Monitoring Sexual Violence Trends in Emergency Department Visits Using Syndromic Data From the National Syndromic Surveillance Program-United States, January 2017-December 2019.

Objectives. To report trends in sexual violence (SV) emergency department (ED) visits in the United States.Methods. We analyzed monthly changes in SV rates (per 100 000 ED visits) from January 2017 to December 2019 using Centers for Disease Control and Prevention's National Syndromic Surveillance Program data. We stratified the data by sex and age groups.Results. There were 196 948 SV-related ED visits from January 2017 to December 2019. Females had higher rates of SV-related ED visits than males. Across the entire time period, females aged 50 to 59 years showed the highest increase (57.33%) in SV-related ED visits, when stratified by sex and age group. In all strata examined, SV-related ED visits displayed positive trends from January 2017 to December 2019; 10 out of the 24 observed positive trends were statistically significant increases. We also observed seasonal trends with spikes in SV-related ED visits during warmer months and declines during colder months, particularly in ages 0 to 9 years and 10 to 19 years.Conclusions. We identified several significant increases in SV-related ED visits from January 2017 to December 2019. Syndromic surveillance offers near-real-time surveillance of ED visits and can aid in the prevention of SV.

Age estimation based on visual parameters of the skin of cadavers.

BACKGROUND: Previous studies have reported relationships between various visual parameters of the skin and changes due to aging. Due to an increase in the discovery of unidentified bodies, the field of forensic medicine anticipates the development of a rapid method for estimating age. The present study measured various visual parameters of the skin in human remains and investigated the correlation between these parameters and age. MATERIALS AND METHODS: Skin images were taken of four body parts (cheek, chin, brachium, and thigh) of 414 forensic cases. We interpreted eight visual parameters of the skin (smoothness, roughness, texture, dullness, brightness, erythema, color phase, and sagging) from skin photograph images, and constructed three age-prediction models, categorized by sex, postmortem interval, and age. RESULTS: Significant correlations were observed in the erythema of the cheek and chin, the roughness of the brachium, and the texture of the brachium and thigh among the visual parameters calculated in four body parts, using the three models. The root-mean-square errors, which indicate the precision of the three prediction models, were 13.06, 13.80, and 13.77. The only model that demonstrated a correlation with the visual parameters was sex (but not age or postmortem interval). CONCLUSION: Similar to living subjects, we observed a correlation with age for a number of visual parameters. The parameters that correlate with age depend on whether the site being measured was exposed to sunlight. Age estimation based on visual parameters requires measurement of visual parameters for skin both exposed and not exposed to sunlight.

Incidence of frailty among community-dwelling older adults: a nationally representative profile in China.

BACKGROUND: Frailty is a clinically recognizable state of reduced resilience to stressors and increased vulnerability to adverse outcomes. The majority of studies have focused on the prevalence and risk factors of frailty, while the incidence of frailty has not been well documented, especially in less developed regions including China-a country that has the largest aging population in the world. We investigated the incidence of frailty among non-frail Chinese older adults by sociodemographic characteristics, disease burden, and geographic region. METHODS: Participants were 4939 adults aged ≥60 years from the China Health and Retirement Longitudinal Study, a cohort study of a nationally representative sample of middle-aged and older community-dwelling adults from 28 provinces in China. Frailty was assessed by an adapted version of the well-validated Fried's physical frailty phenotype, in which five criteria were included: weakness, slowness, exhaustion, physical inactivity, and shrinking. RESULTS: Over an average of 2.1 years of follow-up (10,514.2 person-years), the weighted incidence rate of frailty was 60.6 per 1000 person-years; the incidence rate was 28.8 and 86.6 per 1000 person-years for those who were initially robust and prefrail, respectively. Participants who were older and widowed, had lower education and household income, lived in rural areas, and had higher burden of chronic conditions had higher frailty incidence. Frailty incidence ranged from 44.8 per 1000 person-years in the Southeast to 93.0 per 1000 person-years in the Northwest. CONCLUSIONS: Incidence rate of frailty was 60.6 per 1000 person-years among community-living Chinese adults aged ≥ 60 years. Substantial sociodemographic and geographical disparities exist in frailty incidence.

Examining constipation assessment and management of patients with advanced cancer receiving specialist palliative care: a multi-site retrospective case note review of clinical practice.

BACKGROUND: Constipation is a common symptom for patients receiving palliative care. Whilst international clinical guidelines are available on the clinical management of constipation for people with advanced cancer receiving specialist palliative care (SPC), the extent to which the guidelines are implemented in practice is unclear. This study aimed to examine clinical practices for the assessment and management of constipation for patients with advanced cancer within inpatient SPC settings. METHODS: A multi-site retrospective case-note review was conducted, consisting of 150 patient case-notes from three inpatient SPC units across the United Kingdom between August 2016 and May 2017. The variables selected for review were determined by the recommendations within the clinical guidelines. Descriptive statistics, cross tabulation, chi square, and bivariate correlations were used to examine clinical practices compared to policy guidelines for the assessment and management of constipation. Reporting was structured by the STROBE checklist for observational research (Additional File 2). RESULTS: A comprehensive assessment, including a full history and performing a physical exam, was recorded for 109 patients (73%), however, no standardised documentation was utilised. Assessment was nurse led, with variable involvement across sites of other members of the multidisciplinary team (MDT). Education on prevention was documented in 30 (20%) case-notes, and 53% recorded evidence of non-pharmacological intervention. Age, gender, and reason for admission did not impact on the likelihood of receiving a comprehensive assessment, education, or non-pharmacological intervention, however, significant differences were evident between sites. Pharmacological management was well developed and aligned to the guidelines however, 33% of patient case-notes recorded no information on the titration of laxatives. Twelve percent of patients experienced partial or complete bowel obstruction, and management strategies were variable. CONCLUSIONS: Constipation management is driven by a pharmacological approach, with little evidence of the implementation of preventative and non-pharmacological strategies. The nurse plays a key coordinating role in assessment; however, involvement and roles of the wider MDT varies. Accurate recording of care is essential when examining clinical practice and identifying areas for improvement. Further education is needed to equip HCPs with the knowledge and skills to ensure consistency in assessment and implementation of appropriate non-pharmacological/ preventative strategies.

Trends in Uterine Cervical Cancer Screening at Physical Health Checkups for Company Employees in Japan.

The consultation rate for uterine cervical cancer screening in Japan is markedly low in comparison with other developed countries. The purpose of this study is to investigate the trends in uterine cervical cancer screening during regular company checkups and to identify potential problems. Questionnaires were sent to occupational health physicians through Sansuiken (Alumni Association of the University of Occupational and Environmental Health, Japan). Overall, 127 valid responses showed that Papanicolaou (Pap) tests are conducted in 100 companies (79%). The detailed information from 50 of the 100 responses was analyzed. Mandatory cervical cancer screenings are performed at just 6 companies (12%). Pap test are started at 30 years of age at 9 of 49 companies, and only 18 of 49 companies (37%) start Pap tests for employees at 20 years old. Of the 86,695 women, 31,294 (36%) received cervical cancer screening. Abnormal Pap test results were detected in 3.0%. Although cervical cancer screening rates have slightly increased compared to our previous studies (17% in 2004, 23% in 2008), it remains at a low level. Complete examinations with colposcopy and punch biopsy were carried out in 70% (61 of 87 women) of those with an abnormal Pap test. Twelve of 26 companies had no information about detailed examination results. It is important to note that cervical cancer incidence and mortality are increasing among young women in Japan. Occupational physicians and health nurses should manage female health education and care at the workplace, by including uterine cervical cancer screening in the growing female working population.

Back to the future: forget ultrasound and focus on clinical assessment in rheumatoid arthritis management.

Ultrasound (US) unquestionably improves many aspects of rheumatoid arthritis (RA) diagnosis and management, but no consensus has been reached regarding the optimal US methodology that should be used, and high levels of standardisation have not yet been attained. Current evidence from two randomised controlled trials does not support the US in directing treatment decisions. A return to the endorsement of clinical assessment and the adoption of T2T strategies aiming at ACR/EULAR remission still represent the standard of care for RA and should be pursued through appropriate educational programmes. Thus, for now, the major application of sonography in arthritis should have a focus on diagnostic and especially differential diagnostic aspects.

Physical diagnoses in nursing home residents - is dementia or severity of dementia of importance?

BACKGROUND: Dementia and physical morbidity are primary reasons for nursing home admission globally. However, data on physical morbidity in nursing home residents with and without dementia are scarce. The first aim of the present study was to explore whether presence and severity of dementia were related to the number of physical diagnoses in nursing home residents. The second aim was to explore if the severity of dementia was associated with having registered the most frequent complexes of physical diagnoses when controlling for physical health and demographic factors. METHODS: A total of 2983 Norwegian nursing home residents from two cross-sectional samples from 2004/2005 and 2010/2011 were included in the analysis. By the use of assessment scales, the severity of dementia (Clinical Dementia Rating), physical health (General Medical Health Rating), activities of daily living (Physical Self-Maintenance Scale) and neuropsychiatric symptoms (Neuropsychiatric Inventory Nursing Home) were determined. Physical diagnoses and medications were assembled from the medical records. The physical diagnoses were categorized into complexes, using the ICD-10 chapters. Linear mixed models and generalized linear mixed models were estimated. RESULTS: Residents with dementia were registered with fewer physical diagnoses than residents without dementia. The frequency of physical diagnoses decreased with increasing severity of dementia. Cardiovascular, musculoskeletal and endocrine, nutritional and metabolic diagnoses were the most common complexes of physical diagnoses in individuals with and without dementia. The odds of having cardiovascular and musculoskeletal diagnoses increased for males and decreased for females with increasing severity of dementia, in contrast to endocrine diagnoses where the odds increased for both genders. CONCLUSION: Increasing severity of dementia in nursing home residents may complicate the diagnostics of physical disease. This might reflect a need for more attention to the registration of physical diagnoses in nursing home residents with dementia.

Retrospective Multicenter Analysis of the Accuracy of Clinical Examination by Community Physicians in Diagnosing Developmental Dysplasia of the Hip.

OBJECTIVES: To determine among general practitioners (GPs) the most common clinical findings that raised concern for developmental dysplasia of the hip (DDH) and necessitated an orthopedic outpatient referral. In addition, we assessed the sensitivity and specificity of the most common of these clinical findings. STUDY DESIGN: We performed a multicenter retrospective review of all referrals by GPs to local orthopedic outpatient departments for DDH over a 12-month period. All patients had undergone pelvic radiographs, and the acetabular index (AI) was measured. The AI was used as a reference test to assess the accuracy of the clinical examination in diagnosing DDH. Sensitivity and specificity of each clinical sign was calculated. RESULTS: Twenty-six of 174 (14.9%) referred patients were diagnosed with DDH, defined as an AI score > 30. The most common indication for referral, per the GP letter was asymmetrical skin folds (97 patients, 45.8%), followed by hip click (42 patients, 19.8%), and limb shortening (34 patients, 16%). Sensitivities and specificities, respectively, among findings were asymmetric skin folds 46.2% (95% CI 26.6%-66.6%) and 42.6% (95% CI 34.5%-51.0%), hip click 23.1% (95% CI 9.0%-43.6%) and 75.7% (95% CI 67.9%-82.3%), limb shortening 30.8% (95% CI 14.3%-51.8%) and 82.4% (75.3%-88.2%), and reduced abduction 19.2% (95% CI 6.6%-39.4%) and 91.9% (95% CI 86.3%-95.7%). Using logistic regression analysis, no clinical sign was found to be a statistically significant indicator of an abnormal AI. CONCLUSIONS: Clinical examination by GPs does not reliably detect radiographically-defined DDH. None of the clinical findings by the GP showed an acceptable level of sensitivity. Absence of reduced abduction and limb shortening are relevant negatives given the high level of specificity of these signs.

Development of a generic wound care assessment minimum data set.

BACKGROUND: At present there is no established national minimum data set (MDS) for generic wound assessment in England, which has led to a lack of standardisation and variable assessment criteria being used across the country. This hampers the quality and monitoring of wound healing progress and treatment. AIM: To establish a generic wound assessment MDS to underpin clinical practice. METHOD: The project comprised 1) a literature review to provide an overview of wound assessment best practice and identify potential assessment criteria for inclusion in the MDS and 2) a structured consensus study using an adapted Research and Development/University of California at Los Angeles Appropriateness method. This incorporated experts in the wound care field considering the evidence of a literature review and their experience to agree the assessment criteria to be included in the MDS. RESULTS: The literature review identified 24 papers that contained criteria which might be considered as part of generic wound assessment. From these papers 68 potential assessment items were identified and the expert group agreed that 37 (relating to general health information, baseline wound information, wound assessment parameters, wound symptoms and specialists) should be included in the MDS. DISCUSSION: Using a structured approach we have developed a generic wound assessment MDS to underpin wound assessment documentation and practice. It is anticipated that the MDS will facilitate a more consistent approach to generic wound assessment practice and support providers and commissioners of care to develop and re-focus services that promote improvements in wound care.

Trends of barriers to eye care among adults with diagnosed diabetes in Germany, 1997-2012.

BACKGROUND AND AIMS: To study trends of barriers to receiving recommended eye care among subjects with diabetes aged 20-81 years in northeast Germany. METHODS AND RESULTS: We analyzed population-based data from two repeated cross-sectional surveys conducted in 1997-2001 and 2008-2012 (Ns of 4308 and 4402). Andersen's Behavioral Model of Health Services Utilization was used to identify individual-level demographic, financial and health-related barriers to annual eye-care utilization in subjects with a self-reported physician's diabetes and to examine population trends in these barriers. The prevalence of diabetes increased from 6.5% to 11.4%. The prevalence of annual eye-care utilization among persons with diabetes decreased from 69.4% to 56.0% (adjusted relative risk = 0.77, p < 0.001). The decline of eye care utilization over the past decade in eye-care use was more pronounced in groups at risk for diabetes-related complications (i.e., lower socio-economic status, >5 years since diagnosis of diabetes, poor glycemic control, obesity, smoking, lack of physical activity, co-existing diseases). We identified relevant predictors of missed annual eye-care use among diabetics. CONCLUSION: The increase of diabetes prevalence and downward trend of eye-care visits at the recommended level call for development, implementation and evaluation of continued efforts to improve access to eye specialists, particularly among those with poor diabetic control, co-existing diabetic complications, and comorbidities.

Medical education in the digital age: personal reflection on a simulation fellowship.

Technology-advanced learning in healthcare has advanced dramatically in the last 10 years, with an increasing ability to recreate complex scenarios with clinical fidelity. Other technological developments can help to advance simulation-based training as part of a resilient approach to both common scenarios and rare events. In this article, I reflect on the some of the challenges of the developing paradigm of inter-professional high-fidelity simulation and the potential affordances of this modality.

Paediatric short case examination.

The short case is a highly artificial scenario, in which the examination candidate is given little or no history and instructed to examine one system or one aspect of a patient and draw conclusions. Despite their artificiality, short cases test clinical skills which senior paediatricians value and consider essential qualities of a competent physician. This article presents some general suggestions on an approach to doing short case examinations.

Ultrasound for internal medicine physicians: the future of the physical examination.

OBJECTIVES: With the advent of compact ultrasound (US) devices, it is easier for physicians to enhance their physical examinations through the use of US. However, although this new tool is widely available, few internal medicine physicians have US training. This study sought to understand physicians' baseline knowledge and skill, provide education in US principles, and demonstrate that proper use of compact US devices is a skill that can be quickly learned. METHODS: Training was performed at the Mayo Clinic in June 2010 and June 2011. The participants consisted of internal medicine residents. The workshop included didactics and hands-on US experiences with human and cadaver models in a simulation center. Pretests and posttests of residents' knowledge, attitudes, and skills with US were completed. We reassessed the 2010 group in the spring of 2012 with a long-term retention survey for knowledge and confidence in viewing images. RESULTS: A total of 136 interns completed the workshop. Thirty-nine residents completed the long-term retention survey. Posttest assessments showed a statistically significant improvement in the knowledge of US imaging, confidence in identifying structures, image identification, and image acquisition (P < .0001). In the long-term retention study, knowledge of US imaging and confidence in identifying structures did decline. CONCLUSIONS: This educational intervention resulted in improvement in US knowledge and image acquisition. However, the knowledge diminished over time, suggesting that further education is needed if US is to become an important component of internal medicine training and practice.

[Methodological basis for modern stage of medical examination of the state aviation air crew].

The main methodological framework to improve the system of medical examination of flight crews is the concept of occupational health. One of the important areas is the study of the epidemiology of professionally caused disadaptation functional disorders and subclinical disease in aircrew, their preclinical diagnosis and classification. Pointed to the need to improve organizational and practical principle of comprehensive and regular inspection of the body of the pilot, not only for diagnostic purposes, but also for the smooth conduct medical and rehabilitation measures. Proved the ways to achieve these goals.

Improvement in the diagnosis of appendicitis.

Our attempts to systematically improve accuracy in the evaluation of patients with suspected appendicitis are, in some ways, hindered by the fact that the condition is so frequently straightforward to diagnose. Careful history-taking and physical examination are reliable in most patients. However, establishing the diagnosis with these skills alone remains vulnerable to conditions that masquerade as acute appendicitis. A substantial body of clinical research over the last quarter-century has shown that improved accuracy is possible. Strategies for improvement include the use of diagnostic scoring systems, laboratory makers such as CRP, diagnostic laparoscopy, and advanced imaging modalities such as CT, MRI, and US. How clinicians use these strategies depends on many factors related to practice setting, the population served, and clinical goals. In children, for instance, the desire to limit exposure to ionizing radiation competes with the greater anatomic detail that a CT scan can provide; at the same time, many hospitals that treat children do not have the resources to maintain the sort of full-time, highly sophisticated abdominal US programs that achieve the highest rates of diagnostic accuracy in clinical studies. Trade-offs have to be made, but improvement is possible in almost all groups of patients: the clinical community should no longer settle for a 15% NA rate when 5% is clearly possible without adverse consequences. Many clinicians will be faced with the task of evaluating patients suspected of having acute appendicitis. A deliberate, proactive, and, ideally, benchmarked strategy for improving diagnosis should be the standard to which we hold ourselves and the promise we deliver to our patients.

The changing picture of substance abuse problems among Finnish prisoners.

PURPOSE: Marginalized people are often absent from population surveys of substance use and from research based on care data. Special methods are needed to reach these small but very significant groups. This study analyses how patterns of intoxicant use have changed over time among one of the most marginalized group of people, the prisoners. METHODS: Nationally representative samples of Finnish prisoners were examined: 903 prisoners in 1985, 325 prisoners in 1992, and 410 prisoners in 2006. Comprehensive field studies consisting of interviews and a clinical medical examination were used. RESULTS: In 1985, a diagnosis for alcoholism was given to 41% of the men and 36% of the women prisoners. An increase over time was observed, and in 2006, 52% of men and 51% of women prisoners were alcohol dependent. Dependence on a drug was diagnosed in 6% of men and 3% of women in 1985; this prevalence had increased to 58% of men and 60% of women in 2006. CONCLUSIONS: A dramatic change in prevalence of illegal drug use and drug addiction among prisoners has taken place in the past 20 years. Recognizing this shift from alcohol to other intoxicants is important since drugs are illegal substances and thus tend to lead to involvement with the judicial sector, thus stigmatizing and deepening the spiral of marginalization.

[Is ABPM an extension of a well done physical examination?]. / La MAPA: prolongation de l'examen physique bien fait?

Hypertension is a key risk factor for developing cardiovascular and renal diseases and one of the most important causes of morbidity and mortality worldwide. Iterative measurement of the clinical blood pressure is the method proposed by international and national organizations to establish the diagnosis of hypertension. However, current data suggest that neither in-hospital nor self home blood pressure measurement is sensitive and specific enough for one to recommend them as the sole diagnostic test. More accurate diagnosis of hypertension would allow a significant cost saving by reducing both cardiovascular and renal complication burden, and costs induced by erroneously diagnosing normal subjects as hypertensives. Therefore, 24h ABPM is increasingly becoming the gold standard for diagnosing hypertension.