Terminology Matters: Patient Understanding of “Opioids” and “Narcotics”

Background: The terms “opioid” and “narcotic” are often used interchangeably by healthcare providers. The purpose of this study was to compare understanding “narcotics” vs. “opioids.” Methods: A convenience sample of English‐speaking women (n = 188), aged 21–45 years, seeking care at a primary care clinic were asked (1) “What is an opioid/narcotic?” (2) “Give an example of an opioid/narcotic?” (3) “Why does someone take an opioid/narcotic?” and (4) “What happens when someone takes an opioid/narcotic for a long time?” Responses were recorded verbatim by a research assistant and then coded independently by two investigators. Results: More than half of respondents (55.9%) responded “don’t know” to all 4 opioid questions, while just 3.2% responded “don’t know” to all 4 narcotic questions (P < 0.01). Most women were unfamiliar with the term opioid (76.3%) and did not know why someone would take an opioid (68.8%). About two‐thirds of respondents were able to give an example of a narcotic (64.2%) and knew the consequences of long‐term narcotic use (63.2%). Conclusions: While more women were more familiar with narcotic, many identified negative connotations with this term. Future research should explore how to improve patient understanding and attitudes regarding both the terms opioids and narcotics.     

The outcome of patients after “collapse”

Objective: There have been few studies examining patients with a triage diagnosis of collapse and none which has determined the outcome of these patients as a group. This study was undertaken to determine the frequency of the triage diagnosis of collapse, the differential diagnosis in these patients, and if any errors in diagnosis occurred. Design: Case notes over a six month period from the 1 October 1991 to the 31 March 1992 were retrospectively studied. Outcome was assessed at six months. Setting: The Emergency Department of the Geelong Hospital, a 450 bed teaching hospital serving a population of 250,000 in a large provincial centre in Victoria. Results: There were 17,588 attendances to the ED during the study period. One hundred and seventy four patients (1%) had a triage diagnosis of collapse, of whom 173 were included in the study. One hundred and seventy patients were followed up at six months. Faint was the commonest diagnosis (28%), and was usually benign. In particular, faint was the commonest diagnosis in patients over 75 years of age. For patients in whom the diagnosis of faint was made, it was correct in 98% of cases. There was a high overall mortality (9%), and a very high mortality in patients over 75 (24%). No patient less than 60 years of age died. Early deaths were generally due to major cerebrovascular accidents. Later deaths were mostly due to either untreated cardiac disease in very elderly or demented patients or metastatic cancer. The high death rate did not reflect misdiagnosis. It reflected the high morbidity and mortality of conditions which present with collapse, particularly in patients over 75 years of age. Misdiagnosis in these patients was uncommon (3%) and was generally related to three diagnostic areas, epilepsy, arrhythmias and gastrointestinal haemorrhage. Conclusion: Patients presenting with a triage diagnosis of collapse form a significant part of the emergency department workload. Faint is the commonest diagnosis and is usually benign. However, many conditions which present with collapse are associated with a high morbidity and mortality, particularly in patients over 75 years of age. Therefore care must be taken to exclude these more serious conditions, particularly epilepsy, arrhythmia and gastrointestinal haemorrhage, before a diagnosis of simple faint is made.     

From “first” to “last” steps in life – Pressure patterns of three generations

Background

The human foot has to bear loads during all kinds of bipedal locomotion throughout the whole life. Rapid developmental changes of foot morphology and foot function occur during the first years of walking. Furthermore, disease dependent modifications can also have an influence on plantar loading. Therefore, it is reasonable to assume that foot function will undergo changes in life. However, the main differences between the pressure patterns in young and elderly have not been well described. The aim of the study was to evaluate age-dependent pressure patterns in different age-related stages.

Methods

Hundred and four healthy humans of four different age groups were retrospectively analysed by means of plantar pressure measurements (toddlers: mean age 1.0 (SD 0.2) year; 7-year olds: 7.0 (SD 0.4) years; adults: 31.9 (SD 2.1) years; seniors: 68.7 (SD 3.2) years). The emed^® pressure platform was used to evaluate peak pressure, maximum force, contact time, contact area and arch index.

Findings

Significant differences were found for each parameter between almost every age group. The highest peak pressure values were observed for the seniors’ (P < 0.001). Peak pressures are low in toddlers (145 kPa), high in 7-year olds and adults (400–600 kPa) and even higher in elderly (?800 kPa).

Interpretation

Elderly adults can still be functionally mobile even if pressures are high. The results for the investigated age groups can be used as normative foot loading data to compare to pathological foot function.