Globus pharyngeus : a review of etiology, diagnostics, and treatment

Globus is a non-painful sensation of a lump or a foreign body in the throat, and it frequently improves with eating. Although globus is a common symptom, only little is known about the etiology, and the causes have remained controversial. Previously, globus was labelled as a hysterical symptom. However, nowadays, the research has been mainly focused on somatic causes and it is suspected that the etiology is complex. Because of the unclear etiology, the diagnostics and treatment are varying, predisposing patients to possible unnecessary investigations. This review presents the current literature of globus: its etiology, diagnostics, and treatment. In addition, a special aim is to discuss the rational investigation methods in globus diagnostics and present a diagnostic algorithm based on recent researches.Peer reviewe

Diagnostiset virheet

Diagnos­tiset vir­heet ovat var­sin taval­lisia, vaik­ka ei­vät usein paljas­tukaan po­tilaan eli­nai­kana, vaan vas­ta ruumii­na­vauksen yhtey­dessä. Lää­käri voi har­hautua seu­raamaan lii­kaa jon­kin aikai­semman poti­las­ta­pauk­sensa an­tamaa diagnos­tista esi­merkkiä tai ei osaa luo­pua diag­noosia koske­vasta ensiar­viostaan, vaik­ka tosi­seikat viittai­si­vatkin jo­honkin muu­hun. Yh­teen oi­reeseen tai löy­dökseen taker­tu­minen tai so­kea luot­to labo­ra­to­rio­tu­loksiin voi hel­posti joh­taa virhe­diag­noosiin

Diagnostiset virheet

Diagnos­tiset vir­heet ovat var­sin taval­lisia, vaik­ka ei­vät usein paljas­tukaan po­tilaan eli­nai­kana, vaan vas­ta ruumii­na­vauksen yhtey­dessä. Lää­käri voi har­hautua seu­raamaan lii­kaa jon­kin aikai­semman poti­las­ta­pauk­sensa an­tamaa diagnos­tista esi­merkkiä tai ei osaa luo­pua diag­noosia koske­vasta ensiar­viostaan, vaik­ka tosi­seikat viittai­si­vatkin jo­honkin muu­hun. Yh­teen oi­reeseen tai löy­dökseen taker­tu­minen tai so­kea luot­to labo­ra­to­rio­tu­loksiin voi hel­posti joh­taa virhe­diag­noosiin

Humant papillomvirus vid cancer i huvud-halsregionen

English summar

Analysis of weekend effect on mortality by medical specialty in Helsinki University Hospital over a 14-year period

Background: The weekend effect, the phenomenon of patients admitted at the weekend having a higher mortality risk, has been widely investigated and documented in both elective and emergency patients. Research on the issue is scarce in Europe, with the exception of the United Kingdom. We examined the situation in Helsinki University Hospital over a 14-year period from a specialty-specific approach. Materials and methods: We collected the data for all patient visits for 2000-2013, selecting patients with in-hospital care in the university hospital and extracting patients that died during their hospital stay or within 30 days of discharge. These patients were categorized according to urgency of care and specialty. Results: A total of 1,542,230 in-patients (853,268 emergency patients) met the study criteria, with 47,122 deaths in-hospital or within 30 days of discharge. Of 12 specialties, we found a statistically significant weekend effect for in-hospital mortality in 7 specialties (emergency admissions) and 4 specialties (elective admissions); for 30-day post-discharge mortality in 1 specialty (emergency admissions) and 2 specialties (elective admissions). Surgery, internal medicine, neurology, and gynecology and obstetrics were most sensitive to the weekend effect. Conclusions: The study confirms a weekend effect for both elective and emergency admissions in most specialties. Reducing the number of weekend elective procedures may be necessary. More disease-specific research is needed to find the diagnoses most susceptible. (C) 2020 Elsevier B.V. All rights reserved.Peer reviewe

Iatrogenic patient injuries in otology during a 10-year period : review of national patient insurance charts

Objective: To assess patient injury characteristics and contributing factors in otology. Methods: Data on the accepted patient-injury claims involving otorhinolaryngology (ORL), closed between 2001 and 2011, from the Finnish Patient Insurance Centre registry was retrieved. We included all injuries concerning otology, with evaluation and classification of their causes and types. Results: During the 10-year study period, a total of 44 claims were accepted as compensated patient injuries in otology. From a total of 233 patient injuries in all ORL, this amounted to 19%. In outpatient care, occurred 12 (27%) injuries and in surgical procedures 32 (73%). Five (11%) patients were children. Errors in surgical technique were identified as the primary cause of the injury in 22 (69%) operation-related cases. Failure to remove all auricular tampons or packing in postoperative control was a contributing factor in 4 (13%) injuries, a facial nerve was damaged in 9 (28%) operations, and in 12 (38%) patients, the injury resulted in severe hearing loss or deafness. Six patients (21%) needed one or more re-operations related to the injury, of which two were due to an incomplete primary operation. Conclusion: Typical compensated patient injuries in operative otology resulted from common complications of common operations in high volume centres.Peer reviewe

Weekend effect on mortality by medical specialty in six secondary hospitals in the Helsinki metropolitan area over a 14-year period

Background The weekend effect is the phenomenon of a patient's day of admission affecting their risk for mortality. Our study reviews the situation at six secondary hospitals in the greater Helsinki area over a 14-year period by specialty, in order to examine the effect of centralization of services on the weekend effect. Methods Of the 28,591,840 patient visits from the years 2000-2013 in our hospital district, we extracted in-patients treated only in secondary hospitals who died during their hospital stay or within 30 days of discharge. We categorized patients based on the type of each admission, namely elective versus emergency, and according to the specialty of their clinical service provider and main diagnosis. Results A total of 456,676 in-patients (292,399 emergency in-patients) were included in the study, with 17,231 deaths in-hospital or within 30 days of discharge. A statistically significant weekend effect was observed for in-hospital and 30-day post-discharge mortality among emergency patients for 1 of 7 specialties. For elective patients, a statistically significant weekend effect was visible in in-hospital mortality for 4 of 8 specialties and in 30-day post-discharge mortality for 3 of 8 specialties. Surgery, internal medicine, and gynecology and obstetrics were most susceptible to this phenomenon. Conclusions A weekend effect was present for the majority of specialties for elective patients, indicating a need for guidelines for these admissions. More disease-specific research is necessary to find the diagnoses, which suffer most from the weekend effect and adjust staffing accordingly.Peer reviewe

Patient injuries in pediatric otorhinolaryngology

Objectives: Patient injuries in children can have lifelong effects on the patient and a marked impact on the whole family. The aim of this study was to identify the errors and incidents leading to patient injuries in pediatric otorhinolaryngology (ORL) by evaluating accepted patient injury claims. Methods: The records of all accepted patient injury claims in ORL between 2001 and 2011 were searched from the nationwide Patient Insurance Centre registry. Pediatric injuries were reviewed and evaluated in detail, and factors contributing to injury were identified. Results: In the 10-year study period, 17 (7.6%) of the 223 patient injuries occurred in children, and of these, 15 (88%) were considered operative care. The median age of the patients was 8 years (range 3-16 years). All operations were performed as daytime elective surgery and by a fully trained specialist in 93% of the cases. One-half of the cases were routine surgeries for common ORL diseases. The most common incidences were incomplete surgery, retained gauze or foreign body, injury to adjacent anatomic structure, and insufficient charts or instructions (each occurred in 3 cases). The most frequent consequence was burn (n = 4). One child died because of post-tonsillectomy hemorrhage. Conclusions: Patient injuries in pediatric ORL are strongly related to surgery. Most injuries occurred after routine operations by a fully trained specialist. Clinicians should be aware of the most likely scenarios resulting in claims.Peer reviewe