Internal and emergency medicine
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The aim of this study was to describe the clinical course of patients with chronic, non-specific neck pain undergoing a public health covered, exercise-based rehabilitation program and to identify predictors of poor outcome. A prospective cohort study was carried out on patients with non-specific neck pain (6 months or longer), referred by their general practitioner to a 6-session program, including education and individually tailored exercise. The primary outcome measure for the course of neck pain was the Northwick neck pain questionnaire (NPQ) administered on baseline, discharge, and 1 year from discharge. ⋯ Pain-related medication intake independently predicted poor short- (OR 4.24; 95% CI 1.83-9.84; p = 0.001) and long-term (OR 2.69; 95% CI 1.19-6.06; p = 0.017) outcome, and catastrophizing (OR 2.91; 95% CI 1.31-6.48; p = 0.009) predicted poor outcome at 1 year. Our cohort of patients with chronic neck pain undergoing an exercise-based rehabilitation program reported improvement by or beyond MICD-NPQ in 55% cases on discharge and in 44% cases at 1 year. Poor outcome was predicted by pain-related medication intake in the short and long term, and by catastrophizing in the long term.
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The aim of the study is to determine the prevalence of inappropriate admission, and to identify the factors that influence appropriateness of hospital admission. Data were prospectively collected from all 345 consecutive patients admitted during the period of 1 month for acute hospital care at a 110-bed division of internal medicine using socio-demographic and medical information. Statistical analyses included χ2 tests, t tests, and logistic regression analyses. ⋯ In multiple logistic regression analyses, age and co-morbidity are not independently related to appropriateness, however, when tested for interaction, inappropriateness is significantly more frequent at a young age in the absence of co-morbidities, and, numerically most relevant, in elderly patients presenting with co-morbidities. In this evaluation of a single centre North Italian hospital admission, co-morbidity turns out to be an important age-dependent determinant of appropriateness. Although in the young age group, co-morbidity increases the likelihood of being appropriately admitted, the presence of chronic illness in the elderly increases the risk of inappropriate hospital use.