Duration Of Chief Complaint Research Articles

Predictors of complicated appendicitis among patients presented to public referral hospitals in Harari region, Eastern Ethiopia: a case-control study

Complicated appendicitis makes up a significant proportion of acute appendicitis. There are well established associated factors for the development of complications, but the magnitude varies between developed and developing countries. This study was aimed to look for possible incriminated factors for higher rate of complicated appendicitis among patients treated in public hospitals found in the Harari region, Eastern Ethiopia. Multi-center case-control study with 1:2 was conducted on adult complicated appendicitis patients. The sample size of 414 was determined using an Open Epi and a simple random sampling technique was used to select the samples. Kobo collect was used for data collection by trained medical doctors. Data analysis was made using a statistical package for social studies version 23. The findings were presented in tables and elaborated in texts. Binary logistic regression analysis was conducted to determine association between predictors and outcome variable with adjusted odds ratio at 95% confidence interval, p value less than 0.05. A total of 402 patients included in the study with 268(66.7%) simple appendicitis and 134(33.3%) complicated appendicitis. More patients with complicated appendicitis had a history of another health facility visit compared to the simple appendicitis groups. Duration of chief complaint, history of constipation, having history of visit to health facilities without surgical intervention for their current problem and fever has shown moderate to strong associations on binary logistic regression analysis. Delayed presentation, patients who had a history of a visit to primary health care facilities and private clinics where surgical intervention not available were also found to have an increased risk of developing complicated appendicitis.

Association of insurance type with time course of care in head and neck cancer management.

To determine differences in time course of care based on major insurance types for patients with head and neck squamous cell carcinoma (HNSCC). Retrospective cohort study. Retrospective study of Health Maintenance Organization (HMO), Preferred Provider Organization (PPO), and Medicare patients with biopsy-proven diagnosis of HNSCC referred to an academic tertiary center for tumor resection and adjuvant therapy. In addition to patient demographic information and tumor characteristics, duration of chief complaint and the following time points were collected: biopsy by referring physician, first specialty surgeon clinic appointment, surgery, and adjuvant radiation start and stop dates. There was a statistically significant increase in time interval for HMO (n = 32) patients from chief complaint to biopsy (P = .003), biopsy to first specialty surgeon clinic appointment (P < .001), and surgery to start of adjuvant radiation (P < .001) compared to that of Medicare (n = 31) and PPO (n = 41) patients. Adjuvant radiation was initiated ≤6 weeks after surgery in 22% of HMO (mean duration of 59 ± 17 days), 48% of Medicare (44 ± 13 days), and 61% of PPO (41 ± 12 days) patients. Compared to PPO and Medicare patients, HMO patients begin adjuvant radiation after surgery later and experience treatment delays in transitions of care between provider types and with referrals to specialists. Delaying radiation after 6 weeks of surgery is a known prognostic factor, with insurance type playing a possible role. Further investigation is required to identify insurance type as an independent risk factor of delayed access to care for HNSCC. 4 Laryngoscope, 130:E587-E592, 2020.

Factors predictive of the failure of medical treatment in patients with pleural infection

Background/AimsThe clinical outcomes of some patients with pleural infection may be favorable with medical treatment alone, but in others, the disease progresses and requires additional surgical treatment. However, little is known about the factors affecting this difference. The aim of this study was to investigate the factors predictive of failure of medical treatment in patients with pleural infection.MethodsA cohort of 127 consecutive patients who were admitted to the hospital with pleural infection was studied. Clinical manifestations and laboratory findings in patients in whom medical treatment succeeded or failed were reviewed.ResultsIn univariate analysis, the significant factors associated with medical treatment outcome were age, smoking history, duration of chief complaint, serum albumin level, and pleural fluid glucose and lactate dehydrogenase levels (p < 0.05). Multivariate logistic regression analysis identified age and duration of chief complaint as independent predictive factors for failure of medical treatment, with odds ratios of 0.871 (p = 0.013) and 0.797 (p = 0.026), respectively. Receiver operating characteristic curve analysis determined cutoff values of 50.5 years for age and 4.5 days for duration of chief complaint.ConclusionsWe demonstrated that a younger age < 50.5 years and shorter duration of chief complaint < 4.5 days were independent predictive factors for the failure of medical treatment in patients with pleural infection. This suggests their role as evaluative criteria in setting indications for the optimal treatment in patients with pleural infection. A larger, prospective study is required to confirm these findings.

Detecting mental disorders in dental patients with occlusion‐related problems

Dentists often treat patients who may be suffering from comorbid mental disorders without paying attention to their symptoms. This leads to a delay in starting the treatment of mental disorders and to inappropriate dental treatments for physical symptoms originating from mental disorders. In the present study, the ways in which dentists can easily detect mental disorders in dental patients with occlusion-related problems were examined. Fifty-three patients who visited the Occlusion Clinic of Kanagawa Dental College were interviewed by a psychiatrist and a dentist specialized in psychosomatic medicine. Thirty-five patients (66.0%) were diagnosed as having DSM-IV Axis I disorders. The demographic and psychological factors that correlate with the presence of mental disorders are duration of chief complaint, number of clinics and hospitals visited for the current symptom, total score of the General Health Questionnaire (GHQ), the scores of the anxiety and insomnia and social dysfunction subscales in the GHQ and the scores of the confusion-bewilderment and fatigue-inertia subscales in the Profile of Mood States (POMS). A logistic regression analysis indicated that number of clinics and hospitals visited markedly correlated with cormobidity of a mental disorder. This information may be useful for screening mental disorder patients. Dental patients having comorbid mental disorders should be treated both odontologically and psychologically.

Chiropractic Patients in Denmark 2002: An Expanded Description and Comparison With 1999 Survey

Objective The purpose of this study is to provide an expanded description of Danish chiropractic patients and to compare characteristics seen in a survey from 1999 with those seen in 2002. Methods All chiropractic clinics in Denmark were asked to collect information on new patients during 1 randomly assigned week in 2002 using a survey questionnaire. All 52 weeks of the year 2002 were represented with an even dispersion of weeks (182 clinics participated). Outcome measures included age, sex, education, occupation, location and duration of chief complaint, pain intensity, limitation of activities of daily living, mode of referral, duration of sick leave, previous treatments, comorbidity, SF-12, smoking habits, and use of x-ray. Results Eighty-five percent of all chiropractic clinics in Denmark participated in the study, and 1595 patients (81%) filled out a self-administered questionnaire. As in 1999, the most frequent area of complaint was pain related to the lower back and pelvis (49%). Contrary to the 1999 survey, most of the patients (64%) had complaints of less than 4 weeks of duration. Twenty-nine percent of the patients had been off work because of their symptoms; most of these for less than 1 week. Fifty-one percent of all patients were referred to chiropractors in 2002 (doubling since 1999). Referrals from general medical practitioners rose from 11% in 1999 to 17% in 2002. Sixty percent of all patients had similar symptoms in the past, and approximately half had previously received treatment of the same or a similar problem. Thirty percent of first-time chiropractic patients were x-rayed. Compared with general population measures, Danish chiropractic patients had significantly worse physical health status measured by the SF-12. Conclusions Most Danish chiropractic patients complain of pain related to the spine, especially the lower back, with duration of symptoms of less than 4 weeks, and many with recurrent back pain. Referrals from general medical practitioners have increased since 1999.

Do chiropractic colleges' off-campus clinical sites offer diverse opportunities for learning? A preliminary study

Objective: This study involved the collection of data on the demographic characteristics and chief complaints of patients of chiropractic college teaching clinics to study whether patients who visited different types of teaching clinics were demographically or clinically dissimilar. It represents a first step toward our ability to collect data from teaching clinics to test for differences between specific clinic populations. Design: Descriptive cross-sectional study, implemented through a survey of patients. A survey form and a data collection infrastructure already in place for an established practice-based research program allowed the application of existing resources in the teaching clinic environment. Participants: Participating clinics included on-campus, off-campus, and outreach teaching clinics of four chiropractic colleges. Recruitment took place by word of mouth; clinic directors volunteered to participate in the 1-week survey. The study population consisted of all patients, new and established and of any age, who came to participating clinics during the week of March 16-21, 1998. Results: Fourteen participating clinics returned surveys on 1612 patients. The age, sex, and race of patients, and the nature, onset, and duration of their chief complaints were significantly different among the categories of teaching clinics. Salient dissimilarities occurred in racial distribution, types of chief complaint, and duration of chief complaint among the patient populations of different clinics. Conclusion: Different types of teaching clinics may facilitate greater diversity in the patient population seen by chiropractic students, broadening the clinical training of chiropractic students by providing diversity in clinical settings and patient populations. (J Manipulative Physiol Ther 2003;26:70-6)

Chiropractic patients in Denmark: A short description of basic characteristics

Background: The vast majority of information on chiropractic and chiropractic patients originates from English-speaking countries. Lately, however, reports describing chiropractic patients and practice in other European countries have emerged.Objective: To describe basic characteristics of Danish chiropractic patients.Design: Survey questionnaire. All chiropractic clinics in Denmark were asked to collect information on new patients during 1 randomly assigned week in 1999.Setting: Private chiropractic practice and a nonprofit research institution.Outcome measures: Age and sex, location and duration of chief complaint, pain intensity, limitation of activities of daily living from chief complaint, and mode of referral.Results: Eighty-eight percent of all chiropractic clinics in Denmark participated in the study. Out of 2020 patients from the participating clinics, 1897 (94%) filled out a self-administered questionnaire. The mean age of participants was 42 years, and slightly more women than men returned the questionnaire. By far the most frequent area of complaint was pain related to the lower back (50%) followed by pain related to the neck (15%). The majority of patients had complaints in the subacute or chronic category (duration 1-6 months). Patients with sciatica had significantly higher pain scores and limitation in activities of daily living (ADL) than any other group, whereas patients with neck pain tended to score lower. Patients in the subacute category had the highest pain scores and limitation in ADL. For complaints lasting more than 6 months, limitation in ADL remained constant at a low level. Twenty-three percent of all patients were referred to the chiropractor, most frequently by a general medical practitioner. More than half of all patients had previously been treated for the same or similar problems, most frequently by a chiropractor. Fifty-one percent had also received chiropractic care for other types of problems.Conclusions: Most Danish chiropractic patients complain of pain related to the low back or neck of between 1 and 6 months' duration. This study confirms that chiropractic is fairly well integrated in the Danish primary health care system. There are differences between the chiropractic patient population in Denmark compared with that of Sweden and Holland.

Emergency Patients Who Leave without Being Seen: Are Urgently Ill or Injured Patients Leaving without Care?

Against Medical Advice (AMA) patients present troubling legal liabilities for emergency medicine physicians. One subset of AMA patients, those who present for care but leave the emergency department prior to evaluation by a physician, represent a potential source of liability. A total of 291 consecutive "Left Without Being Seen" (LWBS) patients were retrospectively studied to see how many died, required admission, or returned for outpatient medical care within 7 days. Nearly half (44%) were found to seek repeat care at clinics or the Emergency Department. Only 5 of 291 (1.7%) required admission. There were no documented deaths. Because of the difficulty in reliably predicting which patients would choose to leave without being seen, an attempt was made to identify specific LWBS patients who would seek a return visit or require admission. With the exception of one specific age group (infants less than 12 months of age), or a chief complaint referable to the cardiovascular system, no presenting parameter of the LWBS patient, including sex, chief complaint, duration of chief complaint, wait in the emergency department, and vital signs, was significantly helpful in differentiating those patients who would later return or require admission.