Abstract: Background The purpose of this study was to determine whether there were characteristics of the trauma patient with a minor head injury. Glasgow Coma Scale (GCS) of 13-15, that would predict a positive cerebral CT scan. Materials and methods An analysis of 300 patients with potential head injuries transported to our department was performed. The following characteristics were analyzed as possible predictors: 1. scene GCS, 2. emergency room GCS, 3. a change in GCS from scene to emergency room, 4. loss of consciousness, 5. focal neurological deficit. Results 50 per cent (150/300) of the patients underwent CT scanning of the head. CT scans were positive in 5,3 per cent (16/300) of the total group and 10.6 per cent (16/150) of those who underwent CT scanning. In the patients without LOC and ER-GCS of 13-15, all CT scans were negative. Conclusions Of all the patients with positive CT scans, 4 underwent emergent craniotomy: 2 for a depressed skull fracture with underlying contusion, and 2 for a temporal bone fracture and an epidural hematoma. Both patients had LOC and SC-GCS and ER-GCS of 15. We present our cases and finally we performed a review of the literature.

Abstract: Background Failure to detect cognitive impairment can result in a domino effect of medical and psychosocial problems, while cognitive dysfunction can have a significant impact on decision-making capacity [1]. Materials and methods A retrospective study was carried out among 126 outpatients aged 74.5 ± 7.6 years old, seen in the Neurology Department of Venizeleion General Hospital of Heraklion, between April 2005 and May 2007. A complete history, physical and neurological examination, CT scanning and neuropsychological tests including the Mini-Mental State Examination (MMSE) [2], the Clock Drawing Test (CDT - the Sunderland method) [3], the Geriatric Depression Scale (GDS) [4] and the Instrumental Activities of Daily Living Scale (IADL), were performed. Results 61.1% of patients showed cognitive impairment (MMSE<24), while 74.6% revealed with CDT (score<6). According to the MMSE and the CDT, there wasn't a statistical significant correlation between cognitive impairment and gender or educational level; a statistically significant difference (p<0.05) was found in relation to the age according the CDT, but not with the MMSE. We found a moderate correlation (r=0.408) between functional disability (IADL score) and the CDT. 11.7% of men and 9.1% of women had mild or moderate depression (GDS?7), but there were not statistically correlated with cognitive impairment or functional disability (p>0.05). Conclusions Memory complaints must be carefully assessed, as these results reaffirm that there is a high prevalence of the studied mental disorders in outpatients and especially in elderly. The CDT seems to be even more sensitive in revealing cognitive impairment in patients who have an MMSE within the normal limits.

Abstract: Objective: To evaluate the ability of elbow extension, with the patient in a supine position, as a diagnostic test of an insignificant injury, with the purpose of avoiding unnecessary radiographs. Methods: Seventy patients suffering from an acute elbow injury were examined at the accident and emergency department. Inability to fully actively extend the elbow in a supine position was defined as a positive diagnostic test. Radiographs were interpreted by a consultant radiologist, blinded to all clinical examination results. Sensitivity, specificity, positive and negative predictive values, and positive and negative likelihood ratios along with their 95% confidence intervals were calculated for the elbow-extension test. Results: Forty out of 70 patients had a positive test. Elbow fracture or dislocation was identified radiographically in 22 patients with positive test (sensitivity 92%). Two out of 30 (with negative test) had a hairline radial head fracture, which was found on radiographs (specificity 61%). Conclusion: Elbow extension as a diagnostic test in a primary care setting can predict severe elbow injuries and can be safely used in practices with no radiology facilities.

Abstract: Anxiety remains one of the most common mental problems that old individuals experience while anxiety disorders in elderly appear to remain under-diagnosed and under-treated by primary care practitioners. The use of standardized tools is considered an important component for the development of Primary Health Care (PHC) research, and the use of common tools constitutes a necessity of the international community for epidemiologic comparisons and further improvement of the citizens’ quality of life. This study reports on the suitability, translation into Greek and cultural adaptation of a screening tool for the detection of anxiety disorders in the elderly and discusses the results of a pilot study in selected visitors of two practices in rural primary care in Crete. The study population was over 65 years of age and the sample constituted by 99 individuals that fulfilled the criteria of attendance, in the interval of December 2006 - January 2007. The translation and cultural adaptation of the questionnaire was performed according to international standards. The Short Anxiety Screening Test (SAST) questionnaire was selected as the most suitable tool. The Greek translation found to be reliable, with a good internal consistency (Cronbach's alpha 0,763) and high reproducibility (kappa=0,930), while the exploratory factor analysis revealed three components that compose the questionnaire. The pilot study results revealed that roughly 29% of elderly had an anxiety disorder, while double frequency was found among women compared to men. The Greek translation of the SAST questionnaire is comparable with that of the original edition in terms of reliability and can be used in PHC research, while its implementation in everyday clinical practice needs further assessment.