Chief Complaints and Related Features of Elderly Patients Presenting to One Region Wide Emergency Medical Center With Medical Problems

BACKGROUND: This research is to determine the chief complaints and related features of elderly patients who are presented to emergency department with medical problems. METHODS: Medical records of patients, 65 years or above, who visited Uijeongbu Hospital Emergency Center between January 1, 2012 and June 30, 2012 were reviewed retrospectively. Age, gender, mode of transportation to the hospital, chief complaints, and diagnosis were among the subjects analyzed. RESULTS: Elderly patients with medical problems, 3,468 visited the emergency department, constituting 12.66% from 27,396 patients in total during the research period. Patients aged 70 to 74 were 28.45%, composing the most among the age groups. Ambulance was the mode of transportation used by 43.06% of the patients and 42.96% of them stayed overnight, while 11.13% stayed in the intensive care units. The most frequent chief complaints were abdominal pain (16.81%), dyspnea (13.96%), and fever (11.16%). The most common diagnosis for patients with abdominal pain was gastritis (20.75%), chronic heart failure (26.03%) for dyspnea, and pneumonia (28.96%) for fever. The main diagnoses of in-patients according to the order of frequency were cerebral vascular accident (16.38%), pneumonia (12.48%), and chronic heart failure (6.04%). CONCLUSION: The number of elderly patients who stayed overnight and stayed in the intensive care units have increased comparing to younger patients. The top 10 most frequent chief complaints accounted for 78.92% by medical elderly patients. The results of this research could be used for the development of geriatric emergency medicine training programs and critical pathway for interns and residents.

Qué es la hiperactividad y cómo ven el problema los padres? Análisis de los motivos de consulta y las estrategias de afrontamiento del TDAH en una muestra de estratos socioeconómicos altos de Bogotá D. C / What is Hyperactivity and How do Parents View The Problem? Analysis of Chief Complaints and Coping Strategies of Adhd in a Sample of High Socioeconomic Status in Bogotá

Introducción: El trastorno por déficit de atención con hiperactividad (TDAH) es el diagnóstico Más frecuente en la consulta Psiquiátrica infantil en distintas sociedades. Clásicamente, la Triada de hiperactividad, déficit de atención e impulsividad es el núcleo y el objetivo de las Diferentes estrategias terapéuticas. Sin embargo, son múltiples los motivos de consulta que Los pacientes y sus familias establecen, debido al impacto de los síntomas en las dinámicas Escolares y de convivencia. Objetivo: Conocer cómo se expresan los motivos de consulta en un medio como el de Bogotá (Colombia). Métodos: Se analizaron 366 encuestas de padres De niños con TDAH, quienes asisten a la reunión mensual de la escuela para padres HIDEA, Especializada en TDAH, en la que relatan sus motivos de consulta y las estrategias con las Cuales tratan de mejorar estas dificultades. Resultados: Las quejas más frecuentes son La rebeldía, el desacato a la autoridad y el bajo rendimiento escolar. Para ayudar al niño, Recurren ante todo a la terapia ocupacional, de acuerdo con la recomendación del colegio. Conclusiones: Para los padres la problemática sentida no se relaciona directamente con Los rasgos clínicos principales del TDAH, sino con sus consecuencias desadaptativas en el medio escolar. Paradójicamente, también se hace evidente una relativa debilidad de las estrategias de afrontamiento que implican cambios profundos en los patrones de crianza y convivencia...

Introduction: The most frequent clinical diagnosis in psychiatric child services in different societies is attention deficit hyperactivity disorder (ADHD). Classically, the core symptoms and the main objective of different therapeutic strategies are the triad hyperactivity, attention deficit, and impulsivity. However, the chief complaints those patients and families states are diverse due to the relevant impact of the symptoms on school and social dynamics. Objective: To learn how the chief complaints are expressed in the context of Bogotá (Colombia). Methods: 366 surveys of parents of children with ADHD were analyzed. They participated in the monthly meeting of the “HIDEA Parent´s School”, which specializes in ADHD. Surveys summarized the complaints and confrontation strategies used to improve these inconveniences. Results: The most frequent complaints were disobedience, defying authority, and low school performance. To help the children the parents turned mainly to occupational therapy as suggested by the school. Conclusions: We observed that parents perceived the problem as linked to social annoyance consequences instead of clinical symptoms of ADHD. Paradoxically a relative weakness of confrontation approaches was also evident, involving deep changes in child rearing patterns and social interactions...

Proposal of Laboratory Test Panel Based on Patients' Chief Complaints in Emergency Department / 대한진단검사의학회지

BACKGROUND: A test panel is a group of tests that are simultaneously performed for diagnosis and follow-up of patients. Organ-specific or disease-specific test panels are currently available. Since the patient's chief complaint plays a key role in obtaining the personal and medical history and performing physical examinations, we proposed a test panel based on the chief complaints of the patients. METHODS: We collected data from 3,127 adults with apparent symptoms who visited the emergency department from April 2009 to May 2009. Subsequently, we classified the patients' chief complaints, ordered the laboratory tests on the basis of these complaints, considered the patients' disease entities, and reviewed the relevant literature. RESULTS: The patients were categorized into 14 groups on the basis of the most common chief complaints presented in the emergency department. We first selected the basic test panels and then organized the test panel for each chief complaint to enable differential diagnosis. CONCLUSIONS: We proposed test panels based on the chief complaints of the patients; these test panels could allow rapid diagnosis and be more useful than the organ-specific or disease-specific tests in critical pathway development. The next step will be evaluating the efficiency and cost effectiveness of the test panel that we suggested.

Current trends in orthodontic patients in Seoul National University Dental Hospital / 대한치과교정학회지

Over the past decades, the number of patients seeking orthodontic treatment has increased markedly with socioeconomic development and change of recognition on appearance. The purpose of this study was to provide an epidemiologic data base related to the orthodontic treatment need. We could take an adequate information regarding the characteristics of orthodontic patients, and the changing trends about treatment mordality. Distrubution and treands were investigated in 676 patients who had been examined and diagnosed at Department of orthodontics, Dental Hosital, Seoul National University from January to June in 1992 and 2002. 1. Sex distribution of patients changed from 1 : 2.1 to 1 : 1.5 (male : female). 2. In 2002, age distribution had shown 7~12 year-old group being the largest (32.0%) and percentage of 19~24, 13~18, over 25, 4~6, 0~3 year-old group were 24.0%, 21.6%, 14.2%, 5.8%, 2.4% respctively. Compared with data in 1992, the number of adult patients highly increased. 3. With regard to Angle classification, each percentage of Class I , Class II div 1, Class II div 2, and Class III malocclusion were 25.0%, 20.9%, 3.4%, and 48.1% respectively in 2002. 4. Geographic distribution showed that most of the patients visited (37.0%) lived in northeast of Seoul in 2002. 5. Mandibular prognathism showed the highest percentage in chief complaints. The percentages of crowding and facial asymmetry were 14.2% and 11.8% in 2002. Patients with facial asymmetry increased significantly. 6. Percentages of patients treated with fixed appliance and orthognathic surgery were 38.0% and 25.0% in 2002. Patients needed to observe the growth pattern comprised 13.0% with increasing trends. The use of chin cap reduced and the percentage of orthognathic surgery and growth observation increased significantly.

Standardization of Main Concept in Chief Complaint Based on SNOMED CT for Utilization in Electronic Medical Record / 대한의료정보학회지

The electronic medical record is gradually penetrating the world-wide healthcare environment, including Korea. Users of electronic medical record want to get full advantages of it, but benefits would not be realized by simple implementation. Wellorganized architecture and controlled medical vocabulary are needed for achieving effective electronic medical record system. Many terminologies are introduced in healthcare system but single noble terminology to cope with users' need is not present. To extract clinically useful and standardized set of chief complaints for electronic medical record in our institutional environment, we analyzed chief complaints in 235,426 discharge summaries in Seoul National University Hospital. We normalized the chief complaint by 27 medical experts. First of all, researchers parsed chief complaints as main concept, qualifier, and modifier. We normalized main concepts, keeping applicability and usability of extracted set to electronic medical record in mind. And then, mapping set of chief complaint to SNOMED CT was done by 4 physicians. Among 94,913 unique strings, we selected 6,317 terms as standard set of chief complaint. The potential users of electronic medical record were asked to evaluate usability of the set and accepted it as representative of chief complaint. The majority of terms in set were completely mapped to SNOMED CT. We discussed several principles in normalizing chief complaints. We also pointed pros and cons of SNOMED CT as reference terminology to chief complaint domain. Through this study, we developed conceptually standardized chief complaint domain with user-friendly terms in Seoul National University Hospital Environment. Furthermore, this result would be the starting point to evolve medical terms in Korea into ontology based terminology system.

The Analysis of Clinical Information by Building the Clinical Data Warehouse / 대한의료정보학회지

This paper presents the design and application of a clinical data warehouse. The clinical data warehouse is built based on past 10 years of clinical data of Seoul National University Hospital. We extracted the clinical data from the database of hospital information system database and the results of Health 21 Project' , which is mainly composed of chief complaints, final diagnosis, discharge notes and survival data. By normalizing the terms of chief complaint, we are able to analyze the distribution patterns of symptoms within a diagnosis, and that of diagnosis related with a certain clinical symptom. Through our involvement with this project, we have learned that in order for a useful clinical data warehouse system, normalization and structured data entry is the key element of building clinical data warehouse.

The relationship of common reasons for encounter and major diagnoses of patients admitted to a hospital

BACKGROUNDS: It is important to know the contents of health problems in patients in a primary care setting. The aim of this study was to explore the main chief complaints and major diagnoses of patients, who were admitted to a hospital using the ICD-10 and to observe difference according to each department and admission route and how diagnoses were made. METHODS: A total of 18,560 patients who were admitted to a hospital located in Chungnam Province from 1 Jan 1998 to 31 Dec 1998. Main chief complaints and major diagnoses made through the admissions departments were chosen as subjects (medical vs. surgical) and by admission route (emergency vs. OPD)were analyzed. How the diagnoses were derived from the most common chief complaints among medical and surgical departments were analyzed by admissions departments and by admission route. RESULTS: The most common 10 chief complaints revealed no significant difference by admission route in medical departments, but there was some difference in surgical departments. There was some difference in the most common 10 major diagnoses by admission routes in both medical and surgical departments. Abdominal and pelvic pain, which was the most common chief complaints, became a significantly different diagnosis by admission route in both departments. CONCLUSION: Main chief complaints were similar regardless of admission routes, but the diagnoses were different. ICD-10 classification may be useful to classify the diagnoses, but have limitations to classify chief complaints or reasons for encounter. It is necessary to introduce a new classification such as ICPC-2 for reasons for encounter in order to explore the dimension of health problems.