A retrospective case series was conducted at a teaching hospital with an emergency department (ED) census of 100,000 patients per year to identify the incidence of, and factors associated with, the misdiagnosis of appendicitis in nonpregnant women aged 15 to 45 years. There were 174 nonpregnant women identified with a pathologic diagnosis of appendicitis. Clinical features were then compared between patients misdiagnosed (seen in prior 10 days and given an incorrect diagnosis) and those who were initially diagnosed correctly. The results showed that 33% of the women with appendicitis were initially misdiagnosed. The most common misdiagnoses included pelvic inflammatory disease, gastroenteritis, and urinary infections. Misdiagnosed women more frequently exhibited diffuse and bilateral lower abdominal pain and tenderness, cervical motion, and right adnexal tenderness. Misdiagnosed women also had a lower incidence of right lower quadrant pain and tenderness, and peritoneal signs. In addition, misdiagnosis was associated with an increased incidence of perforation, abscess formation, and an increase in the total length of hospitalization. In conclusion, the incidence of misdiagnosis of appendicitis in women of childbearing age is high. Women who are misdiagnosed have less typical symptoms and physical findings and more frequent abnormal pelvic findings than those who are diagnosed correctly. Emergency physicians should be aware that atypical signs and symptoms are associated with misdiagnosed appendicitis in nonpregnant women of childbearing age.

Adolescent↗

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Outcome of acute otitis media with abnormal tympanometric patterns in children.

OBJECTIVE: To assess the ability of ED tympanometry to identify those children with acute otitis media who are at greater risk for treatment failure, recurrent infection, or persistent middle ear effusion. METHODS: A prospective observational study was performed in the EDs of a county hospital and a university medical center. One hundred seventeen children, aged 5 months to 5 years, with acute otitis media and abnormal tympanometric patterns were categorized into three groups--low compliance, high pressure, and low pressure--based on the initial patterns. All the children received oral amoxicillin for ten days. They had repeat tympanometry and otoscopy at 14- and 60-day follow-up visits, and were followed to determine clinical outcomes. RESULTS: Initial treatment success was equivalent for all groups: low compliance 93% (95% confidence interval 81%-97%), high pressure 91% (95% CI 71%-98%), low pressure 89% (95% CI 59%-99%). Rates of relapse, reinfection, 90-day non-recurrence, and persistent otoscopic and tympanometric middle ear effusion did not differ significantly between groups. CONCLUSION: ED tympanometry of children with acute otitis media is unable to provide prognostic information regarding treatment failure, recurrent infection, or persistent middle ear effusion.

Acoustic Impedance Tests↗

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Obesity: prevalence, causes, health risks and treatment.

This article reviews the latest research on the prevalence, causes, health risks and treatment of obesity. The attitudes and beliefs of nurses about obesity are also examined. Obesity is an increasing health problem. Contributing factors to the development of obesity include a genetic disposition to gain weight, a high fat diet and a lowered energy expenditure. Obesity is a risk factor for a number of chronic diseases and therefore weight loss is usually advisable. Treatment of obesity can take several approaches and requires a change in dietary intake. Changing dietary habits to reduce the health risks associated with obesity should be viewed differently from normal weight individuals dieting to achieve a cultural ideal. Nurses, health visitors and midwives should be knowledgeable about the possible causes, associated health risks and current treatment of obesity in order to provide appropriate care and support within the multidisciplinary team for their patients/clients. They should also be aware of their own personal attitudes and beliefs about obesity as these could affect the care given to patients and clients.

Attitude of Health Personnel↗

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Caring for patients with morbid obesity in hospital.

Caring for the patient with morbid obesity may require adaptation of routine nursing care; however, as with all patients, care should be tailored to individual needs. This article aims to highlight the specific needs of patients with morbid obesity and discusses ways of addressing these needs. The activities of living model is commonly used to assess, plan, implement and evaluate nursing care. This model, used to identify the potential needs of a patient with obesity, will provide the framework for the article. Documentation of procedures used for patient care, e.g. lifting and bathing, must be made in the patient's care plan enabling other nurses caring for the patient to identify quickly the most appropriate and safe way to care for the patient.

Activities of Daily Living↗