determination of pre-hospital delay time of patients with acute myocardial infarction and seeking ways of speeding up the time for reperfusion is an important factor to lower mortality in these patients. this is a cross-sectional study to determine pre-hospital delay time, its components, and related causes and conditions, obtained in 375 patients with prolonged chest pain referred to four hosp...

Delay in the presentation of symptoms and in referral of patients for surgical opinion remains an important problem in colorectal cancer. Factors influencing patients to consult early include advice from close family or other associates and abdominal pain or vomiting, or both, as one of the early symptoms. More localised rectal symptoms and loss of weight are often associated with long delay. T...

BACKGROUND Discogenic, facet joint, and sacroiliac joint mediated axial low back pain may be associated with overlapping pain referral patterns into the lower limb. Differences between pain referral patterns for these three structures have not been systematically investigated. OBJECTIVE To examine the individual and combined relationship of age, hip/girdle pain, leg pain, and thigh pain and t...

Chronic pain is a common, complex, and challenging condition, where understanding the biological, social, physical and psychological contexts is vital to successful outcomes in primary care. In managing chronic pain the focus is often on promoting rehabilitation and maximizing quality of life rather than achieving cure. Recent screening tools and brief intervention techniques can be effective i...

Differential diagnosis of orofacial pain is crucial, as the course of each process and its clinical management varies markedly. A case is illustrated here of trigeminal neuralgia in a 49-year-old Indian female whose complaint was initially diagnosed as dental pain leading to sequential extractions of her right mandibular and maxillary molars but with no pain abatement. Subsequent neurological a...

OBJECTIVES The recent National Service Framework for coronary heart disease advocates the establishment of rapid assessment clinics for chest pain. But how should these clinics be organised and do they fulfil their objectives? The aim of this study was to compare referral patterns to a daily and a weekly "one stop" rapid access chest pain clinic (RACPC), and to examine clinical outcome in patie...

BACKGROUND The number of patients who have difficulty with mutual understanding has been increasing recently due to an aging society. This emerging issue needs to be addressed. We report an instructive case of a patient who had communication difficulties due to dementia and sequelae of alcoholic encephalopathy. CASE PRESENTATION A 66-year-old man of Mongolian race presented with coronary arte...

OBJECTIVE To assess the concerns of adult patients with spine-related complaints during the period between referral to and consultation with a spine surgeon. DESIGN Prospective survey. SETTING Toronto, Ont. PARTICIPANTS A total of 338 consecutive, nonemergent patients before consultation with a single spine surgeon over a 5-month period. MAIN OUTCOME MEASURES Patient concerns, effect of...

Purpose: A vertebral artery dissection (VAD) is a rare disorder that can masquerade as musculoskeletal head and/or neck pain and requires an urgent medical referral. If the diagnosis missed or mismanaged it progress to stroke death. Headaches are one of main symptoms VAD precedes ischaemic signs. The aim this systematic review identify common features headaches ascertain if key characteristics ...