Chief Complaints Of Patients Research Articles

Development of a Definition to Identify Severe Opioid Overdoses Treated in Emergency Departments, 2019-2022.

Existing surveillance systems monitor nonfatal and fatal opioid overdoses but do not monitor severe nonfatal overdoses that require intensive medical interventions. The Centers for Disease Control and Prevention's Drug Overdose Surveillance and Epidemiology system was used to query emergency department data from local syndromic systems and the National Syndromic Surveillance Program from January 2019 to August 2022. Opioid overdoses were classified as not severe or severe using a definition from the patient's chief complaint terms and discharge diagnosis codes. The percentage of opioid overdoses treated in emergency departments classified as severe was described by patient demographics, US Census region, and month. Among 503156 opioid overdoses in 29 states and Washington, DC, from January 2019 to August 2022, 17.4% were classified as severe. Common key terms found among severe opioid overdoses were hypoxia (34.8%), unresponsive (32.9%), and naloxone/Narcan (20.9%). The largest severity percentage was in the South Census region (19.6%). The trends of severe opioid overdoses remained stable during the study period. Based on the severe opioid overdose definition, there was minimal change in the severity of opioid overdoses during the study period. This definition can help monitor trends of severe opioid overdoses, guiding public health action such as focusing on naloxone and fentanyl test strip distribution to areas of need.

Synergistic patient factors are driving recent increased pediatric urgent care demand.

We aimed to use the high fidelity urgent care patient data to model the factors that have led to the increased demand at our local pediatric urgent care centre. The dataset for this retrospective cohort study was obtained from our local healthcare centre's national reporting data for pediatric urgent care visits from 2006 to 2022. Variables analyzed included: basic patient demographics, chief complaint, triage urgency, date and time of registration/discharge, discharge diagnosis, and discharge destination. Statistical analysis of non-linear trends was summarized by locally estimated scatterplot smoothing splines. For machine learning, we used the tidymodels R package. Models were validated in training using k-fold cross validation with k = 5. We used univariate linear regression as a baseline model. After the data was standardized, correlation and homoscedasticity were evaluated between all parameter permutations. This dataset consisted of 164,660 unique visits to our academic centre's pediatric urgent care. Over the study period, there was an overall substantial increase in the number of urgent care visits per day, with a rapid increase beyond previous levels in 2021 and further in 2022. The increased length of stay trend was consistent across presenting complaint categories. The proportion of patients without primary care in 2022 was 2.5 times higher than in 2013. A random forest machine learning model revealed the relative importance of features to predicting a visit in 2022 were: longer stay, later registration in the day, diagnosis of an infectious illness, and younger age. This study identified a combination of declining primary care access, circulating viral infections, and shifting chief complaints as factors driving the recent increase in frequency and duration of visits to our urgent care service.

An Ayurvedic approach towards management of Acute Pancreatitis: A Case Study

In acute pancreatitis, there is sudden inflammation of the pancreas, histologically characterized by the destruction of acinar cells, which can range from mild to life-threatening. A 22-year-old non-alcoholic male patient presented to the outpatient department (OPD) with acute abdominal pain, accompanied by heartburn and nausea. MRCP findings suggested acute pancreatitis, with a large heterogeneous collection observed along the body and tail of the pancreas in the lesser sac, containing internal debris and hemorrhagic contents indicative of a pancreatic pseudocyst, along with elevated serum amylase and lipase concentrations. Due to the similarity between the patient's chief complaints and the symptoms of Pittaja Gulma, treatment was administered based on the principles of Pittaja Gulma. The treatment regimen included Dashmool Kwath, Mulethi Kwath with Narikela Lavana, Drakshovin syrup, and a combination of Avipattikar Churna, Kamdhudha Ras, Praval Panchamrit Ras, and Shankha Bhasma. After 15 days of treatment, serum markers returned to normal levels, and ultrasonography reports indicated satisfactory changes. The therapy's effectiveness was deemed satisfactory, with statistically significant improvements observed in both clinical and laboratory findings.

Provider Impressions of Inpatient Teleneurology Consultation.

Teleneurology usage has increased during the severe acute respiratory syndrome coronavirus 2 pandemic. However, studies evaluating physician impressions of inpatient teleneurology are limited. We implemented a quality improvement initiative to evaluate neurologists' impression following individual inpatient teleneurology consultation at a satellite hospital of a large academic center with no in-person neurology coverage. A REDCap survey link was embedded within templates used by neurologists for documentation of inpatient consultations to be completed immediately after encounters. All teleneurology encounters with completed surveys at a single satellite hospital of the University of Pennsylvania Health System Neurology Department between May 10, 2021, and August 14, 2022, were included. Individual patient-level and encounter-level data were extracted from the medical record. A total of 374 surveys (response rate of 54.05%) were completed by 19 neurologists; 341 questionnaires were included in the analysis. Seven neurologists who specialized as neurohospitalists completed 231 surveys (67.74% of total surveys completed), while 12 non-neurohospitalists completed 110 (32.36%). The history obtained was rated as worse (14%) or the same (86%) as an in-person consult; none reported the history as better than nonteleneurology encounters. The physician-patient relationship was poor or fair in 25% of the encounters and good or excellent in 75% of visits. The overall experience was judged to be worse than in-person consultation in 32% of encounters, the same in 66%, and better in 2%. Fifty-one percent of providers responded that there were elements of the neurologic examination that might have changed their assessment and plan of care if performed in-person. Encounters with peripheral or neuromuscular-related chief complaints had the most inadequate examinations and worse overall experiences, while the most positive impressions of these clinical experiences were observed among seizure-related chief complaints. Determining best practices for inpatient teleneurology should consider the patient chief complaint to use teleneurology in scenarios with the highest likelihood of a positive experience. Further efforts should be made to the patient experience and to improve the remote examination to enhance the applicability of teleneurology to the full spectrum of inpatient neurologic consultations.

Chief complaints and computed tomography results in the emergency department: a three-year retrospective cohort study

BackgroundComputed tomography (CT) is frequently performed in the patients who admitted to the emergency department (ED), discharged but returned to ED within 72 h. It is unknown whether the main complaints of patients assist physicians to use CT effectively. This study aimed to find the association between chief complaints and the CT results.MethodsThis three-year retrospective cohort study was conducted in the ED of a tertiary medical center. Adult patients who returned to the ED after the index visit were included from 2019 to 2021. Demographics, pre-existing diseases, chief complaints, and CT region were recorded by independent ED physicians. A logistic regression model with an odds ratio (OR) and 95% confidence interval (CI) was used to determine the relationship between chief complaints and positive CT results.ResultsIn total, 7,699 patients revisited ED after the index visit; 1,202 (15.6%) received CT. The top chief complaints in patients who received CT were abdominal pain, dizziness, and muscle weakness. Patients with abdominal pain or gastrointestinal symptoms had a significantly higher rate of positive abdominopelvic CT than those without it (OR 2.83, 95% CI 1.98–4.05, p < 0.001), while the central nervous system and cardiopulmonary chief complaints were not associated (or negatively associated) with new positive CT findings.ConclusionChief complaints of patients on revisit to the ED are associated with different yields of new findings when CT scans of the chest, abdomen and head are performed. Physicians should consider these differential likelihoods of new positive findings based on these data.

Factors Associated with Acute Telemental Health Consultations in Older Veterans.

The United States Veterans Health Administration is a leader in the use of telemental health (TMH) to enhance access to mental healthcare amidst a nationwide shortage of mental health professionals. The Tennessee Valley Veterans Affairs (VA) Health System piloted TMH in its emergency department (ED) and urgent care clinic (UCC) in 2019, with full 24/7 availability beginning March 1, 2020. Following implementation, preliminary data demonstrated that veterans ≥65years old were less likely to receive TMH than younger patients. We sought to examine factors associated with older veterans receiving TMH consultations in acute, unscheduled, outpatient settings to identify limitations in the current process. This was a retrospective cohort study conducted within the Tennessee Valley VA Health System. We included veterans ≥55years who received a mental health consultation in the ED or UCC from April 1, 2020-September 30, 2022. Telemental health was administered by a mental health clinician (attending physician, resident physician, nurse practitioner, or physician assistant) via iPad, whereas in-person evaluations were performed in the ED. We examined the influence of patient demographics, visit timing, chief complaint, and psychiatric history on TMH, using multivariable logistic regression. Of the 254 patients included in this analysis, 177 (69.7%) received TMH. Veterans with high-risk chief complaints (suicidal ideation, homicidal ideation, or agitation) were less likely to receive TMH consultation (adjusted odds ratio [AOR]: 0.47, 95% confidence interval [CI] 0.24-0.95). Compared to attending physicians, nurse practitioners and physician assistants were associated with increased TMH use (AOR 4.81, 95% CI 2.04-11.36), whereas consultation by resident physicians was associated with decreased TMH use (AOR 0.04, 95% CI 0.00-0.59). The UCC used TMH for all but one encounter. Patient characteristics including their visit timing, gender, additional medical complaints, comorbidity burden, and number of psychoactive medications did not influence use of TMH. High-risk chief complaints, location, and type of mental health clinician may be key determinants of telemental health use in older adults. This may help expand mental healthcare access to areas with a shortage of mental health professionals and prevent potentially avoidable transfers in low-acuity situations. Further studies and interventions may optimize TMH for older patients to ensure safe, equitable mental health care.

SURGICAL MANAGEMENT IN ESOTROPIA AT CIPTO MANGUNKUSUMO HOSPITAL: A 4-YEAR OBSERVATION ON CHARACTERISTIC AND RESULT

Introduction: Esotropia, although have low prevalence in Indonesia, give significant impacts on its sufferer, and due to the wide range of types creates numerous options for surgery without much consensus. Success rates of the surgery also varied depends on many factors. This study aims to evaluate clinical characteristics, success rate in esotropia surgery, and factors that may influence the outcome. Methods: A retrospective descriptive study based on secondary data from medical records of child and adult esotropia patients who underwent surgery from January 2018 to December 2021. Result: Of 68 patients included in the study, 60.2% were adults. More than half of patients have an onset before 7 years of age, though amblyopia only affects 29.4% of patients. Squinted-eye was the chief complaint in most patients (76.5%). One-third of patients had basic type esotropia and 59.7% had large preoperative deviation. Unilateral procedure was done in 50% of patients. The surgery success rate reached 65% with good stability on 8 months of follow-up. Better results were seen in congenital and basic type esotropia than in other types. Although none of the believed influenced factors affecting outcome were significant statistically, duration &lt;5 years and preoperative deviation &lt;50 PD had a higher success rate of 75% and 84.6%. Conclusion: Esotropia surgery in Cipto Mangunkusumo hospital were performed majorly in adults with large pre-operative deviations, mostly by unilateral procedure of recession and resection. The surgeries yield good results and stability, with shorter duration and smaller preoperative deviation giving higher success rates.

Root to recovery: Successfully healing a large periapical lesion in the mandibular first molar: A case report

This case report presents the diagnosis, successful management, and healing of a large periapical lesion associated with the mandibular first molar teeth The patient's chief complaint was severe, intermittent pain in the lower right posterior region of the mouth, and radiographic examination revealed a substantial periapical radiolucency around the apices of the mandibular first molar. The treatment involved root canal therapy along with adjunctive procedures to promote healing of the periapical lesion. Follow-up radiographs demonstrated a significant reduction of the periapical lesion with complete resolution of symptoms.

Combined Endodontic and Surgical Management of a Maxillary Lateral Incisor with Type 3 of Dens Invaginatus

Dens invaginatus (DI) is a developmental anomaly characterized by invagination of the enamel organ into the dental papilla before calcification of the dental tissues. The etiology of this phenomenon has been related either to focal growth retardation or focal growth stimulation, or localized external pressure in certain areas of the tooth bud. In this case of upper lateral incisor showing type 3 dense invaginatus and diagnose as necrotic pulp with chronic apical abscess and treated by nonsurgical root canal treatment during follow up patient comlaing of recurrent swelling associated with treated tooth so we did surgical approach has been employed to resolve patient chief complaint. A follow up of one year is also presented to show healing.

Management of Full-Thickness Lower Eyelid Defect After MOHS Procedure and Mustard Flap

Introduction : Large full-thickness eyelid defects are considered a challenging case. This study reports how to manage the reconstruction of eyelid defect in a case with a history of carcinoma cell basal of the eyelid, which is removed with MOHS procedure and mustard flap reconstruction but full-thickness of more than 50% defect of the lower eyelid remains.&#x0D; Case Illustration : A 67 years old woman was referred from the dermatology and venereology clinic with a history of eyelid cancer operation, 13 days prior. The patient's chief complaint was the left lower eyelid felt pulled down. Examination revealed a left lower eyelid full-thickness defect of more than 50% and ectropion at the lateral side. An 8 mm lagophthalmos without corneal exposure was present. The reconstruction was done with a lips mucosa graft to form posterior lamella, at the medial side anterior lamella was formed by the glabellar flap, and at the lateral side was formed by a skin graft due to lack of the anterior lamella from the mustard flap previously.&#x0D; Discussion : Eyelid reconstruction aims to provide adequate globe protection. The principle management of reconstruction in full-thickness eyelid defects horizontally of more than 50% can’t be done by an anterior flap (mustard) only because it's unstable and the eyelid can be retracted. The reconstruction must consist of the anterior and posterior lamella which have to be tight to the periosteum.&#x0D; Conclusion : One step procedure for large defects of the lower eyelid after cancer removal can be done with considering the proper plan of reconstruction technique.

Tomographic diagnosis of alveolar bone coverage impact in orthodontic planning: cross-sectional study.

Alveolar bone coverage can be diagnosed through cone beam computed tomography (CBCT) and this information can prevent orthodontic tooth movement beyond the biological limit. This study evaluated the impact of the bone coverage (BC) diagnosis by CBCT in the orthodontists' planning. One hundred fifty-nine Brazilian orthodontists suggested treatment plans for six patients at two different times, using two sequential questionnaires. The first questionnaire consisted of extra and intra-oral photographs, one panoramic radiograph; one lateral cephalometric radiograph with Steiner and Tweed analysis, and the patient chief complaint. The second questionnaire included the same presentations of cases with tomographic images and the radiologist's report. The McNemar test assessed the difference between the first and the second treatment plans. In all six cases, most participants changed the treatment plan after evaluating the CBCT images and the radiologist's report (93.7% in case 5, 78.6% in case 4, 74.2% in case 3, 69.8% in case 6, 66% in case 2 and 61% in case 1; p≤0.01). The evaluation of bone coverage through CBCT images has a substantial impact on the orthodontic diagnosis and planning of the Brazilian orthodontists.

Morning headache caused by obstructive sleep apnea misdiagnosed as temporomandibular disorders-related headache: A case report.

A 67-year-old woman presented to our clinic with chief complaints of headache and mandibular heaviness. Physical examination revealed bilateral tenderness in the temporalis and masseter muscles, corresponding to the patient's chief complaint. Thus, a diagnosis of temporomandibular disorders (TMDs)-related headache was made. However, sleep disorders were identified after further consultation. Hence, sleep apnea-related headache was suspected due to a snoring habit with a Mallampati classification of Class IV. Out-of-center sleep testing (OCST) revealed a respiratory event index (REI) of 10.1/h and a low peripheral oxygen saturation (SpO2) of 76%. Consequently, a diagnosis of obstructive sleep apnea (OSA) was made, and treatment using the mandibular advancement device (MAD) was recommended. Following MAD treatment, the patient's sleep quality improved, and morning headaches ceased. Subsequent OCST performed while wearing the MAD showed a significant reduction in the REI to 1.6/h and an increase in the SpO2 to 86%, indicating the therapeutic efficacy of the MAD in treating OSA. MAD treatment effectively alleviated the patient's morning headaches, suggesting that sleep bruxism should not be considered the only cause of headaches. OSA should also be considered and addressed when investigating the potential causes of morning headaches in patients. In patients experiencing TMDs symptoms and morning headaches, TMDs should not be presumed as the sole cause. Dentists should discuss the likelihood of sleep disorders during consultations. If sleep disorders are suspected, the possibility of OSA should be considered, and sleep tests should be conducted when necessary.

Perawatan saluran akar periodontitis apikalis kronis pada gigi insisivus lateral maksilaris kiri

Background: Root canal treatment is one of the modalities to treat periapical lesions. The success of root canal treatment in periapical lesions can be seen with the patient's chief complaint and the healing of periapical lesions as seen by the radiograph. Objective: This case report aims to demonstrate root canal treatment on a maxillary anterior tooth with periapical lesion. Case report: A 22-year-old female patient came with complaints of a maxillary anterior tooth that had throbbing pain several months ago, after having it filled by a previous dentist, and since then, it has never hurt again. Intra-oral examination of tooth 12 showed composite resin on the mesiopalatal surface. Radiographic findings showed that there was a round radiolucency in the periapical area with a diameter of 4 mm. Root canal treatment was performed based on the diagnosis of chronic apical periodontitis et causa necrotic pulp. Root canal treatment begins with the application of a rubber dam, opens the cavity, explores the root canal, and shapes the root canal. Biomechanical preparation was carried out using Protaper Hand Use with crown down technique, combined with 2.5% NaOCl irrigation. The first visit ends with the disinfection of the root canal using calcium hydroxide. Subsequent treatment was carried out with subjective and objective examination, removal of temporary filling, cleaning of calcium hydroxide, and final irrigation with 2.5% NaOCl, 17% EDTA, and 2% CHX. Obturation was achieved using the vertical condensation technique. The restoration was accomplished at the next visit using composite resin. Conclusion: Root canal treatment on teeth with chronic apical periodontitis was successfully carried out.

Enhancing efficiency and capacity of telehealth services with intelligent triage: a bidirectional LSTM neural network model employing character embedding

BackgroundThe widespread adoption of telehealth services necessitates accurate online department selection based on patient medical records, a task requiring significant medical knowledge. Incorrect triage results in considerable time wastage for both patients and medical professionals. To address this, we propose an intelligent triage model based on a Bidirectional Long Short-Term Memory (Bi-LSTM) neural network with character embedding to enhance the efficiency and capacity of telehealth services.MethodsWe gathered a 1.3 GB medical dataset comprising 200,000 records, each including medical history, physical examination data, and other pertinent information found on the electronic medical record homepage. Following data preprocessing, a clinical corpus was established to train character embeddings with a medical context.These character embeddings were then utilized to extract features from patient chief complaints, and a 2-layer Bi-LSTM neural network was trained to categorize these complaints, enabling intelligent triage for telehealth services.Results60,000 chief complaint-department data pairs were extracted from clinical corpus and divided into the training, validation, and test sets of 42,000, 9,000, and 9,000, respectively. The character embedding based Bi-LSTM neural network achieved a macro-precision of 85.50% and an F1 score of 85.45%. ConclusionThe telehealth triage model developed in this study demonstrates strong implementation outcomes and significantly improves the efficiency and capacity of telehealth services. Character embedding outperforms word embedding, and future work will incorporate additional features such as patient age and gender into the chief complaint feature to future enhance model performance.

Considerations for Selecting Root Coverage Techniques in the Anterior Mandible.

The anterior mandible is the most challenging anatomical site for performing periodontal plastic surgeries. Increased demands for optimal root coverage and esthetic outcomes contribute to the development of pedicle flap-based surgical solutions, in contrast to the predominantly used free gingival graft. The aims of this study were to (1) summarize the current literature to identify the mostused techniques, indications, and their efficacy, and (2) provide a decision table for surgeons to navigate through the selection of appropriate techniques. Four main approaches were identified: free gingival graft, lateral sliding, tunneling, and coronally advanced flap. The flap approaches are mostly combined with a connective tissue graft. The decision table considers the patient's chief complaint, local anatomical factors, and technique sensitivity. The table provides a framework for supporting an evidence-based selection of surgical techniques and for studying novel methods to achieve predictable root coverage in the anterior mandible.

How to Enhance the Success of Selective Neurectomy for Facial Synkinesis by Considering the Patient's Preferences: Lesson Learned from a Retrospective Analysis of 122 Cases.

Facial synkinesis can result in facial tightness, smile dysfunction, and eyelid aperture narrowing due to overactive and uncoordinated muscle activity. We hypothesized that the outcome of a selective neurectomy could rely on the patient's chief complaints. We retrospectively reviewed 122 patients who underwent selective neurectomy at our hospital. Preoperatively, the patients were asked nine questionnaires to identify their two major chief complaints (treatment priorities). Postoperatively, facial tightness, limited mouth movement, and eyelid aperture narrowing were measured. The most common chief complaints in our series were facial tightness (n=38), eyelid narrowing (n=32), and limited mouth movement (n=28); the second most common chief complaints (second priority) were limited mouth movement (n=47), facial tightness (n=21), and eyelid narrowing (n=20). The mean score for facial tightness significantly improved from 4.3 to 1.1 in the first priority group. Among the 28 patients whose corners of the mouth constituted the top priority of surgical correction, the vertical inclination on the affected side significantly improved from 74.1 ± 7.6° to 55.5 ± 6.0°, and the horizontal angles were changed from 4.2 ± 2.7° to 2.0 ± 1.3° after selective neurectomy without statistically significant. Among the 32 patients for whom eyelid narrowing constituted the top priority, the mean eyelid narrowing score improved from 4.5 ± 1.1 to 1.5 ± 1.2. Selective neurectomy can provide a significantly satisfactory outcome regarding facial tightness and eyelid aperture narrowing. The vertical inclination of the mouth corner can be significantly improved, while the improvement of horizontal angles can be suboptimal. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

The association between periodontitis patients' chief complaints and the stage of periodontitis: A clinical retrospective study.

The purposes of this retrospective study were to investigate the prevalence of various periodontal chief complaints (pCCs) of patients, diagnosed with periodontitis, as well as to identify the association between pCCs and periodontal parameters or periodontitis staging according to AAP/EFP 2017 classification. Five hundred eighty-nine patients, applied to the clinic with pCCs, were screened. The demographic characteristics, smoking status, brushing behaviors, history of periodontal therapy, medical data, and periodontal parameters were obtained. A multinomial logistic regression analysis was performed to determine the most common pCCs and co-variables among the indicators of Stage III and IV periodontitis. In Stage IV periodontitis, patients with pCC of mobility were observed the most (26.8%), and pCC of halitosis were the least (7.3%). Among all pCCs of patients, those with the pCC of gingival enlargement and tooth mobility had the highest percentage of sites with PPD ≥ 4mm and CAL ≥ 5mm, respectively (p < .001). According to regression analysis, those with pCC of gingival bleeding, recession and mobility were more likely to be in Stage IV than those in Stage I/II. Among pCCs, only patients with pCCs of mobility, gingival recession and bleeding are related to periodontitis staging. Moreover, the extent of periodontal pockets in patients with pCC of gingival enlargement, and the extent of attachment loss in patients with pCC of mobility are greater than other patients. New machine-learning technology models can be developed with the aim of classifying the patients based on their chief complaints, to support diagnosing the severity of periodontal diseases.

Brain-based medical education model for expert's clinical decision making.

The expertise of medicians in clinical decision-making is very important since it improves the quality of medical services provided to patients. This study analyzed the characteristics of the decision-making process and confirmed clinicians' electroencephalography (EEG) characteristics by measuring their cerebral activity during clinical decision-making. This study aims to present learning directions for brain-based clinical decision-making to develop medical experts. This study was performed in the following two projects: (1) a qualitative study of clinical decision-making in a clinical scenario and (2) an analysis of differences in cortical activity of experts and novices through EEG. In the 1st study, this study found that "confirmation of the patient's chief complaints," "physical examination," and "radiography reading" steps, which showed the most prominent differences in the experts' and novices' decision making, were set as the significant steps of dentists' clinical decision making. In the 2nd study, the experts' and novices' cortical activities were measured through a 32-channel EEG. In task 6, which had the lowest accuracy of diagnoses made by the experts, the brain activities in both groups were higher than in other tasks. This study developed and suggested a model of the decision-making process for experts and novices and suggested the basic directions for brain-based learning needed to raise experts based on brain activity.

A comparative analysis of computed tomography and ultrasonography in diagnosis of neck masses

Background: Neck swellings constitute the chief complaint of many patients coming to ENT outpatient department. Adequate evaluation of all cases with assistance from radiological, cytopathological, and histopathological is necessary. Aims and Objectives: The present study aims to evaluate the role of clinical, radiological, and cytopathological evaluation to reach the diagnosis and the accuracy of these tools. Materials and Methods: The study was conducted in the Department of Otorhinolaryngology and Head and Neck Surgery and the Department of Radiodiagnosis, AMU, and included 100 patients with neck swelling. Results: Maximum number of patients were of lymph node masses (44%), followed by thyroid masses (26%) and salivary gland pathologies, congenital neck masses, and others. 78% were benign masses while only 22% were malignant. Out of all cases, the maximum were reactive lymphadenitis (16%), followed by metastatic lymph nodes (12%) and pleomorphic adenoma (10%). The correlation between clinical diagnosis and ultrasound (USG) was 70.93 with a diagnostic accuracy of 86%; with fine-needle aspiration cytology (FNAC) accuracy being 82%. 91% of metastatic lymph node swellings were accurately diagnosed by these two modalities alone. The sensitivity and specificity of FNAC with computed tomography (CT) were 62.25% and 98.59%, respectively; while with biopsy were 84.63% and 97.10%. Conclusion: Clinical evaluation remains the utmost important step in the management of patients with neck swellings. USG provides the necessary information to guide further management, followed by FNAC. Although CT and histopathological evaluation provide detailed information, it was rarely needed in our study to reach the clinical diagnosis however their need in the management of pathology could not be ruled out.

A Comparison of Patients' and Neurologists' Assessments of their Teleneurology Encounter: A Cross-Sectional Analysis.

Background and Objectives: To better understand patients' and neurologists' assessments of their experiences regarding effectiveness of teleneurology encounters. Methods: Following an audio-video telehealth visit, neurologists asked patients to participate in a survey-based research study about the encounter, and then, the neurologists also recorded their own evaluations. Data were analyzed using standard quantitative and qualitative techniques for dichotomous and ordered-category survey responses in this cross-sectional analysis. Results: The study included unique encounters between 187 patients and 11 general neurologists. The mean patient age was 49 ± 17.5 years. Two thirds of the patients (66.8%, 125/187) were female. One third (33.2%; 62) were patients new to the NYU Langone Health neurology practices. The most common patient chief complaints were headache (69/187, 36.9%), focal and generalized numbness or tingling (21, 11.2%), memory difficulty (15, 8%), spine-related symptoms (12, 6.4%), and vertigo (11, 5.9%). Most patients (94.7%, 177/187) reported that the teleneurology encounter satisfied their needs. Patients and their neurologists agreed that the experience was effective in 91% (162/178) of encounters, regardless of whether the visit was for a new or established patient visit. Discussion: More than 90% of new and established patients and their neurologists agreed that teleneurology encounters were effective despite some limitations of the examination, the occasional need for patient assistance, and technical difficulties. Our results provide further evidence to justify and to expand the clinical use of teleneurology.