scholarly journals Agreement between Impression of Stroke in the Emergency Department and Diagnosis at the Neurology Department

2019 ◽  
Vol 7 (3) ◽  
pp. 7
Author(s):  
Samad Shams-Vahdati ◽  
Alireza Ala ◽  
Eliar Sadeghi-Hokmabad ◽  
Neda Parnianfard ◽  
Maedeh Gheybi ◽  
...  
Keyword(s):  
Emergency Department ◽  
Ischemic Stroke ◽  
Statistical Significance ◽  
Retrospective Chart Review ◽  
Chi Square ◽  
Prevention Therapy ◽  
Significant Difference ◽  
Chi Square Test ◽  
Academic Teaching Hospital ◽  
The Mean

Background: Missing to detect an ischemic stroke in the emergency department leads to miss acute interventions and treatment with secondary prevention therapy. Our study examined the diagnosis of stroke in the emergency department (ED) and neurology department of an academic teaching hospital. Methods and Materials: A retrospective chart review was performed from March 2017 to March 2018. ED medical document (chart) were reviewed by a stroke neurologist to collect the clinical diagnosis and characteristics of ischemic stroke patients. For determining the cases of misdiagnosed and over diagnosed data, the administrative data codes were compared with the chart adjudicated diagnosis. The adjusted estimate of effect was estimated through testing the significant variables in a multivariable model. The comparisons were done with chi square test. Statistical significance was considered at P < 0.05. Results: Of 861 patients of the study, 54% were males and 43% were females; and the mean age of them was 66.51 ± 15.70. We find no statically significant difference between patient’s Glasgow Coma Scale (GCS) in the emergency department (12.87±3.25) and patients GCS in the neurology department (11.77±5.15). There were 18 (2.2%) overdiagnosed of ischemic stroke, 8 (0.9%) misdiagnosed of ischemic stroke and 36 (4.1%) misdiagnosed of hemorrhagic strokes in the emergency department. Conclusion: There was no significant difference between impression of stroke in the emergency department and diagnosis at the neurology department.

scholarly journals Facial Profile Shape, Malocclusion and Palatal Morphology in Malay Obstructive Sleep Apnea Patients

2010 ◽  
Vol 80 (1) ◽  
pp. 37-42 ◽  
Author(s):  
S. M. Banabilh ◽  
A. R. Samsudin ◽  
A. H. Suzina ◽  
Sidek Dinsuhaimi
Keyword(s):  
Obstructive Sleep Apnea ◽  
Null Hypothesis ◽  
Control Group ◽  
Class Ii Malocclusion ◽  
Chi Square ◽  
Facial Profile ◽  
Obstructive Sleep ◽  
Significant Difference ◽  
Chi Square Test ◽  
The Mean

Abstract Objective: To test the null hypothesis that there is no difference in facial profile shape, malocclusion class, or palatal morphology in Malay adults with and without obstructive sleep apnea (OSA). Materials and Methods: Subjects were 120 adult Malays aged 18 to 65 years (mean ± standard deviation [SD], 33.2 ± 13.31) divided into two groups of 60. Both groups underwent clinical examination and limited channel polysomnography (PSG). The mean OSA and control values were subjected to t-test and the chi square test. Results: Physical examination showed that 61.7% of the OSA patients were obese, and 41.7% of those obese patients had severe OSA. The mean body mass index (BMI) was significantly greater for the OSA group (33.2 kg/m2 ± 6.5) than for the control group (22.7 kg/m2 ± 3.5; P &lt; .001). The mean neck size and systolic blood pressure were greater for the OSA group (43.6 cm ± 6.02; 129.1 mm Hg ± 17.55) than for the control group (35.6 cm ± 3.52; 114.1 mm Hg ± 13.67; P &lt; .001). Clinical examination showed that the most frequent findings among OSA groups when compared with the control group were convex profiles (71.7%), Class II malocclusion (51.7%), and V palatal shape (53.3%), respectively; the chi square test revealed a significant difference in terms of facial profile and malocclusion class (P &lt; .05), but no significant difference in palatal shape was found. Conclusion: The null hypothesis is rejected. A convex facial profile and Class II malocclusion were significantly more common in the OSA group. The V palatal shape was a frequent finding in the OSA group.

Abstract 14721: Impact of Covid-19 on Cardiology Consultation in Tertiary Care Hospital of a Developing Country

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
ghufran adnan ◽  
Osman Faheem ◽  
Maria Khan ◽  
Pirbhat Shams ◽  
Jamshed Ali
Keyword(s):  
Emergency Department ◽  
Tertiary Care ◽  
Reduction Rate ◽  
Care Hospital ◽  
Chi Square ◽  
Coronary Syndrome ◽  
Significant Difference ◽  
Drastic Increase ◽  
Chi Square Test ◽  
The Difference

Introduction: COVID-19 pandemic has overwhelmed the healthcare system of Pakistan. There has been observation regarding changes in pattern of patient presentation to emergency department (ED) for all diseases particularly cardiovascular. The aim of the study is to investigate these changes in cardiology consultations and compare pre-COVID-19 and COVID-19 era. Hypothesis: There is a significant difference in cardiology consultations during COVID era as compared to non-COVID era. Method: We collected data retrospectively of consecutive patients who visited emergency department (ED) during March-April 2019 (non-COVID era) and March-April 2020 (COVID era). Comparison has been made to quantify the differences in clinical characteristics, locality, admission, type, number, and reason of Cardiology consults generated. Results: We calculated the difference of 1351 patients between COVID and non-COVID era in terms of cardiology consults generated from Emergency department, using Chi-square test. Out of which 880 (59%) are male with mean age of 61(SD=15). Analysis shows pronounced augmentation in number of comorbidities [Hypertension(6%), Chronic kidney disease (6%), Diabetes (5%)] but there was 36% drop in total cardiology consultations and 43% reduction rate in patient’s ED visit from other cities during COVID era. There was 60% decrease in acute coronary syndrome presentation in COVID era, but fortuitously drastic increase (30%) in type II myocardial injury has been noted. Conclusion: There is a remarkable decline observed in patients presenting with cardiac manifestations during COVID era. Lack in timely care could have a pernicious impact on outcomes, global health care organizations should issue directions to adopt telemedicine services in underprivileged areas to provide timely care to cardiac patients.

scholarly journals The mortality of ill infants with false tooth extraction in a rural Ugandan emergency department

2017 ◽  
Vol 8 (1) ◽  
Author(s):  
Amyna Husain ◽  
M. Douglas Baker ◽  
Mark C. Bisanzo ◽  
Martha W. Stevens
Keyword(s):  
Emergency Department ◽  
Tooth Extraction ◽  
Chart Review ◽  
Statistical Significance ◽  
Univariate Analysis ◽  
Retrospective Chart Review ◽  
Cultural Practice ◽  
Fluid Bolus ◽  
Significant Difference ◽  
To Receive

False tooth extraction (FTE), a cultural practice in East Africa used to treat fever and diarrhea in infants, has been thought to increase infant mortality. The mortality of clinically similar infants with and without false tooth extraction has not previously been examined. The objective of our retrospective cohort study was to examine the mortality, clinical presentation, and treatment of infants with and without false tooth extraction. We conducted a retrospective chart review of records of infants with diarrhea, sepsis, dehydration, and fever in a rural Ugandan emergency department. Univariate analysis was used to test statistical significance. We found the mortality of infants with false tooth extraction (FTE+) was 18% and without false tooth extraction (FTE−) was 14% (P=0.22). The FTE+ study group, and FTE− comparison group, had similar proportions of infants with abnormal heart rate and with hypoxia. There was a significant difference in the portion of infants that received antibiotics (P=0.001), and fluid bolus (P=0.002). Although FTE+ infants had clinically similar ED presentations to FTE− infants, the FTE+ infants were significantly more likely to receive emergency department interventions, and had a higher mortality than FTE− infants.

scholarly journals Sonographic gallbladder wall thickness in normal adult population in Nigeria

2010 ◽  
Vol 14 (4) ◽  
pp. 84 ◽  
Author(s):  
S Mohammed ◽  
A Tahir ◽  
A Ahidjo ◽  
Z Mustapha ◽  
Franza O
Keyword(s):  
Wall Thickness ◽  
Adult Population ◽  
Clinical History ◽  
Gallbladder Wall ◽  
Normal Adult ◽  
Chi Square ◽  
Normal Ranges ◽  
Significant Difference ◽  
Chi Square Test ◽  
The Mean

Aim. The aim of the study was to determine the ultrasonic gallbladder wall thickness in normal adult Nigerians so as to create standards for defining gallbladder abnormalities in Nigerians. Method. Four hundred adults comprising 228 (57%) women and 172 (43%) men aged 16 - 78 years, who had normal clinical history and physical findings, were recruited. The gallbladder wall thickness was obtained in the supine, prone and right anterior oblique positions. Differences in gallbladder wall thickness were determined using the chi-square test, while the relationship between the ultrasound-measured gallbladder wall thickness and the subjects’ age, sex, height and weight were analysed using the Pearson product moment correlation. Normal ranges and related statistics were estimated and tabulated according to age group and sex. Results. The mean age of the subjects was 32±13.2 years. The mean gallbladder wall thickness range was 1.8 - 2.8 mm±0.5mm. The thickness range for females was 1.7 - 2.7 mm±0.5 mm, and that for males was 1.9 - 2.9 mm±0.5 mm. There was a statistically significant difference (p

scholarly journals Palatal Rugae Pattern in Nepalese Subjects

2013 ◽  
Vol 3 (2) ◽  
pp. 36-39 ◽  
Author(s):  
Dipshikha Bajracharya ◽  
Anisha Vaidya ◽  
Sunaina Thapa ◽  
Sujita Shrestha
Keyword(s):  
Statistical Analysis ◽  
Population Differentiation ◽  
Forensic Odontology ◽  
Chi Square ◽  
Statistical Significant Difference ◽  
Palatal Rugae ◽  
Significant Difference ◽  
Chi Square Test ◽  
The Mean ◽  
Gender Groups

Objective: To determine the number and pattern of palatal rugae in Nepalese subjects and to find the association of gender with the number and pattern of palatal rugae. Materials & Method: 200 Nepalese subjects comprising of 100 male and 100 female were randomly selected and their maxillary casts were examined for the palatal rugae length applying the classification proposed by Thomas and Kotze and palatal rugae pattern was recorded using the classification given by Kapali. Statistical analysis using Student t-test was applied for comparing the number of palatal rugae between right and left sides. Chi square test was used to find the association between gender and number of rugae as well as the pattern. Result: The study demonstrated that the mean number of primary palatal rugae on left side was predominant, similarly wavy pattern was the most predominant in Nepalese subjects. No statistical significant difference was noticed in the palatal rugae number and pattern between the gender groups. Conclusion: The study found predominant palatal form in Nepalese subjects which might have superior effectiveness in population differentiation and may be used as an effective tool in forensic odontology identification.  

scholarly journals Randomized controlled trial on the effectiveness of silver diamine fluoride in arresting caries in Lagos, Nigeria

2021 ◽  
Vol 21 ◽  
pp. e226341
Author(s):  
Moses Okechukwu Azouru ◽  
Modupe Olufunmilayo Ashiwaju ◽  
Augustine Edomwonyi ◽  
Afolabi Oyapero ◽  
Bola Obisesan ◽  
...  
Keyword(s):  
Controlled Trial ◽  
Phase Iii ◽  
Treatment Modalities ◽  
Control Group ◽  
Chi Square ◽  
Silver Diamine Fluoride ◽  
Randomized Controlled ◽  
Significant Difference ◽  
Chi Square Test ◽  
The Mean

Treatment of dental caries in children still remains challenging due to lack of cooperation with conventional treatment modalities. Recently, the use of Silver Diamine Fluoride (SDF) has proved useful in addressing this challenge. Aim: This clinical trial aimed to evaluate the effectiveness of Silver Diamine Fluoride (SDF) in arresting caries in children in Lagos, Nigeria. Methods: This was a phase III balanced randomized controlled school based interventional study on 240 children. The study group was treated with SDF while GIC was used in the control group. Follow up visits in 2 weeks, 1 month, and 3 months were carried out to assess the treatment outcome. Inferential statistics with the use of Pearson Chi-square test and Independent Student t-test were used at 5% level of significance. Results: There was significant relationship between SDF and caries arrest in 2 weeks, 1 month and 3 months’ assessment period (p = 0.001). The control group showed continuous decline (71.7%, 54.3% and 50.9%) in restorative success from 2 weeks to 3 months respectively. The mean ± SD and Confidence Interval (CI) of arrested caries in the SDF group were 113± 1.24 and 113.1 – 113.5 respectively. In the control group the mean ± SD and CI of restorative success were 69.3±11.8 and 67.2 – 71.4. The effect size was 5.24. Conclusion: The result of the study showed that SDF was effective in arresting caries in children without any harm and there was statistically significant difference in the use of 38% SDF in arresting caries in children.

Preoperative Gabapentin Administration and Its Impact on Postoperative Opioid Requirement and Pain in Sinonasal Surgery

2020 ◽  
pp. 019459982095280
Author(s):  
Amarbir S. Gill ◽  
Farrukh R. Virani ◽  
Joshua C. Hwang ◽  
Machelle D. Wilson ◽  
Angela M. Beliveau ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Wilcoxon Test ◽  
Opioid Use ◽  
Chi Square ◽  
Vas Score ◽  
Significant Difference ◽  
Patient Reported ◽  
Chi Square Test ◽  
Sinonasal Outcome Test ◽  
The Mean

Objective To determine the efficacy of preoperative gabapentin on patient-reported pain levels and postoperative opioid requirements following sinonasal surgery. Study Design Retrospective review. Setting Academic institution. Methods Patients undergoing sinonasal surgery between July 2019 and January 2020 were followed. Groups were divided into those that received 600 mg of oral gabapentin 1 hour preoperatively (gabapentin) and those that did not (control). Postoperatively, each patient was counseled to use acetaminophen, ibuprofen, and oxycodone as needed for pain control. Patients completed a daily postoperative pain and medication log. Pain was measured by the visual analog scale (VAS) and opioid use by morphine equivalent dose (MED). Chi-square test and Wilcoxon test were used for data analysis. Results Fifty-seven patients were included (control, n = 28; gabapentin, n = 29). There was no significant difference in age, sex, or baseline Sinonasal Outcome Test–22 scores between the groups. The total MED, postoperative day (POD) 1-2 MED, POD 3-4 MED, and POD 5-6 MED did not differ significantly between the control (17.9, 12.2, 4.6, 1.5) and gabapentin (19.0, 8.9, 7.2, 3.5) groups ( P = .98, .25, .16, .44). The mean daily VAS score did not differ significantly between the control (3.1) and gabapentin (2.8) groups ( P = .81). The mean daily VAS score decreased significantly in both groups with each successive POD ( P = .004). Conclusion Preoperative gabapentin did not significantly reduce postoperative pain or opioid use. Postoperative discomfort following sinonasal surgery is mild, and opioid intake is minimal.

scholarly journals Caregiver Burden and Disability in Somatoform Disorder: An Exploratory Study

2020 ◽  
pp. 025371762095756
Author(s):  
Esther Chinneimawi ◽  
Padmavathi Nagarajan ◽  
Vikas Menon
Keyword(s):  
Caregiver Burden ◽  
Somatoform Disorders ◽  
Statistical Significance ◽  
International Classification Of Diseases ◽  
Somatoform Disorder ◽  
Chi Square ◽  
Disability Score ◽  
Chi Square Test ◽  
The Mean ◽  
Student’S T

Background: Very few Indian studies have explored disability among patients with somatoform disorder and the burden experienced by their caregivers. We aimed to assess the levels of disability among patients with somatoform disorder and the levels of burden among their caregivers and compare these parameters against patients with schizophrenia. Methods: Participants included adults with a diagnosis of somatoform disorders (F45.0–F 45.9) ( n = 28) or schizophrenia (F20.0–F20.9) ( n = 28) diagnosed as per the International Classification of Diseases, Tenth Revision ( ICD-10), clinical descriptions, and diagnostic guidelines, as well as their caregivers. The WHO Disability Assessment Schedule 2.0 and Family Burden Interview Schedule were used to assess patient disability and caregiver burden, respectively. Independent Student’s t-test or chi-square test was used to compare relevant sociodemographic and clinical parameters. Results: Out of 56 patients, the mean (±SD) age of the sample was 38.6 (±10.5) years. Females constituted a slender majority of the sample ( n = 29, 51.8%). The mean disability score of patients with somatoform disorders was slightly higher (83.6 ±20.9) than that of patients with schizophrenia (82.3 ±16.7). Similarly, the mean burden score of caregivers of patients with somatoform disorders was nominally higher (18.96 ±9.9) than that of caregivers of patients with schizophrenia (15.7 ±9.7). Neither of these differences approached statistical significance (P > 0.05). Conclusion: Patients with somatoform disorders experience considerable levels of disability, and their caregivers go through various levels of burden in their daily life that is comparable to schizophrenia.

Abstract W MP61: Prevalence of Echocardiographic Abnormalities in Acute Ischemic Stroke

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Bryan Eckerle ◽  
Heidi Sucharew ◽  
Kathleen Alwell ◽  
Charles J Moomaw ◽  
Matthew Flaherty ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Clinical Decision Making ◽  
Retrospective Chart Review ◽  
Clinical Decision ◽  
Imaging Method ◽  
Chi Square ◽  
Exact Test ◽  
High Prevalence ◽  
Chi Square Test

Introduction: Non-invasive cardiac imaging is an important tool in evaluation of acute ischemic stroke, as a cardiac source can be implicated in approximately 20% of cases. However, the preferred imaging method is unclear due in part to the lack of consistent data regarding the yield of the two most commonly employed modalities, transthoracic and transesophageal echocardiography (TTE and TEE). Here we examine, in a large, biracial population, the prevalence of abnormalities detected by echocardiography during evaluation of acute ischemic stroke. Methods: Acute ischemic stroke cases were identified from a population of 1.3 million in the Greater Cincinnati area in 2005. Medical history and echocardiography results were determined by retrospective chart review. Echocardiographic abnormalities were pre-defined based on possibility of change in clinical decision making. All cases were abstracted by study nurses and subsequently verified by study physicians. Results were stratified by cardiac history and choice of echocardiographic technique; groups were compared using chi-square test or Fisher’s Exact test. Results: There were 2197 hospital-ascertained ischemic stroke cases in 2005. Median age was 73 (IQR 61-81), 22% were black, and 55% were female. TTE was performed in 68% of cases; TEE was performed in 7%. TEE revealed at least one abnormality in 55% of cases with cardiac history and 32% of cases without (Table). Yield of TTE was 20% in cases with cardiac history and 3% in cases without. Discussion: TEE is of considerable yield in selected patients, irrespective of cardiac history. This is in keeping with prior cost-effectiveness analyses recommending TEE alone for patients in whom suspicion of occult source of cardiac embolism is high. Prevalence of abnormalities on TTE in this population is similar to that of previously published series.

Abstract TP240: Missed Ischemic Stroke Diagnosis in the Emergency Department at an Academic Center and Community Hospital

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Allison E Arch ◽  
David C Weisman ◽  
Steven Coca ◽  
Karin V Nystrom ◽  
Charles R Wira ◽  
...  
Keyword(s):  
Emergency Department ◽  
Ischemic Stroke ◽  
Community Hospital ◽  
Retrospective Chart Review ◽  
Therapeutic Window ◽  
Academic Hospital ◽  
Stroke Patients ◽  
Academic Center ◽  
Prevention Therapy ◽  
Stroke Diagnosis

Introduction: The failure to recognize an ischemic stroke in the emergency department (ED) is a missed opportunity for acute interventions and for prompt treatment with secondary prevention therapy. Our study examined the characteristics of misdiagnosed strokes in the ED of an academic teaching hospital and a large community hospital. Methods: A retrospective chart review was performed from February 2013 to February 2014. A stroke was “missed” if practitioners in the ED did not initially consider stroke in the differential, or the diagnosis was delayed causing the patient to miss the therapeutic window for thrombolytic therapy. Results: A total of 465 ischemic stroke patients were included; 280 patients from the academic hospital and 185 patients from the community hospital. One hundred three strokes were initially misdiagnosed. Fifty-five of these were missed at the academic hospital (22%) and 48 were at the community hospital (26%, p=0.11). Of the missed stroke patients, 26 at the academic hospital (47%) and 10 at the community hospital (21%) presented within 3 hours of symptom onset. At the academic hospital where a neurologist is consulted on all potential acute strokes, a neurologist was called for 95% of the accurate stroke diagnoses but only 36% of the stroke misses (p<0.001). Factors independently associated with greater odds of a missed stroke diagnosis were nausea/vomiting (OR=4.02, 95% CI=1.60-10.1), dizziness (OR=1.99, 95% CI=1.03-3.84), and a positive stroke history (OR=2.40, 95% CI=1.30-4.42). Thirty-seven percent of posterior strokes were initially misdiagnosed compared with 16% of anterior strokes (p<0.001). Conclusion: Greater than 20 percent of stroke patients admitted through the ED at both an academic center and community hospital had a missed diagnosis. These strokes were more likely to be posterior circulation strokes and associated with nausea, vomiting and dizziness. A neurologist consultation decreased the likelihood of a missed stroke. Next steps are the development of improved identification systems and tools in the ED to improve the accuracy of stroke diagnosis.

Sign in / Sign up

Export Citation Format

Share Document