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Complaints
Kinds of Complaints Selected AbstractsChief Complaints, Emergency Department Clinical Documentation Systems, and the Challenge of Dealing with the Patient's Own WordsACADEMIC EMERGENCY MEDICINE, Issue 1 2007Gregg Husk MD First page of article [source] Unified Medical Language System Coverage of Emergency-medicine Chief ComplaintsACADEMIC EMERGENCY MEDICINE, Issue 12 2006Debbie A. Travers PhD Abstract Background Emergency department (ED) chief-complaint (CC) data increasingly are important for clinical-care and secondary uses such as syndromic surveillance. There is no widely used ED CC vocabulary, but experts have suggested evaluation of existing health-care vocabularies for ED CC. Objectives To evaluate the ED CC coverage in existing biomedical vocabularies from the Unified Medical Language System (UMLS). Methods The study sample included all CC entries for all visits to three EDs over one year. The authors used a special-purpose text processor to clean CC entries, which then were mapped to UMLS concepts. The UMLS match rates then were calculated and analyzed for matching concepts and nonmatching entries. Results A total of 203,509 ED visits was included. After cleaning with the text processor, 82% of the CCs matched a UMLS concept. The authors identified 5,617 unique UMLS concepts in the ED CC data, but many were used for only one or two visits. One thousand one hundred thirty-six CC concepts were used more than ten times and covered 99% of all the ED visits. The largest biomedical vocabulary in the UMLS is the Systematized Nomenclature of Medicine Clinical Terms (SNOMED CT), which included concepts for 79% of all ED CC entries. However, some common CCs were not found in SNOMED CT. Conclusions The authors found that ED CC concepts are well covered by the UMLS and that the best source of vocabulary coverage is from SNOMED CT. There are some gaps in UMLS and SNOMED CT coverage of ED CCs. Future work on vocabulary control for ED CCs should build upon existing vocabularies. [source] A System for Grouping Presenting Complaints: The Pediatric Emergency Reason for Visit ClustersACADEMIC EMERGENCY MEDICINE, Issue 8 2005MSCE, Marc H. Gorelick MD Abstract Objectives: To develop a set of chief complaint groupings for pediatric emergency department (ED) visits that is comprehensive, parsimonious, clinically sensible, and evidence-based. Methods: Investigators derived candidate chief complaint clusters and ranked them a priori into three perceived severity categories. Pediatric visits were extracted from the National Hospital Ambulatory Medical Care Survey (NHAMCS); data for years 1998 and 2000 (n= 13,186) were used for derivation and data for year 1999 (n= 5,365) were used for validation. Visits were assigned to clusters based on the recorded complaints; clusters were combined to ensure adequate numbers for analysis (minimum n= 20), and the clusters were reviewed for clinical sensibility. Resource utilization was categorized in three levels: routine (examination only), ED treatment (tests or therapy in the ED but not admitted), and admission. Area under the receiver-operating characteristic (ROC) curve (AUC) was used to demonstrate the discriminative ability of the clusters in predicting resource use. Results: There were 463 unique complaints in the derivation database; 95 (20%) had a single associated visit. Fifty-two clusters were generated; only 2.4% of complaints were classified as other. The eight most common clusters encompassed 52% of the visits. The top five were fever (11%), extremity pain/injury, vomiting, cough, and trauma (unspecified). Complaint clusters were associated with actual resource utilization: for routine care, the AUC was 0.73 (0.74 in the validation set), and for admission, the AUC was 0.77 (0.74 in the validation set). Both resource utilization and triage classification increased with increased expert severity ranking (test for trend, p < 0.001). Conclusions: The proposed Pediatric Emergency Reason for Visit Cluster (PERC) system is a comprehensive yet parsimonious, clinically sensible means of categorizing pediatric ED complaints. The PERC system's association with measures of acuity and resource utilization makes it a potentially useful tool in epidemiologic and health services research. [source] Mastering 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] Sleep patterns, sleep disturbances and sleepiness in retired Iranian eldersINTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 11 2009Seyed Kazem Malakouti Abstract Objectives Complaints of sleep disturbance increase with age and many studies have reported on the relationship of sleep problems to the greater use of health services, physical and mental morbidity, functional decline, and all causes of mortality. This study aimed to examine sleep patterns and sleep disturbances in Iranian elders and correlate their sleep quality to their health status. Methods Four hundred men and women, aged 60 years or older, were interviewed by trained interviewers regarding their physical and mental health status. The Pittsburghh Sleep Quality Index, the Epworth Sleepiness Scale (ESS), and a General Health Questionnaire (GHQ) were then administered to each participant. The data gathered were analyzed using ,2 -test, t -test, and one-way analysis of variance and logistic regression. Results The results indicated that the majority of participants (82.6%) suffered from poor sleep quality and approximately one-third (29.2%) experienced sleepiness during the daytime. Difficulty falling asleep (p,,,0.001) and maintaining sleep (p,,,0.01) and the feeling of being too hot at night (p,,,0.005) were significantly more prevalent in women, but men suffered more from leg twitching (p,,,0.01). Being female (OR,=,2.52), and having GHQ scores of more than 11 (OR,=,4.14) increased the risk of poor sleep quality considerably. Conclusion Promoting sleep hygiene education of elders in primary health care services are recommended. Copyright © 2009 John Wiley & Sons, Ltd. [source] Changes in aspects of children's oral-health-related quality of life following dental treatment under general anaesthesiaINTERNATIONAL JOURNAL OF PAEDIATRIC DENTISTRY, Issue 5 2004H. K. ANDERSON Summary. Objectives. This study was intended to examine the treatment-associated change in aspects of oral-health-related quality of life (QoL) among children (and their families) undergoing dental rehabilitation under general anaesthesia (GA). Methods. The parents or caregivers of a consecutive clinical sample of children receiving comprehensive dental treatment under GA at the University of Otago School of Dentistry, Dunedin, and the Christchurch Oral Health Centre, Christchurch, New Zealand, were interviewed by telephone before and after the treatment. Questions were asked relating to the impact of the condition on the child and the family. The post-treatment questionnaire also sought information related to parental satisfaction with the care provided under GA. Results. The parents or caregivers of 95 children participated in the study: 49 had treatment completed at the University of Otago School of Dentistry; and 46 were treated at the Christchurch Oral Health Centre. The child sample comprised 55·8% males and 44·2% females with a mean age of 5·1 years. Their mean dmft was 8·2. A consistent pattern of improvement was found with each indicator used. Complaints of pain, problems with eating and sleeping, and behaviour concerns showed significant improvements, with 100% improvement for children for whom frequent pre-GA problems associated with eating, sleeping and behaviour were reported. Sixty-six parents had to arrange time away from employment on the day of the GA and almost half of those incurred a loss of income. The majority of parents reported a high degree of satisfaction with the care received. Conclusions. Treating young children with high disease experience in a single session under GA results in immediate improvement in oral health and aspects of their QoL for both the children and their families. [source] Patients Presenting to the Emergency Department With Non-specific Complaints: The Basel Non-specific Complaints (BANC) StudyACADEMIC EMERGENCY MEDICINE, Issue 3 2010Marek Nemec MD Abstract Objectives:, Patient management in emergency departments (EDs) is often based on management protocols developed for specific complaints like dyspnea, chest pain, or syncope. To the best of our knowledge, to date no protocols exist for patients with nonspecific complaints (NSCs) such as "weakness,""dizziness," or "feeling unwell." The objectives of this study were to provide a framework for research and a description of patients with NSCs presenting to EDs. Methods:, Nonspecific complaints were defined as the entity of complaints not part of the set of specific complaints for which evidence-based management protocols for emergency physicians (EPs) exist. "Serious conditions" were defined as potentially life-threatening or those requiring early intervention to prevent health status deterioration. During a 6-month period, all adult nontrauma patients with an Emergency Severity Index (ESI) of 2 or 3 were prospectively enrolled, and serious conditions were identified within a 30-day period. Results:, The authors screened 18,261 patients for inclusion. A total of 218 of 1,611 (13.5%) nontrauma ESI 2 and 3 patients presented with NSCs. Median age was 82 years (interquartile range [IQR] = 72 to 87), and 24 of 218 (11%) were nursing home inhabitants. A median of 4 (IQR = 3 to 5) comorbidities were recorded, most often chronic hypertension, coronary artery disease, and dementia. During the 30-day follow-up period a serious condition was diagnosed in 128 of 218 patients (59%). The 30-day mortality rate was 6%. Conclusions:, Patients with NSC presenting to the ED are at high risk of suffering from serious conditions. Sensitive risk stratification tools are needed to identify patients with potentially adverse health outcomes. ACADEMIC EMERGENCY MEDICINE 2010; 17:284,292 © 2010 by the Society for Academic Emergency Medicine [source] Personality and psychopathology in an impulsive aggressive college sampleAGGRESSIVE BEHAVIOR, Issue 1 2006Laura E. Helfritz Abstract Certain personality traits have been associated with impulsive aggression in both college and community samples, primarily irritability, anger/hostility, and impulsivity. The literature regarding the psychopathology associated with impulsive aggression is relatively sparse and strongly emphasizes DSM-IV-TR [APA, 2000] Axis II personality disorders, although some comorbidity with Axis I clinical disorders has been reported. The current study compares impulsive aggressive (IA) college students with their non-aggressive peers on several self-report measures of personality and psychopathology. Personality results were as predicted, with IAs scoring higher than controls on measures of impulsivity and aggression. Additionally, the Psychopathic Personality Inventory (PPI), which was given for exploratory purposes, revealed a unique pattern of psychopathic traits in impulsive aggression that contained key differences from the callous-unemotional profile seen in premeditated aggression. Contrary to our hypothesis that a specific pattern of psychopathology (personality disorders, bipolar disorder, and adult attention deficit hyperactivity disorder) would emerge for impulsive aggression, IAs scored significantly higher than controls on nearly every clinical scale of the Personality Assessment Inventory (PAI; Somatic Complaints, Anxiety, Anxiety-Related Disorders, Depression, Mania, Schizophrenia, Borderline Features, Antisocial Features, Alcohol Problems, and Drug Problems), indicating a global elevation of psychopathology. In conclusion, while the personality traits and behaviors that characterize impulsive aggression are relatively consistent across individuals, its associated psychopathology is unexpectedly variable. Aggr. Behav. 00:1,10, 2005. © 2005 Wiley-Liss, Inc. [source] Complaints and claims in the UK National Health ServiceJOURNAL OF EVALUATION IN CLINICAL PRACTICE, Issue 1 2002T.S. Usha Kiran MRCOG [source] Diagnosis and management of geriatric insomnia: A guide for nurse practitionersJOURNAL OF THE AMERICAN ACADEMY OF NURSE PRACTITIONERS, Issue 12 2008MN (Nurse Practitioner), Preetha Krishnan RN Abstract Purpose: To discuss the assessment, diagnosis, and management of geriatric insomnia, a challenging clinical condition of older adults frequently seen by primary care providers. Data sources: Extensive literature review of the published research articles and textbooks. Conclusions: Complaints of insomnia among older adults are frequently ignored, considered a part of the normal aging process or viewed as a difficult to treat condition. Geriatric insomnia remains a challenge for primary care providers because of the lack of evidence-based clinical guidelines and limited treatment options available. Effective management of this condition is necessary for improved quality of life, which is a primary issue for the elderly and their families. Therefore, geriatric insomnia warrants thorough attention from the nurse practitioners (NPs) who provide care for older adults. Implications for practice: Undiagnosed or under treated insomnia can cause increased risk for falls, motor vehicle accidents, depression, and shorter survival. Insomniacs double their risk for cardiovascular disease, stroke, cancer, and suicide compared to their counterparts. Insomnia is also associated with increased healthcare utilization and institutionalization. NPs could play a central role in reducing the negative consequences of insomnia through a systematic approach for diagnosis, evaluation, and management. [source] Evaluating Acute Musculoskeletal ComplaintsJOURNAL OF THE AMERICAN ACADEMY OF NURSE PRACTITIONERS, Issue 5 2001Mary Jo Goolsby EdD Clinical practice guidelines (CPG) are now widely available summarizing large amounts of scientific evidence and providing specific recommendations for the evaluation, diagnosis, and management of varied health problems. In order to take advantage of the available CPGs in clinical practice, providers must be aware of their existence and be able to critique them for scientific merit and relevance to specific clinical settings. This ongoing series is designed to provide a brief review of a different CPG each month. This month, the CPG reviewed addresses the evaluation of an extremely common set of complaints: musculoskeletal symptoms. The document emphasizes the importance of a thorough history and physical for these presentations and indicates when specific diagnostic studies and/or consultations are warranted. [source] Unraveling the Ivory Fabric: Institutional Obstacles to the Handling of Sexual Harassment ComplaintsLAW & SOCIAL INQUIRY, Issue 1 2000Jennie Kihnley Title VII of the Civil Rights Act of 1964 and Title IX of the Educational Amendments of 1972 make universities liable for sexual harassment that occurs within both the employment and academic contexts. This article examines how universities implement and enforce the mandates of both Title VII and Title IX through exploratory research about sexual harassment complaint procedures at a public university system on the West Coast. In-depth interviews with personnel at each campus shed light on problems with inserting a complaint resolution process into an institution that simultaneously strives to eliminate sexual harassment, while wanting to protect itself from liability. This inherent conflict of goals is reflected in the differing roles of the Title IX office and the Women's Resource Center, in creation of a user friendly policy, and in the two branches of dispute resolution. [source] Peripheral neuropathy in an outpatient cohort of patients with Sjögren's syndromeMUSCLE AND NERVE, Issue 5 2006Glenn Lopate MD Abstract Peripheral neuropathy is common in patients with Sjögren's syndrome (SS), but its precise prevalence is unknown. Most prior studies were conducted at neurology or rheumatology specialty clinics and likely selected for a more severely affected population. We evaluated 22 SS patients and 10 controls for evidence of neuropathy in an outpatient setting at a regional meeting of the Sjögren's Syndrome Foundation. We performed neurological examinations and nerve conduction studies (NCSs) and measured serum antinuclear antibody (ANA) and SS-A and SS-B antibody levels. Participants filled out a questionnaire pertaining to symptoms, diagnosis, and treatment. We found that signs and symptoms related to small axons were more common in patients with SS than in controls. Complaints of painful distal paresthesias in the feet were noted in 59% of patients but in only 10% of controls, and of abnormal sweating in 41% and 0%, respectively. Examination revealed decreased pinprick sensation in 64% of patients with SS, but in only 30% of controls. Overall, 45% of the patients but none of the controls were thought to have an isolated small-fiber neuropathy. Large-fiber dysfunction (as measured by testing vibration, deep tendon reflexes, and NCSs) was similar between the two groups. We conclude that small-fiber neuropathy is common in patients with SS. Muscle Nerve 2006 [source] Ambulatory foot temperature measurement: A new technique in polyneuropathy evaluationMUSCLE AND NERVE, Issue 6 2003Peter B. Kang MD Abstract Complaints of abnormal foot temperature are common among patients with polyneuropathy. However, there is no published method of ambulatory foot temperature measurement to identify possible thermoregulatory disturbances in these patients. We configured a digital electronic thermometer and thermocouple to measure and record distal foot and ambient temperatures simultaneously every minute for 24 to 48 h. Sixteen patients with polyneuropathy and 5 normal subjects were studied; 12 patients with polyneuropathy and 4 normal subjects had at least 24 h of successful recording. The data obtained from these patients were consistent and easily summarized by standard statistical methods. In the others, technical difficulties produced nonphysiological readings. In the patients with polyneuropathy, changes in foot temperature mirrored ambient temperature fluctuations more closely than in normal subjects. This technique shows promise in studying temperature regulation in the feet and may provide new insights into neuropathy-associated pain and the pathogenesis of polyneuropathy. Muscle Nerve 27: 737,742, 2003 [source] Complaints related to respiratory events in anaesthesia and intensive care medicine from 1994 to 1998 in DenmarkACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 1 2001C. Rosenstock Background: In Denmark, a National Board of Patients' Complaints (NBPC) was founded in 1988. This study analyses anaesthetic complaints related to adverse respiratory events filed at the NBPC from 1994 to 1998 to point out directions for possible preventive measures. Methods: All decisions made by the NBPC from 1994 to 1998 concerning personnel employed in the Danish health care system were scrutinized. Cases related to anaesthesia and intensive care medicine were reviewed. Adverse respiratory events were identified and classified by mechanism of the incident that had caused the complaint. Detailed information on anaesthetic technique, personnel involved, sequence of events, clinical manifestation of injury, and outcome was recorded. Results: A total of 284 cases was identified. One-fifth (n=60) of the complaints were related to an adverse respiratory event. The overall mortality in these cases was 50% (n=30). In 19 complaints (32%), the treatment was considered substandard. Conclusion: Complaints related to respiratory events reveal that inadequate anaesthetic and intensive care medicine treatment leads to patient damage and death. Preventive strategies should be directed at the development of guidelines for handling the difficult airway, education in the management of the difficult airway, instruction in the correct use of anaesthetic equipment, improvement of interpersonnel communication routines, as well as implementation of simulator training. [source] Habitual snoring in an outpatient population in JapanPSYCHIATRY AND CLINICAL NEUROSCIENCES, Issue 4 2000Yuhei Kayukawa MD Abstract In order to investigate the occurrence and history of sleep problems in Japan, the 11-Centre Collaborative Study on Sleep Problems (COSP) project was carried out. Complaints of snoring are examined, and its prevalence, risk factors and screening reliability are discussed. The subjects who participated in the study were 6445 new outpatients from a general hospital. They were asked to answer a sleep questionnaire that consisted of 34 items with seven demographic items; each item was composed of four grades of frequency. In order to offset possible seasonal variations in sleep habits, data were collected across four seasons. Sleep patterns, insomnia, hypersomnia, parasomnia and circadian rhythm sleep disorders were covered. Habitual snoring was seen in 16.0% of males and 6.5% of females. Male predominance was noted. From these data, the relationship between habitual snoring and sleep complaints was statistically analyzed. Habitual snorers (HS) were observed to wake up more frequently during sleep (17.8% of males, 21.5% of females) than were non-habitual snorers (NHS; 6.6% of males, 9.7% of females). Mid-sleep awakening of HS was also more frequent than it was for NHS; however, there were no differences in difficulty in falling asleep and early morning awakening. Body mass index, cigarette smoking and alcohol consumption were also correlated with habitual snoring. [source] Police Complaints and Criminal ProsecutionsTHE MODERN LAW REVIEW, Issue 3 2001Graham Smith The police complaints process is the sole means by which criminal proceedings are initiated against police officers after allegations by members of the public that they were the victim of an offence committed by officers when in the execution or purported execution of their duty. Yet this state of the law has hardly figured in recent debate, which has seen the complaints process examined almost exclusively as the preliminary stage of the disciplinary process. This paper considers police complaints, the criminal liability of the officer and the implications for reform of the process after incorporation of the European Convention on Human Rights. [source] Childhood Abuse and Common Complaints in PregnancyBIRTH, Issue 3 2009Mirjam Lukasse RM ABSTRACT: Background: Childhood abuse affects adult health. The objective of this study was to examine the prevalence of emotional, physical, and sexual childhood abuse within a large Norwegian cohort of pregnant women and its association with common complaints in pregnancy.Methods: This study is based on the Norwegian Mother and Child Cohort Study (MoBa) conducted by the Norwegian Institute of Public Health. Regression analyses were used to examine associations of childhood abuse and 16 common complaints in pregnancy.Results: Eighteen percent (10,363/55,776) of the women reported some type of childhood abuse. Of all women, 3,870 (6.9%) reported sexual abuse, 3,075 (5.5%) physical abuse, and 7,619 (13.6%) emotional abuse as a child. Of those reporting childhood abuse, 31 percent reported two or more types of abuse. All 16 common complaints in pregnancy were associated with reported childhood abuse. Women reporting three types of childhood abuse reported 5.4 common complaints in pregnancy (mean) compared with 3.7 for women without childhood abuse (p < 0.001). Women reporting childhood abuse are more likely to report seven or more common complaints in pregnancy: adjusted odds ratio (AOR) 1.7 (95% CI 1.6,1.9) for emotional abuse; AOR 2.5 (95% CI 2.0,3.1) for combined physical and sexual abuse; and AOR 3.5 (95% CI 3.0,4.0) for all three kinds of abuse. Sociodemographic characteristics and other risk factors did not explain this graded association.Conclusions: Abuse in childhood is associated with increased reporting of common complaints of pregnancy. Clinicians should consider the possible role of childhood abuse when treating women with many common complaints in pregnancy. [source] Hiding Customer Complaints: Studying the Motivations and Forms of Service Employees' Complaint Concealment BehavioursBRITISH JOURNAL OF MANAGEMENT, Issue 2 2010Lloyd C. Harris This study aims to explore both how and why customer service employees conceal the complaints made by customers. Using an exploratory qualitative approach, data were gathered through the in-depth interviewing of 25 managers, 25 supervisors and 57 front-line employees of UK general retailers/supermarkets. Data analysis reveals that the concealment of customer complaints by store employees of all hierarchical levels is common. Front-line, customer-contact employees were found to conceal complaints in four ways: through (1) misleading customers, (2) complaint resolution without logging, (3) concealing recorded complaints and (4) falsification of recorded complaints. Store-level supervisory and managerial employees were also found to conceal complaints in four ways: through (1) complaint resolution without logging, (2) concealing recorded complaints, (3) the non-recording of complaints and (4) the disregarding of ,minor' complaints. The motives for complaint concealment differed between managerial/supervisory and front-line employees but included reasons of (1) personal protection, (2) perceived customer unpleasantness, (3) serial complaint avoidance, (4) alienation, (5) friends or family protection, (6) instrumental gain, (7) avoidance of additional work, (8) perceived unfairness and (9) limited time. These findings suggest that theorists and practitioners need to acknowledge the existence and prevalence of these motives and behaviours and incorporate them into their conceptualizations and practices. [source] Differences in Long-term Mortality for Different Emergency Department Presenting ComplaintsACADEMIC EMERGENCY MEDICINE, Issue 1 2008Urban Safwenberg MD Abstract Objectives:, To characterize long-term mortality based on previous emergency department (ED) presenting complaints. Methods:, The authors followed, for 10 years, all of the 12,667 nonsurgical patients visiting an ED during 1995/1996. Differences in standardized mortality ratio (SMR) depending on presenting complaints were then investigated. Results:, During follow-up, 5,324 deaths occurred (mortality rate 6.6 per 100 person-years at risk), giving a SMR of 1.33 (95% CI = 1.30 to 1.37, p < 0.001) when compared with the expected mortality in the catchment area. Different presenting complaints were associated with different long-term mortality rates, independent of age and gender (p < 0.0001). The subjects with seizures had the highest SMR (2.62, 95% CI = 2.13 to 3.22) followed by intoxications (2.51, 95% CI = 2.11 to 2.98), asthmalike symptoms (1.84, 95% CI = 1.65 to 2.06), and hyperglycemia (1.67, 95% CI = 1.42 to 1.95). The largest complaint group, chest pain, had a 20% higher mortality rate than the background population (95% CI = 1.13 to 1.26). Patients with a discharge diagnosis of myocardial infarction, but without chest pain as the presenting complaint, had an increased long-term mortality (hazard ratio [HR] 1.70, 95% CI = 1.15 to 2.42) compared to the group with chest pain. In contrast, stroke patients without strokelike symptoms had a reduced mortality (HR 0.74, 95% CI = 0.65 to 0.84) compared to patients with strokelike symptoms. Conclusions:, Long-term age- and gender-adjusted mortality is the highest with seizures out of 33 presenting complaints and differs markedly between different ED admission complaints. Furthermore, depending on the admission complaint, long-term mortality differs within the same discharge diagnosis. Hence, the presenting complaint adds unique information to the discharge diagnosis regarding long-term mortality in nonsurgical patients. [source] FS09.1 Diacetylmorphine (heroin) allergyCONTACT DERMATITIS, Issue 3 2004Aliet J Hogen Esch Since heroin is delivered to a selected group of drug addicts under supervision of nurses in the Netherlands, we reported about several nurses who presented with work-related eczema and positive patch tests to heroin. To investigate the prevalence of heroin contact allergy among all workers in this heroin delivery project, a study was started using questionnaires. Altogether 31 nurses reported work-related complaints out of 100 who returned questionnaires. Besides reports of eczema, mainly of eyelids (probably airborne) and hands, there were mucosal and respiratory complaints. Patch tests were performed in 25 nurses with complaints; in 9 of them a heroin contact allergy could be confirmed. In 6 out of these 9 nurses this was combined with mucosal or respiratory complaints. There were also 6 nurses with mucosal or respiratory complaints without a contact allergy. Contact dermatitis from opioids, such as morphine and codeine, has been documented among opioid industry workers, nurses, doctors, pharmacists, and in patients. In conclusion heroin appears to be a potent contact allergen, causing contact dermatitis. Mucosal and respiratory complaints however, cannot be explained by this contact allergy; they might be caused by a type-1-allergy to heroin, or by a direct histamine liberating effect. Opioids are known histamine liberators causing urticaria, rhinitis and anaphylactoid reactions; therefore intracutaneous tests with heroin are unreliable. In an ongoing research project it will be attempted to detect specific IgE to heroin in the 12 workers with mucosal or respiratory complaints; within the next few months results will be available. [source] P03 Type-I and -IV hypersensitivity to platinum saltsCONTACT DERMATITIS, Issue 3 2004Willeke Kamphof A 28-year-old female analytical chemist visited our patch test clinic with initially complaints of severe hand dermatitis. Later on she developed rhinitis, bronchial asthma and tightness of the chest. The complaints seemed work related: her condition improved during holidays and on sick leaves. She worked in a laboratory with several platinum salts and used different kinds of gloves (latex, nitril, etc.). Methods:, Patch tests were performed with the European Standard series and prick tests with common inhalant allergens. Patch-, prick- and open patch tests were carried out with various aqueous dilutions of platinum chloride (PtCl2). Results:, Patch tests with 0.01,2% PtCl2 were positive on day 2, 3 and 6, and at 0.001% a follicular reaction was found. The prick-test was already positive at the lowest concentration tested (0.001%). The open patch test, carried out retro-auricular, showed a positive reaction at 1 and 2% PtCl2 after 20 min. Controls in healthy volunteers (n = 5) were all negative. Discussion:, It is well known that platinum salts can cause type-I hypersensitivity reactions like allergic rhinitis, conjunctivitis, bronchial asthma and urticaria, also referred to as platinosis. Contact dermatitis to platinum salts, however, is very rare. In our patch test clinic, 78 patients were tested between 1987 and 2001 with PtCl2 2%. Only 2 women showed a positive patch test for PtCl2. The patient presented here, stopped working with platinum salts and recovered from all complaints. We interpret our case as occupational type-I and type-IV hypersensitivity to platinum salts with mucosal and dermal manifestations. [source] Dental gold alloys and contact allergyCONTACT DERMATITIS, Issue 2 2002Halvor Möller Contact allergy to gold as demonstrated by patch testing is very common among patients with eczematous disease and seems to be even more frequent among patients with complaints from the oral cavity. There is a positive correlation between gold allergy and the presence of dental gold. Gold allergy is often found in patients with non-specific stomatitides as well as in those with lichenoid reactions or with only subjective symptoms from the oral cavity. The therapeutic effect of substituting other dental materials for gold alloys is conspicuous in casuistic reports but less impressive in larger patient materials. The amount of dental gold is correlated qualitatively and quantitatively to the blood level of gold and the effects if any of circulating blood gold are unknown. There is clearly a need for prospective studies in the field and gold sodium thiosulfate is considered an important item in the dental series for patch testing. [source] The use of protective gloves and the prevalence of hand eczema, skin complaints and allergy to natural rubber latex among dental personnel in the county of Uppsala, SwedenCONTACT DERMATITIS, Issue 1 2000Magnus Lindberg During the past decade, there has been an increasing problem with acrylate allergy and natural rubber latex (NRL) allergy among dental personnel. The aim of the present study was to evaluate the prevalence of these problems among dentists, dental nurses and dental hygienists in Uppsala county, Sweden. The study was based on a self-administered questionnaire sent to 690 persons with 527 responders (76%). The most common skin problem was dry skin, fissures and/or itching on the hands. Of the 72 persons (13.6%) reporting to have suffered from hand eczema during the past 12 months, 41 were patch tested with the TRUE Test standard series and the Swedish dental screening series. In the patch tested group, 9.8% reacted to 1 or more of the acrylates. In addition, 389 persons were tested for NRL allergy with the Pharmacia Upjohn CAP-RAST test, and of these, we found 7.2% to be positive. The prevalence of self-reported hand eczema and the number of positive CAP-RAST tests differed between the 3 occupations, with higher figures for the dentists. There was also a correlation between atopic eczema and hand eczema. Of those reporting skin symptoms, 67.7% connected them to the place of work and 28.8% related them to the use of gloves. [source] POLICE INTERVENTION AND THE REPEAT OF DOMESTIC ASSAULTCRIMINOLOGY, Issue 3 2005RICHARD B. FELSON We use the National Crime Victimization Survey to examine whether domestic violence is less likely to be repeated if it is reported to the police and if the offender is arrested. Our longitudinal analyses suggest that reporting has a fairly strong deterrent effect, whereas the effect of arrest is small and statistically insignificant. We find no support for the hypothesis that offenders retaliate when victims (rather than third parties) call the police or when victims sign complaints. We also find no evidence that the effects of reporting or arrest depend on the seriousness of the offense, a history of violence by the offender or sociodemographic characteristics. Our results suggest that the best policies for deterrence will be those that encourage victims and third parties to report violence by intimate partners to the police. [source] Do memory complaints represent impaired memory performance in patients with major depressive disorder?DEPRESSION AND ANXIETY, Issue 10 2008Arash Mowla M.D. Abstract Memory complaints are found to be associated with depression. However, the question is, "How much these subjective complaints indicate objective memory impairments?" The aim of this study is to determine whether subjective memory complaints represent objective memory impairments and to establish the demographic and clinical characteristics of patients with major depressive disorder (MDD) and subjective memory complaints. Sixty-four patients with MDD were assessed for objective memory performance through subtests of the Wechsler Memory Scale-III. Memory complaints also were assessed in these patients with a structured interview. Thirty healthy controls were also included in the study to compare memory performance among groups. The Hamilton Rating Scale for Depression was used to measure the severity and characteristics of depression. Patients with MDD who had longer duration and earlier onset of depression reported more memory complaints. MDD patients with memory complaints had more hypochondriac concerns but not more depression severity compared with those without memory complaints. There was no relationship between subjective memory complaints and objective memory performance in MDD patients. Patients with MDD with and without memory complaints had lower scores on the Wechsler Memory Scale-III than the control group. Subjective memory complaints are not a valid indictor of objective memory impairments, and the diagnostic value of self-reported memory is being questioned in patients with MDD. The cognitive status of MDD patients should be assessed routinely, regardless of the patient awareness of his or her cognitive deficits. Depression and Anxiety, 2008. © 2007 Wiley-Liss, Inc. [source] Ergonomics in Office-Based Surgery: A Survey-Guided Observational StudyDERMATOLOGIC SURGERY, Issue 11 2007ADAM C. ESSER MD BACKGROUND The practice of office-based surgery is increasing in many specialties. OBJECTIVE Using Mohs surgery as a model, we investigated the role of ergonomics in office-based surgery to limit work-related musculoskeletal disorders. METHODS All Mayo Clinic surgeons currently performing Mohs surgery and Mohs surgeons trained at Mayo Clinic between 1990 and 2004 received a questionnaire survey between May 2003 and September 2004. A sample of respondents were videotaped during surgery. The main outcome measures were survey responses and an ergonomist's identification of potential causes of musculoskeletal disorders. RESULTS All 17 surgeons surveyed responded. Those surveyed spend a mean of 24 hours per week in surgery. Sixteen said they had symptoms caused by or made worse by performing surgery. Symptom onset occurred on average at age 35.4 years. The most common complaints were pain and stiffness in the neck, shoulders, and lower back and headaches. Videotapes of 6 surgeons revealed problems with operating room setup, awkward posture, forceful exertion, poor positioning, lighting, and duration of procedures. CONCLUSION Symptoms of musculoskeletal injuries are common and may begin early in a physician's career. Modifying footwear, flooring, table height, operating position, lighting, and surgical instruments may improve the ergonomics of office-based surgery. [source] Subjective complaints in mild cognitive impairment make a differenceACTA PSYCHIATRICA SCANDINAVICA, Issue 4 2010Rosebud O. Roberts No abstract is available for this article. [source] Risk factors for incident mild cognitive impairment , results from the German Study on Ageing, Cognition and Dementia in Primary Care Patients (AgeCoDe)ACTA PSYCHIATRICA SCANDINAVICA, Issue 4 2010T. Luck Luck T, Riedel-Heller SG, Luppa M, Wiese B, Wollny A, Wagner M, Bickel H, Weyerer S, Pentzek M, Haller F, Moesch E, Werle J, Eisele M, Maier W, van den Bussche H, Kaduszkiewicz H for the AgeCoDe Study Group. Risk factors for incident mild cognitive impairment , results from the German Study on Ageing, Cognition and Dementia in Primary Care Patients (AgeCoDe). Objectives:, To provide age- and gender-specific incidence rates of MCI among elderly general practitioner (GP) patients (75+ years) and to identify risk factors for incident MCI. Method:, Data were derived from the longitudinal German Study on Ageing, Cognition and Dementia in Primary Care Patients (AgeCoDe). Incidence was calculated according to the ,person-years-at-risk' method. Risk factors were analysed using multivariate logistic regression models. Results:, During the 3-year follow-up period, 350 (15.0%) of the 2331 patients whose data were included in the calculation of incidence developed MCI [person-years (PY) = 6198.20]. The overall incidence of MCI was 56.5 (95% confidence interval = 50.7,62.7) per 1000 PY. Older age, vascular diseases, the apoE ,4 allele and subjective memory complaints were identified as significant risk factors for future MCI. Conclusion:, Mild cognitive impairment is frequent in older GP patients. Subjective memory complaints predict incident MCI. Especially vascular risk factors provide the opportunity of preventive approaches. [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] | |||||||||||||||||||||||||||||||||||||||||||||||||