The 12 patients less than 35 years of age treated for squamous cell carcinoma of the oral cavity at the American Oncologic Hospital between 1954-1979 are examined. Group A (eight patients) had involvement of the tongue; Group B (4 patients) had carcinoma of other oral sites. Mean "T" stage for Group A and Group B was 1 and 1.5, respectively. Treatment was surgical in the majority of cases. Seventy-one percent of Group A and 25% of Group B developed metastatic disease to the neck. The 2-year survival rate was 57% (A) and 75% (B)--75% combined. The collective results of this and other studies suggest lower control rates than those reported for older patients with similar initial presentations. The implications of this observation are discussed in relation to the management of the younger patient with squamous carcinoma of the oral cavity.

Objectives: To describe a new chief-complaint categorization schema, the development of a computer textparsing algorithm to automatically classify free-text chief complaints into this schema, and use of these coded chief complaints to describe the case mix of a community emergency department (ED).Methods: Coded Chief Complaints for Emergency Department Systems (CCC-EDS) is a new and untested schema of 228 chief complaints, grouped within dimensions of type and system. A computerized text-parsing algorithm for automatically reading and classifying free-text chief complaints into 1 of these 228 coded chief complaints was developed by using a consecutive derivation sample of 46,602 patients who presented to a community teaching-hospital ED in 2004. Descriptive statistics included frequency of patients presenting with the 228 coded chief complaints; percentage of free-text complaints not categorizable by the CCC-EDS; and admission rate, age, and gender differences by chief complaint.Results: In the derivation sample, the text-parsing algorithm classified 87.5% of 45,329 ED visits with nonnull free-text chief complaints into 1 of 194 coded chief complaints. The text-parsing algorithm successfully classified 87.3% of the free-text chief complaints in a validation sample. The five most common coded chief complaints were Abdominal Pain (3,734 visits), Fever (2,234), Chest Pain (2,183), Breathing Difficulty (2,030), and Cuts-Lacerations (2,028). Conclusions:The CCC-EDS is a new comprehensive, granular, and useful classification schema for categorizing chief complaints in an ED. A CCC-EDS text-parsing algorithm successfully classified the majority of free-text chief complaints from an ED computer log. These coded chief complaints were used to describe the case mix of a community teaching-hospital ED.ACADEMIC EMERGENCY MEDICINE 2006; 13:774-782 ª

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Over the course of their postgraduate medical education, physicians are expected not only to acquire an extensive knowledge of clinical medicine and sound procedural skills, but also to develop competence in their other professional roles as communicator, collaborator, mediator, manager, teacher, and patient advocate. Although the need for physicians to develop stronger service delivery skills is well recognized, residency programs may underemphasize formal training in nonclinical proficiencies. As a result, graduates can begin their professional careers with an incomplete understanding of the operation of health care systems and how to utilize system resources in the manner best suited to their patients' needs. This article proposes the content, educational strategy, and needs assessment for an academic program entitled The Business of Emergency Medicine (BOEM). Developed as an adjunct to the (predominantly) clinical content of traditional emergency medicine (EM) training programs, BOEM is designed to enhance the existing academic curricula with additional learning opportunities by which EM residents can acquire a fundamental understanding of the nonclinical skills of their specialty.ACADEMIC EMERGENCY MEDICINE 2009; 16:900-907 ª

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