scholarly journals Combinations of Symptoms in Emergency Presentations: Prevalence and Outcome

2019 ◽  
Vol 8 (3) ◽  
pp. 345 ◽  
Author(s):  
Tobias Kuster ◽  
Christian Nickel ◽  
Mirjam Jenny ◽  
Lana Blaschke ◽  
Roland Bingisser
Keyword(s):  
Time Course ◽  
Predictive Power ◽  
Secondary Analysis ◽  
Clinical Work ◽  
Adverse Outcomes ◽  
University Hospital ◽  
Chief Complaints ◽  
The University ◽  
Work Up ◽  
Inclusion Period

The predictive power of certain symptoms, such as dyspnoea, is well known. However, research is limited to the investigation of single chief complaints. This is in contrast to patients in the emergency department (ED) presenting usually more than one symptom. We aimed to identify the most common combinations of symptoms and to report their related outcomes: hospitalisation, admission to intensive care units, and mortality. This is a secondary analysis of a consecutive sample of all patients presenting to the ED of the University Hospital Basel over a total time course of 6 weeks. The presence of 35 predefined symptoms was systematically assessed upon presentation. A total of 3960 emergency patients (median age 51, 51.7% male) were included. Over 130 combinations of two, 80 combinations of three, and 10 combinations of four symptoms occurred 42 times or more during a total inclusion period of 42 days. Two combinations of two symptoms were predictive for in-hospital mortality: weakness and fatigue (Odds ratio (OR) = 2.45), and weakness and headache (OR = 3.01). Combinations of symptoms were frequent. Nonspecific complaints (NSCs), such as weakness and fatigue, are among the most frequently reported combinations of symptoms, and are associated with adverse outcomes. Systematically assessing symptoms may add valuable information for prognosis and may therefore influence triage, clinical work-up, and disposition.

scholarly journals THYROID SURGERY

2018 ◽  
Vol 25 (12) ◽  
pp. 1814-1818
Author(s):  
Abdul Salam Memon ◽  
Riaz Ahmed Memon ◽  
Bheesham Kumar ◽  
Afzal Junejo
Keyword(s):  
Risk Factors ◽  
Observational Study ◽  
Serum Calcium ◽  
Thyroid Surgery ◽  
Clinical Work ◽  
University Hospital ◽  
Retrosternal Goiter ◽  
Recurrent Goiter ◽  
Before And After ◽  
Work Up

Objectives: The present prospective observational study was conducted to determine frequency and thyroid conditions as likely risk factors for hypocalcaemia following thyroid surgery. Study Design: Observational study. Place and Duration: Department of surgery, Liaquat University Hospital from December 2011 to December 2015. Materials and Methods: A sample of 201 patients, undergoing thyroid surgery with bilateral exploration, was selected according to criteria. Pre operative clinical work up was conducted for patient history, neck examination, thyroid hormone assay, serum calcium, Technetium99 thyroid scanning, laryngoscopy and sonography. Serum Ca++ was estimated before and after thyroid surgery.Hypocalcaemia was defined as calcium level <8 mg/dl. Data was analyzed on SPSS 22.0 (IBM, incorporation, USA) at 95% confidence interval. Results: Of 201 patients, male and female were noted as 93 (46.2%) and 108 (53.7%) respectively. Female to male ratio was 1: 0.86. Mean± SD age was noted as 42.3 ± 7.4 years. Overall frequency of hypocalcaemia was identified in 23 (11.4%) of subjects. Mean± SD serum calcium in hypocalcemia subjects was noted as 7.1 ± 0.78 mg/dl. Symptomatic hypocalcaemia was noted in 11 (5.4%) of total subjects. Conclusion: In the present study, an overall frequency of hypocalcaemia was identified in 23 (11.4%) of subjects. Large goiters, recurrent goiter, retrosternal goiter, hyperthyroidism and Grave’s disease were noted as risk factors.

scholarly journals ICHD-3 is significantly more specific than ICHD-3 beta for diagnosis of migraine with aura and with typical aura

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Carl H. Göbel ◽  
Sarah C. Karstedt ◽  
Thomas F. Münte ◽  
Hartmut Göbel ◽  
Sebastian Wolfrum ◽  
...  
Keyword(s):  
Emergency Room ◽  
Diagnostic Criteria ◽  
Migraine With Aura ◽  
University Hospital ◽  
Headache Disorders ◽  
Ischemic Attack ◽  
Diagnostic Work ◽  
The University ◽  
Work Up

Abstract Background In the emergency room, distinguishing between a migraine with aura and a transient ischemic attack (TIA) is often not straightforward and mistakes can be harmful to both the patient and to society. To account for this difficulty, the third edition of the International Classification of Headache disorders (ICHD-3) changed the diagnostic criteria of migraine with aura. Methods One hundred twenty-eight patients referred to the emergency room at the University Hospital of Lübeck, Germany with a suspected TIA were prospectively interviewed about their symptoms leading to admission shortly after initial presentation. The diagnosis that resulted from applying the ICHD-3 and ICHD-3 beta diagnostic criteria was compared to the diagnosis made independently by the treating physicians performing the usual diagnostic work-up. Results The new ICHD-3 diagnostic criteria for migraine with aura and migraine with typical aura display an excellent specificity (96 and 98% respectively), and are significantly more specific than the previous ICHD-3 beta classification system when it comes to diagnosing a first single attack (probable migraine with aura and probable migraine with typical aura). Conclusions The ICHD-3 is a highly useful tool for the clinical neurologist in order to distinguish between a migraine with aura and a TIA, already at the first point of patient contact, such as in the emergency department or a TIA clinic.

scholarly journals Staff survey on the care for persons with dementia / Mitarbeiter/-innenbefragung zum Umgang mit Menschen mit Demenz

2016 ◽  
Vol 3 (2) ◽  
pp. 200-215
Author(s):  
Christine Rungg ◽  
Aloisia Angermair ◽  
Ursula Costa ◽  
Sabrina Neururer ◽  
Markus Moosbrugger ◽  
...  
Keyword(s):  
Nursing Staff ◽  
Clinical Work ◽  
Education Programme ◽  
University Hospital ◽  
Educational Support ◽  
Emotional Burden ◽  
Patient Transport ◽  
Relevant Topic ◽  
The University ◽  
Inpatient Department

Abstract This pilot study at the University Hospital of Innsbruck aimed to interview employees in order to optimise the treatment of patients with dementia. Available data concerning prevalence of dementia in this hospital were analysed and show a slight increase in numbers. Nurses at one inpatient department and one outpatient clinic completed a standardized questionnaire developed by the German Institute for Applied Nursing Research (dip, 2012). Dementia is a highly relevant topic for the participating nursing staff. Results show potential for improvement in pain management, assurance of continuity of services, and communication skills. Nursing staff responded questions about emotional burden, based in their work with this group of patients. The emotional burden was rated as being higher in the inpatient department. Participants from both departments expressed their wish for better involvement of dementia clients’ relatives in the clinical work. Finally, the nursing staff’s needs for educational support was surveyed. Additionally, six members of the patient transport service participated in a focus group interview. Specific types of burden related to handling patients with dementia, as well as wishes and requirements for improvement related to the patient transport for persons with dementia were expressed. The survey shows both, the current state and further potential for improvement of the treatment of patients with dementia at the University Hospital of Innsbruck. Based on the results of this survey a continuing education programme meeting staff needs was developed as one of the measures resulting in the project aiming to improve the treatment of patients with dementia.

Adrenal venous sampling in the diagnostic workup of primary aldosteronism

2021 ◽  
Author(s):  
Matthias Johannes Betz ◽  
Christoph Johannes Zech
Keyword(s):  
Primary Aldosteronism ◽  
Adrenal Adenoma ◽  
Secondary Hypertension ◽  
University Hospital ◽  
Bilateral Disease ◽  
Bilateral Adrenal Hyperplasia ◽  
Diagnostic Work ◽  
The University ◽  
Work Up ◽  
Current Guidelines

Primary aldosteronism (PA) is the primary cause of secondary hypertension. The prevalence of PA has probably been underestimated in the past and recent studies suggest that PA could be present in up to 10% of patients suffering from hypertension. Aldosterone excess in PA can be caused by unilateral adrenal disease, usually adrenal adenoma, or bilateral adrenal hyperplasia. Differentiation between unilateral and bilateral disease is clinically important as the former can effectively be treated by removal of the affected adrenal. CT or MRI cannot reliably distinguish unilateral from bilateral disease. Therefore, adrenal vein sampling (AVS) is an important step of the diagnostic work-up in patients with PA. Current guidelines recommend PA in virtually all patients with biochemically diagnosed PA who would undergo adrenal surgery if unilateral PA was diagnosed. In this narrative review, we give an overview of the current technique used for AVS with a focus on the experience with this technique at the University Hospital Basel, Switzerland.

scholarly journals Organizing the Estonian Physicians’ Nutritional and Dietetics Society in Tartu University Hospital

2018 ◽  
Vol 27 (2) ◽  
pp. 38-42
Author(s):  
Liidia Kiisk
Keyword(s):  
Information Exchange ◽  
Clinical Work ◽  
Clinical Nutrition ◽  
University Hospital ◽  
Nutrition Guidelines ◽  
Nutrition Research ◽  
Nurses And Physicians ◽  
The University ◽  
Attending Physicians ◽  
Disease Specific

Along with everyday clinical work, many nurses and physicians are dealing with clinical nutrition – counselling of patients, nutrition research and cooperation with specialists. It is essential to organise the clinical nutrition of inpatients, outpatients and home-care patients. Patients with chronic diseases and their carers expect increasingly profound information and guidelines about their nutrition from their attending physicians or department nurses and later at home – for this, specific guidelines are needed. An initiative group of physicians at Tartu University Hospital founded the Estonian Physicians’ Nutritional and Dietetics Society. The aims of the Estonian Physicians’ Nutritional and Dietetics Society are development of cooperation and information exchange with specialists in different areas, development and conducting of continuing education programmes in dietetics in cooperation with the Centre for Continuing Medical Education at the University of Tartu. The terminology of dietetics needs unification and updating. Disease-specific clinical nutrition guidelines have to be compiled and published.

scholarly journals Early- and Late-Onset Preeclampsia: A Comprehensive Cohort Study of Laboratory and Clinical Findings according to the New ISHHP Criteria

2019 ◽  
Vol 2019 ◽  
pp. 1-9 ◽  
Author(s):  
Anna Wójtowicz ◽  
Małgorzata Zembala-Szczerba ◽  
Dorota Babczyk ◽  
Monika Kołodziejczyk-Pietruszka ◽  
Olga Lewaczyńska ◽  
...  
Keyword(s):  
Cohort Study ◽  
Diagnostic Criteria ◽  
Late Onset ◽  
Neurological Complications ◽  
Clinical Findings ◽  
Adverse Outcomes ◽  
University Hospital ◽  
Adverse Conditions ◽  
Early Onset Preeclampsia ◽  
The University

Recently, the diagnostic criteria of preeclampsia have been changed. No studies are available in the literature that analyzed in detail the differences between early-onset preeclampsia (EOP) and late-onset preeclampsia (LOP), taking into account the International Society for the Study of Hypertension in Pregnancy (ISSHP) criteria. Thus, we sought to retrospectively investigate in detail the differences in clinical and laboratory outcomes between EOP and LOP diagnosed according to the ISSHP criteria. A retrospective cohort study was conducted in 214 women with singleton pregnancies and preeclampsia admitted to the Department of Obstetrics and Perinatology of the University Hospital in Kraków, Poland, from 2013 to 2017 (113 (52.8%) women with EOP and 101 (47.2%) women with LOP). Electronic medical records were reviewed for demographics and medical history, laboratory tests, and delivery and neonatal data. Patients with preeclampsia accounted for 1.7% of the women who delivered during the study period. The EOP and LOP groups did not differ in the distribution of risk factors for preeclampsia. The most common risk factor was primiparity, which was observed in 72.0% of cases. Regarding the ISSHP diagnostic criteria, the two groups differed in the incidence of fetal growth restriction (p=0.0009), hemolysis (p=0.0416), and neurological complications (p=00342), which were found more often in the EOP group. In addition, the EOP group had more frequent occurrence of severe cardiorespiratory (p<0.0001) and hematological (p=0.0127) complications, adverse fetoplacental conditions (p<0.0001), and severe fetoplacental complications (p=0.0003). Children born to women with EOP had lower Apgar scores (p<0.001) and higher rates of intraventricular hemorrhage (p<0.0001), respiratory disorders requiring mechanical ventilation (p<0.0001), and early (p=0.0004) and late sepsis (p=0.002). EOP differed from LOP in terms of maternal and perinatal adverse outcomes. The observed higher rates of fetoplacental adverse conditions and severe complications indicate a significant contribution of impaired placentation to the etiopathogenesis of EOP.

Symptomatic vascular complications after vascular closure device use following diagnostic and interventional catheterisation

VASA ◽  
2004 ◽  
Vol 33 (2) ◽  
pp. 78-81 ◽  
Author(s):  
Thalhammer ◽  
Aschwanden ◽  
Jeanneret ◽  
Labs ◽  
Jäger
Keyword(s):  
Current Literature ◽  
Vascular Complications ◽  
University Hospital ◽  
Closure Device ◽  
Ultrasound Guided ◽  
Vascular Closure Device ◽  
Device Use ◽  
Arterial Stenoses ◽  
The University ◽  
Stenotic Lesions

Background: Haemostatic puncture closure devices for rapid and effective hemostasis after arterial catheterisation are a comfortable alternative to manual compression. Implanting a collagen plug against the vessel wall may become responsible for other kind of vascular injuries i.e. thrombotic or stenotic lesions and peripheral embolisation. The aim of this paper is to report our clinically relevant vascular complications after Angio-Seal® and to discuss the results in the light of the current literature. Patients and methods: We report the symptomatic vascular complications in 17 of 7376 patients undergoing diagnostic or therapeutic catheterisation between May 2000 and March 2003 at the University Hospital Basel. Results: Most patients presented with ischaemic symptoms, arterial stenoses or occlusions and thrombotic lesions (n = 14), whereas pseudoaneurysms were extremely rare (n = 3). Most patients with ischaemic lesions underwent vascular surgery and all patients with a pseudoaneurysm were successfully treated by ultrasound-guided compression. Conclusions: Severe vascular complications after Angio-Seal® are rare, consistent with the current literature. There may be a shift from pseudoaneurysms to ischaemic lesions.

User Evaluation of an Integrated Medical Workstation for Clinical Data Analysis

1993 ◽  
Vol 32 (05) ◽  
pp. 365-372 ◽  
Author(s):  
T. Timmeis ◽  
J. H. van Bemmel ◽  
E. M. van Mulligen
Keyword(s):  
Data Analysis ◽  
Clinical Research ◽  
Clinical Data ◽  
University Hospital ◽  
User Evaluation ◽  
Scientific Staff ◽  
Medical Institutions ◽  
Clinical Data Analysis ◽  
Research Problems ◽  
The University

AbstractResults are presented of the user evaluation of an integrated medical workstation for support of clinical research. Twenty-seven users were recruited from medical and scientific staff of the University Hospital Dijkzigt, the Faculty of Medicine of the Erasmus University Rotterdam, and from other Dutch medical institutions; and all were given a written, self-contained tutorial. Subsequently, an experiment was done in which six clinical data analysis problems had to be solved and an evaluation form was filled out. The aim of this user evaluation was to obtain insight in the benefits of integration for support of clinical data analysis for clinicians and biomedical researchers. The problems were divided into two sets, with gradually more complex problems. In the first set users were guided in a stepwise fashion to solve the problems. In the second set each stepwise problem had an open counterpart. During the evaluation, the workstation continuously recorded the user’s actions. From these results significant differences became apparent between clinicians and non-clinicians for the correctness (means 54% and 81%, respectively, p = 0.04), completeness (means 64% and 88%, respectively, p = 0.01), and number of problems solved (means 67% and 90%, respectively, p = 0.02). These differences were absent for the stepwise problems. Physicians tend to skip more problems than biomedical researchers. No statistically significant differences were found between users with and without clinical data analysis experience, for correctness (means 74% and 72%, respectively, p = 0.95), and completeness (means 82% and 79%, respectively, p = 0.40). It appeared that various clinical research problems can be solved easily with support of the workstation; the results of this experiment can be used as guidance for the development of the successor of this prototype workstation and serve as a reference for the assessment of next versions.

Sharing of Worldwide Spread Knowledge Using Hypermedia Facilities & Fast Communication Protocols (Mosaic and World Wide Web): The Example of ExPASy

1995 ◽  
Vol 34 (01/02) ◽  
pp. 75-78 ◽  
Author(s):  
R. D. Appel ◽  
O. Golaz ◽  
Ch. Pasquali ◽  
J.-C. Sanchez ◽  
A. Bairoch ◽  
...  
Keyword(s):  
World Wide Web ◽  
World Wide ◽  
Relevant Literature ◽  
Communication Protocols ◽  
Laboratory Data ◽  
Central Element ◽  
University Hospital ◽  
New Information ◽  
The University ◽  
Link Information

Abstract:The sharing of knowledge worldwide using hypermedia facilities and fast communication protocols (i.e., Mosaic and World Wide Web) provides a growth capacity with tremendous versatility and efficacy. The example of ExPASy, a molecular biology server developed at the University Hospital of Geneva, is striking. ExPASy provides hypermedia facilities to browse through several up-to-date biological and medical databases around the world and to link information from protein maps to genome information and diseases. Its extensive access is open through World Wide Web. Its concept could be extended to patient data including texts, laboratory data, relevant literature findings, sounds, images and movies. A new hypermedia culture is spreading very rapidly where the international fast transmission of documents is the central element. It is part of the emerging new “information society”.

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