Search

Abstract Lower gastrointestinal perforation is rare and challenging to diagnose in patients presenting with an acute abdomen. However, no study has examined the frequency and associated factors of diagnostic errors related to lower gastrointestinal perforation. This large-scale multicenter retrospective study investigated the frequency of diagnostic errors and identified the associated factors. Factors at the level of the patient, symptoms, situation, and physician were included in the analysis. Data were collected from nine institutions, between January 1, 2015 and December 31, 2019. Timely diagnosis was defined as diagnosis at the first visit in computed tomography (CT)-capable facilities or referral to an appropriate medical institution immediately following the first visit to a non-CT-capable facility. Cases not meeting this definition were defined as diagnostic errors that resulted in delayed diagnosis. Of the 439 cases of lower gastrointestinal perforation identified, delayed diagnosis occurred in 138 cases (31.4%). Multivariate logistic regression analysis revealed a significant association between examination by a non-generalist and delayed diagnosis. Other factors showing a tendency with delayed diagnosis included presence of fever, absence of abdominal tenderness, and unavailability of urgent radiology reports. Initial misdiagnoses were mainly gastroenteritis, constipation, and small bowel obstruction. In conclusion, diagnostic errors occurred in about one-third of patients with a lower gastrointestinal perforation.

Abstract Variabilities or fluctuations in foot clearance are considered as a risk factor for falls during walking in older adults. The present study aimed to investigate whether the foot trajectory variability can be reduced by applying vibratory stimulation to the foot's plantar surface during walking. Ten healthy adults were asked to walk on a treadmill with vibratory shoes, and body kinematics were measured. Changes in the mean absolute deviations of the foot trajectory and joint and trunk angles were compared between the periods of applied or absent vibratory stimulus. Our results demonstrated that toe trajectory variability in the swing phase was significantly smaller when a vibratory stimulus was applied. Applying vibratory stimulus to the soles of the forefoot could potentially be used to reduce foot trajectory variability, which could reduce the risk of trips and associated falls during walking in older adults.