Search

Health conditions are associated with a variety of functional outcomes. Even though functional outcomes are diverse for different health conditions, they can have important commonalities. The aim of this study was to identify the most common problems in functioning across the wide range of health conditions using the International Classification of Functioning (ICF). Existing databases created for the 21 ICF Core Sets studies were descriptively analyzed. These included data collected in 44 countries on 9978 patients with one of 21 health conditions as the main diagnosis. A frequency cutoff of 50% was used to identify the most common problems in functioning when looking at single health conditions and across them. No category was identified as common to all health conditions included in the study. Fifteen most frequent categories were common in 10 to 13 health conditions out of 21. Eleven categories correspond to the list of activities and participation, and four to the list of body functions. These are related to mobility, daily routine, mental functions, intimate relations, employment, and leisure. Some health conditions have more commonalities between each other. The most common problems across health conditions are therefore related to mental functions, mobility, daily life, intimate relations, employment, and leisure. The results contribute toward the identification of the universal set of ICF categories that can be used in clinical practice for the general assessment of functioning.

Objective: There is still little evidence regarding the type of mattress that is the best for preventing pressure ulcers (PUs). In a Dutch nursing home, a new type of overlay mattress (air inflated visco-elastic foam) was tested to analyze the opportunity for replacement of the normally used static air overlay mattress in its three-step PU prevention protocol In this small pilot the outcome measures were: healing of a category one pressure ulcer, new development or deterioration of a category one PU and need for repositioning. Methods: We included 20 nursing home residents with a new category one pressure ulcer, existing for no longer than 48 h following a consecutive sampling technic. All residents were staying for more than 30 days in the nursing home and were lying on a visco-elastic foam mattress without repositioning (step one of the 3-step protocol) at the start of the pilot study. They had not suffered from a PU in the month before. The intervention involved use of an air inflated foam overlay instead of a static air overlay (normally step 2 of the 3-step protocol). At the start; the following data were registered: age; gender; main diagnosis and presence of incontinence. Thereafter; all participating residents were checked weekly for PU healing tendency; deterioration of PUs; new PUs and need of repositioning. Only when residents showed still a category one PU after 48 h or deterioration of an existing pressure ulcer or if there was development of a new pressure ulcer, repositioning was put into practice (step 3 of the PU protocol). All residents participated during 8 weeks. Results: Seven residents developed a new pressure ulcer category one and still had a category one pressure ulcer at the end of the study period. One resident developed a pressure ulcer category 2. Fifteen residents needed repositioning from one week after start of the study until the end of the study. Conclusions: Overall 40% of the residents developed a pressure ulcer. Seventy five percent of the residents started with repositioning because there was no healing tendency of their category one PU diagnosed at the start of the pilot. Because this new type of overlay mattress resulted in an increased PU incidence, and almost standard need of repositioning with accompanied high costs, this type of overlay mattress gives no benefit above the traditional visco-elastic foam mattresses in combination with the originally used static air overlay.

CONTEXT: Severe self-mutilation episodes are rare in psychiatric practice. Most patients are psychotic during such acts and the main diagnosis is schizophrenia. The regions most commonly self-mutilated are the penis and the eyes. CASE REPORT: A patient previously diagnosed with schizophrenia started self-mutilating his lip and phalanxes secondary to command auditory hallucinations and influenced by mystic-religious delusions. CONCLUSION: Self-mutilation episodes are rare in schizophrenic patients. In such case, it should be identified prodrome symptoms or provoking situations in order to promptly institute strategies to prevent or lessen the risk of new episodes.

Objective. The implementation of diagnosis-related groups – prospective payment system (DRGs-PPS) and the work of classifying and coding disease play a very important role in the operation and management of a hospital. This paper aims to discover problems affecting the accuracy of coding, to improve accuracy of the disease and operation coding, and to improve the report quality, through the retrospective examination of the coding contents on the homepage of medical records. Methods. The Six Sigma method was used for randomly inspecting a part of the medical record data statistically reported by tertiary hospitals and secondary hospitals from the information center of the Beijing Municipal Health Bureau, and on-site inspection was performed, in order to find out reasons affecting the coding accuracy. Results. In the 695 medical records inspected, there were 258 cases having problems in the selection of the main diagnosis and the coding of the operation, accounting for 37% of the total. Conclusions....

On account of the Hospital Statistics Regulation from 1990 all hospitals have to run a diagnosis-related and regionally structured hospital documentation, beginning with the year 1993. In the State of Berlin, this routine documentation from 74 hospitals of Berlin is centralised in the Statistics State Office. We obtained the data records with the main diagnosis alcoholism (303 ICD 9) for the years 1993 to 1999 for evaluation. The treatment frequency is male dominated with average yearly 400 vs. 100 female cases per 100 000 inhabitants. In East Berlin men reached due to continuous increase of cases for the first time in 1998 higher values in comparison with West Berlin. The treatment frequency of female West Berlin patients is in the period under review continually about twice as high than that of female East Berlin patients. The age peak for both sexes lies between 40 and < 50 years. The patients were especially treated in the wards of "psychiatry" (ca. 40 %), of "addiction diseases" (ca. 30 %) and "internal medicine" (ca. 23 %). The average hospital retention period was reduced from 22 (1993) to 12 days (1999).

Penicillin allergy is commonly reported, but only a minority of claimants has a confirmed diagnosis. Nevertheless, patients labeled as having penicillin allergy are treated with second-line antibiotics, which are more expensive and less effective, possibly increasing the risk of drug-resistant infections.To compare hospitalizations with and without registration of penicillin allergy concerning their morbidity and hospital resource use.We analyzed a national administrative database containing a registration of all Portuguese hospitalizations from 2000 to 2014. All episodes occurring in adults with a penicillin allergy registration were compared with an equal number of hospitalizations without such registration and matched for inpatients' age, sex, and main diagnosis. We compared those episodes concerning their length of stay, hospital price charges, comorbidities, and frequency of drug-resistant infections. Differences between medical and surgical hospitalizations were explored.Hospitalizations with registration of penicillin allergy (n = 102,872) had a longer average length of stay than the remainder episodes (8 vs 7 days; P .001) and higher hospital charges (3,809.0 vs 3,490.0 USD; P .001). Inpatients with penicillin allergy registration also had a higher mean Charlson Comorbidity Index (0.91 vs 0.76; P .001) and a significantly higher frequency of infections by several agents, including methicillin-resistant Staphylococcus aureus, Enterococcus species, and Escherichia coli. Among surgical episodes, septicemia was 1.2-fold more frequent among penicillin allergy cases.Hospitalizations with registration of penicillin allergy are associated with increased economic costs and frequency of infections by drug-resistant agents, reinforcing the need to establish a correct diagnosis of penicillin allergy.

Background: This study aimed to highlight the health seeking behavior of children in an Emergency Department (ED). Materials and Methods: Retrospective files review of ED was done for the month of July, 2008. Data about the children ≤12 years of age was gathered. Results: In one month period a total 21000 patients visited our ED, out of them 6120 (29%) were children. Males, Saudis and children of (1‑6 years) were more frequent, i.e., 3540 (57.8%), 5760 (94.1%) and 3180 (52%), respectively. Majority of patients visited in shift “2”, i.e., 15:30 hours to 23:30 hours. Among the patients “diseases of respiratory system” were found more frequent 4170 (68.1%) and main diagnosis was “acute upper respiratory tract infection” 3300 (53.9%). Non‑urgent cases were 2020 (33%) while 244 (4%) were admitted. Conclusion: Young children as well as non‑urgent cases were predominant. Evening shift was the busiest one.Keywords: Children, emergency, infection, respiratory tractNigerian Medical Journal | Vol. 53 | Issue 3 | July-September | 2012

Background Demographic changes have resulted in an increase in the number of older (> 75 years) multimorbid patients in clinics. In addition to the primary acute diagnoses that lead to hospitalization, this group of patients often has cognitive dysfunctions, such as delirium. According to clinical experience, delirium patients are more time-consuming for clinicians and their function is often poor. The costs caused by delirium patients are currently unknown. In the present study, a retrospective examination of a database was carried out to calculate the costs that arise during the clinical treatment of documented delirium patients. Setting and methods The purpose of this retrospective analysis was to collect information recorded by nursing personnel trained in the treatment of delirium and information from a manual documentation matrix for additional time expenditure. In the database analysis anonymous data of previously discharged patients for a time window of 3 months were analyzed. Documented additional expenditure for patients with hyperactive delirium at hospitalization were analyzed by personnel. Material costs, the duration of hospitalization by main diagnosis and age clusters during hospitalization until discharge were also examined. The analysis was performed in a hospital with internal wards. Results Data for 82 hyperactive delirium patients were examined and an average of approximately 240 min of additional personnel expenditure for these patients was found. These patients were approximately 10 years older (p

OBJECTIVE: To analyze the trend in hospitalizations for primary care-sensitive cardiovascular conditions for residents of the state of Paraná, Brazil, from 2000 to 2011. METHODS: Ecological, time series study of the rates of hospitalization for cardiovascular diseases in residents aged 35-74 years old by sex, age and main diagnosis for hospitalization. Data from the Hospital Information System of the Unified Health System (SIH-SUS) and polynomial regression models for trend analyses were used. RESULTS: Hospitalization rates for cardiovascular conditions decreased during the period (r2 = 0.96; p < 0.001), with similar decreasing patterns for males and females, in all age ranges, although always higher for males. Although hospitalization trends for hypertension, heart failure and cerebrovascular disease decreased, angina remained stable for males and females. CONCLUSION: A downward trend in hospital admissions due to primary care-sensitive cardiovascular conditions in the state of Paraná between 2000 and 2011 may have resulted from the expansion of the health network of and the access to primary health attention, as well as other factors that influence this set of diseases, such as improved socioeconomic conditions of the population, organization of primary care services for higher age ranges and women and decrease in risk factors. OBJETIVO: Analisar a tendência das internações por condições cardiovasculares sensíveis à atenção primária de residentes no Estado do Paraná de 2000 a 2011. MÉTODOS: Estudo ecológico de séries temporais das taxas de internação por doenças cardiovasculares de residentes de 35 a 74 anos de idade por sexo, idade e diagnóstico principal de internação. Foram utilizados os dados do Sistema de Informações Hospitalares do Sistema Único de Saúde (SIH-SUS). Para as análises de tendência foram utilizados modelos de regressão polinomial. RESULTADOS: As taxas de internação por condições cardiovasculares declinaram no período (r2= 0,96; p < 0,001) e, embora sejam sempre maiores para os homens, foi observado decréscimo significativo em todas as faixas de idade para ambos os sexos. Enquanto a tendência das taxas de internação por hipertensão, insuficiência cardíaca e doenças cerebrovasculares foi de queda, observou-se estabilidade para a angina, tanto para homens como para mulheres. CONCLUSÕES: A redução nas taxas de internação por doenças cardiovasculares pode ser resultado da expansão da rede e do acesso à atenção primária à saúde, e de outros fatores que influenciam nesse conjunto de doenças como a melhoria das condições socioeconômicas da população e organização dos serviços primários para faixas etárias mais altas e mulheres e diminuição dos fatores de risco.

Made available in DSpace on 2015-12-07T15:35:49Z (GMT). No. of bitstreams: 0 Previous issue date: 2015. Added 1 bitstream(s) on 2015-12-07T15:54:22Z : No. of bitstreams: 1 S0100-39842015000400007-pt.pdf: 254444 bytes, checksum: 041b74b250c3712195058294360f8047 (MD5). Added 1 bitstream(s) on 2015-12-07T15:54:23Z : No. of bitstreams: 2 S0100-39842015000400007-pt.pdf: 254444 bytes, checksum: 041b74b250c3712195058294360f8047 (MD5) S0100-39842015000400007-en.pdf: 247462 bytes, checksum: dacb04e4d64586ce5d14ece416c38318 (MD5) Objetivo: estabelecer padrões de referência e estudar algumas características ultrassonográficas tireoidianas em um grupo de crianças eutireoidianas até os 5 anos de idade, comparando-as a crianças portadoras de hipotireoidismo congênito de mesma faixa etária. materiais e métodos: trinta e seis crianças foram divididas em dois grupos – 23 eutireoidianas e 13 portadoras de hipotireoidismo congênito – e convocadas para a realização de ultrassonografia de tireoide. dessas crianças, 17 eram do sexo feminino e 19, do sexo masculino, com idades entre 2 meses e 5 anos. resultados: no grupo de crianças eutireoidianas (n = 23), o volume total médio da glândula tireoide foi 1,12 ml (mínimo: 0,39 ml; máximo: 2,72 ml), sendo observadas, também, glândula homogênea em 17 crianças (73,91%) e glândula heterogênea em 6 crianças (26,08%). no grupo de crianças com hipotireoidismo congênito (n = 13), o volume total médio da glândula tireoide foi 2,73 ml (mínimo: 0,20 ml; máximo: 11,00 ml). quanto à localização da tireoide, foram encontradas 3 crianças (23,07%) com tireoide ectópica e 10 (69,23%) com tireoide tópica, sendo que, nessas últimas, 5 tinham glândula homogênea (50%) e 5, glândula heterogênea (50%). das crianças com hipotireoidismo congênito, 6 (46,15%) apresentavam diagnóstico etiológico de disormoniogênese, 3 (23,07%) tinham diagnóstico etiológico de ectopia e 4 (30,76%) possuíam diagnóstico etiológico de hipoplasia tireoidiana. conclusão: a ultrassonografia de tireoide, por se tratar de um método não invasivo, bastante disponível, de fácil realização, pode e deve ser realizada a qualquer momento, inclusive ao nascimento, sem preparação ou interrupção do tratamento, para auxiliar na definição etiológica precoce do hipotireoidismo congênito. To establish benchmarks and study some sonographic characteristics of the thyroid gland in a group of euthyroid children aged up to 5 years as compared with age-matched children with congenital hypothyroidism. Thirty-six children (17 female and 19 male) aged between 2 months and 5 years were divided into two groups - 23 euthyroid children and 13 children with congenital hypothyroidism - and were called to undergo ultrasonography. In the group of euthyroid children (n = 23), mean total volume of the thyroid gland was 1.12 mL (minimum, 0.39 mL; maximum, 2.72 mL); a homogeneous gland was found in 17 children (73.91%) and 6 children (26.08%) had a heterogeneous gland. In the group of children with congenital hypothyroidism (n = 13), mean total volume of the thyroid gland was 2.73 mL (minimum, 0.20 mL; maximum, 11.00 mL). As regards thyroid location, 3 patients (23.07%) had ectopic thyroid, and 10 (69.23%) had topic thyroid, and out of the latter, 5 had a homogeneous gland (50%) and 5, a heterogeneous gland (50%). In the group with congenital hypothyroidism, 6 (46.15%) children had etiological diagnosis of dyshormoniogenesis, 3 (23.07%), of ectopic thyroid, and 4 (30.76%), of thyroid hypoplasia. Thyroid ultrasonography is a noninvasive imaging method, widely available, easy to perform and for these reasons could, and should, be performed at any time, including at birth, with no preparation or treatment discontinuation, to aid in the early etiological definition of congenital hypothyroidism. Physician on duty at Hospital São Marcos de Uberaba, Uberaba, MG, Brazil Resident in Medical Practice at Universidade Estadual Paulista Júlio de Mesquita Filho (Unesp), Botucatu, SP, Brazil Service of Endocrinology, Universidade Federal do Triângulo Mineiro (UFTM), Uberaba, MG, Brazil. Radiologist, Graduate Student degree of Ultrasonography, Computed Tomography and Magnetic Resonance Imaging, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil Resident in Medical Practice at Universidade Estadual Paulista Júlio de Mesquita Filho (Unesp), Botucatu, SP, Brazil

The death rate among people admitted to hospital with heart failure in England and Wales fell to 8.9% in 2015-16, down from 9.6% the previous year, saving about 500 lives, show figures from the National Heart Failure Audit.1 The audit was based on an analysis of 66 695 admissions to hospital where the patient’s main diagnosis was heart failure, and it used data from 82% of all heart failure …

BackgroundThere is an urgent need for an effective psychological treatment for patients with obsessive compulsive disorder (OCD) with poor insight, since this disorder is associated with severe suffering and a low quality of life. The inference based approach (IBA), a new psychotherapy for OCD specifically targets insight in OCD. In a randomized controlled multicentre trial, the effectiveness of IBA was compared to the effectiveness of CBT for treating patients with OCD with poor insight. In this study, 24 sessions of IBA were tested versus 24 sessions of CBT. Ninety patients with a main diagnosis of OCD with poor insight according to the DSM-IV criteria participated in the study. The primary outcome was reduction of the obsessive-compulsive symptoms.ResultsIn both conditions, a significant OCD symptom reduction was reached, but no condition effects were established. Post hoc, in a small subgroup of patients with the worst insight (n = 23), it was found that the patients treated with the IBA reached a significantly higher OCD symptom reduction than patients treated with CBT [estimated marginal mean = –7.77, t(219.45) = –2.4, P = 0.017]. Of patients treated with IBA, 41.9% were responder and 20.9% completely recovered. Of the patients treated with CBT, 42.6% were responder and 12.8% recovered.ConclusionPatients with OCD with poor insight improve significantly after psychological treatment. The results of this study suggest that both CBT and the IBA are effective treatments for OCD with poor insight. The IBA might be more promising than CBT for patients with more extreme poor insight.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Tumor of follicular infundibulum (TFI) is currently believed to be a benign epithelial neoplasm with follicular differentiation. It has been suggested that TFI is associated with dermal scarring, but further investigation is needed to confirm this correlation. To approach this question, a retrospective study was presented, a total of 67 cases (64 lesions) were found in a search covering cases over a 10-year period. Overall, the presence of histological dermal scarring was noted in 34 of 64 (53.13%) cases. Of the cases where TFI was an incidental finding, the presence of dermal scarring was noted in 13 of 18 (72.22%) cases. Meanwhile, of the cases where TFI was the main diagnosis, the presence of dermal scarring was noted in 12 of 34 (35.29%) cases. This suggests that TFI may, in some cases, represent an epidermal reaction pattern to dermal scarring.

This study examined how differences in visuo-perceptual patterns are related to psychopathology. Fifty-six patients (37 women, 19 men; M age = 43.8 yr., SD = 13.4) with a main diagnosis of unipolar depression and 42 patients (22 women, 20 men; M age = 42.0 yr., SD = 11.1) with a main diagnosis of somatoform disorder were compared. The duration and trend of a visual motion aftereffect were measured with the Spiral Aftereffect Technique (SAT). The results indicated that successively increasing aftereffect durations characterized the depressive patients, whereas patterns of very short or short final aftereffect preceded by successively decreasing aftereffect durations characterized the patients with a somatoform disorder. The SAT is thus a valuable tool for linking objectively measured perceptual-personality characteristics with some mental disorders.

The use of currently available guidelines such as the International Classification of Diseases, 10th Revision (ICD-10) and its clinical modification to assign a principal diagnosis to a patient who has multiple principal diagnoses appears unreliable. This is because these guidelines are complex and uses criteria that are highly subjective. Even when one main diagnosis is selected, the comprehensive list of other diseases that the patient has is often not reported such that the overall clinical condition of the patient is obscured. To address these issues, we have proposed: (i) a simple, potentially reliable and stepwise guide that can be used to assign the single most appropriate main principal diagnosis to each patient and illustrated this with case reports (ii) how to simultaneously report the main and other diagnoses in a scientific paper. It is hoped that our proposal (named NJ model for easy referencing) will help standardize how diagnosis is assigned to patients.

The aim was to audit symptomatic referrals to this breast unit in 1998, in order to ascertain the main diagnosis in relation to age, and thereby identify the percentage and age of patients who were reassured and discharged without investigation. 3199 general practitioner referrals were seen in 1998. Of these, 8.7% (n=274) were diagnosed as cancer and 91.3% (n=2925) were given a non-malignant diagnosis. In those under 40 years, only 18 patients of the 1231 seen were diagnosed with cancer, and only one of these was younger than 30 years (29 years). Twenty-seven per cent (n=333) of women under 40 were diagnosed as normal, and of these 14% (n=174) had no investigation. We confirm the recommendations of the guidelines issued by the Department of Health, that in younger women without discrete lumps or family history, clinical examination and reassurance is adequate. This audit should therefore empower general practitioners, to confidently reassure the younger patient, without a discrete lump.

Studies comparing the accuracy of clinical diagnosis in unselected patients who died in hospital in different medical eras have shown no decline of errors in the main diagnosis. We assessed changes in diagnostic accuracy over 20 years.We analysed retrospectively diagnostic errors, with use of necropsy as the gold standard for diagnosis. We randomly selected 300 patients who died at a tertiary-care teaching hospital in Switzerland--100 in each of 1972, 1982, and 1992. We classified discrepancies between clinical diagnosis and necropsy findings as major and minor errors.The overall necropsy rate at the hospital stayed at around 90% for the whole period. During the study, the frequency of major discrepancies declined significantly (1972, 30%; 1982, 18%; 1992, 14%; p=0.007). The rate of minor diagnostic errors increased significantly from 23% in 1972 to 46% in 1992 (p0.001). The increase in overall diagnostic accuracy occurred mainly because of a significant improvement in specificity for cardiovascular diseases (1972, 85%; 1982, 82%; 1992, 97%; p=0.034) and non-significantly improved sensitivity (1972, 69%; 1982, 82%; 1992, 86%; p=0.061). Sensitivity also improved for infectious diseases (1972, 25%; 1982, 67%; 1992, 86%; p=0.036). Sensitivity and specificity for neoplastic diseases were high originally and did not change. The total number of diagnostic procedures per year increased from 191 in 1972 to 259 in 1992, mainly because of non-invasive techniques, such as ultrasonography, and endoscopies.The frequency of major diagnostic errors in unselected patients who died in hospital was halved over 20 years, probably because of improved clinical skills and new diagnostic procedures.

Objective: To evaluate the overall effectiveness in general practice of homeopathy and acupuncture, and to estimate costs.Method: Prospective documentation of all patients insured with an insurance company who are provided with free treatment of acupuncture and homeopathy. 4000 patients treated by acupuncture and 1000 patients by homeopathy will be enrolled. All patients will be followed up from the beginning of treatment for another 4 years. Doctors will provide data on each visit (diagnosis, treatment, change of symptoms, etc.), patients will fill in questionnaires at the beginning and at the end of treatment, as well as each year after the end of treatment (complaints, current treatment, general health status as measured by the MOS-SF 36). Insurance data on workdays lost will be provided by the insurance company.Results: Data acquisition and entry is continuing. Up to now data from the first questionnaire of 1453 patients have been entered and 951 patients have returned the follow-up questionnaire. Doctors’ ratings of the change of the main diagnosis shows improvement of around 80% with only 2% deteriorated. This impression is vindicated by the patients’ follow-up questionnaire. 36% patients rated the therapy as efficacious, 47% as partially efficacious. Quality of life as measured by the SF 36 questionnaire improved significantly in all dimensions. Data on workdays off will be presented.Conclusion: Homeopathy and acupuncture are clinically effective in a variety of medical problems.

Objectives. The safety and efficacy of ectoine nasal spray and ectoine nasal spray with dexpanthenol in the treatment of rhinitis sicca were evaluated in two studies. Design and Methods. Two noninterventional observational studies were performed to evaluate the efficacy and safety of a nasal spray containing ectoine (study 1) and ectoine/dexpanthenol (study 2) over a period of two weeks including comparable numbers of patients suffering from rhinitis sicca anterior. Patients and physicians were asked to rate the efficacy in reducing symptoms and the tolerability over the treatment phase. Results. The treatment in both studies resulted in a clinical and statistical significant reduction of the main diagnosis parameters, nasal airway obstruction, and crust formation. There was also a significant reduction in the secondary diagnosis parameters in both studies. Importantly, the tolerability was very good. During the whole observational study, neither patients nor doctors stopped the medication due to unwanted effects. Conclusion. Rhinitis sicca could be successfully treated with a nasal spray containing ectoine and a nasal spray combining ectoine with dexpanthenol. The combination of both substances led to slight advantages.

Neonatal terminal ileum volvulus in the absence of malrotation has never been reported before in English literature. However, another similar rare entity known as neonatal primary segmental volvulus without malrotation has been reported before. Volvulus, in general, is an extreme emergency and cases not diagnosed in time lead to death. The main diagnosis is based on radiological features seen on imaging. We present a case of volvulus of terminal ileum that was diagnosed and surgically treated at age of 15 h ensuring the newborn survived. The definitive diagnosis was based mainly on ultrasonographic findings.

In the nonexistence of medical diagnosis substantiations, it is complicated for the expert to speak out about the grade of disease with affirmation. Generally many tests are done that involve clustering or classification of large scale data. However many tests could complicate the main diagnosis process and lead to the difficulty in obtaining the end results, particularly in the case where many tests are performed. This kind of difficulty could be resolved with the aid of machine learning techniques. In this paper survey on three different disease diagnosis are taken in to the consideration. The heart Disease, Breast Cancer Disease and the Diabetes Disease are analyzed and observed with existing works. This survey paper reveals various existing approaches that have processed for diagnosis these diseases using data mining techniques.

Non-lethal macular diseases greatly impact patients’ life quality, and will cause vision loss at the late stages. Visual inspection of the optical coherence tomography (OCT) images by the experienced clinicians is the main diagnosis technique. We proposed a computer-aided diagnosis (CAD) model to discriminate age-related macular degeneration (AMD), diabetic macular edema (DME) and healthy macula. The linear configuration pattern (LCP) based features of the OCT images were screened by the Correlation-based Feature Subset (CFS) selection algorithm. And the best model based on the sequential minimal optimization (SMO) algorithm achieved 99.3% in the overall accuracy for the three classes of samples.

Conduct disorders are common between ADHD, some series has shown that even almost 40% of patients develop some of the two main diagnosis: ODD or CD.That comorbidity between ADHD and ODD or CD has made that treatment become complex and requires different interventions.One field of treatment has been parental functioning.It has been common that reward or punishment as two effective strategies modulate familiar interactions when they are referred to AHD sons.However, in a long time, they failed to improve functioning, and frustration appears.Attachment somehow is been hidden behind diagnosis and treatment, and family stop its evolution repeating wrong strategies.Group therapy is a well-known tool that may help with this dysfunction in two ways: psychoeducation and debriefing.The aim of this work is to resume our experience working with parents in a group therapy model.We have found that affective symptoms are common between parents, ant that they difficult parenting strategies.Taking that into account we promoted emotional expression using debriefing groups as model, before introducing psychoeducational issues.Our hypothesis is that change is not possible if there is not a corrective attachment experience that let parents recover their role.We use it as a complementary tool to family and individual therapy.We will explain this model and its results based in therapists’ and patients’ experiences using open interviews.Disclosure of interestThe authors have not supplied their declaration of competing interest.

The aim of this study was to create a scoring method to distinguish between sudden infant death syndrome (SIDS) and cases of sudden death resulting from life-threatening conditions (LTC). Four hundred infants less than one year old who died suddenly out of hospital in St Petersburg between 1983 and 1990 and who underwent a complete autopsy, were entered into the study. In 200 cases, the main diagnosis was SIDS, while in the remaining 200 cases, death was interpreted as resulting from LTC; 115 clinical and 240 morphological signs and symptoms were evaluated in each case. The statistical approach was based on the method of stepwise logistic regression analysis and it helped to identify 6 clinical and 12 morphological signs which, combined, made it possible to distinguish between SIDS and non-SIDS (LTC) cases most accurately.

Sara Llorente-González1, J Peralta-Calvo2, JM Abelairas-Gómez21Ophthalmology Service of Hospital de Torrejón, Madrid, Spain; 2Ophthalmology Service of Hospital Universitario La Paz, Madrid, SpainObjective: To describe the prevalence of congenital anophthalmia and microphthalmia in Hospital Universitario La Paz, and to identify associated risk factors and evaluate cosmetic results in treated and nontreated patients.Methods: A retrospective, descriptive, cross-sectional study of patients treated with orbital expanding techniques (cases) and nontreated patients (controls) was carried out as a comparative case series study. A total of 36 patients with unilateral or bilateral anophthalmia or microphthalmia as main diagnosis were included; 52 epidemiological and management variables for each patient were analyzed. The study evaluated orbital growth and facial symmetry.Results: The overall cosmetic result in the study’s group of patients was satisfactory: 66.7% showed good or very good orbital growth, and 75% showed good or very good facial symmetry. Controls had better cosmetic outcome but showed more cataracts (P = 0.05), inferior colobomas (P = 0.026), and family history (P = 0.056) than the cases. Controls also showed significantly better orbital growth (P = 0.042) and facial symmetry (P = 0.014) than the cases.Conclusion: This study suggests that the mere presence of a globe (controls) still provides better orbitofacial development than the artificial stimulation (cases) currently available for patients with congenital anophthalmia and microphthalmia, who receive internal and external orbital rehabilitation.Keywords: cosmetic outcome, orbital rehabilitation, ocular malformation, congenital cataract, persistent fetal vasculature

The aim was to describe the epidemiological profile of adult patients who were treated with HFOV like a rescue method after conventional mechanical ventilation failure, during 2009 in our ICU, in Santiago, Chile, and to describe patient characteristics, HFOV strategies and outcomes.

Causes of hospitalization in elderly patients in two general hospitals under Brazil's public health system. The aim of this study was to determine the main causes of hospitalization in elderly patients (60 years and older) in the cities of Cândido de Abreu and Jardim Alegre, which belong to the 22 nd Regional Health Area, Ivaipora, Parana State, in general hospitals of the Public National Health System (SUS) in Brazil in the year 2005. Elderly patients were studied in Cândido de Abreu and Jardim Alegre hospitals using data from the Hospital Information System of the Public National Health System (SIH/SUS), using the following variables: gender, age group (60-79 years and 80 years or older) and main diagnosis according to the chapters of the International Classification of Diseases (ICD) 10, 1996 revision. From a total of 1,489 hospital admissions in Cândido de Abreu and 1,103 admissions in Jardim Alegre from January to December 2005, the number of hospitalizations in elderly patients is 376 (25.2%) and 352 (31.9%) respectively. The results show the high prevalence of elderly hospitalization and reinforce the need to prepare capable staff and the assistance the public health system for this elderly population that increases quite rapidly.

From 1970 to 1989, 915 people were admitted for the first time to psychiatric institutions in Denmark and had as their main diagnosis an eating disorder, ICD-8 306.50-59. The incidence of these admissions increased from 0.42/100,000 population in 1970 to a maximum of 1.36/100,000 in 1988. During the time of our investigation, the number of discharges of patients with an eating disorder as the main diagnosis was constant from somatic hospitals, whereas discharges from psychiatric institutions increased.

We analyzed our stroke care unit (SCU), which was established 20 years ago, from the clinical and financial points of view. Our SCU has 15 beds, 22 nurses, and 30 doctors, who also work in general wards, and can afford to permit thrombolytic and hypothermic therapies. During the last 20 years, the number of patients increased gradually exceeding 500 patients/year in 1999. The increase has been accelerated since 1997 when a hot-line system with ambulance was established. The main diagnosis was acute stroke in 75% of patients, and other neurologic emergencirs was the remainders. Mean ages of patients increased by 5 years during the 20 years. The increase of elderly patients resulted in the increase of poor outcome cases and the prolongation of admission period. Since the critical-path was partially introduced in 1999, the period of hospital stay has re-duced. The financial state of our institute was analyzed 1999. The income expenditure balance in SCU was the worst among general wards and intensive care unit. The main reason for poor balance is that the costs for acute stroke diagnosis and management are rated disproportionally low in spite of a large amont of manpowers. While SCU appears to be effective to bring about better clinical outcome of stroke, its financial problems have to be solved urgently.(Jpn J Stroke 22: 546-548, 2000)

Aim Eyes that are predisposed to primary angle closure usually have a shallow anterior chamber secondary to a relatively forward position of the lens and progressive lens thickening with ageing. The aim of this study was to examine trends over time in rates of primary angle closure glaucoma (PACG) in England, and to compare these rates with rates of cataract surgery. Methods Hospital episode statistics and the hospital inpatient inquiry were analyzed for PACG as the main diagnosis between the years 1968 and 2004, and for cataract surgery over the same period. Age-specific and sex-specific rates of PACG and cataract surgery were calculated over 3 representative time periods. Results Annual rates of patients with PACG did not change significantly from the late 1960s to the mid-1980s and then increased until the early 1990s before reaching a plateau; from 1999 to 2004, rates of patients with PACG declined significantly. From the 1980s to 2004, annual rates of patients undergoing cataract surgery increased significantly and substantially. In the recent period of decline in PACG, the decline was greatest in older age groups, whereas rates of cataract surgery increased significantly in all age groups for both men and women throughout the whole time period. Conclusions Rates of patients with PACG have started to decline in recent years, after a long period of increases in rates of patients undergoing cataract surgery. Although other explanations are possible, this lends support to the hypothesis that cataract surgery may reduce the likelihood of acute angle closure.

Two classifications, DSM–III and catego4–derived ICD–8, included in the CIDI, are compared in 63 in-patients and out-patients with a broad range of psychiatric illness. Agreement for main diagnosis between these classifications was statistically significant for two time frames, the present state and lifetime. However, while diagnostic assignment by catego4 remained fairly constant between time frames, there was a marked shift in DSM–III-assigned diagnosis, with cases changing from anxiety state diagnosis (present state) to affective disorder (lifetime). Thirty-nine subjects were assigned a DSM–III diagnosis of affective disorder for lifetime illness compared with 21 assigned to this diagnostic group by catego4.

The objective of this experiment was to describe healthcare use for the treatment of melanoma in a hospital setting and to assess the related annual cost using French hospital records for the year 2004. The 2004 French national database was the main source of data. Hospital stays related to melanoma care were extracted from this database, which exhaustively records hospital stays in the country. We selected stays that included at least one diagnosis of melanoma: International Classification of Diseases (ICD)-10 codes C43 'malignant melanoma of skin' or D03 'melanoma in situ'. A second database (the French National Hospital Costs Survey) was used to compute unit costs. For each diagnosis-related group involved in melanoma care, we calculated an average cost per day from this database. Unit costs were then applied to the duration of each hospital stay related to melanoma from the 2004 national database. A total of 42,911 stays related to melanoma were identified for the year 2004. New patients, estimated by the number of surgical stays with a melanoma ICD code as the main diagnosis, amounted to 6897. Annual hospital costs for melanoma care were estimated at 59 million euros. Almost half of these costs (27 million euros) were attributable to stays with a metastasis ICD code. The main cost drivers were surgery (38% of hospital costs), follow-up evaluations (20%) and chemotherapy (17%). It was concluded that the impact of melanoma on hospital expenditures for cancer was modest. Hospital costs for stays related to melanoma represented less than 1% of total annual hospital costs for cancer for the year 2004.

The natural history of classification systems for the organic mental disorders from ICD-8 through ICD-10 and DSM-III is presented. Out of a total of 31 cases the 6 with a main diagnosis of the F0-section of ICD-10 are described and field trial results analysed in terms of classification errors, goodness of fit, difficulty, and interrater-reliability. Specific categories (instead of "collective categories") were used more frequently and fewer classification errors made on the basis of ICD-10 as compared with ICD-9. The authors suggest that an operationalized differentiation of dementia as one of the core categories would further increase the reliability and clinical practicability of this section.

The effects of the growing spreading of heart failure (HF) in Italy can be described on the basis of data from the Italian National Health Care System (www.sanita.it) relating to the number of patients discharged from Italian hospitals with the main diagnosis of HF (DRG 127) in the last 5 years (Fig. 1). From 86 235 patients discharged in 1995, the number reached 170 972 discharged with DRG 127 in 1999. In 5 years, the number of patients with HF discharged from Italian hospitals has nearly doubled, with an estimated global cost of about € 500 million per year.

This paper describes a diagnostic module which is a part of the EPD-CAR (Electronic Patient Dossier for Cardiology) project of the Interuniversity Cordiology Institute of the Netherlands. It consists of 13 coding trees, each containing between 3 and 20 subitems. The scheme evolved from daily practice where standard coding schemes proved insufficient. It consists of one main diagnosis and up to 10 optional sub diagnoses. Back-end integration is achieved through conversion tables to ICD-9 and ICD-10. The current system is in use now for over 1.5 years and contains diagnoses of over H 6100 patients. The system is written in Visual Foxpro 60 and is an ActiveX-component.

• Bacterial pneumonias have similar radiographic patterns in immunocompetent and immunosuppressed patients. Chest radiographs and CT show consolidation, which may be focal (segmental or lobar), patchy or diffuse.• Tuberculosis in immunocompetent patients most frequently manifests as the reactivation (secondary) pattern, whereas immunosuppressed patients present the primary pattern of the disease.• If a neutropenic febrile patient presents with pulmonary nodules or consolidation surrounded by ground-glass opacities (“halo sign”), angioinvasive fungal infection must be the first diagnosis.• Pneumocystis jiroveci pneumonia should be the main diagnosis when ground-glass attenuation is seen in patients with human immunodeficiency virus with CD4+

Background and aim Not all babies from whom neonatal intensive care (IC) is withdrawn die swiftly. We reviewed cases, characteristics, and outcomes of babies who unexpectedly survived for ≥1 week following IC withdrawal. Methods Retrospective review of the medical notes of infants cared for in our NICUs in the period 1/7/06 to 31/12/13 who had IC withdrawn but who unexpectedly survived for ≥1 week. Babies with trisomies were excluded. Our study had prior research ethics approval. Results We identified 9 long-term survivors (6 term, 3 preterm). 8 had a main diagnosis of grade 3 hypoxic ischaemic encephalopathy; 1 preterm infant had a diagnosis of myelomeningocele and hydrocephalus. All had abnormal neuroimaging prior to planned IC withdrawal. IC was withdrawn with parental agreement at median 5 days postnatal age (range: 1–9 days). The possibility of long-term survival had been broached by clinicians prior to IC withdrawal in only 2 of the 9 cases. Median age at discharge/transfer from NICU was 10 days (range: 1–31 days) and destination was home (n = 3) or hospice (n = 6). 4 infants died at ages ranging between 19–66 days. Yet remarkably, 5 infants remain alive to date with current ages ranging between 10 months and 5.3 years, but all have cerebral palsy. Conclusion Unexpected long-term survival after neonatal IC withdrawal is neither predictable nor uncommon. Significant disability in survivors is invariable. Even if protracted survival is considered very unlikely, the possibility should always be specifically mentioned during the sensitive discussions with parents that precede IC withdrawal.

The frequency of oral health problems in 353 Finnish conscripts aged 21.0 (SD 1.2 years) was studied by means of a questionnaire and by investigating the dental records. One hundred five (30%) conscripts had seeked dental help during their 8 months' military service. Forty-four percent of these patients had dental caries as their main diagnosis; endodontic problems comprised 9% of all cases. The problems related to third molars were second in frequency, accounting for 27% of the conscripts treated. Six and one-half percent of the patients had lost serving time on dental grounds (mean absence 3.6 days), most often (90%) due to acute pericoronitis or post-operative status following third molar surgery.

To assess the value of echo-planar imaging (EPI) for ultra-fast routine clinical diagnostic MRI, we compared four different EPI sequences with conventional T2-weighted spin-echo images on a commercial clinical imager. We examined 25 randomly selected patients who posed different clinical questions. The images were interpreted by two experienced neuroradiologists blinded as to the sequence used. Image quality and diagnostic certainty were evaluated and the main diagnosis established from the EPI study was compared to that obtained from the T2-weighted images. Finally, EPI- and T2-based diagnoses were compared with the diagnosis resulting from a complete MRI examination. Apart from one sequence that was generally rated low as regards both diagnostic certainty and image quality, the EPI sequences were comparable to each other, but inferior to the T2-weighted images. However, two EPI sequences gave better diagnostic results than T2-weighted images compared to the full MRI examination. Gradient-echo EPI was particularly sensitive to haemorrhagic lesions. All normal cases were correctly identified on EPI studies. Only two pathological cases were missed; both had isolated cranial nerve lesions. The absence of false-positive results and the high sensitivity to ischaemic and mass lesions mean that EPI can be used for ultra-fast screening. However, from these initial studies, EPI seems unsuitable for neuroradiological investigation of patients who may have subtle lesions whose detection requires either special sequences or administration of contrast medium. EPI can nevertheless be used in addition to high-resolution T1-weighted images and may replace T2-weighted spin-echo sequences for special indications.

Introduction Regarding the patient clientele with main diagnosis (MD) F19.*[ICD 10] new needs have been seen to emerge. The increase in the number of consumers of N -methylamphetamine (by 29 % in 2011) in Saxony correlates with an impressive increase of the number of inpatients and emphasizes the need of adapted treatment offers. Objectives In this context, in 2009 an open-door ward (8 beds) for detoxification and motivation treatment for adults at age between 18-40 years with MD F19.* was opened which pursues an integrative therapeutic concept including both addiction-specific group- and talking therapy orientation and behavioral therapy approaches. Methods By using a pre-post study (pre: 2008, post I: 2010, post II: 2011, post III: 2012) selected key figures such as length of stay, readmission rate and kind of discharge, trends in individual substance-related detoxification motivation and associated mental disorders (F19.5) were monitored. Results A continuous growing number of patients with MD F19.* has been achieved, marked by an increase of treated cases (pre: 77, post III: 156) and planned admissions (pre: 58 %, post III: 72%). Other data (length of stay, readmissions, treatment discontinuations) showed no significant changes. Individual detoxification motivation data point to a trend in favour of N -methylamphetamine. The number of patients with MD F19.5 (psychotic disorder) increased by >100 %. Summary The results refer to the necessity of identifying and monitoring valid quality indicators regarding our treatment concept. Therefore, those as yet evaluated indicators may act as a preliminary basis. Further projects are planned.

In geriatric rehabilitation, discharge to the living conditions in which elderly patients lived before admission is one of the most important treatment goals. The objective of this study therefore was to determine the extent to which this criterion was influenced by age, sex, main diagnosis and activities of daily living. For that purpose the results of 1845 patients, admitted consecutively from 1993 to 1995 were analysed. With advancing age an increasing number of patients was unable to return to their previous living conditions (10% vs. 24% comparing the age groups '64 years and younger' versus '85 years and older'). This age-associated decline was present for both sexes and for several diagnosis groups. A low (0-40 points) ADL-score on admission was found to be associated with a significantly smaller percentage of patients returning home (75%) than a high (90-135 points) score (95%). The criteria sex and main diagnosis were not significantly linked with the return home. According to multiple regression analysis, ADL-score on admission was the only parameter found to be significantly associated with return to preadmission living conditions, but not age. But if the ADL-score at discharge was added to the regression analysis, this criterion proved to be the only predictor. Despite the negative correlations between age as well as ADL-score on admission with return home and due to the fact that nearly three quarters of the oldest patients and of those most severely impaired on admission were able to return to their previous living conditions it seems worthwhile not to exclude patients only because of their age or the initial degree of dependence on care alone from rehabilitation services.

SummaryWe studied DSM-IV catatonic features in 120 psychiatric inpatients with a main diagnosis of acute psychotic, affective or cognitive disorder. Individual catatonic features were highly intercorrelated, although diagnostically nonspecific. A single factor, accounting for 85% of the variance, was extracted and interpreted as representing both types (excited and retarded) of catatonic syndrome.

Introduction: Pediatric SUDEP (Sudden Unexpected Death in Epilepsy) is an uncommon event, but its unpredictability has rendered the issue very important to be addressed, under all points of view: medical, moral and legal one. The death of a child has been always considered a dramatic event for the Albanian families, and when it overcomes unexpectedly the emotional reactions might even be more exaggerated. Discussion: Debates about truth-telling on the prognosis, or even on the probability of a sudden death related to the main diagnosis (epilepsy) are old and controversial. Risk factors for SUDEP have been formulated and strategies to confront them have been put in place; however medical (pharmacological) compliance seems by large the most important protective factor. Conclusion: To our opinion, disclosing the risk of a sudden death to the family on a child suffering from epilepsy is a necessary act; timing and ways of disclosure are details that need to be refined case-by-case, in a situation where a general consensus or guidelines are lacking. A step-by-step approach and a gradual informing are helpful and psychologically acceptable from the parents or other relatives.

Introduction Until now, no reliable biological markers of risk and relapse in cocaine-dependent patients have been identified. The yawn-inducing Apomorphine test has been proposed as a marker for predicting relapse during cocaine withdrawal. Objectives Studying the Apomorphine complete Test as a predictor of relapse in intranasal cocaine dependet-patients during abstinence. Aims 39 (35 men) cocaine addicts were recruited and included in an addiction program involving 2 weeks in-patient setting and a 23 follow-up weeks. Dependence was diagnosed according to DSM-IV-TR criteria and other axis I comorbid main diagnosis were excluded. Methods We performed the Apomorphine complete Test (including an Apomorphine Test plus a Placebo Test) at the beginning (day 1) and end (day 11 or 12) of a detoxification program. Patient received 0′005 mg/kg of apomorphine and 0′005 mg/kg of placebo subcutaneously each test. Results The patients who relapse prematurely (before 4 weeks), yawn more 11′42 (0–31) in the Apomorphine complete Test realized the first day of the detoxification compared with patients that relapse no prematurely (after 4 weeks of follow-up), 6′83 (0–20), Z -2′14 p Conclusions There an increased number of yawns in relapse-patients The Apomorphine complete Test could be proposed as a biological marker of early relapse.

This paper addresses the problem of data quality in electronic patient records using a computerized haematology biopsy report system as an example. Physicians extracted five parameters from a traditional free text cytology report and encoded these parameters thus producing a computer processable report. The parameters were 1) the organ biopsied, 2) quality of specimen, 3) cytological diagnosis including 4) a modifier code for the main diagnosis code (i.e. status post chemotherapy, Y-code) and 5) an additional key describing the degree of remission obtained after chemotherapy of acute leukemias. From the various steps involved in generating the electronic record we selected two critical ones: encoding of free text terms by physician staff; entering of the coded terms into a computer by lab staff. We analyzed the rates of correct, incorrect and missing codes for each of the five parameters. Our findings indicate that in this model of an electronic patient record: 1) there is significant inaccuracy of physicians during the process of encoding the free text report with error rates between 3.2 and 28% and omission rates up to 64%. 2) lab staff entering these coded data into the computer introduce additional errors (0-7.8%) but rarely miss correctly encoded data (0-0.9%). 3) introducing a revised coding system data quality improved significantly (por = 0.001) with a fivefold increase of correct and a 75% reduction of missing codes. 4) the clinical relevance of the diagnoses encoded as perceived by clinicians is a significant factor affecting error and omission rates.(ABSTRACT TRUNCATED AT 250 WORDS)