Home About us Contact
|
Home About us Contact | ||
|
|
||
Complaint
Kinds of Complaint Terms modified by Complaint Selected AbstractsMastering Complaint: Michael Drayton's Peirs Gaveston and the Royal Mistress ComplaintsENGLISH LITERARY RENAISSANCE, Issue 3 2008Kelly Quinn Michael Drayton's poem Peirs Gaveston tells the story of Edward II's doomed lover and is modeled closely on the royal mistress complaint poems of the 1590s, and reading the poem through the genre is illuminating. The poem differs from its models significantly, however, in that the royal "mistress" of Drayton's poem is male. This difference signifies politically, and the poem demonstrates the dangerous power of male royal consorts who translate their erotic sway into active political power. Pointed parallels with the royal mistress complaint poems accentuate the consequences for rulers in taking male lovers, and Drayton makes connections between Gaveston's use of the penetrative sexual position with his increasing political power and authority over Edward II. In distinction, the female royal mistress poems in fact tend to minimize the political power the historical women actually wielded; whereas their power is contained by the complaint poems, Gaveston's is magnified. Gaveston frames his relationship in the language of humanist friendship, but he uses the rhetoric of friendship and its mirroring imagery as part of his strategy for achieving first equality and then dominance over the King. For Drayton, the royal mistress complaint genre functions as both precursor and foil to Peirs Gaveston. (K.Q.) [source] Complaint handling in pharmaceutical companiesQUALITY ASSURANCE JOURNAL, Issue 1 2007Glaucia Karime Braga Abstract Complaints show customer dissatisfaction about the quality of a pharmaceutical product. Despite a regulatory obligation in several countries, a good complaint handling system gives the company an opportunity to improve the quality of their products, being a good tool for the maintenance of Good Manufacturing Practices and a way to establish a committed relationship with their customers. A systematic procedure must be developed and implemented in order to register and investigate each complaint received and not only the Quality Assurance area must be involved. This process must involve other critical areas such as Marketing, Production, Quality Control, Finance, Regulatory and Legal Affairs. Thus the aim of this article is to discuss the main steps of a good complaint handling procedure that can be readily implemented in pharmaceutical companies. Copyright © 2007 John Wiley & Sons, Ltd. [source] Toward Vocabulary Control for Chief ComplaintACADEMIC EMERGENCY MEDICINE, Issue 5 2008Stephanie W. Haas PhD Abstract The chief complaint (CC) is the data element that documents the patient's reason for visiting the emergency department (ED). The need for a CC vocabulary has been acknowledged at national meetings and in multiple publications, but to our knowledge no groups have specifically focused on the requirements and development plans for a CC vocabulary. The national consensus meeting "Towards Vocabulary Control for Chief Complaint" was convened to identify the potential uses for ED CC and to develop the framework for CC vocabulary control. The 10-point consensus recommendations for action were 1) begin to develop a controlled vocabulary for CC, 2) obtain funding, 3) establish an infrastructure, 4) work with standards organizations, 5) address CC vocabulary characteristics for all user communities, 6) create a collection of CC for research, 7) identify the best candidate vocabulary for ED CCs, 8) conduct vocabulary validation studies, 9) establish beta test sites, and 10) plan publicity and marketing for the vocabulary. [source] Recurrent abdominal pain, food allergy and endoscopyACTA PAEDIATRICA, Issue 1 2001Steffen Husby Gastrointestinal food allergy, a well-recognized clinical entity, has a wide spectrum of clinical features, including cutaneous, respiratory and gastrointestinal symptoms and objective abnormalities. The gastrointestinal alterations in food allergy have been described throughout the gastrointestinal tract. Recurrent abdominal pain (RAP) is a common complaint in school-age children. The findings among children with RAP of an underlying food allergy associated with mucosal pathology of the foregut may support a causal relationship between food allergy and RAP. Further studies are needed to elucidate whether well-documented food allergy (based on double-blind placebo-controlled food challenges) is a major cause of RAP. [source] Clinicopathological Conference: Case Report,A Case of Anorexia and Weak ArmACADEMIC EMERGENCY MEDICINE, Issue 1 2007Jennifer L. Wiler MD Abstract The authors present the case of a 49-year-old female who presented to the emergency department with a chief complaint of "not eating well." She was found to have a heart murmur, a focal neurological deficit, and large mitral valve vegetation. The patient was later diagnosed with acute Pseudomonal endocarditis with septic emboli to the brain, liver, spleen, and kidneys. A discussion of the patient presentation, diagnostic evaluation, and outcome are reviewed. [source] Gait disturbance interpreted as cerebellar ataxia after MMR vaccination at 15 months of age: a follow-up studyACTA PAEDIATRICA, Issue 1 2000A-M Plesner Measles, mumps and rubella (MMR) vaccination was included in the Danish childhood vaccination programme in 1987. During the following 10-y period, 550 notification records of adverse events after MMR vaccination at 15 mo of age have been registered, and a total of 41 notifications have included "gait disturbance". This corresponds to a frequency of 8 per 100 000 doses of MMR vaccine used for 15-mo-old children. The symptoms and signs are characteristic of cerebellar ataxia. In 28 notifications, the descriptions by the doctors included only "gait disturbance", while in 13 an additional interpretation was included. Thirty-two parents (78%) filled in a questionnaire and 26 (63%) agreed to participate in a clinical follow-up study. The gait disturbance symptoms mainly occurred 7,14 d after the vaccination, and the duration was median 1,2 wk (range 1 d to more than 4 mo). One-third of the children had symptoms lasting more than 2 wk. Significantly more children with long duration of symptoms had some kind of complaint or clinical signs at the follow-up in 1997. Gait disturbance registered after MMR vaccination seems to be more frequent than hitherto reported. Most cases are mild and short-lasting and a longer duration of symptoms seems to be predictive of late sequelae. A clinical diagnosis of cerebellar ataxia after MMR and the exact frequency of this adverse event remains to be tested in prospective studies. [source] Sensitive skin: closing in on a physiological causeCONTACT DERMATITIS, Issue 3 2010Miranda A. Farage The phenomenon of ,sensitive skin' is a relatively recent complaint in which certain individuals report more intense and frequent adverse sensory effects than the normal population upon use of cosmetic (personal-care) products. Originally defined as a minority complaint, sensitive skin is now claimed by a majority of women in industrialized countries and nearly half of men. Sensitive skin is self-diagnosed and typically unaccompanied by any obvious physical signs of irritation, and the number of individuals who claim sensitivity has risen steadily with the number of consumer products targeted towards this supposedly uncommon group. Believed by many dermatologists, therefore, to be a ,princess and the pea' phenomenon, the problem of sensitive skin has largely avoided focussed research. Over the last few years, however, the evidence of documentable biophysical changes associated with the largely sensory symptoms of this disorder has accumulated, including some gained by improved methods of identifying subclinical signs of skin irritation. Although the understanding of the aetiology of this phenomenon is as yet incomplete, existing research now supports a biophysical origin for this disorder. Effective methods of diagnosis, intrinsic and extrinsic contributors to exaggerated neural sensitivity, and the specific mechanisms of the discomfort associated with the compliant are required, as are appropriate means of prevention and treatment. [source] Effects of transient muscle contractions and stretching on the tendon structures in vivoACTA PHYSIOLOGICA, Issue 2 2002K. KUBO ABSTRACT This study compared the effects of static stretching (ST) and repeated muscle contractions (CON) on the viscoelastic properties of tendon structures in vivo. Eight male subjects performed ST (passively flexed to 35 of dorsiflexion) for 5 min and 50 repetitions of isometric maximum voluntary contraction (MVC) for 3 s each with 3 s relaxation. Before and after each task, the elongation of the tendon and aponeurosis of the medial gastrocnemius muscle (MG) was directly measured by ultrasonography, while the subjects performed ramp isometric plantar flexion up to MVC, followed by a ramp relaxation. The relationship between the estimated muscle force (Fm) and tendon elongation (L) during the ascending phase was applied to a linear regression, the slope of which was defined as stiffness of the tendon structures. The percentage of the area within the Fm,L loop to the area beneath the curve during the ascending phase was calculated as an index representing hysteresis. The ST protocol significantly decreased the stiffness (,8%) and hysteresis (29%)., respectively. In contrast, the CON protocol significantly decreased the stiffness, but not the hysteresis. These results suggested that the stretching and repeated contractions would make the tendon structures more complaint, and further decreased the hysteresis of the tendon structures. [source] Approach to the patient with vulvovaginal complaintsDERMATOLOGIC THERAPY, Issue 5 2010Bethanee J. Schlosser ABSTRACT Although vulvovaginal diseases may seem daunting, dermatologists possess all of the requisite tools and skills necessary to comprehensively assess and accurately diagnose primary cutaneous, systemic, and inflammatory diseases that affect the vulva. A simple but comprehensive dermatologic approach to the patient with a vulvovaginal complaint is presented. We begin with a review of the normal vulvar anatomy and normal variants and proceed to the clinical approach with special emphasis on the history, physical examination, and common diagnostic procedures. [source] Contact dermatitis of the vulvaDERMATOLOGIC THERAPY, Issue 1 2004Lynette J. Margesson ABSTRACT:, Vulvar diseases rarely stand alone. They are often caused or worsened by primary irritant or allergic contact dermatitis, and this should be considered when evaluating any vulvar complaint. All irritants should be avoided in all women, and those with vulvar dermatoses should be patch tested to help define or rule out allergens. [source] Clinical and Economic Factors Associated with Ambulance Use to the Emergency DepartmentACADEMIC EMERGENCY MEDICINE, Issue 8 2006Jennifer Prah Ruger PhD Background: Concern about ambulance diversion and emergency department (ED) overcrowding has increased scrutiny of ambulance use. Knowledge is limited, however, about clinical and economic factors associated with ambulance use compared to other arrival methods. Objectives: To compare clinical and economic factors associated with different arrival methods at a large, urban, academic hospital ED. Methods: This was a retrospective, cross-sectional study of all patients seen during 2001 (N= 80,209) at an urban academic hospital ED. Data were obtained from hospital clinical and financial records. Outcomes included acuity and severity level, primary complaint, medical diagnosis, disposition, payment, length of stay, costs, and mode of arrival (bus, car, air-medical transport, walk-in, or ambulance). Multivariate logistic regression identified independent factors associated with ambulance use. Results: In multivariate analysis, factors associated with ambulance use included: triage acuity A (resuscitation) (adjusted odds ratio [OR], 51.3; 95% confidence interval [CI] = 33.1 to 79.6) or B (emergent) (OR, 9.2; 95% CI = 6.1 to 13.7), Diagnosis Related Group severity level 4 (most severe) (OR, 1.4; 95% CI = 1.2 to 1.8), died (OR, 3.8; 95% CI = 1.5 to 9.0), hospital intensive care unit/operating room admission (OR, 1.9; 95% CI = 1.6 to 2.1), motor vehicle crash (OR, 7.1; 95% CI = 6.4 to 7.9), gunshot/stab wound (OR, 2.1; 95% CI = 1.5 to 2.8), fell 0,10 ft (OR, 2.0; 95% CI = 1.8 to 2.3). Medicaid Traditional (OR, 2.0; 95% CI = 1.4 to 2.4), Medicare Traditional (OR, 1.8; 95% CI = 1.7 to 2.1), arrived weekday midnight,8 AM (OR, 2.0; 95% CI = 1.8 to 2.1), and age ,65 years (OR, 1.3; 95% CI = 1.2 to 1.5). Conclusions: Ambulance use was related to severity of injury or illness, age, arrival time, and payer status. Patients arriving by ambulance were more likely to be acutely sick and severely injured and had longer ED length of stay and higher average costs, but they were less likely to have private managed care or to leave the ED against medical advice, compared to patients arriving by independent means. [source] Screening for Adolescent Depression in a Pediatric Emergency DepartmentACADEMIC EMERGENCY MEDICINE, Issue 5 2006Emily Gale Scott MD Abstract Objectives: To describe the prevalence of depressive symptoms in adolescents presenting to the emergency department (ED) and to describe their demographics and outcomes compared with adolescents endorsing low levels of depressive symptoms. Methods: The Beck Depression Inventory,2nd edition (BDI-II) was used to screen all patients 13,19 years of age who presented to the ED during the period of study. The BDI-II is a 21-item self-report instrument used to measure the presence and severity of depressive symptoms in adolescents and adults. Demographics and clinical outcomes of screening-program participants were abstracted by chart review. Patients were categorized into one of four severity categories (minimal, mild, moderate, or severe) and one of three presenting complaint categories (medical, trauma, mental health). Results: Four hundred eighty-seven patients were approached, and 351(72%) completed the screening protocol. Participants endorsed minimal (n= 192, 55%), mild (n= 52, 15%), moderate (n= 41, 11%), or severe depressive symptoms (n= 66, 19%). Those with moderate or severe depressive symptoms were more likely to be hospitalized. Of patients completing the BDI-II, 72% with psychiatric, 12% with traumatic, and 19% with medical chief complaints endorsed either moderate or severe depressive symptoms. Conclusions: Depressive symptoms are prevalent in this screening sample, regardless of presenting complaint. A substantial proportion of patients with nonpsychiatric chief complaints endorsed moderate or severe depressive symptoms. A screening program might allow earlier identification and referral of patients at risk for depression. [source] Psammoma bodies in cervical smear in association with keratinizing squamous cell carcinoma of cervix: A case reportDIAGNOSTIC CYTOPATHOLOGY, Issue 6 2009K. Raveendran Pillai Ph.D. Abstract The presence of psammoma bodies (PBs) in cervical smears is a rare finding. These structures have been identified in association with a wide range of benign and malignant conditions within the female genital tract. PBs in cervical smears have usually been associated with malignant serous epithelial ovarian tumors. However, many PBs associated with atypical squamous cells were detected in cervical smears of an 83-year-old woman with complaint of postmenopausal bleeding. Colposcopic examination revealed an ulceroinfiltrative growth in the cervix. Histological examination of the biopsy specimen from the growth revealed keratinizing squamous cell carcinoma with multiple and singly arranged PBs. This report suggests that cytologists should aware of the possibilities, on finding PBs associated with atypical cells in cervical specimens and report the cases accordingly. Diagn. Cytopathol. 2009. © 2009 Wiley-Liss, Inc. [source] Primary relapse of acute lymphoblastic leukemia in a cervical smear: A case reportDIAGNOSTIC CYTOPATHOLOGY, Issue 7 2006Akiko Ikuta M.D. Abstract Uterine cervix and corpus are rarely the initial site of relapse in leukemia or lymphoma. We report herein a case of uterine cervical relapse with B-cell acute lymphoblastic leukemia (ALL). The patient, a 60-yr-old woman, had a history of ALL that had been in remission for 2 yr after chemotherapy. She presented with a chief complaint of genital bleeding. In a routine cervico-vaginal Papanicolau smear, abundant atypical lymphoid cells with round-to-oval nuclei, scant cytoplasm, and high nuclear to cytoplasmic ratios was observed. The nuclei of these cells had fine and dark chromatin and thickened nuclear membranes, with one or several nucleoli being visible. Biopsy under colposcope was performed, and a diagnosis of relapse of ALL was confirmed. The ongoing genital bleeding presented a problem with clinical management of the patient. It was decided to proceed with hysterectomy to end that problem and thereafter proceed with therapy directed against the leukemia. Our results suggest that in patients with known extrauterine cancer, the presence of malignancy in uterine cellular samples provides information regarding the extent of the neoplasm. Diagn. Cytopathol. 2006;34:499,502. © 2006 Wiley-Liss, Inc. [source] SCHISTOSOMIASIS JAPONICA IDENTIFIED BY LAPAROSCOPIC AND COLONOSCOPIC EXAMINATIONDIGESTIVE ENDOSCOPY, Issue 2 2010Keiko Hosho A 45-year-old Philippine woman who came from Mindanao Island was admitted to our hospital with a complaint of epigastric discomfort. Abdominal ultrasonography and computed tomography demonstrated a network pattern and linear calcification in the liver. Laparoscopic examination showed numerous yellowish, small speckles over the liver surface. The liver surface was separated into many small blocks by groove-like depressions, demonstrating a so-called tortoise shell pattern. Conventional colonoscopy and narrow-band imaging showed irregular areas of yellowish mucosa, and diminished vascular network and increased irregular microvessels extending from the descending colon to the rectum. Liver biopsy showed many Schistosoma japonicum eggs in Glisson's capsule and colon biopsy showed many S. japonicum eggs in the submucosal layer. These findings established a diagnosis of schistosomiasis japonica. The present case is imported schistosomiasis japonica. Even though new cases have not occurred recently in Japan, we should remain aware of schistosomiasis japonica for patients who came from foreign epidemic areas. [source] Safety, tolerability, and efficacy of endoscopic low-pressure liquid nitrogen spray cryotherapy in the esophagusDISEASES OF THE ESOPHAGUS, Issue 1 2010Bruce D. Greenwald SUMMARY Endoscopic cryotherapy is a new technique for ablation of esophageal dysplasia and neoplasia. Preliminary studies have shown it to be safe and effective for this indication. The objective of this study is to characterize safety, tolerability, and efficacy of low-pressure liquid nitrogen endoscopic spray cryotherapy ablation in a large cohort across multiple study sites. Parallel prospective treatment studies at four tertiary care academic medical centers in the U.S. assessed spray cryotherapy in patients with Barrett's esophagus with or without dysplasia, early stage esophageal cancer, and severe squamous dysplasia who underwent cryotherapy ablation of the esophagus. All patients were contacted between 1 and 10 days after treatment to assess for side effects and complications of treatment. The main outcome measurement was the incidence of serious adverse events and side effects from treatment. Complete response for high-grade dysplasia (HGD) (CR-HGD), all dysplasia (CR-D), intestinal metaplasia (CR-IM) and cancer (CR-C) were assessed in patients completing therapy during the study period. A total of 77 patients were treated for Barrett's high-grade dysplasia (58.4%), intramucosal carcinoma (16.9%), invasive carcinoma (13%), Barrett's esophagus without dysplasia (9.1%), and severe squamous dysplasia (2.6%). Twenty-two patients (28.6%) reported no side effects throughout treatment. In 323 procedures, the most common complaint was chest pain (17.6%) followed by dysphagia (13.3%), odynophagia (12.1%), and sore throat (9.6%). The mean duration of any symptoms was 3.6 days. No side effects were reported in 48% of the procedures (155/323). Symptoms did not correlate with age, gender, diagnosis, or to treatment early versus late in the patient's or site's experience. Logit analysis showed that symptoms were greater in those with a Barrett's segment of 6 cm or longer. Gastric perforation occurred in one patient with Marfan's syndrome. Esophageal stricture developed in three, all successfully treated with dilation. In 17 HGD patients, cryotherapy produced CR-HGD, CR-D, and CR-IM of 94%, 88%, and 53%, respectively. Complete regression of cancer and HGD was seen in all seven patients with intramucosal carcinoma or stage I esophageal cancer. Endoscopic spray cryotherapy ablation using low-pressure liquid nitrogen in the esophagus is safe, well-tolerated, and efficacious. [source] The Accuracy and Completeness of Data Collected by Prospective and Retrospective MethodsACADEMIC EMERGENCY MEDICINE, Issue 9 2005J. Tobias Nagurney MD Abstract Objectives: To describe and test a model that compares the accuracy of data gathered prospectively versus retrospectively among adult emergency department patients admitted with chest pain. Methods: The authors developed a model of information flow from subject to medical record to the clinical study case report form, based on a literature review. To test this model, a bidirectional (prospective and retrospective) study was conducted, enrolling all eligible adult patients who were admitted with a chief complaint of chest pain. The authors interviewed patients in the emergency department to determine their chest pain history and established a prospective database; this was considered the criterion standard. Then, patient medical records were reviewed to determine the accuracy and completeness of the information available through a retrospective medical record review. Results: The model described applies the concepts of reliability and validity to information passed on by the study subject, the clinician, and the medical record abstractor. This study was comprised of 104 subjects, of which 63% were men and the median age was 63 years. Subjects were uncertain of responses for 0,8% of questions and responded differently upon reinterview for subsets of questions 0,30% of the time. The sensitivity of the medical record for risk factors for coronary artery disease was 0.77 to 0.93. Among the 88 subjects (85%) who indicated that their chest pain was substernal or left chest, the medical record described this location in 44%. Timing of the chest pain was the most difficult item to accurately capture from the medical record. Conclusions: Information obtained retrospectively from the abstraction of medical records is measurably less accurate than information obtained prospectively from research subjects. For certain items, more than half of the information is not available. This loss of information is related to the data types included in the study and by the assumptions that a researcher performing a retrospective study makes about implied versus explicitly stated responses. A model of information flow that incorporates the concepts of reliability and validity can be used to measure some of the loss of information that occurs at each step along the way from subject to clinician to medical record abstractor. [source] Unusually Large Left Atrial Myxoma Presenting with Severe Mitral Valve Obstruction SymptomsECHOCARDIOGRAPHY, Issue 2 2004Mustafa Yilmaz M.D. A 13-year-old girl with the complaint of severe mitral valve obstruction symptoms was diagnosed as having an unusually large left atrial tumor by echocardiography. The giant mass was surgically removed and the postoperative course was uneventful. Histologic examination confirmed the mass was a benign atrial myxoma. (ECHOCARDIOGRAPHY, Volume 21, February 2004) [source] TAKING OUT THE PINS: ECONOMICS AS ALIVE AND LIVING IN THE HISTORY OF ECONOMIC THOUGHTECONOMIC PAPERS: A JOURNAL OF APPLIED ECONOMICS AND POLICY, Issue 2 2005William Coleman The paper seeks to vindicate the value of the study of the history of economic thought (HET). It argues against the complaint that the study is antiquarian. It contends that, although HET does not confer operational and objective skills, it does provide insight into economic ideas, and sharpens our acumen in responding to them. [source] Responding to formal complaints about the emergency department: Lessons from the service marketing literatureEMERGENCY MEDICINE AUSTRALASIA, Issue 4 2004Gavan Doig Abstract The ability to respond to formal complaints is a necessary part of emergency medicine practice. In spite of the significance of formal complaints there is little guidance within the medical literature to understand why patients complain or how to provide satisfaction to individuals who complain. Practitioners are usually left to their own devices in the style and substance of complaint responses even when working within a defined complaint management system. This article draws on relatively abundant literature in the service marketing field to provide an understanding of dissatisfaction, complaining and complaint handling. Having developed an appropriate theoretical framework the article provides guidance for applying these concepts in dealing with formal complaints. [source] Association between Insurance Status and Admission Rate for Patients Evaluated in the Emergency DepartmentACADEMIC EMERGENCY MEDICINE, Issue 11 2003Jennifer Prah Ruger PhD Abstract Objectives: To determine if differences exist in hospital and intensive care unit (ICU)/operating room admission rates based on health insurance status. Methods: This was a retrospective, cross-sectional study of data from hospital clinical and financial records for all 2001 emergency department (ED) visits (80,209) to an academic urban hospital. Hospital admission and intensive care unit (ICU)/operating room admissions were analyzed, controlling for triage acuity, primary complaint, diagnosis, diagnosis-related group (DRG) severity, and demographics. Multivariate logistic regression models identified factors associated with hospital admission for underinsured (self-pay and Medicaid) compared with other insured (private health maintenance organization, preferred provider organization, worker's compensation, and Medicare) patients. Results: Compared with the other insured group, underinsured patients were less likely, overall, to be admitted to the hospital (odds ratio [OR], 0.82; 95% CI = 0.76 to 0.90), controlling for all other factors studied. Subgroup analysis of common complaints showed underinsured patients with a chief complaint of abdominal pain (OR, 0.67; 95% CI = 0.55 to 0.80) or headache (OR, 0.61; 95% CI = 0.39 to 0.95) had the lowest adjusted ORs for admission to the hospital, compared with other insured patients. Underinsured patients with DRG of "menstrual and other female reproductive system disorders" (OR, 0.17; 95% CI = 0.06 to 0.51) or "esophagitis, gastroenteritis, and miscellaneous digestive disorders" (OR, 0.55; 95% CI = 0.28 to 0.96) also were less likely to be admitted compared with the other insured group. No significant differences in ICU/operating room admission rates were found between insurance groups. Conclusions: Whereas there was no difference in admission rates to the ICU/operating room by insurance status, this single-center study does suggest an association between insurance status and admission to a general hospital service, which may or may not be causally related. Factors other than provider bias may be responsible for this observed difference. [source] Evolution of hazardous waste combustors MACT standardsENVIRONMENTAL PROGRESS & SUSTAINABLE ENERGY, Issue 4 2001Charles W. Lamb Ph.D. This year, on July 24, the DC Circuit Court ruled that the EPA had not correctly derived emission standards, and vacated the MACT (Maximum Achievable Control Technology) rule for Hazardous Waste Combustors (HWC) [1, 2]. A major complaint, voiced by the Sierra Club, was that the MACT methodology was misapplied in a manner that produced overly lenient standards. Industry and trade associations argued just the opposite. The Sierra Club won the first round when the court agreed that the emission standards should be based on the average of the best-performing 12% of units in each category. The next question was, "What will be the regulations until the final standards can be developed?" This caused considerable angst because, if no standards were in place by May 15, 2002, control would revert to case-by-case permits by Federal and State regulatory agencies as set forth in Section 112 of the Clean Air Act. Obviously, that would be the antithesis of the Congressional mandate and the objectives of environmental groups. The Sierra Club and most litigants did not want the uncertainties and inconsistencies this would introduce. [source] Comparisons of overground endoscopy and treadmill endoscopy in UK Thoroughbred racehorsesEQUINE VETERINARY JOURNAL, Issue 3 2010K. J. ALLEN Summary Reasons for performing study: To date there is no information on the comparison of the more recently documented technique of performing endoscopy during ridden exercise in the field, with the more traditional method of endoscopy during high-speed treadmill exercise. Objectives: To compare the results of upper respiratory tract endoscopy in UK Thoroughbred racehorses performed during ridden exercise in the field with those obtained during exercise on the treadmill. Methods: A direct comparison was undertaken in 4 horses whereby both procedures were performed in the same horse within 10 days of each other. An indirect comparison was also undertaken whereby the results of overground endoscopy performed in 50 racehorses was compared to the results obtained during treadmill endoscopy in a further 50 racehorses. Horses were matched for age, gender, use (National Hunt vs. Flat) and presenting complaint (abnormal respiratory noise vs. poor performance). Results: Dorsal displacement of the soft palate was diagnosed less frequently during overground endoscopy than during treadmill endoscopy. There was no significant difference in the diagnosis of dynamic laryngeal collapse between the 2 techniques. The treadmill exercise test was performed over longer distances at higher inclines, albeit at lower speeds than the overground test. In contrast to the treadmill test, the overground test was frequently performed in intervals. Conclusions: The results of both the direct and indirect comparisons suggest that dorsal displacement of the soft palate is diagnosed less often during overground endoscopy than during treadmill endoscopy. Strenuous exercise tests may be more easily performed on a treadmill than by performing multiple exercise intervals in the field. Potential relevance: Care should be taken in interpreting negative findings during both procedures, but particularly during overground endoscopy if racing conditions have not been appropriately replicated. [source] Complementary and alternative medicine practitioner consultations among those who have or have had cancer in a Norwegian total population (Nord-Trøndelag Health Study): prevalence, socio-demographics and health perceptionsEUROPEAN JOURNAL OF CANCER CARE, Issue 3 2010A. STEINSBEKK phd, research fellow STEINSBEKK A., ADAMS J., SIBBRITT D. & JOHNSEN R. (2010) European Journal of Cancer Care19, 346,351 Complementary and alternative medicine practitioner consultations among those who have or have had cancer in a Norwegian total population (Nord-Trøndelag Health Study): prevalence, socio-demographics and health perceptions The aim of the study was to identify the use of complementary and alternative medicine (CAM) practitioners among current and previous cancer patients in a total population. A secondary analysis of data from the Nord-Trøndelag Health Study (otherwise known as the HUNT 2 Study) , a total population survey conducted in central Norway , was undertaken. Analysis focused upon the response of 1406 individuals who reported to have or have had cancer and who answered a question on visits to CAM practitioners. The study identified 16.1% of respondents had visited a CAM practitioner in the prior 12 months compared with 12.8% in the total population, and the likelihood of consulting a CAM practitioner was significantly increased among those who had a university degree, who reported a lower perceived global health and who had experienced a health complaint during the last 12 months. Complementary and alternative medicine practitioner consultations among individuals with a previous or current malignant disease were highest for those with poor self-reported health status and with a recent health complaint. From the socio-demographic variables studied only the reporting of a university degree was significantly associated with higher CAM practitioner use. [source] Clinical tests in distinguishing between persons with or without craniomandibular or cervical spinal pain complaintsEUROPEAN JOURNAL OF ORAL SCIENCES, Issue 6 2000Corine M. Visscher The recognition of a craniomandibular or cervical spinal pain is usually based upon the pain complaint of the patient, reported during an oral history, and the pain responses provoked in a clinical examination. Often used clinical tests are palpation, and function tests like dynamic/static tests or active movements. The relative importance of these tests for the recognition of the musculoskeletal pain is important. Therefore, it was the aim of the present study to determine which test, or combination of tests, best discriminates between persons with or without craniomandibular and/or cervical spinal pain complaints. Two hundred and fifty persons participated. From each person, a standardized oral history was taken. Then, in a randomized order and using a blind design, physical examinations of the craniomandibular system and of the neck were performed. Forward stepwise logistic regression analyses showed that the dynamic/static tests discriminated better between persons with and without pain complaints than the other tests did. In conclusion, in studies to the coexistence of craniomandibular and cervical spinal pain, it may be a good choice to base the recognition of these disorders on the pain complaints reported in the oral history which are verified by the pain response of the dynamic/static tests. [source] Electrocardiographic ST-segment Elevation: Correct Identification of Acute Myocardial Infarction (AMI) and Non-AMI Syndromes by Emergency PhysiciansACADEMIC EMERGENCY MEDICINE, Issue 4 2001William J. Brady MD Abstract. Objective: To determine the emergency physician's (EP's) ability to identify the cause of ST-segment elevation (STE) in a hypothetical chest pain patient. Methods: Eleven electrocardiograms (ECGs) with STE were given to EPs; the patient in each instance was a 45-year-old male with a medical history of hypertension and diabetes mellitus with the chief complaint of chest pain. The EP was asked to determine the cause of the STE and, if due to acute myocardial infarction (AMI), to decide whether thrombolytic therapy (TT) would be administered (the patient had no contraindication to such treatment). Rates of TT administration were determined; appropriate TT administration was defined as that occurring in an AMI patient, while inappropriate TT administration was defined as that in the non-AMI patient. Results: Four hundred fifty-eight EPs completed the questionnaire; levels of medical experience included the following: postgraduate year 2-3, 193 (42%); and attending, 265 (58%). The overall rate of correct interpretation of the study ECGs was 94.9% (4,782 correct interpretations out of 5,038 instances). Acute myocardial infarction with typical STE, ventricular paced rhythm, and right bundle branch block were never misinterpreted. The remaining conditions were misinterpreted with rates ranging between 9% (left bundle branch block, LBBB) and 72% (left ventricular aneurysm, LVA). The overall rate of appropriate thrombolytic agent administration was 83% (1,525 correct administrations out of 1,832 indicated administrations). The leading diagnosis for which thrombolytic agent was given inappropriately was LVA (28%), followed by benign early repolarization (23%), pericarditis (21%), and LBBB without electrocardiographic AMI (5%). Thrombolytic agent was appropriately given in all cases of AMI except when associated with atypical STE, where it was inappropriately withheld 67% of the time. Conclusions: In this survey, EPs were asked whether they would give TT based on limited information (ECG). Certain syndromes with STE were frequently misdiagnosed. Emergency physician electrocardiographic education must focus on the proper identification of these syndromes so that TT may be appropriately utilized. [source] The Emergency Department Presentation of Patients with Active Pulmonary TuberculosisACADEMIC EMERGENCY MEDICINE, Issue 9 2000Peter E. Sokolove MD Abstract. Objective: To determine the clinical presentation of emergency department (ED) patients with active pulmonary tuberculosis (TB). Methods: This was a retrospective medical record review of adult patients, identified through infection control records, diagnosed as having active pulmonary TB by sputum culture over a 30-month period at an urban teaching hospital. The ED visits by these patients from one year before to one year after the initial positive sputum culture were categorized as contagious or noncontagious, using defined clinical and radiographic criteria. The medical records of patients with contagious visits to the ED were reviewed to determine chief complaint, presence of TB risk factors and symptoms, and physical examination and chest radiograph findings. Results: During the study period, 44 patients with active pulmonary TB made 66 contagious ED visits. Multiple contagious ED visits were made by 12 patients (27%; 95% CI = 15% to 43%). Chief complaints were pulmonary 33% (95% CI = 22% to 46%), medical but nonpulmonary 41% (95% CI = 29% to 54%), infectious but nonpulmonary 14% (95% CI = 6% to 24%), and traumatic/orthopedic 12% (95% CI = 5% to 22%). At least one TB risk factor was identified in 57 (86%; 95% CI%= 76 to 94%) patient visits and at least one TB symptom in 51 (77%; 95% CI = 65% to 87%) patient visits. Cough was present during only 64% (95% CI = 51% to 75%) of the patient visits and hemoptysis during 8% (95% CI = 3% to 17%). Risk factors and symptoms that, if present, were likely to be detected at triage were foreign birth, homelessness, HIV positivity, hemoptysis, and chest pain. Conclusions: Patients with active pulmonary TB may have multiple ED visits, and often have nonpulmonary complaints. Tuberculosis risk factors and symptoms are usually present in these patients but often missed at ED triage. The diversity of clinical presentations among ED patients with pulmonary TB will likely make it difficult to develop and implement high-yield triage screening criteria. [source] Teaching Gambits: The Effect of Instruction and Task Variation on the Use of Conversation Strategies by Intermediate Spanish StudentsFOREIGN LANGUAGE ANNALS, Issue 2 20022Article first published online: 10 SEP 200, Gregory Taylor This study, based in part on previous research by Wildner-Bassett (1984), examined (1) whether gambit use in Spanish can be taught effectively in the classroom, allowing the student to use gambits appropriately in unplanned speech; (2) how the type of interactional situation (a friendly discussion versus a complaint) affects the production of gambits; and (3) what types of gambits show the greastest increases in use for each interactional situation. Participants were intermediate students. A repeated-measures design was used. Results suggest that students can be taught to use gambits effectively and appropriately in the classroom. In addition, the nature of the interactional situation seemed to make a difference in the ability of the students to produce gambits in spontaneous interaction and in the types of gambits they produced. [source] Prospective Validation of a Modified Thrombolysis In Myocardial Infarction Risk Score in Emergency Department Patients With Chest Pain and Possible Acute Coronary SyndromeACADEMIC EMERGENCY MEDICINE, Issue 4 2010Erik P. Hess MD Abstract Objectives:, This study attempted to prospectively validate a modified Thrombolysis In Myocardial Infarction (TIMI) risk score that classifies patients with either ST-segment deviation or cardiac troponin elevation as high risk. The objectives were to determine the ability of the modified score to risk-stratify emergency department (ED) patients with chest pain and to identify patients safe for early discharge. Methods:, This was a prospective cohort study in an urban academic ED over a 9-month period. Patients over 24 years of age with a primary complaint of chest pain were enrolled. On-duty physicians completed standardized data collection forms prior to diagnostic testing. Cardiac troponin T-values of >99th percentile (,0.01 ng/mL) were considered elevated. The primary outcome was acute myocardial infarction (AMI), revascularization, or death within 30 days. The overall diagnostic accuracy of the risk scores was compared by generating receiver operating characteristic (ROC) curves and comparing the area under the curve. The performance of the risk scores at potential decision thresholds was assessed by calculating the sensitivity and specificity at each potential cut-point. Results:, The study enrolled 1,017 patients with the following characteristics: mean (±SD) age 59.3 (±13.8) years, 60.6% male, 17.9% with a history of diabetes, and 22.4% with a history of myocardial infarction. A total of 117 (11.5%) experienced a cardiac event within 30 days (6.6% AMI, 8.9% revascularization, 0.2% death of cardiac or unknown cause). The modified TIMI risk score outperformed the original with regard to overall diagnostic accuracy (area under the ROC curve = 0.83 vs. 0.79; p = 0.030; absolute difference 0.037; 95% confidence interval [CI] = 0.004 to 0.071). The specificity of the modified score was lower at all cut-points of >0. Sensitivity and specificity at potential decision thresholds were: >0 = sensitivity 96.6%, specificity 23.7%; >1 = sensitivity 91.5%, specificity 54.2%; and >2 = sensitivity 80.3%, specificity 73.4%. The lowest cut-point (TIMI/modified TIMI >0) was the only cut-point to predict cardiac events with sufficient sensitivity to consider early discharge. The sensitivity and specificity of the modified and original TIMI risk scores at this cut-point were identical. Conclusions:, The modified TIMI risk score outperformed the original with regard to overall diagnostic accuracy. However, it had lower specificity at all cut-points of >0, suggesting suboptimal risk stratification in high-risk patients. It also lacked sufficient sensitivity and specificity to safely guide patient disposition. Both scores are insufficiently sensitive and specific to recommend as the sole means of determining disposition in ED chest pain patients. ACADEMIC EMERGENCY MEDICINE,2010; 17:368,375 © 2010 by the Society for Academic Emergency Medicine [source] Postradiotherapy surveillance practice for head and neck squamous cell carcinoma,too much for too little?,HEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 12 2003David L. Schwartz MD Abstract Introduction. Limited information is available regarding surveillance patterns after head and neck cancer radiotherapy. We cataloged follow-up for a specified patient cohort treated at three neighboring university, community, and Veterans Administration institutions. Methods. One hundred fifteen patients were treated with curative intent between 1994,1998 with definitive or postoperative radiotherapy for newly diagnosed squamous cell carcinoma of the oral cavity, oropharynx, larynx, or hypopharynx. One hundred patients had continuous follow-up at their treating institution and were included for analysis. Median follow-up until disease recurrence or censorship was 28.5 months. Results. Median follow-up frequency was 5.7 visits/year and was highly variable. Although visit frequency correlated with disease stage and the presence of high-risk disease features, this association was lost when patients with early recurrences were removed from analysis. Procedure and test utilization closely mirrored visit frequency, resulting in a wide range of estimated yearly charges ($0,15,668/year; median, $1,772/year). Actuarial 3-year overall survival for the study group was 71%. Eighty-six percent (19 of 22) of potentially salvageable locoregional failures were discovered secondary to symptomatic complaint rather than by test results. Disease failure, whether detected by symptom or testing, predicted for poor survival (22% at 24 months after recurrence). Conclusions. Postradiotherapy surveillance for head and neck cancer is inconsistently pursued. A proven correlation between intensive follow-up and improved patient survival is lacking. Surveillance directed by patient symptoms should be investigated as an alternative approach. © 2003 Wiley Periodicals, Inc. Head Neck 25: 000,000, 2003 [source] | ||||||||||||||||||||||||||||||||||||||||