scholarly journals COMORBIDITY CHARACTERISTICS OF ADULT PATIENTS WITH REPORTED NECK AND LOW BACK COMPLAINTS - AN OUTPATIENT CLINICAL POPULATION-BASED COHORT STUDY

2021 ◽  
Vol 57 (2) ◽  
pp. 159-167
Author(s):  
Victor M. Pedro ◽  
◽  
Elena Oggero ◽  
◽  

In clinical practice, a comprehensive history and examination often includes questionnaires covering all systems. Physical examination is augmented by functional assessment using subjective (neck and lumbar disability indexes, NDI and LBDI respectively) and objective measures (computerized dynamic posturography, CDP). In this retrospective chart review of patients with complaints of postural instability and neck or low back pain, the presence and number of comorbidities and their classification were analyzed by age, gender, and severity of the disability. In general subjects showed higher disability in the NDI than in the LBDI (with more significant impact of the proximal vs. distal pain, joint and receptor dysfunction); they had a wide range of CDP results (the more difficult the test, the higher the number of subjects that were not able to complete it and the lower the number that had healthy balance); and on average 3.84 comorbid conditions were present, with 21 subjects presenting with 5 or more, 3 with 10 or more, and one reporting 15 comorbidities. No statistically significant differences were found for age, BMI and LBDI; sex and NDI affected metabolic comorbidities; certain tests of the CDP affected the Musculoskeletal and Other type of comorbidities. It was difficult to detect strong correlation trends that could be easily explained. Complex subjects cases complicate the possibility of doing practice based clinical research, but more importantly they create a challenge for the clinician in deciding the best course of action for treating the patient. New algorithmic assessments and integrated approaches are needed.

Author(s):  
Adrian Traeger ◽  
Gustavo C Machado ◽  
Sally Bath ◽  
Martin Tran ◽  
Lucinda Roper ◽  
...  

ABSTRACT Background Imaging for low back pain is widely regarded as a target for efforts to reduce low value care. We aimed to estimate the prevalence of overuse and underuse of lumbar imaging in the Emergency Department. Methods Retrospective chart review study of five public hospital Emergency Departments in Sydney, Australia, in 2019/20. We reviewed the clinical charts of consecutive adult patients who presented with a complaint of low back pain and extracted clinical features relevant to a decision to request lumbar imaging. We estimated the proportion of encounters where a decision to request lumbar imaging was inappropriate (overuse) or where a clinician did not request an appropriate and informative lumbar imaging test when indicated (underuse). Results 649 patients presented with a complaint of low back pain of which 158 (24.3%) were referred for imaging. 79 (12.2%) had a combination of features suggesting lumbar imaging was indicated according to clinical guidelines. The prevalence of overuse and underuse of lumbar imaging was 8.8% (57 of 649 cases, 95%CI 6.8% to 11.2%) and 4.3% (28 of 649 cases, 95%CI 3.0% to 6.1%), respectively. 13 cases were classified as underuse because the patient was referred for an uninformative imaging modality (e.g. referred for radiography for suspected cauda equina syndrome). Conclusion In this study of emergency care there was evidence of overuse of lumbar imaging, but also underuse through failure to request lumbar imaging when indicated or referral for an uninformative imaging modality. These three issues seem more important targets for quality improvement than solely focusing on overuse.


Pain Practice ◽  
2008 ◽  
Vol 8 (1) ◽  
pp. 11-17 ◽  
Author(s):  
Alex Macario ◽  
Charlotte Richmond ◽  
Martin Auster ◽  
Joseph V. Pergolizzi

Author(s):  
Daisy Duan ◽  
Leen Wehbeh ◽  
Debraj Mukherjee ◽  
Amir H Hamrahian ◽  
Fausto J Rodriguez ◽  
...  

Abstract Context Craniopharyngiomas, while benign, have the highest morbidity of all nonmalignant sellar tumors. Studies on weight and metabolic outcomes in adult-onset craniopharyngioma (AOCP) remain sparse. Objective To examine postsurgical weight and metabolic outcomes in AOCP and to identify any clinical predictors of weight gain. Methods Retrospective chart review of patients with AOCP who underwent surgery between January 2014 and May 2019 in a single pituitary center. The study included 45 patients with AOCP with a minimum follow-up of 3 months. Median follow-up time was 26 months (interquartile range [IQR] 10-44). Main outcome measures were the changes in weight/body mass index (BMI), metabolic comorbidities, and pituitary deficiencies between preoperative and last follow-up. Results Both weight and BMI were higher at last follow-up, with a mean increase of 3.4 kg for weight (P = .015) and 1.15 kg/m2 for BMI (P = .0095). Median % weight change was 2.7% (IQR –1.1%, 8.8%). Obesity rate increased from 37.8% at baseline to 55.6% at last follow-up. One-third of patients had ~15% median weight gain. The prevalence of metabolic comorbidities at last follow-up was not different from baseline. Pituitary deficiencies increased postoperatively, with 58% of patients having ≥3 hormonal deficiencies. Preoperative BMI was inversely associated with postoperative weight gain, which remained significant after adjusting for age, sex, race, tumor, and treatment characteristics. Patients with ≥3 hormonal deficiencies at last follow-up also had higher postoperative weight gain. Conclusion In this AOCP cohort, those with a lower BMI at the preoperative visit had higher postoperative weight gain. Our finding may help physicians better counsel patients and provide anticipatory guidance on postoperative expectations and management.


2018 ◽  
Author(s):  
◽  
Nompumelelo Marcia Sibeko

Brief background In the practice of Homoeopathy, widely acting remedies or polychrest homoeopathic medicines are prescribed in the treatment of a wide range of clinical conditions. The documenting of the guiding symptoms in successfully treated cases will assist in offering guidelines for the prescription of remedies in the future and thus serves as scientific and clinical verification of the remedies. The operational definition of success for the purposes of clinical verification is the alleviation or improvement of existing symptoms (Van Wassenhoven 2013). This definition was applied in the context of this study. To facilitate high standards of health care as well as teaching and learning, Durban University of Technology (DUT) Department of Homoeopathy in collaboration with Lifeline established its first Homoeopathic Community Clinic in 2004 called Ukuba Nesibindi Homoeopathic Community Clinic (UNHCC) located in Warwick Junction, Durban. UNHCC provides a free Homoeopathic primary health care service on the third floor of the Lifeline building in Acorn Road, Warwick Triangle, less than one kilometre from the main DUT campus The area is classified as being disadvantaged with high crime rates, prostitution, violence, small informal businesses and low cost housing (Smillie 2010, Watson 2015 and Dube 2015). Aim of the study The study aimed to determine and compare the guiding symptoms of the successful prescription of Natrum muriaticum at Ukuba Nesibindi Homoeopathic Community Clinic (UNHCC) between 2013 and 2016. Methodology A retrospective chart review was conducted at the Ukuba Nesibindi Homoeopathic Community Clinic on the patient files between 2013 and 2016. A rubric (Appendix B) was used to document the demographics, clinical conditions, homoeopathic guiding symptoms, posology and follow up presentation of each chart where Natrum muriaticum was successfully prescribed. Furthermore, a comparison of the guiding prescribing symptoms was made against existing materia medica. A sample size of 197 patient files which had appropriate consent forms enclosed allowing for the use of information for research purposes was established. Prior to gathering the relevant information and the commencement of the study, gate keeper permission to conduct the study on patient files and at the mentioned location was requested and granted by all relevant stakeholders. The actual sample size was derived from the successful cases with follow ups until data saturation. Files that were excluded from the 197 patient files were of those patients who did not attend the follow up appointment and cases which were not treated successfully with the remedy. The sample size for the study was 37. Descriptive statistics was derived and illustrated using bar graphs and pie charts. Tabulations and graphical presentation of the comparison were created. Themes and inferences were drawn based on the emerged data from the symptoms and rubrics. Thereafter, a comparison to the existing materia medica was conducted by comparing the arising symptomatology with the existing content in the materia medica. Results The results of the study showed that the symptoms that arise in the study corresponded with the symptoms in the existing materia medica, however there were additional symptoms that emerged in the study and these symptoms were not listed in the materia medica, but were successfully treated with Natrum muriaticum. It was concluded that the guiding symptoms that were considered in formulating the prescriptions of Natrum muriaticum correlate with the characteristic symptoms of Natrum muriaticum in the materia medicas by Vermeulen, Boericke and Phatak


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