Πέμπτη, 1 Αυγούστου 2019

Internal and Emergency Medicine

Progressive splenomegaly and mild thrombocytosis in beta-thalassaemia trait and coexisting hereditary hemochromatosis: possible confounders for a subsequent hematological diagnosis


Acute pericarditis or a systemic disease with pleuropulmonary involvement?


Utility of intestinal ultrasound in the diagnosis and short-term follow-up of non-steroidal anti-inflammatory drug-induced enteropathy


Is vitamin D deficiency predictor of complications development in patients with HCV-related cirrhosis?


Unusual radiographic presentation of pneumonia in adults with chronic kidney disease


The de Winter ECG pattern occurred after ST-segment elevation in a patient with chest pain


Goebbels´ clubfoot: a case of osteomyelitis?


The impact of different models of resident supervision on patient safety and resident education


Pathergy testing: prospective comparison of dermatoscopic evaluation and naked eye examination

Abstract

Pathergy phenomenon is a non-specific tissue hyperreactivity reaction due to trauma and is a minor diagnostic criterion of Behcet's disease. In this study, 100 patients with a suspicion of Behcet's disease who were referred to Cerrahpasa Medical Faculty Dermatology department between 01.11.2014 and 31.01.2015 are included. Skin pathergy tests were applied to all the patients and results were evaluated by two dermatologists separately at 48th hour, each with naked eye and with dermatoscopy. Test results were scored on a scale of 0–6. At the end of the study, score results of naked eye and dermatoscopy for doctor number 1 were statistically similar. Same results applied for doctor number 2. However, naked eye results of doctor number 1 and 2 for the same patients were significantly different from each other (p 0.0372) and with dermatoscopy examination this difference was eliminated (p > 0.05). This study revealed that naked eye evaluation of pathergy test results can yield different results among different interpreters. Use of dermatoscopy during the evaluation process decreases interobserver variation and subjectivity of the test.



Detecting delirium in elderly medical emergency patients: validation and subsequent modification of the German Nursing Delirium Screening Scale

Abstract

Detecting delirium in elderly emergency patients is critical to their outcome. The Nursing Delirium Screening Scale (Nu-DESC) is a short, feasible instrument that allows nurses to systematically screen for delirium. This is the first study to validate the Nu-DESC in a German emergency department (ED). The Nu-DESC was implemented in a high-volume, interdisciplinary German ED. A consecutively recruited sample of medical patients aged ≥ 70 years was screened by assigned nurses who performed the Nu-DESC as part of their daily work routine. The results were compared to a criterion standard diagnosis of delirium. According to the criterion standard diagnosis, delirium was present in 47 (14.9%) out of the 315 patients enrolled. The Nu-DESC shows a good specificity level of 91.0% (95% CI 87.0–94.2), but a moderate sensitivity level of 66.0% (95% CI 50.7–79.1). Positive and negative likelihood ratios are 7.37 (95% CI 4.77–11.36) and 0.37 (95% CI 0.25–0.56), respectively. In an exploratory analysis, we find that operationalizing the Nu-DESC item "disorientation" by specifically asking patients to state the day of the week and the name of the hospital unit would raise Nu-DESC sensitivity to 77.8%, with a specificity of 84.6% (positive and negative likelihood ratio of 5.05 and 0.26, respectively). The Nu-DESC shows good specificity but moderate sensitivity when performed by nurses during their daily work in a German ED. We have developed a modified Nu-DESC version, resulting in markedly enhanced sensitivity while maintaining a satisfactory level of specificity.



Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182
6948891480

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