Total Number Of New Patients Research Articles

545 - Prevalence of moderate and severe atopic dermatitis in Ireland: a cross-sectional, real-world study of a secondary care population.

Abstract Introduction/Background Atopic dermatitis (AD) is a common chronic inflammatory skin disease with significant unmet needs globally.1 European prevalence rates range from up to 8% and 20% of adults and children respectively.2 In the E.U., a 12-month prevalence of AD has been reported at 4.4%.4 Self-reported moderate-to-severe AD affects between 46-66% of E.U. adult AD patients.4 However, global prevalence estimates vary widely. In Ireland, the epidemiology of AD is not fully understood. Objectives The aim of this study was to estimate the prevalence of patients aged 12 years or older presenting to secondary care dermatology clinics in Ireland with moderate-to-severe AD. The primary objective was to estimate the prevalence of patients aged 12 years and over with moderate or severe AD within secondary care clinics in Ireland. Secondary objectives included estimating the prevalence and incidence of moderate-to-severe AD patients aged 12–17 and ≥ 18 years respectively within secondary care clinics in Ireland. Methods Three secondary care sites located in the south of Ireland collated the number of AD patients ≥ 12 years old (one visit per patient only) with moderate or severe AD presenting between August 2021 and March 2022. The aggregated six-month data from each site was expected to include all patients with AD being actively treated within secondary care in the Munster region. As this epidemiological study was exploratory in nature, no limit was placed on the volume of aggregated patient data collected. Prevalence of AD was standardised to the regional population by dividing the total number of patients with a clinic visit, by the regional population covered by the sites using the 2016 census data. Incidence of AD was standardised similarly by dividing the total number of new patients attending clinic by the regional population covered by the sites using the 2016 census data. The regional prevalence and incidence estimates were stratified by age group and gender and then multiplied by the total Irish population (per the 2016 county level census data) to estimate the national number of cases of moderate and severe AD in secondary care over a six-month period. Results The outcome of the analysis estimates an overall prevalence rate for moderate-to-severe AD in secondary care in Ireland of 2.893 patients per 10,000 people in the Irish population. The total estimated number of moderate-to-severe AD cases in secondary care was 1,141. The prevalence rate (95% CI) was 1.456 (1.236, 1.704) and 1.437 (1.218, 1.683) per 10,000 for patients with moderate AD and severe AD respectively. The highest overall prevalence rate of 6.03 patients per 10,000 of the Irish population was observed for patients aged 12–17 years with moderate-to-severe AD in secondary care. Amongst adults, similar prevalence rates were reported for moderate and severe AD patients (1.204 and 1.359 patients per 10,000 respectively) with the highest prevalence rates for 18–24 year olds (2.680 and 2.776 patients per 10,000 for moderate and severe AD respectively). An overall incidence rate of 0.385 patients per 10,000 (in 6-months) was observed for patients aged 12 years and older with moderate-to-severe AD in secondary care, with an estimated 152 new AD patients entering secondary care in Ireland in 6 months. Twenty percent of all current AD patients had attended their first secondary care AD clinic visit during the study period. Conclusions Considering E.U. prevalence estimates of AD4, the findings of this study suggest that a very small proportion of patients with moderate-to-severe AD are being seen in secondary care clinics in Ireland.

Pattern of Haematological Malignant Patients Attending OPD in a Tertiary Level Hospital in A Calendar Year

Background: Hematologic malignancies are of diverse incidence, prognosis, and etiology. Dhaka medical college hospital (DMCH) is a tertiary level hospital and dealing with patients attending from all over the country. We have analyzed data of patients present with hematological malignancy in our Out Patient Department (OPD). As Hematology Dept DMCH deal with patients referred from all over the country, its OPD data represents the picture of whole country. Methods: This is a retro-spective study of OPD patients with hematological malignancy in the department of Hematology of DMCH from January 2018 to December 2018. The diseases were diagnosed on the basis of bone marrow morphology or histopathology (Lymphoma) and or immunophenotyping & molecular genetics. Results: Total 5747 patients were treated in 2018 with the complaints related to hematological malignancy of which 4599 (80%) were old patients and 1148 (20%) were new patients. Among all the treated patients 1420 (24.7%) were female and 4327 (75.3%) were male. Among 1148 new cases 37 were AL(3%), 386 were ALL (34%), 265 were AML(23%), 32 were CLL (3%), 126 were CML (11%), 40 were HL (3%), 18 were MDS (1%), 76 were MM (7%), 168 were NHL (15%). Data shows variation in total number of new patients per month- 83 in January (7.23%), 96 in February (8.36%), 140 in March (12.20%), 98 in April (8.54%), 94 in May (8.19), 89 in June (7.75%), 98 in July (8.54%), 66 in August (5.75%), 99 in September (8.62%), 103 in October (8.97%), 98 in November (8.54%), 84 in December (7.31%) But it does not show any statistical significant frequencies of diseases according to months. Conclusion: We deal a lot of patients with hematological malignancy each year in DMCH. A good portion of them are of ALL because of monthly maintenance of ALL protocols. Analysis of new cases shows ALL, AML, NHL is most common three diseases encounter in OPD. OPD patients’ inflow does not show any significant monthly variation for any of the diseases.

Epidemiology of uveitis in Japan: a 2016 retrospective nationwide survey.

To investigate the epidemiology of uveitis in Japan and assess its changes over time. Retrospective multicenter study METHODS: Sixty-six hospitals in Japan with uveitis specialty clinics participated in this retrospective nationwide survey. A questionnaire was sent to each hospital to survey the total number of patients who made a first visit to the outpatient uveitis clinic of each hospital between 1 April 2016 and 31 March 2017. The diagnosis of uveitis was based on guidelines when available or on commonly used diagnostic criteria. In 2016, new patients with uveitis accounted for 3.2% of the total number of new patients with ophthalmic diseases. A total of 5378 patients were enrolled in the survey; 3408 cases could be classified with a specific uveitis entity, and 1970 cases were described as unclassified intraocular inflammation. Among the classified cases, the most frequent disease was sarcoidosis (10.6%), followed by Vogt-Koyanagi-Harada disease (8.1%), herpetic iritis (6.5%), acute anterior uveitis (5.5%), sclerouveitis (4.4%), Behçet's disease (4.2%), malignant disease (2.6%), acute retinal necrosis (1.7%), Posner-Schlossman syndrome (1.7%), and diabetic iritis (1.4%). The rates of sarcoidosis, Vogt-Koyanagi-Harada disease, and Behçet's disease were similar; however, the rate of herpes iritis increased (4.2-6.5%) when compared with the 2009 survey. Some changes were observed between the previous nationwide surveys (2002 and 2009) and the present survey. It must be valuable to continue such nationwide epidemiologic surveys at regular intervals.

The ALERT model of care for the assessment and personalized management of patients with lymphoedema.

This study documents the development and evaluation of a comprehensive multidisciplinary model for the assessment and personalized care of patients with lymphoedema. The Australian Lymphoedema Education Research and Treatment (ALERT) programme originated as an advanced clinic for patients considering surgery for lymphoedema. The programme commenced liposuction surgery in May 2012 and then introduced lymph node transfer in 2013 and lymphovenous anastomosis (LVA) in 2016. An outpatient conservative treatment clinic was established in 2016. ALERT commenced investigations with indocyanine green (ICG) lymphography in late 2015, leading to the creation of a diagnostic assessment clinic offering ICG in 2017. Since 2012, 1200 new patients have been referred to ALERT for assessment of lymphoedema for a total of 5043 episodes of care. The introduction of ICG lymphography in 2015 initially allowed better screening for LVA, but is now used not only to guide surgical options, but also as a diagnostic tool and to guide manual lymphatic drainage massage. The total number of new patients who attended the surgical assessment clinic to December 2018 was 477, with 162 patients (34·0 per cent) undergoing surgery. The ALERT programme has developed a multidisciplinary model of care for personalized lymphoedema treatment options based on clinical, imaging and ICG lymphography. Patients are selected for surgery based on several individual factors.

Ten-year Clinical Trends among 575 Consecutive Oral Cancer Patients at Tokyo Dental College Oral Cancer Center.

The facilities comprising Tokyo Dental College (TDC) -the college itself and its medical institutions at Suidobashi, Ichikawa, and Chiba - have been officially recognized as a center for treating oral cancer. The TDC Oral Cancer Center (OCC) was established on April 1, 2006. It provides comprehensive medical care, including that aimed at recovery of postoperative function, such as restoration of stomatognathic function, dysphagia therapy, and placement of maxillary prostheses. The purpose of this study was to investigate patient trends at TDC-OCC over the 10 years following its establishment in order to determine how the safe and high-quality cancer care already provided might be even further improved. Oral cancer patients attending TDC-OCC between April 2007 and March 2017 were investigated. Clinical information was obtained from medical records and analyzed, including that on patient numbers, age, sex, primary site of tumor, clinical stage, and surgery provided. There were 758 new cases, and the number of new cases showed an annual increase. Among the total number of new patients, 575 (75.9%) represented primary cases. The number of operations also showed an increase, which correlated with the increase in the number of patients. The incidence in oral cancer has increased in several countries, including Japan. Oral cancer can be observed macroscopically and touched. In contrast to with cancers at many other sites, and despite various diagnostic devices for early detection having been developed, however, cases are often advanced when first encountered. Many advanced cases were treated at TDC-OCC, and the number of reconstructive operations following progressive cancer also increased over time.

Experience Within the Emergency Department and Improved Productivity for First-Year Residents in Emergency Medicine and Other Specialties.

IntroductionResident productivity is an important educational and operational measure in emergency medicine (EM). The ability to continue effectively seeing new patients throughout a shift is fundamental to an emergency physician’s development, and residents are integral to the workforce of many academic emergency departments (ED). Our previous work has demonstrated that residents make gains in productivity over the course of intern year; however, it is unclear whether this is from experience as a physician in general on all rotations, or specific to experience in the ED.MethodsThis was a retrospective cohort study, conducted in an urban academic hospital ED, with a three-year EM training program in which first-year residents see new patients ad libitum. We evaluated resident shifts for the total number of new patients seen. We constructed a generalized estimating equation to predict productivity, defined as the number of new patients seen per shift, as a function of the week of the academic year, the number of weeks spent in the ED, and their interaction. Off-service residents’ productivity in the ED was analyzed in a secondary analysis.ResultsWe evaluated 7,779 EM intern shifts from 7/1/2010 to 7/1/2016. Interns started at 7.16 (95% confidence interval [CI] [6.87 – 7.45]) patients per nine-hour shift, with an increase of 0.20 (95% CI [0.17 – 0.24]) patients per shift for each week in the ED, over 22 weeks, leading to 11.5 (95% CI [10.6 – 12.7]) patients per shift at the end of their training in the ED. The effects of the week of the academic year and its interaction with weeks in the ED were not significant. We evaluated 2,328 off-service intern shifts, in which off-service residents saw 5.43 (95% CI [5.02 – 5.84]) patients per nine-hour shift initially, with 0.46 additional patients per week in the ED (95% CI [0.25 – 0.68]). The weeks of the academic year were not significant.ConclusionIntern productivity in EM correlates with time spent training in the ED, and not with experience on other rotations. Accordingly, an EM intern’s productivity should be evaluated relative to their aggregate time in the ED, rather than the time in the academic year.

The impact of the aging population and incidence of cancer on future projections of general surgical workforce needs

BackgroundAssessments of the future general surgery workforce continue to project substantial shortages of general surgeons. The general surgery workforce is targeted currently to maintain a surgeon/population ratio of 6.5–7.5/100,000. MethodsWe examined population and age-associated incidence of cancer to estimate the number of general surgeons needed for initial surgical treatment of the patient with cancer in the year 2035 compared with 2010. We hypothesized that the number of general surgeons needed to provide future cancer care will exceed the projections of available general surgeons based on current training numbers, as well as on population-based ratios alone. ResultsThe total number of new patients with cancers treated by general surgeons is projected to increase 56% (511,450 in 2010 to 798,070 in 2035). To maintain the same patient census per surgeon, it is estimated that 34,698 general surgeons will be needed. This is an increase of 9,198 over that based on current training numbers and 5,300–7,400 greater than the need projected by population growth alone. ConclusionThe analysis supports the hypothesis that an increasing incidence of cancer in the future will exceed the potential capacity of the general surgeon workforce. Regionalization of cancer care may be one solution to projected access issues.

Pattern of Neuropsychiatric Illnesses in Geriatric Population: An Outpatient Study Report

Introduction: Few studies are available till date on the pattern of neuro-psychiatric illnesses in geriatric population in Nepal.Objective: The study was aimed to know the demographic and clinical profiles of geriatric outpatients in our neuropsychiatry OPD.Method: This study was conducted at the Department of Psychiatry, Universal College of Medical Sciences-Teaching Hospital (UCMS-TH), Bhairahawa, Nepal. We screened through our ‘OPD case registrar’, which maintains few demographic and clinical data of all the new and old cases registered daily in the OPD. Socio-demographic and clinical data of all the patients in the age of 60 years and above were noted in a data sheet specially designed for the present study. This is a retrospective study by chart review. Descriptive analysis of these data were undertaken by using simple frequency distribution.Result: During the one year study period total number of new patients registered were 3711. Two-hundred and fifty-seven (6.9%) among them were in the geriatric age group (≥60 years age). Psychoses form the biggest diagnostic entity with 71 patients (27.6%) followed by Depression in 39 patients (15.2%), Chronic headache in 33 (12.8%), Alcohol Dependence Syndrome in 27 (10.5%), Anxiety disorders in 25 (9.7%) and Dementia in 23 (8.9%) elderly patients. We also recorded 11 patients (4.3%) with symptoms of Mania. ‘Psychosis’ and ‘Depression’, were more represented amongst female elderly while ‘Alcohol dependence’ and ‘Mania’ and were more frequently prevailed among male elderly patient population.Conclusion: Present study is expected to add some more light on this sub-specialty in Psychiatry and hope to induce more interest among young researchers to carry our further research among geriatric psychiatric patients in Nepal.

Trends in use of electroconvulsive therapy among geriatric patients over a period of 9 years at a tertiary care center in North India

Background: Electroconvulsive therapy (ECT) is an important modality of treatment for various psychiatric disorders in all age groups. The trends of use of ECT in the elderly population have not been studied despite wide variation in the utilization of this treatment modality. Aim: This study aimed to evaluate the trends in use of ECT in geriatric patients at a tertiary care center over a period of 9 years. Methodology: Data were extracted from the departmental registry for the period of 2008–2016 to evaluate the total number of new patients attending the psychiatric services, total number of new elderly (i.e., ≥60 years) patients attending the psychiatric services, total number of inpatients, total number of elderly inpatients, total number of patients who received ECT, and total number of elderly patients who received ECT. Results: During the period of 2008–2016, elderly formed from 4.6% to 19.11% of the total number of patients who received ECT. There was an upward trend in the proportion of elderly patients receiving ECT, with a nearly 10-fold rise in absolute number and doubling of the percentage of elderly patients among those receiving ECT. Over the years, there was an increase in use of ECT among elderly inpatients and use of ECT as an outpatient treatment for elderly. Conclusion: Over the years, there has been increase in the absolute number as well as proportion of elderly patients receiving ECT. There is a significant increase in the use of ECT among elderly at the outpatient basis.

Management of lower urinary retention in a limited resource setting.

There is a projected increase in lower urinary tract obstruction by 2018, especially in the developing economies of Asia and Africa. However in many of these countries, the problems encountered both by the patients and the clinicians are not well documented. Our aims are, to prospectively analyse the management of urinary retention, the associated difficulties, and complications in our setting, where access to investigative modalities such as Computerize Tomography and Magnetic Resonance Imaging are not available. The study was approved by the University Of Calabar Teaching Hospital ethical committee. A validated Proforma was used to collect data from all patients who were clinically diagnosed with urinary retention based on history, and physical examination, from July 2009 to June 2010. Data collected from the 1st of July 2009 to the 30th of June 2010, include demographics, findings on physical examination, previous medical history and co-morbid conditions. The results of investigations done such as: urinalysis, full blood count, electrolytes, urea and creatinine, intravenous urography, trans- abdominal ultrasonography, chest X-ray and histology of trans-rectal biopsies of the prostate . The total number of new patients seen, including those with urinary retention during the study was documented. The retentions were also classified into acute and chronic. All the patients were followed up throughout the study. The data was analysed using Epi-Info statistical program version 3.4 of 2007 to analyse the data, estimating averages, mean, median and percentages. The total number of new patients seen, including those with urinary retention was Seventy thousand, one hundred and thirty nine (70,139).Of this number, hundred and fifty nine (0.23%), presented with urinary retention; 145 (91.2%) were acute, and14 (8.8%) were chronic. The male: female ratio was 39:1.The patients ages ranged from 4 to 94 years, with a mean of 53.7±11.2. Seventy seven [48.4%] of them were in the 6(th) and 7(th) decades of life. The common causes were; prostatic diseases [BPH and cancer of the prostate] 77.0%, infections 75.8%, trauma 12.1%, and congenital 12.1%. Urinary retention was relieved by: indwelling urethral catheterization [IUC] 120 patients (75.5%), supra- pubic cystostomy [SC] 34 (21.4%) and intermittent urethral catheterization [IC] 5 (3.1%). The most frequently encountered complications include pyuria (18.2%), pericatheter sepsis 17.5%, and haemorrhage during change of catheter 16.8% [figure 2]. Figure 2Complication after one week bladder drainage. Lower urinary retention is common in our environment. The management is appropriate and standard. The man power and facilities are inadequate, and requires urgent improvement.

Trial sequential methods for meta-analysis.

Statistical methods for sequential meta-analysis have applications also for the design of new trials. Existing methods are based on group sequential methods developed for single trials and start with the calculation of a required information size. This works satisfactorily within the framework of fixed effects meta-analysis, but conceptual difficulties arise in the random effects model. One approach applying sequential meta-analysis to design is 'trial sequential analysis', developed by Wetterslev, Thorlund, Brok, Gluud and others from the Copenhagen Trial Unit. In trial sequential analysis, information size is based on the required sample size of a single new trial, which, in the random effects model, is obtained by simply inflating it in comparison with fixed effects meta-analysis. However, this is not sufficient as, depending on the amount of heterogeneity, a minimum of several new trials may be indicated, and the total number of new patients needed may be substantially reduced by planning an even larger number of small trials. We provide explicit formulae to determine the requisite minimum number of trials and their sample sizes within this framework, which also exemplify the conceptual difficulties referred to. We illustrate all these points with two practical examples, including the well-known meta-analysis of magnesium for myocardial infarction.

Causes of red eye in Aminu Kano Teaching Hospital, Kano-Nigeria

The red eye is one of the commonest reasons for presenting to the eye clinic. Red eye due to serious conditions that may threaten patient's vision require early detection and referral to ophthalmologists for prompt care. The aim of the study is to determine the prevalence and causes of red eye amongst patients' attending the eye clinic over a two year period from 2004 to 2005. The eye clinic register was used to determine the total number of new patients attending the eye clinic and those found to have red eye. The information retrieved included patients age, sex, laterality of the condition and cause of red eye. During the review period 4723 new patients were seen in the eye clinic and 693 patients (14.8%) had red eye. There were 356 males and 337 females (M:F= 1.1:1). Sixty three percent of the patients were below the age of 20 years. The common causes of red eye were allergic conjunctivitis in 40%, microbial conjunctivitis in 17%, corneal ulcer 11% and inflamed pterygium in 11%. Red eye is a common cause of presentation to the eye clinic. Most of the common causes of red eye in our environment are treatable.

Personal and Practice Predictors Associated With the Income of Ontario Chiropractors

Objective Practice-based information may allow policy makers and associations the opportunity to interpret utilization rates and anticipate the impact of future growth of professions. The objective of this study was to assess the association between income and specific personal, practice, and treatment characteristics in a sample of Ontario chiropractors. Methods Descriptive and regression analyses were used to assess end-of-year practice summary data obtained from a professional billing software program voluntarily submitted by 731 individual chiropractors. Results The model explained 65% of the variance in income. Significant explanatory factors regarding income were those related to treatment characteristics, with the largest contribution made by the total number of new patients seen in the year, which uniquely contributed 17% of the total variance. Personal and practice-related characteristics made significant but relatively small contributions; however, the location of the practice and years since graduation appear to impact income, especially in the formative years of practice development. Conclusion The variance in annual practitioner income was predicted by a combination of personal, practice, and treatment characteristics but not surprisingly primarily by the total number of new patients seen in the year. A negative association between average treatment costs and number of patients seen suggests cost sensitivity. The results provide important benchmarks that can be used to guide expectations of new graduates and to assess future trends. Further work is needed to determine if the findings can be generalized.

Survey of sexual dysfunction services in Bristol, UK

We present the results of a survey of providers of sexual dysfunction services in Bristol. Seventeen stakeholders were identified and were sent a questionnaire to establish the availability of the services to clients. We enquired about provision of time, number and frequency of sessions offered to clients by different service providers. Fourteen of the seventeen (80%) questionnaires were returned. The total number of new patients seen was given as 1956. The private sector saw 90 new patients per year and 1834 were seen in the National Health Service (NHS) clinics. Currently there are two levels of management available for people with sexual problems in Bristol and these are broadly divided into the private/charitable and the NHS. It is important that all sectors work together to provide an appropriate service for the local population. There is a clear need for more resources for service provision for the management of sexual dysfunction.

Using nurses to identify HAART eligible patients in the Republic of Mozambique: results of a time series analysis

BackgroundThe most pressing challenge to achieving universal access to highly active anti-retroviral therapy (HAART) in sub-Saharan Africa is the shortage of trained personnel to handle the increased service requirements of rapid roll-out. Overcoming the human resource challenge requires developing innovative models of care provision that improve efficiency of service delivery and rationalize use of limited resources.MethodsWe conducted a time-series intervention trial in two HIV clinics in central Mozambique to discern whether expanding the role of basic-level nurses to stage HIV-positive patients using CD4 counts and WHO-defined criteria would lead to more rapid information on patient status (including identification of HAART eligible patients), increased efficiency in the use of higher-level clinical staff, and increased capacity to start HAART-eligible patients on treatment.ResultsOverall, 1,880 of the HAART-eligible patients were considered in the study of whom 48.5% started HAART, with a median time of 71 days from their initial blood draw. After adjusting for time, expanding the role of nurses to stage patients was associated with more rational use of higher-level clinical staff at one site (Beira OR 1.9, 95% CI 1.1–3.3; Chimoio OR 0.2, 95% CI 0.1–0.5). In multivariate analyses, the rate of starting HAART in patients with CD4 counts of less than 200/mm3 increased over time (HR = 1.07, 95% CI 1.02–1.13), as did the total number of new patients initiating HAART (β = 7.3, 95% CI 1.3–13.3). However, the intervention was not independently associated with either of these outcomes in multivariate analyses (HR = 0.9, 95% CI 0.7–1.2) for starting HAART in patients with CD4 counts of less than 200/mm3; (β = -5.2, p = 0.75) for the total number of new patients initiating HAART per month. No effect of the intervention was found in these outcomes when stratifying by site.ConclusionThe CD4 nurse intervention, when implemented correctly, was associated with a more rational use of higher-level clinical providers, which may improve overall clinic flow and efficient use of the limited supply of human resources. However, this intervention did not lead to an increase in the number of patients starting HAART or a reduction in the time to HAART initiation. Study month appears to play an important role in all outcomes, suggesting that general improvements in clinic efficiency may have overshadowed the effect of the intervention. The lack of observed effect in these outcomes may be due to additional health systems bottlenecks that delay the initiation of treatment in HAART-eligible patients.

Epidemiological Survey of Intraocular Inflammation in Japan

To report the frequency and trend of intraocular inflammation based on a survey of new ophthalmology patient visits to university hospitals throughout Japan during 2002. A questionnaire was sent to the departments of ophthalmology in 110 university hospitals nationwide to survey the total number of new patients who visited the outpatient clinics for the first time between 1 January and 31 December 2002, and also the number of patients diagnosed with intraocular inflammation during this period. The surveys completed by 41 university hospitals were analyzed in this study. During 2002, a total of 151 299 new ophthalmological patients presented at the 41 institutions, and 3060 (2.2%) of the new patients were diagnosed as having intraocular inflammation. The most frequent intraocular inflammatory disease identified was sarcoidosis (13.3%), followed by Vogt-Koyanagi-Harada (VKH) disease (6.7%), Behçet disease (6.2%), bacterial endophthalmitis (3.8%), herpetic iridocyclitis (3.6%), diabetic iritis (1.6%), human leukocyte antigen-B27-associated uveitis (1.5%), acute retinal necrosis (1.3%), ocular toxoplasmosis (1.1%), ocular toxocariasis (1.1%), uveitis associated with human T lymphotropic virus-1 (also known as HAU) (1.1%), and others. Infectious intraocular inflammation accounted for 16% of all uveitis cases. Through the collaboration of a large number of institutions, some aspects of the epidemiology of intraocular inflammation in Japan were elucidated. However, the disease concept and diagnostic criteria remain ambiguous for a considerable number of diseases within the spectrum of intraocular inflammation, and the possibility that such factors may bias the present findings cannot be denied. In the future, a prospective survey based on well-defined, common diagnostic criteria is required to obtain more precise epidemiological data.

Effect of Shifting Costs to Patients on Specialty Evaluation for Sleep Disorders

To determine whether the introduction of out-of-pocket expenses to medical center employees would lead to decreased use of sleep disorder services. We retrospectively analyzed and compared the clinical and medical accounting data from visits by Mayo Clinic employees to the Sleep Disorders Center from January 1 to March 31, 2003, with that of January 1 to March 31, 2004, le, before and after a January 2004 increase in co-payments for evaluation and testing. The total number of new patients evaluated in the first quarters of 2003 and 2004 was similar (113 vs 119; P = .37). Snoring, restless legs symptoms, hypertension, atrial fibrillation, and prior overnight oximetry testing were more prevalent in 2004 than in 2003 (P = .05, P = .01, P < .001, P = .003, P = .02, respectively). In contrast, insomnia and parasomnia complaints were less common in 2004 (P < .001). The mean apnea-hypopnea index, minimum oxygen saturation, and percentage of time with oxygen saturation less than 90% were all more severe in 2004 (P = .01, P = .001, P < .001, respectively). Sleep-related breathing disorders were more commonly diagnosed in 2004 (83.2% vs 67.2%; P = .02), whereas the diagnoses of nonbreathing disorders declined. The insurance policy changes that resulted in larger employee co-payments shifted the spectrum of diagnoses seen at the Sleep Disorders Center toward more symptomatic patients, with more associated comorbidities, and patients who had more severe sleep-related breathing disorders. Total utilization did not decrease.

Spectrum of skin diseases in Yemen (Hajjah and adjacent region).

Epidemiological study of skin diseases from Yemen is not available, although some data has been published from nearby Arab countries. To determine the pattern of skin diseases in Yemen and particularly in Hajjah and nearby regions. This is a prospective study and analysis of the consecutive new patients attending the Dermatology Clinic of Saudi Hospital at Hajjah, Yemen, from January 1997 to December 1999. The majority of the patients were from Hajjah and nearby regions but a substantial number of patients came from different distant regions of Yemen. The diagnosis was mainly based on clinical features but supported by laboratory investigations, diagnostic procedures and histopathology when needed. The total number of new patients was 13,840 with 14,259 diseases, with a male to female ratio of 1:0.81. Ninety-nine percent of the patients were Yemeni nationals. The leading group of diseases was dermatitis and eczematous disorders, followed by infections and infestations (including cutaneous leishmaniasis and mycetoma), followed by acne and acneiform disorders. The spectrum of skin diseases in this analysis revealed that more than 50% of the diseases belonged to dermatitis and eczematous disorders and infectious diseases groups. Socioeconomic and environmental factors of the region are responsible for this. Implementation of public health programs, a proper health education, and inclusion of a suitable training program of dermatology in the undergraduate medical studies of this country may help to prevent and manage these problems rationally.

A nurse case management intervention improved medical care given to older women with newly diagnosed breast cancer

Goodwin JS, Satish S, Anderson ET, et al . Effect of nurse case management on the treatment of older women with breast cancer. J Am Geriatr Soc 2003;51:1252–9. [OpenUrl][1][CrossRef][2][PubMed][3][Web of...

Spain: The WHO Demonstration Project of Palliative Care Implementation in Catalonia: Results at 10 Years (1991–2001)

Xavier Gomez-Batiste, MD, Josep Porta, PhD, MD, Albert Tuca, MD, Esther Corrales, RN, Federico Madrid, MD, Jordi Trelis, MD, Dulce Fontanals, SW, Josep M. Borras, PhD, MD, Jan Stjernsward, PhD, MD, Antoni Salva, MD, and Eduard Rius, MD Palliative Care Service (X.G.-B., J.P., A.T., E.C., F.M., J.T.), Institut Catala d’Oncologia, Barcelona, Spain; Fundacio SAR (D.F.), Barcelona, Spain; Institut Catala d’Oncologia (J.M.B), Barcelona, Spain; Global Cancer Concern (J.S.), Stockholm, Sweden; Divisio Sociosanitaria (A.S.), Servei Catala de la Salut, Barcelona, Spain; and Ministry of Health (E.R.), Government of Catalonia, Barcelona, Spain