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Outpatient Department (outpatient + department)
Selected AbstractsIncreasing trend of acute hepatitis A in north India: Need for identification of high-risk population for vaccinationJOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY, Issue 4 2006Zahid Hussain Abstract Background and Aims:, Hepatitis A (HAV) is endemic in India and most of the population is infected asymptomatically in early childhood with lifelong immunity. Because of altered epidemiology and decreasing endemicity, the pattern of acute HAV infection is changing from asymptomatic childhood infection to an increased incidence of symptomatic disease in the 18,40 age group. The aims of the present study were to assess whether the proportion of adults with acute HAV infection has been increasing over the years and to analyze the seroprevalence of immunoglobulin G (IgG) anti-HAV antibodies in young adults above the age of 15 years as well as in cases of chronic liver disease. Methods:, Sera collected from 3495 patients with acute (1932) and chronic (1563) liver disease attending the Medical Outpatient Department of Lok Nayak Hospital during the previous five years (1999,2003) were tested for various serological markers of acute (HBsAg, HBcIgM, anti-HCV, HEV-IgM, and HAV-IgM) and chronic (HBsAg, HBcIgG, HBeAg, and anti-HCV) hepatitis. In addition, 500 normal healthy attendants of the patients above the age of 15 years were tested for IgG anti-HAV as controls. Results:, Of 1932 patients with acute viral hepatitis, 221 (11.4%) were positive for immunoglobulin M (IgM) anti-HAV. The patients who were IgM anti-HAV negative included hepatitis B (321 patients), C (39 patients), E (507 patients) and unclassified (844 patients). Although the frequency of HAV infection among children had increased (10.6% to 22.0%) in the 5-year period, the frequency of HAV infection among adults had also increased (3.4% to 12.3%) during the same period. A total of 300 patients with chronic liver diseases that were etiologically related to hepatitis B (169), C (73) or dual infection (10) and alcoholic liver injury (48) were tested for the presence of IgG anti-HAV antibody; 98% (294/300) were positive for the antibody. Conclusions:, Although universal vaccination against HAV is not currently indicated, selective vaccination of the high-risk population, based on their serological evidence of HAV antibody, would be a rational and cost-effective approach. [source] Erythema dyschromicum perstans and hepatitis C virus infectionINTERNATIONAL JOURNAL OF DERMATOLOGY, Issue 5 2001George J. Kontochristopoulos MD A 48-year-old woman with a 10-month history of widespread, hyperpigmented, slightly pruritic macules, with a red border, involving the trunk and the proximal limbs (Fig. 1) was referred to our outpatient department. The oral mucosa, palms, soles, scalp, and nails were normal. Figure 1. Multiple hyperpigmented macules with an active border on the trunk Laboratory tests showed elevated liver enzymes [alanine aminotransferase (ALT), 68 IU/L (normal value, <,40 IU/L); aspartate aminotransferase (AST), 41 IU/L (normal value, <,40 IU/L)], the presence of antibodies to hepatitis C virus (anti-HCV) and HCV RNA (Amplicor Roche). In addition, cryoglobulinemia type III (IgM,,,, IgG,,,) was detected with a high cryocrit value, and there was detectable C-reactive protein, rheumatoid factor, and a low titer of antinuclear antibodies (1 : 80). A percutaneous liver biopsy showed changes compatible with mild chronic hepatitis (grade, 6; stage, 0). The possible source of infection was unknown, as the patient had no history of parenteral transmission (e.g. blood transfusions, intravenous illicit drug use). A skin biopsy specimen from the active border of a lesion showed hyperkeratosis, parakeratosis, and hydropic degeneration of the basal cell layer, with the formation of colloid bodies in the epidermis. A moderate perivascular lymphohistiocytic infiltrate with melanophages and free melanin granules was observed in the upper dermis (Fig. 2). Immunostaining of paraffin-embedded tissue sections with the TORDJT-22 IgG1 mouse monoclonal antibody to HCV (Biogenex, Son Ramon, USA), which is specific for the nonstructural region of HCV (NS3-NSH, C100 antigen) using the avidin,biotin,peroxidase complex (ABC) as well as the alkaline phosphatase antialkaline phosphatase (APAAP) methods, failed to detect HCV in the lesion of erythema dyschromicum perstans (EDP) (Nakopoulou L, Manolaki N, Lazaris A et al. Tissue immunodetection of C100 hepatitis C virus antigen in major thalassemic patients. Hepato-Gastroenterol 1999; 46: 2515,2520). Direct immunofluorescence showed IgG, IgM, IgA, and fibrinogen deposits on colloid bodies. EDP was diagnosed on the basis of these clinical and laboratory findings. Figure 2. Hydropic degeneration of the basal cell layer with colloid bodies in the epidermis. Moderate perivascular lymphohistiocytic infiltrate with melanophages and free melanin granules in the upper dermis (hematoxylin and eosin, ×,200) The patient was treated with interferon-,2b (Intron-A, Schering Plough Athens, Greece), 3 MU thrice weekly subcutaneously for 12 months, with additional topical steroid application. There was no response to this treatment with new lesions appearing in previously unaffected areas of the trunk and extremities. HCV RNA remained persistently positive. Thus, a modified regimen with interferon-,2b, 6 MU thrice weekly for 6 months, was tried. At the end of the treatment course, the eruption of EDP had greatly improved. Liver enzymes were normal (ALT, 22 IU/L; AST, 24 IU/L) and HCV RNA had become negative. Four months later, however, cutaneous lesions reappeared and hepatitis C relapsed. At this time point, combination therapy of interferon-,2b, 3 MU thrice weekly, with ribavirin, 1000 mg daily, was given. Six months later, liver enzymes were normal (ALT, 42 IU/L; AST, 39 IU/L), HCV RNA was negative, and the lesions of EDP had resolved. [source] The informant questionnaire on cognitive decline in the elderly (IQCODE) is associated with informant stressINTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 11 2009Harald A. Nygaard Abstract Objective To study the association between informant stress and appraisal of patients' cognitive functioning as reported by the Informant Questionnaire on Cognitive Decline in the Elderly,IQCODE. Methods Routinely collected data from a geriatric outpatient department (207 dyads) during the years 1995,1998 were analysed. Relative stress scale (RSS) has been categorised for possible low, intermediate and high risk of psychiatric morbidity and caregivers were combined to four groups (female and male spouses and female and male non-spouses, respectively). The relationship between IQCODE (dependent) and categorised RSS and informant groups and patient age was further studied by means of the general linear model (GLM,UNIANOVA). Results In general, spouses reported better cognitive functioning than non-spouses. There was a significant association between IQCODE and RSS (p,<,0.001), and the composite variable informant group and informant gender (p,<,0.001). The main effect of the interaction term RSS,×,informant group,+,informant gender was not significant. Post hoc test, however, revealed a significant effect of the interaction term RSS,×,female spouses (p,<,0.001) on IQCODE. Conclusion IQCODE is associated with informant stress. Categorisation of RSS score into groups of low, intermediate and high risk for psychiatric morbidity can be a valuable contribution to a more meaningful application of RSS in general practice. Copyright © 2009 John Wiley & Sons, Ltd. [source] Prostate-specific antigen adjusted for the transition zone volume as a second screening test: A prospective study of 248 casesINTERNATIONAL JOURNAL OF UROLOGY, Issue 7 2006SEOK-HO KANG Aim:, This study was conducted to verify the effectiveness of prostate-specific antigen adjusted for the transition zone volume (PSATZ), and its availability as a second screening test for prostate cancer detection. Materials and methods:, Total prostate-specific antigen (PSA) and free PSA was measured in male patients who visited our outpatient department for voiding difficulty or screening for prostate cancer. Patients who had an intermediate PSA level between 4.0 and 10.0 ng/mL, with an apparently normal prostate on a digital rectal examination, were enrolled. PSATZ, free-to-total PSA ratio (F/T ratio) and PSA density (PSAD) were calculated and statistical comparisons between biopsy-positive (cancer) and biopsy-negative patients (benign) were conducted. Results:, Of 248 patients, 51 (20.6%) had prostate cancer and 197 (79.4%) had benign prostatic hyperplasia (BPH) on pathologic examination. Mean PSA, PSAD, F/T ratio and PSATZ were 7.48 ± 1.77 ng/mL, 0.23 ± 0.09 ng/mL per mL, 0.14 ± 0.08 and 0.71 ± 0.44 ng/mL per mL in patients with prostate cancer and 6.59 ± 1.60 ng/mL, 0.16 ± 0.07 ng/mL per mL, 0.21 ± 0.11 and 0.36 ± 0.30 ng/mL per mL in patients with benign, respectively. Receiver operating characteristics (ROC) curve analysis demonstrated that PSATZ predicted the biopsy outcome better than F/T ratio. With a cut-off value of 0.37 ng/mL per mL, PSATZ had a sensitivity of 74.5% and a specificity of 72.6% for predicting prostate cancer. The maximal cut-off value that preserves 100% of sensitivity was 0.2, and at this cut-off value, 16.1% of unnecessary biopsies could be reduced. Conclusions:, Prostate-specific antigen adjusted for the transition zone volume may be more useful than other strategies in detecting prostate cancer in patients with intermediate PSA levels of 4.0,10.0 ng/mL. It can be used as a second screening test to reduce unnecessary biopsy. [source] Cytokines, Osteoprotegerin, and RANKL In Vitro and Histomorphometric Indices of Bone Turnover in Patients With Different Bone Diseases,JOURNAL OF BONE AND MINERAL RESEARCH, Issue 3 2003Heide Siggelkow Abstract Cytokines are supposed to play an essential role in the regulation of the bone metabolic unit. However, information on cytokine production of primary human osteoblasts from patients with metabolic bone disease is scarce, and few attempts have been made to correlate such data to histomorphometric parameters of individual patients. We investigated 11 patients with metabolic bone disease referred to our outpatient department for bone biopsy and analyzed interleukin (IL)-1, IL-6, and TNF-, protein release and gene expression in primary osteoblast cultures. Compared with four controls, five patients showed normal cytokine protein release, whereas six patients showed much higher levels of interleukin-6 (26-fold) and TNF-, (84-fold). All three cytokines were strongly correlated concerning gene expression and/or protein levels (r = 0.72,0.96). Histomorphometric analysis of the bone samples showed that eroded surface (ES/BS) as a parameter of bone resorption was significantly associated with TNF-,. In addition, RANKL gene expression was positively associated with ES/BS and osteoclast surface (Oc.S/BS). Finally, the formation parameters osteoid volume and osteoid surface were negatively associated with TNF-,. In conclusion, in an in vitro-ex vivo model of bone cells obtained from a group of 11 patients with different forms of metabolic bone disease, cytokine release in conditioned medium was significantly associated with bone resorption and bone formation, as quantified by histomorphometry. TNF-, seemed to be the more important cytokine; its effect on bone resorption could be mediated by RANKL. [source] The fatigue experiences of older Taiwanese women with breast cancerJOURNAL OF CLINICAL NURSING, Issue 5-6 2010Sung-Ling Tsai Aims and objectives., This study explored the fatigue experiences in older Taiwanese women with breast cancer. Background., Cancer is a common disease for older people, and breast cancer ranks second in occurrence among all cancers. Fatigue is the most frequently seen symptom, with more than 90% of cancer patients having such experiences. Fatigue may lead to functional dependence, affecting the care and quality of life for this older population. Design., A qualitative design was used in this study. Methods., In-depth interviews were conducted with participants being treated at the oncology outpatient department in a teaching hospital in northern Taiwan. Data were collected from November 2006,March 2007. Results., The study included 15 women, aged 65,82, with breast cancer. Analysis of the interviews revealed three themes: factors related to fatigue, interpretation of fatigue and ways to deal with fatigue. The factors related to fatigue arose from treatment, symptom distress and the impact of their emotions. Participants interpreted the fatigue as an inevitable normal reaction, and they were embarrassed to share its occurrence with others. Although fatigue made participants suffer, they found the ways to decrease the feeling of fatigue using psychological adjustments, practical changes and support systems. Conclusions., Facing the multilayered influences from treatments and ageing, older women with breast cancer considered fatigue as a physical and psychological expression. By raising the awareness of fatigue, nurses can help this older population manage or relieve fatigue by controlling symptoms, providing emotional support and making related resources available. Relevance to clinical practice., The results of this study can enhance the sensitivity and evaluation abilities of nurses in dealing with the cancer-related fatigue in older women with breast cancer. [source] Clinical drug interactions in outpatients of a university hospital in ThailandJOURNAL OF CLINICAL PHARMACY & THERAPEUTICS, Issue 6 2005B. Janchawee PhD Summary Background:, A clinical event is likely to occur in patients receiving a pair of drugs, that have the potential to cause an interaction. The occurrence of a clinical drug,drug interaction in outpatients of university hospitals in Thailand is unknown. Purpose:, To investigate the occurrence of a clinical event associated with drug,drug interactions in outpatients at a Thai university hospital. Methods:, A case,control study was established. The case was a sample group, randomly selected from a 1-year sample of outpatient prescriptions containing ,significance-1' potential drug,drug interactions, whereas the control was from the same year but with no potential drug interactions. Medical records of the cases and the controls were reviewed for an adverse event (AE) using a newly developed review form. The odds ratio of occurrence of the AE between the cases and the controls was determined. The AE was assessed for its possibility of being caused from a drug,drug interaction. Results:, The most common specific AE in both the cases and the controls was cough. An unplanned revisit to outpatient department or emergency room was found to be the most common general AE. The odds ratio of the occurrence of an AE in the cases, compared with the controls, was 1·495 (95% CI: 0·917,2·438). The possibility that the AEs resulted from drug interactions in the case group was nine ,probable' patients and 15 ,possible' patients, whereas that in the control group was eight ,possible' patients. The most common interacting drug pair was isoniazid,rifampin with an increase in serum hepatic enzymes as the corresponding AE. Conclusions:, Despite outpatients receiving drug pairs with a high potential for adverse interactions, the rate of occurrence of clinical drug interaction events was low. [source] Epidemiology of gallstone disease in Chandigarh: A community-based studyJOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY, Issue 5 2001Virendra Singh Abstract Background: Cholelithiasis is frequent in our country (India), and is a common cause for abdominal surgery. We studied the prevalence of gallstone disease and its association with various risk factors in the city of Chandigarh. Methods: A house-to-house survey of residents aged 15 years or above in a subsector of Chandigarh was conducted as a part of a pilot survey. All individuals with a history of gallstone disease, and equal or more number of asymptomatic individuals were asked to attend the outpatient department of the Postgraduate Medical Institute. On the basis of the pilot survey, the sample size to be studied was 2648 and we screened 2649 persons. Results: Two hundred and fifty-four individuals attended the outpatient services of the Institute, and 248 underwent an ultrasound. There were 37 symptomatic and 211 asymptomatic individuals (male : female, 93:155). Gallstone disease was seen in 24 out of 37 (64.9%) in the symptomatic, and seven out of 211 (3.3%) in the asymptomatic group. Out of these, 27 females and four males had gallstone disease (mean age: 48.30 ± 16.03 years). Approximately 67% of patients were between 20 and 60 years of age. Gallstone disease was more frequently seen in those from high socioeconomic status as compared to middle socioeconomic status (,2 = 8.9, d.f. = 1, P < 0.01), and in multiparous as compared to nulliparous females (,2 = 4.8, d.f. = 1, P < 0.05). Body mass index, smoking, alcohol consumption, and a vegetarian/non-vegetarian diet did not influence the prevalence of gallstone disease. Conclusions: Gallstone disease is frequent in northern India. Gallstones were frequent in those belonging to high socioeconomic status and multiparous females. However, body mass index, smoking, alcohol or other dietary habits did not make a difference. [source] Usefulness of single spot plasma glucose at a routine clinic: a preliminary reportPRACTICAL DIABETES INTERNATIONAL (INCORPORATING CARDIABETES), Issue 2 2008OR Adetunji MBBS Fellow of the West African College of Physicians (FWACP), Research Registrar, Senior Registrar Abstract While glycated haemoglobin remains the gold standard for assessing glycaemic control, the facilities for measuring it are not readily available in resource-poor health systems like that which exists in Nigeria. This study set out to determine the usefulness of fasting single spot plasma glucose at clinic visits in the management of diabetes. Fifty consecutive patients with type 2 diabetes attending the medical outpatient department at the University College Hospital, Ibadan, Nigeria, were recruited after informed written consent was obtained. HbA1c was measured using boronate affinity technique with a portable , Primus' autoanalyser, NycoCard® Reader II, which was standardised to the DCCT. Fasting plasma glucose (FPG) was measured in mg/dl but converted to mmol/L. Anthropometric measurements were taken from the patients. The results showed that the mean HbA1c in the population was 7.4% and the mean FPG was 7.0mmol/L. There was a significant correlation between FPG and HbA1c, (p<0.0001, r2 = 0.749). We concluded that the significant correlation between the HbA1c and FPG in this patient population shows that the FPG remains a useful tool for assessing control at routine outpatient clinics and its continued use is recommended. Copyright © 2008 John Wiley & Sons. [source] Sudden bilateral sensorineural hearing loss after intravenous cocaine injection: A case report and review of the literatureTHE LARYNGOSCOPE, Issue 12 2009Markus Stenner MD Abstract Little is known about the effects of intravenous abuse of cocaine, especially on the inner ear. We report on a 26-year-old man who presented to our outpatient department with a sudden severe hearing loss after intravenous injection of cocaine. The audiogram on admission showed symmetric air conduction levels up to 80 dB at 4 kHz. After treatment with intravenous sodium chloride, prednisolone, and pentoxifylline, the audiogram 2 days later showed a bilateral normacusis. A review of the literature on the topic is given and possible reasons for inner ear damages caused by cocaine are discussed. Laryngoscope, 2009 [source] Antisperm antibodies detected by mixed agglutination reaction and immunobead test are not associated with chronic inflammation and infection of the seminal tractANDROLOGIA, Issue 4 2008M. Marconi Summary The association between chronic inflammatory/infectious diseases of the male reproductive tract and the presence of antisperm antibodies (ASA) in semen is still controversial. We compared the results of the mixed agglutinin reaction (MAR) test and immunobead test for detecting ASA type IgG and IgA in 133 patients attending our special outpatient department for andrological infections and evaluated the differences in the detection rate of ASA. Patients were divided into three groups: a study group that included 79 patients with symptomatic nonacute inflammatory/infectious diseases of the seminal tract, a control group (n = 44) and a third group of men with a history of successful vasectomy reversal (n = 10). The two tests correlated in a statistically significant manner for the detection of IgG and IgA in all groups. The overall positive detection rate of clinical significant levels of IgG and IgA was 2.5% and 1.3% (respectively) in the patients with inflammation/infection of the seminal tract. No statistical significant difference in the detection rate of ASA levels between the inflammatory/infectious group and the controls was detected. The results of the MAR test and immunobead test have a statistical significant correlation and their results provide evidence that there is no association between inflammatory/infectious diseases of the male reproductive tract and the presence of ASA in semen. [source] The 2001 Giessen Cohort Study on patients with prostatitis syndrome , an evaluation of inflammatory status and search for microorganisms 10 years after a first analysisANDROLOGIA, Issue 5 2003H. Schneider Summary. During the last years tremendous changes have occurred in the epidemiologic knowledge and the diagnostic process of the prostatitis syndrome. A new worldwide-accepted classification system has become the gold standard in contemporary literature. The aim of this study was to compare the inflammatory and infectious status of men with prostatitis syndrome with results from our study cohort from 1992. A total of 168 symptomatic men (mean age 43.2 years; range 18,79) attending the Giessen prostatitis outpatient department were included. All men underwent a standard four-glass-test including leucocyte analysis in all specimens. A routine search for Ureaplasma urealyticum and Chlamydia trachomatis was performed. Ejaculate analysis following World Health Organization (WHO) criteria has been performed including the evaluation of increased number of peroxidase-positive leucocytes (PPL). Men were classified according to the National Institutes of Health (NIH) prostatitis classification. The distribution of patients according to NIH criteria is as follows: NIH II (4.2%), NIH IIIA (31.5%), NIH IIIB (50.0%) and urethroprostatitis (14.3%). Chlamydial infection was present in one man (0.6%). Only two men with increased leucocytes in prostatic secretions demonstrated , 106 million mF1 PPL in semen. As compared with our cohort study 10 years ago, the proportion of the different subtypes of the prostatitis syndrome have remained stable. The aetiological spectrum of chronic bacterial prostatitis has not changed whereas, in contrast, the prevalence of C. trachomatis now is found to be strikingly reduced. Using the WHO cutpoints for leucocytospermia the inclusion of seminal leucocytes to the diagnostic process has not influenced the distribution between inflammatory (type NIH IIIA) and noninflammatory (type NIH IIIB) chronic pelvic pain syndrome. [source] Impact of Preceding Ventricular Premature Beats on Heart Rate TurbulenceANNALS OF NONINVASIVE ELECTROCARDIOLOGY, Issue 4 2009Hung Yi Chen M.D. Background: Heart rate turbulence (HRT) has recently been introduced as a noninvasive tool for studying autonomic dysfunction. It presented short time fluctuation of sinus cycle length following single ventricular premature contraction (VPC). However, HRT parameters may be influenced by different factors. This study aimed to evaluate the possible influence of VPC frequency on HRT. Methods: 24-h Holter recording was performed in patients with VPCs initially detected by 12-lead electrocardiography (ECG) in the outpatient department. The numbers of VPCs in 2- and 5-minute durations preceding each VPC tachogram were calculated. The HRT parameters and the numbers of the VPCs preceding VPC tachograms were analyzed. Results: There were 23,122 available VPC tachograms from 107 healthy subjects included in the study. The turbulence onset (TO) value increased and the turbulence slope (TS) value decreased as VPC's frequency increased. The TO values rapidly increased when the number of VPCs was >15 beats in the 2-minute and >35 beats in the 5-minute durations. There was also a prominent decrease in TS values when the VPCs reached 14 and 30 beats in the 2- and 5-minute durations, respectively. Conclusion: Physiologic baroreflex may be attenuated under intensive stimulation, which is evidenced by blunted HRT parameters by frequent VPCs. Physiologic response to VPC's frequency may be related to baroreflex fatigue and is demonstrated as a sigmoid curve. [source] Medical visits among adults with symptoms commonly associated with an overactive bladderBJU INTERNATIONAL, Issue 3 2006SUNNY H. KIM OBJECTIVES To examine nationally representative data and thus obtain estimates of the use of healthcare providers associated with the overactive bladder (OAB) symptoms, a condition characterized by frequency, urgency and nocturia, with or with no urge incontinence, as although it is ranked among the 10 most common chronic medical conditions in the USA, the level of OAB-associated medical treatment remains largely unknown. METHODS To estimate the number of annual OAB-associated medical visits among patients aged ,18 years, three national databases in the USA (year 2000) were examined: the National Ambulatory Medical Care Survey, the National Hospital Ambulatory Medical Care Survey, and the National Hospital Discharge Survey. Population estimates were constructed using design-based statistical analyses to account for the complex survey designs of data. RESULTS During 2000, adult Americans made 1.4 million (95% confidence interval 1.1,1.8 million) ambulatory visits to non-Federal office-based physicians with International Classification of Disease (ICD-9) coding indicative of OAB symptoms. Accounting for emergency and outpatient department visits, as well as non-Federal short-stay hospital discharges, the estimated number of medical visits with OAB-associated ICD-9 coding was <1.5 million. CONCLUSION The prevalence of OAB was estimated to be 34 million adult Americans. When 1.4 million ambulatory visits were compared with this prevalence, as few as 4% of adult Americans with OAB sought medical treatment during the year 2000. The present results therefore suggest a large unmet medical need among the population of adult Americans with OAB. [source] Children are reliable reporters of common symptoms: results from a self-reported symptom diary for primary school childrenACTA PAEDIATRICA, Issue 7 2010C Lundqvist Abstract Background:, Collecting information on subjective symptoms in children by parental reports or physician's interview is indirect and not suited for prospective data collection over extended time periods. Aim:, To examine the reliability of a diary for symptom self-reports by primary school children. Methods:, Children aged 7,8 or 11,12 were recruited from primary school and a paediatric outpatient department. A picture-based symptom diary was completed individually. Children were asked about presence of 10 specified subjective symptoms for five time periods covering the previous 24 h. The diary was completed twice for test,retest and answers were compared with semi structured physician's interviews. Results:, Test,retest reliability for reporting a symptom during the previous 24 h gave reliable kappa values of 0.64,0.91. Comparison with physician's interview gave kappas of 0.18,0.68. Requiring correct time of day for each symptom reduced reliability and validity. Kappa values for test,retest and child-physician agreement for the individual symptoms were respectively: sneezing, 0.80 and 0.30; sore throat, 0.89, 0.30; tiredness, 0.88, 0.65; headache, 0.64, 0.66; runny nose, 0.91, 0.68; sore eyes, 0.67, 0.18; cough, 0.73, 0.58; stomach ache, 0.69, 0.45. Conclusion:, Our symptom diary gives reliable self-report data from primary school children. It may be used for prospective symptom monitoring. [source] Prevalence of foot diseases in outpatients attending the Institute of Dermatology, Bangkok, ThailandCLINICAL & EXPERIMENTAL DERMATOLOGY, Issue 1 2004R. Ungpakorn Summary Two thousand patients who visited the outpatient department at the Institute of Dermatology, Bangkok, were assessed for the presence of foot diseases by questionnaire and physical examination. Abnormalities were detected in 741 individuals (37.1%). Nonfungal conditions were more prevalent (31.4%), mainly consisting of eczema (254 cases, 12.7%) and psoriasis (176 cases, 8.8%). Fungal disease was observed in 119 cases (6.0%). There were 76 cases (3.8%) with tinea pedis and 33 cases (1.7%) with onychomycosis. The identified organisms causing tinea pedis were 57.9% nondermatophyte moulds, 36.8% dermatophytes, and 2.6%Candida spp. The corresponding organisms causing onychomycosis were 51.6% nondermatophyte moulds, 36.3% dermatophytes, and 6.0%Candida spp. Among nondermatophytes, Scytalidium dimidiatum was the leading pathogen while Trichophyton rubrum and T. mentagrophytes were the predominant dermatophytes identified. Diabetes mellitus, peripheral vascular disease and activities related to foot trauma were noted to be predisposing factors for onychomycosis. Footwear, particularly sandals and cut shoes, was the only factor relevant to individuals with tinea pedis (P , 0.05). In contrast with other published data on fungal foot infections, this study disclosed a higher prevalence of nondermatophyte organisms, predominantly S. dimidiatum, as the major cause of tinea pedis and onychomycosis. An increase in awareness is necessary to identify such cases, prevent misdiagnosis and initiate appropriate treatment. [source] Eye injuries in rural Victoria, AustraliaCLINICAL & EXPERIMENTAL OPHTHALMOLOGY, Issue 7 2009Simon Raymond MPH Abstract Background:, Eye injury causes significant morbidity and is a leading cause of blindness worldwide. This study investigates the incidence, spectrum and patterns of eye injury presenting to a rural hospital in Victoria, Australia. Methods:, A retrospective review of the medical records of all patients presenting with eye injury to the emergency department of Mildura Base Hospital, Victoria, Australia in year 2004 was conducted. As the emergency department of Mildura Base Hospital also acts as the outpatient department for this hospital, the series included all patients treated for eye injury at Mildura Base Hospital in year 2004, including admissions. Results:, There were 435 patients present to Mildura Base Hospital emergency department for eye injury in 2004, which represented approximately 1% of the population of Mildura. The majority of eye injuries were superficial. Fifty-six (13%) patients required specialist attention. Most patients were male (83%) and were middle-aged. The most common locations where eye injuries took place were residential homes (47%) and workplaces (32%). The most common causes of eye injuries were trade tools and machinery (47%), followed by chemicals (12%) and branches/sticks/twigs (11%). Of particular concern for Mildura is that approximately one-quarter of the patients treated at Mildura Base Hospital for eye injury in 2004 had been treated at Mildura Base Hospital for a separate episode of eye injury in the past. Conclusion:, Eye injuries represent a significant socioeconomic burden. This research contributes to the knowledge required for the design and implementation of effective preventative strategy. [source] Assessment of subjective scales for selection of patients for nasal septal surgeryCLINICAL OTOLARYNGOLOGY, Issue 4 2006J.M. Boyce Objective:, To investigate the use of subjective measures to assist the surgeon in patient selection for septal surgery. Study design:, Prospective, observational. Approved by local ethics committee. Setting:, ENT outpatient department, University Hospital of Wales. Participants:, Forty-six participants on the waiting list for septal surgery for nasal obstruction. Main outcome measure:, Measurement of nasal partitioning of airflow by rhinospirometer (GM Instruments, Scotland), subjective scales, and investigator's assessment of septal deviation. Results:, The subjective scores, and investigator's assessment of septal deviation, were compared with the rhinospirometer objective measurements for correlation, sensitivity and specificity. The rhinospirometry results showed that 20% of the patients on the waiting list had objective measures of partitioning of nasal airflow within a normal range for healthy subjects. The ordinal scale proved to be more useful than the visual analogue scale for patient selection. The subjective scores of airflow partitioning from the double ordinal scale correlated well with the rhinospirometry measurements (r = 0.8). The ordinal scale also had a sensitivity of 81% and a specificity of 60%. The investigator's subjective assessment of septal deviation had a high sensitivity at around 100% but had a lower specificity (30%). Conclusions:, The use of a subjective ordinal scale to measure partitioning of airflow greatly increased the specificity of patient selection and it is proposed that this scale may be useful to the surgeon when assessing patients for septal surgery. [source] Influence of dietary intervention on growth in children with hypercholesterolaemiaACTA PAEDIATRICA, Issue 9 2003M Sánchez-Bayle Aim: To determine whether a moderately reduced fat diet affects longitudinal growth in children with hypercholesterolaemia with a mean duration of 7.42 ± 1.93 y. Methods: Subjects with hypercholesterolaemia, total cholesterol above 5.18 mmol/L and LDL-cholesterol above 3.49 mmol/L (n= 144; 69 males and 75 females) from 2 to 13 y of age were studied. Patients were seen in our outpatient department for regular health check-ups. Weight and height were measured every year. At the same time, cholesterol, triglycerides, LDL-C, HDL-C, A-apoprotein and B-apoprotein levels were analysed. Furthermore, degrees of compliance at 1 mo, 6 mo and each year after starting the dietary treatment were determined. Results: No significant change in height or weight was found after fat restriction. In contrast, significant reductions in total cholesterol, LDL cholesterol and B-apoprotein levels of 19%, 24% and 14%, respectively, were detected. Finally, no significant differences were seen in HDL-cholesterol, A-apoprotein or triglycerides. Conclusions: These data support the hypothesis that growth is not influenced by moderate fat restriction in healthy children who otherwise have normal nutrition. [source] Sacral nerve modulation and other treatments in patients with faecal incontinence after unsuccessful pelvic floor rehabilitation: a prospective studyCOLORECTAL DISEASE, Issue 4 2010S. M. Koch Abstract Objectives Sacral nerve modulation (SNM) is a minimally invasive technique for the treatment of faecal incontinence. This study investigates the results of SNM after negative outcome of a standardized pelvic floor rehabilitation (PFR) programme for the treatment of faecal incontinence. Method, A prospective cohort study was performed between December 2001 and August 2007. Consecutive patients who visited the outpatient department for faecal incontinence were included in a multicentre study and treated with standardized PFR. Those with an unsuccessful result who were eligible for SNM were included in the present study. Failures at test stimulation or SNM received another treatment. Clinical outcome, Vaizey scores and Hirschsprung's disease/anorectal malformation quality-of-life (EQ-5D and HAQL) were assessed during follow-up in patients with SNM and in patients with other treatments (OT). Adverse events (AE) were documented. Results, Thirty-five patients (mean age 59.7 years; 31 females) were included. Twenty-one had a successful test stimulation and 19 patients proceeded to a SNM implant. Incontinence episodes per week decreased significantly from 11.1 ± 11.7 to 1.9 ± 2.6 during test stimulation (P < 0.0001) and SNM over 24.1 months follow-up. The overall success rate was 49% (17/35). The patients with unsuccessful test stimulation or SNM received OT. The Vaizey score improved in both SNM (18.2 ± 3.5 vs 13.7 ± 4.8; P = 0.004) and other treatment (18.2 ± 3.5 vs 13.9 ± 6.9; P = 0.019). The HAQL scale improved significantly during SNM in all subscales (P < 0.005), but not in the other treatment group. Eight AE occurred during test stimulation (23%) and six AE after permanent implantation (26%). Conclusion, Sacral nerve modulation improves disease specific quality of life significantly compared with other treatment. [source] Exploring potential associations of suicidal ideation and ideas of self-harm in patients with congestive heart failureDEPRESSION AND ANXIETY, Issue 8 2009Nicole Lossnitzer Ph.D. Abstract Objective: To determine the factors, which are associated with suicidal ideation and ideas of self-harm in patients with congestive heart failure (CHF). Methods: We examined 294 patients with documented CHF, New York Heart Association (NYHA) functional class II-IV, in a cross sectional study at three cardiac outpatient departments. Measures included self-reports of suicidal ideation and self-harm (PHQ-9), depression (SCID), health-related quality of life (SF-36), multimorbidity (CIRS-G), consumption of alcoholic beverages, as well as comprehensive clinical status. Data were analyzed using logistic regression analyses. Results: 50 patients (17.1%) reported experiencing suicidal ideation and/or ideas of self-harm on at least several days over the past two weeks. The final regression model revealed significant associations with health-related quality of life, physical component (odds ratio [OR] 0.56; 95% confidence interval [CI]: 0.35,0.91), and mental component (OR 0.50; 95% CI: 0.31,0.82), consumption of alcoholic beverages (OR 1.27; 95% CI: 1.05,1.54), first-episode depression (OR 3.92; 95% CI: 1.16,13.22), and lifetime depression (OR 10.89; 95% CI: 2.49,47.72). Age was only significant in the univariable (P=.03) regression analysis. NYHA functional class, left ventricular ejection fraction (LVEF), etiology of CHF, medication, cardiovascular interventions, multimorbidity, gender, and living situation were not significantly associated with suicidal ideation or ideas of self-harm. Conclusions: Lifetime depression, in particular, increases the risk of suicidal ideation and ideas of self-harm in CHF patients. Furthermore, the findings of our study underline the necessity of differentiating between first-episode and lifetime depression in CHF-patients in future research and clinical practice. Depression and Anxiety, 2009. © 2009 Wiley-Liss, Inc. [source] Urinary incontinence in men with chronic obstructive pulmonary diseaseINTERNATIONAL JOURNAL OF UROLOGY, Issue 8 2008Fumi Hirayama Abstract: This study investigated urinary incontinence in men with chronic obstructive pulmonary disease (COPD). A total of 244 community-dwelling men (mean age 66.5 years) diagnosed with COPD within the past 4 years were recruited from six hospital outpatient departments in central Japan. The prevalence of urinary incontinence was 10% according to the International Consultation on Incontinence criterion. Urine leakage among the 24 incontinent men was typically a small amount (75%) and occurred once a week or less often (58%). Fifteen (63%) of them reported urge incontinence while only two men experienced stress incontinence. On average they had urine leakage for 2.5 (SD 2.3) years and the majority (n = 19, 79%) developed the condition after diagnosis of COPD. The finding of higher prevalence of urge incontinence challenges the conventional view that COPD is associated with stress incontinence due to high pressure coughs. [source] Opioid-taking tasks and behaviours in Taiwanese outpatients with cancerJOURNAL OF CLINICAL NURSING, Issue 15 2008Shu-Yuan Liang PhD Candidate Aim., The aim of this study was to describe those tasks and behaviours that contribute to self-efficacy in the context of opioid-taking in Taiwanese outpatients with cancer and to explore those factors that influence a patient's self-efficacy with engaging in these behaviours. Background., Self-management with prescribed opioid regimen has become a necessary component of the cancer pain experience at home. Tailoring prescribed regimens is a complex and continuing effort for cancer pain control. Few studies, however, have explored the specific skills and behaviours required by patients to manage their opioid analgesics effectively. Design., A qualitative approach was used to explore those behaviours that contribute to patients' ability to self-manage medication for their cancer pain. Method., Ten Taiwanese cancer patients aged between 41,75 years attending two oncology outpatient departments, who were prescribed opioid analgesics, were interviewed. All interviews were tape-recorded and were transcribed verbatim. Qualitative content analysis was undertaken to identify categories. Results., Five main categories of behaviours were identified, which reflected patient's perceptions of the actions required for effective opioid-taking. These behavioural domains included communicating about pain and analgesic-taking, taking analgesics according to schedule, obtaining help, tailoring medication regimens and managing treatment-related concerns. In addition, patients described various situations in which performance of these behaviours was more or less difficult. Conclusions., Our results suggest that self-efficacy with opioid-taking includes not only beliefs about the ability to communicate, but also the ability to fulfil more complex tailoring of medication regimens and management of treatment-related concerns. Relevance to clinical practice., Health professionals need to incorporate strategies to assist cancer patients' ability to engage in these behaviours and to manage situational impediments that may influence this ability. More importantly, clinicians need to assist patients to enhance their beliefs in their ability in overcoming various situation impediments for opioid-taking. [source] Effect of an interactive computerized psycho-education system on patients suffering from depressionJOURNAL OF CLINICAL NURSING, Issue 5 2008MPsychN, Mei-Feng Lin PhD Aims., The aim of this study was to examine the effect of an Interactive Computerized Psycho-Education System on patients suffering from depression and to compare the use of an Interactive Computerized Psycho-Education System vs. traditional pamphlet education approach. Background., Depression management depends on pharmacological treatment and psychotherapy and on appropriate and timely patient education. Whilst multimedia learning concepts have been applied in areas such as education, this approach has not been widely used in psychiatric outpatient departments. Design and method., A preliminary pre and post quasi-experimental design with patients with depression was employed at an hospital. Participants in the experimental group (n = 19) received an Interactive Computerized Psycho-Education System intervention programme (Interactive Computerized Psycho-Education System and the educational manual). Participants in the control group (n = 13) were exposed only to the traditional pamphlet education approach (consultation from psychiatrists and information sheets). Primary outcome was depression knowledge scores. Secondary outcomes were scores on the Compliance Behaviour Assessment Scale. Results., In the experimental group (n = 19), the time spent working on the Interactive Computerized Psycho-Education System was about 30,180 minutes per session, with an average of 67 minutes. Participants in the experimental group had a considerably decreased incidence of medication non-compliance compared with participants in the control group. Knowledge scores of the experimental group ranged from 30,100, with an average score of 74.7. Conclusion., The Interactive Computerized Psycho-Education System is acceptable and may be as more effective than a traditional education approach to achieve adherence to medications for depression. Relevance to clinical practice., Compared with a traditional approach, the combination of the Interactive Computerized Psycho-Education System and a nursing-consulting clinic may assist patients with depression to achieve and maintain better medication compliance in addition to improving their knowledge of depression. [source] No Effect of a Nasal Decongestant on Eustachian Tube Function in Children With Ventilation Tubes,THE LARYNGOSCOPE, Issue 6 2002Niels van Heerbeek MD Abstract Objective The aim of the study was to assess the effect of a topical decongestant on eustachian tube function in children with ventilation tubes because of persistent otitis media with effusion. Study Design A randomized, double-blinded, placebo-controlled study. Methods At the outpatient departments of a secondary referral hospital and a tertiary referral hospital, eustachian tube function was measured before and after intranasal administration of five drops of 0.05% xylometazoline hydrochloride or placebo in 80 randomly selected children with ventilation tubes because of otitis media with effusion. Results Xylometazoline nose drops had no effect on the ventilatory or the protective function of the eustachian tube. Conclusions Topical decongestants do not have a positive effect on eustachian tube function in children. Therefore, the use of topical decongestants to prevent or treat otitis media with effusion in children is not justified and should be discouraged. [source] Hypogonadism-related symptoms: development and evaluation of an empirically derived self-rating instrument (HRS ,Hypogonadism Related Symptom Scale')ANDROLOGIA, Issue 5 2009J. Wiltink Summary While self-report screening instruments are highly sensitive to hypogonadism in the ageing male, they have lacked specificity as evidenced by low or absent correlations with testosterone. The purpose of this paper was to develop an economical and specific screening instrument for identifying hypogonadal ageing men. Based on a comprehensive study of physical, somatoform and affective complaints, sexual behaviour and function and hormonal parameters of 263 outpatients aged 40 years and above (M = 56.2; 40,84 years) recruited from six andrological outpatient departments in Germany, we identified those items correlating significantly with testosterone. By factor analyses, five factors were identified: ,reduced activity', ,dissatisfaction with sexual function', ,negative self-concept of physical fitness', ,reduced sexual desire' and ,hot flushes'. The corresponding scales were reliable and only moderately inter-correlated. Consistent correlations were found with the level of testosterone, ageing male scales (Androgen Deficiency in the Aging Male, Aging Male Survey), specific affective, somatoform and sexual functioning scales and potential determinants of low testosterone (body mass index, physical inactivity, etc.). While further validation is needed, the new Hypogonadism Related Symptoms Scale appears to be a promising hypogonadism screening tool. [source] Retinal photography for diabetic retinopathy screening in Indigenous primary health care: the Inala experienceAUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH, Issue 2010Geoffrey K. P. Spurling Abstract Objective: We aimed to determine the impact of clinic based retinal photography on access to appropriate screening for diabetic retinopathy (DR). Design, setting and participants: We opportunistically recruited patients undergoing their annual diabetic cycle of care over a two year period in the urban Indigenous primary health care clinic. Data were collected on retinal outcomes, health variables and referral patterns. Main outcome measures: Access to appropriate screening and ophthalmic follow up, prevalence of DR, acceptability and feasibility of clinic-based retinal photography were the main outcome measures of this study. Results: One hundred and thirty-two of a possible 147 patients consented to participate. 30% of participants had DR. Appropriate screening and ophthalmic follow up increased six fold, from 20 to 124 participants, following the introduction of the retinal camera. Most participants felt very positive about DR screening. Conclusions: Primary care DR screening using retinal photography can improve access to DR screening for indigenous patients, reduce the burden on busy outpatient departments and should reduce visual loss. Policy-makers could contribute to screening sustainability by funding a medicare item-number for primary care based DR screening associated with the annual diabetic cycle of care. An upfront Practice Incentive Program (PIP) payment could offset set up costs. [source] Neuroimaging for Pediatric Head Trauma: Do Patient and Hospital Characteristics Influence Who Gets Imaged?ACADEMIC EMERGENCY MEDICINE, Issue 7 2010Rebekah Mannix MD ACADEMIC EMERGENCY MEDICINE 2010; 17:694,700 © 2010 by the Society for Academic Emergency Medicine Abstract Objectives:, The objective was to identify patient, provider, and hospital characteristics associated with the use of neuroimaging in the evaluation of head trauma in children. Methods:, This was a cross-sectional study of children (,19 years of age) with head injuries from the National Hospital Ambulatory Medical Care Survey (NHAMCS) collected by the National Center for Health Statistics. NHAMCS collects data on approximately 25,000 visits annually to 600 randomly selected hospital emergency and outpatient departments. This study examined visits to U.S. emergency departments (EDs) between 2002 and 2006. Multivariable logistic regression was used to analyze characteristics associated with neuroimaging in children with head injuries. Results:, There were 50,835 pediatric visits in the 5-year sample, of which 1,256 (2.5%, 95% confidence interval [CI] = 2.2% to 2.7%) were for head injury. Among these, 39% (95% CI = 34% to 43%) underwent evaluation with neuroimaging. In multivariable analyses, factors associated with neuroimaging included white race (odds ratio [OR] = 1.5, 95% CI = 1.02 to 2.1), older age (OR = 1.3, 95% CI = 1.1 to 1.5), presentation to a general hospital (vs. a pediatric hospital, OR = 2.4, 95% CI = 1.1 to 5.3), more emergent triage status (OR = 1.4, 95% CI = 1.1 to 1.8), admission or transfer (OR = 2.7, 95% CI = 1.4 to 5.3), and treatment by an attending physician (OR = 2.0, 95% CI = 1.1 to 3.7). The effect of race was mitigated at the pediatric hospitals compared to at the general hospitals (p < 0.001). Conclusions:, In this study, patient race, age, and hospital-specific characteristics were associated with the frequency of neuroimaging in the evaluation of children with closed head injuries. Based on these results, focusing quality improvement initiatives on physicians at general hospitals may be an effective approach to decreasing rates of neuroimaging after pediatric head trauma. [source] The rhinological side-effects of systemic drugsCLINICAL OTOLARYNGOLOGY, Issue 5 2003N.D. Bateman Patients often present to otolaryngologists with nasal symptoms where no cause is apparent. A number of patients seen in outpatient departments are taking medication for other conditions and the adverse affects of these drugs may potentially be the source of these symptoms. In this short review, we present an overview of the more common drugs that may be responsible and outline the possible mechanisms where these are known. [source] Carotid Sinus Hypersensitivity is Common in Patients Presenting with Hip Fracture and Unexplained FallsPACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 9 2009M.Sc., VASILEIOS SACHPEKIDIS M.D. Background:We tried to determine the prevalence of carotid sinus hypersensitivity (CSH) in patients with hip fractures with and without a clear history of an accidental fall. Methods:We studied 51 patients hospitalized for a hip fracture and 51 matched controls from our outpatients department. All patients were subjected to a carotid sinus massage in the supine and upright position. Patients were categorized in accidental (Group A) and unexplained (Group B) fallers. Results:Six of 33 (18.2%) patients in Group A and 12 of 18 (66.7%) patients in Group B (P < 0.001) had a positive response to the carotid sinus massage. Nine controls (17.6%) also demonstrated CSH. Patients in Group B were older (A: 75.5 ± 8.5 years vs B: 80.1 ± 5.9 years, P =0.029) and were more likely to have a history of unexplained falls or syncope in the past (A: 0% vs B: 66.7%, P < 0.0001) than individuals in group A. Vasodepressor/mixed forms accounted for the majority of CSH responses in Group B (75%). When compared with the control group, CSH was still more common in Group B (B: 66.7% vs control: 17.6%, P < 0.0001) but not in Group A (A: 18.2% vs control: 17.6%, P =1.000). Conclusions:The prevalence of CSH is increased in elderly patients with hip fractures, only in those who present with an unexplained fall and report a history of syncope or unexplained falls in the past. The vasodepressor/mixed forms account for the majority of CSH responses in the group of unexplained fallers. [source] | ||||||||||||||||||||||||||||