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IntroductionEmergency department ergonomics is an under researched topic. To our knowledge, this is the only study investigating the effectiveness of a patient self-assessment form in managing patient flow through an emergency department in a busy teaching hospital.MethodsSelf-reported information contained on the forms included patient demographics, presenting complaint, past medical, surgical and drug history, and the option to consent for the emergency care summary, which provides an up-to-date drug history from the general practitioner. This form followed the patient through the department and was utilised by the triage nurse and care providers. 200 patients in Manchester triage categories three to five were recruited, half of whom were given self-assessment forms. Time spent in triage, time taken for first assessment and total time in the department were recorded for all patients.ResultsPatients without a self-assessment form had a mean time spent in triage of 6.0± 3.6 SD min and mean time taken for first assessment of 11.0±6.0 SD min. Patients managed with a self-assessment form had a mean time spent in triage of 4.9 ±3.5 SD min and mean time taken for first assessment of 9.0±5.0 SD min. Patients without a self-assessment form had a median total time spent in the department of 201 min (range 33–301), whereas patients managed with the self-assessment form had a median time of 121 min (range 19–240). The differences in triage, first assessment and total department times between groups were significant (pConclusionThis pilot study showed the effectiveness of a self-assessment form at increasing patient flow through the department, reducing triage, first assessment and total department times. The reasons for this are complex and merit further investigation.

Studies show that there is a correlation between Modified Mallampati Score (MMS) and presence and severity of obstructive sleep apnea (OSA), this measurement being a common part of patient examinations.1,2 As a screening method sleep clinics and primary care centres can use questionnaires, as this method has been shown to predict OSA prior to full polysomnography.3,4 We asked whether patients could assess their own score as part of a service-improvement audit, with the aim of validating a home-scoring system that could be added to pre-outpatient sleep clinic questionnaires, or used as a screening method in primary care. We assessed 50 patients (age range 28-76 years, mean age 52.14 years, 17 female, 33 male), referred for suspected OSA. MMS scores were taken by an experienced clinical physiologist. Once the observer had taken the measurement, standardized verbal instructions were given and patients were invited to assess their own score using a mirror in a well-lit room, comparing their view to a large MMS chart. They were instructed on posture, head position and asked not to phonate in order to standardize the view of the oropharyngeal structures.5 Once instructions were issued, no further intervention was made. Thirty-eight patients agreed with the physiologist. Seven answered within one classification, and 3 were greater than 1 classification from the physiologist. Two patients did not answer. Agreement between physiologist and patients was analyzed using Cohen's kappa and Spearman's correlation coefficient using the 95% confidence interval. Spearman's correlation showed good correlation between physiologist and patient assessments (ρ = 0.836). Both standard kappa (κ = 0.717) and weighted kappa (κ = 0.768, crediting patients who scored within 1 classification of the physiologist) show good strength of agreement between physiologist and patients. Our results show that following standardized spoken instructions, 76% of our 50 patients were able to assess their own MMS, and the majority of the remainder were able to score within one classification of an experienced observer. Statistical analysis shows good correlation and strength of agreement between physiologist and patients. Although further investigation using written instructions for the patient at home and subsequent comparison with the physiologist's scores are required to further evaluate its predictive value, self-assessed MMS score could be a valid addition to screening questionnaires as a predictor of OSA.

Objective To compare the efficacy of single dose oral dexamethasone with five days of twice daily prednisolone in the management of mild to moderate asthma exacerbation in children. Methods A prospective, randomized, double blinded trial of children 2 to 16 years of age who presented to the emergency department with acute mild to moderate asthma exacerbations. Subjects received single dose oral dexamethasone (0.6mg/kg to a maximum of 18mg) or five days of twice daily oral prednisolone (1mg/kg/dose to a maximum of 30mg). After discharge, subjects were called in 48 hours to assess progress, and re-evaluated in five days. Results Baseline characteristics were comparable in the Dex group (n=67, mean age= 60 months), and in the Pred group (n=67, mean age= 48.5months). When Dex was compared to Pred, during the first visit mean time to discharge was 210 minutes vs. 258 minutes (mean difference -48 minutes, CI: -108, 12) and admission rate was 6(9%) vs. 9(13.4%). Two subjects from the Pred group dropped out of the study due to repeated vomiting. For subjects discharged home (61 vs. 56), the admission rate after initial discharge was 3(4.9%) vs. 1(1.8%). The mean number of days needed for Patient Self Assessment score to return to baseline (0-0.5) was 5.21vs 5.22 (mean difference 0.01, CI -0.70, 0.68). Conclusion In children with mild to moderate asthma exacerbation, a single dose of oral dexamethasone (0.6 mg/kg) is safe and efficacious, when compared to five days of oral prednisolone.

Eighty-five consecutive patients referred to the Musculoskeletal Tumor Service completed a standardized short form questionnaire to evaluate their health status and function. Each patient completing the Short Form-36 questionnaire had a diagnosis of musculoskeletal neoplasm, including benign soft tissue and bone tumors, malignant soft tissue and bone tumors, and metastatic tumors. The results of this preliminary study show that the authors' patient population experienced health status and functional deficits in each of the eight Short Form-36 assessed domains. Data show that the most severe deficits were experienced by patients who had diagnoses of bone tumors and malignant tumors. This study shows that the Short Form-36 is a practical and effective method for documenting perceived deficits in health status in patients with musculoskeletal tumors. These data allow the physician to understand the presenting condition from the patient's perspective. This is an important and often neglected aspect of the overall assessment of the health of patient on presentation. An understanding of these deficits is critical for effective planning of treatment and evaluation of treatment effectiveness.

To evaluate interexaminer agreement on palpatory diagnostic findings, we compared interexaminer results, patient disability self-evaluations, and assessment of patients' progress by referring physicians. Three examiners (two clinicians and a third-year osteopathic medical student fellow) monitored patients' progress using negotiated examination procedures. The patients were examined independently by each examiner at each of eight weekly visits. Patients completed a disability assessment form at each visit, and the referring physicians recorded changes in their patients' condition. The patients' disability self-rating and examiner test results did not show clear correlation. There was a 62.2% agreement between the two physician examiners when the general descriptors ''improvement,'' ''no change," or "aggravation" were used. The student examiner's agreement with the clinician examiners was 60.2% and 51.8%. Interexaminer agreement of findings from osteopathic testing procedures appears to depend on general clinical experience and specific experience with the testing procedures.

The present paper describes an example of practical analysis of data from an application of visual analogue scales. Potentially useful and simple methods for analysing visual analogue scales are described for effective handling of complex data when the desire is to compare two or more groups of patients. Visual analogue scales were used to assess subjective tolerability in the International Prospective Primary Prevention Study in Hypertension, a large scale clinical trial. The methods are illustrated on the IPPPSH data.

We studied adaptability to the stresses of bome bemodialysis and CAPD programs by asking patients (143 on bemodialysis; 53 on CAPD) to assess particular treatment -associated stressors. A 14-item questionnaire was constructed to measure areas in which the patients felt stress and the intensity of the stress. Also we used a self-rating scale to obtain information about both the patient's overall and bis or ber physical wellbeing. The majority of patients complained of physical weakness and an inability to sleep. This paper outlines stressors for each treatment modality, and based on patient self-assessment concludes that the two modes of treatment are comparable.

Logistic regression models are widely used in medicine, but difficult to apply without the aid of electronic devices. In this paper, we present a novel approach to represent logistic regression models as nomograms that can be evaluated by simple line drawings. As a case study, we show how data obtained from a questionnaire-based patient self-assessment study on the risks of developing melanoma can be used to first identify a subset of significant covariates, build a logistic regression model, and finally transform the model to a graphical format. The advantage of the nomogram is that it can easily be mass-produced, distributed and evaluated, while providing the same information as the logistic regression model it represents.

A randomised double-blind placebo-controlled trial of phenylethylmalonamide, the major metabolite of primidone was performed in eight patients with essential tremor. Phenylethylmalonamide was given in a daily dose of 400 mg for one week and 800 mg for a second week. The compound had no statistically significant effect on the amplitude of tremor assessed by an accelerometric method, tests of performance, clinical evaluation and patient self assessment. No side effects occurred. Serum levels of phenylethylmalonamide on a daily dose of 400 mg were 11-27 micrograms/ml and on 800 mg daily were 16-48.5 micrograms/ml.

Background Preoperative assessment of functional capacity is necessary to direct decisions regarding cardiac evaluation and may help identify patients at high risk for perioperative complications. Patient self-triage regarding functional capacity could be useful for discerning which patients benefit from a clinician evaluation at a Preoperative Evaluation Center prior to the day of surgery. We evaluated the feasibility of preoperative, patient self-triage regarding functional capacity. Methods Patients were recruited immediately prior to their preoperative evaluation. Study participants completed electronic versions of the Duke Activity Status Index (DASI) and the Patient-Reported Outcomes Measurement System (PROMIS)–Short Form 12a–Physical Function. DASI and PROMIS questionnaire responses were scored and evaluated for correlation with clinician assessments of functional capacity. Correlation was analyzed around the dichotomous outcome of