance to show that the treatment is effective in all co-primary endpoints should be small. Therefore, it may not be necessary to require all the co-primary endpoints to be statistically significant at the 1-sided 0.025 level to control the error rate of wrongly approving an ineffective treatment. Rather it is reasonable to allow certain variation for the p -values within a range close to 0.025. In this paper, statistical methods are developed to derive decision rules to evaluate co-primary endpoints collectively. The decision rules control the error rate of wrongly accepting an ineffective treatment at the level of 0.025 for a study and the error rate at a slightly higher level for a treatment that works for all the co-primary endpoints except perhaps one. The decision rules also control the error rates for individual endpoints. Potential applications in clinical trials are presented (© 2009 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim) [source] | |||||||||||||||||||