1
|
Holderried F, Stegemann-Philipps C, Herschbach L, Moldt JA, Nevins A, Griewatz J, Holderried M, Herrmann-Werner A, Festl-Wietek T, Mahling M. A Generative Pretrained Transformer (GPT)-Powered Chatbot as a Simulated Patient to Practice History Taking: Prospective, Mixed Methods Study. JMIR Med Educ 2024; 10:e53961. [PMID: 38227363 PMCID: PMC10828948 DOI: 10.2196/53961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 12/09/2023] [Accepted: 12/14/2023] [Indexed: 01/17/2024]
Abstract
BACKGROUND Communication is a core competency of medical professionals and of utmost importance for patient safety. Although medical curricula emphasize communication training, traditional formats, such as real or simulated patient interactions, can present psychological stress and are limited in repetition. The recent emergence of large language models (LLMs), such as generative pretrained transformer (GPT), offers an opportunity to overcome these restrictions. OBJECTIVE The aim of this study was to explore the feasibility of a GPT-driven chatbot to practice history taking, one of the core competencies of communication. METHODS We developed an interactive chatbot interface using GPT-3.5 and a specific prompt including a chatbot-optimized illness script and a behavioral component. Following a mixed methods approach, we invited medical students to voluntarily practice history taking. To determine whether GPT provides suitable answers as a simulated patient, the conversations were recorded and analyzed using quantitative and qualitative approaches. We analyzed the extent to which the questions and answers aligned with the provided script, as well as the medical plausibility of the answers. Finally, the students filled out the Chatbot Usability Questionnaire (CUQ). RESULTS A total of 28 students practiced with our chatbot (mean age 23.4, SD 2.9 years). We recorded a total of 826 question-answer pairs (QAPs), with a median of 27.5 QAPs per conversation and 94.7% (n=782) pertaining to history taking. When questions were explicitly covered by the script (n=502, 60.3%), the GPT-provided answers were mostly based on explicit script information (n=471, 94.4%). For questions not covered by the script (n=195, 23.4%), the GPT answers used 56.4% (n=110) fictitious information. Regarding plausibility, 842 (97.9%) of 860 QAPs were rated as plausible. Of the 14 (2.1%) implausible answers, GPT provided answers rated as socially desirable, leaving role identity, ignoring script information, illogical reasoning, and calculation error. Despite these results, the CUQ revealed an overall positive user experience (77/100 points). CONCLUSIONS Our data showed that LLMs, such as GPT, can provide a simulated patient experience and yield a good user experience and a majority of plausible answers. Our analysis revealed that GPT-provided answers use either explicit script information or are based on available information, which can be understood as abductive reasoning. Although rare, the GPT-based chatbot provides implausible information in some instances, with the major tendency being socially desirable instead of medically plausible information.
Collapse
Affiliation(s)
- Friederike Holderried
- Tübingen Institute for Medical Education, Eberhard Karls University, Tübingen, Germany
| | | | - Lea Herschbach
- Tübingen Institute for Medical Education, Eberhard Karls University, Tübingen, Germany
| | - Julia-Astrid Moldt
- Tübingen Institute for Medical Education, Eberhard Karls University, Tübingen, Germany
| | - Andrew Nevins
- Division of Infectious Diseases, Stanford University School of Medicine, Stanford, CA, United States
| | - Jan Griewatz
- Tübingen Institute for Medical Education, Eberhard Karls University, Tübingen, Germany
| | - Martin Holderried
- Department of Medical Development, Process and Quality Management, University Hospital Tübingen, Tübingen, Germany
| | - Anne Herrmann-Werner
- Tübingen Institute for Medical Education, Eberhard Karls University, Tübingen, Germany
| | - Teresa Festl-Wietek
- Tübingen Institute for Medical Education, Eberhard Karls University, Tübingen, Germany
| | - Moritz Mahling
- Tübingen Institute for Medical Education, Eberhard Karls University, Tübingen, Germany
- Department of Diabetology, Endocrinology, Nephrology, Section of Nephrology and Hypertension, University Hospital Tübingen, Tübingen, Germany
| |
Collapse
|
2
|
Tasaki Y, Yokoyama T, Yamamiya M, Takakuwa M, Toyama T, Wada T, Ohta K. Importance of History Taking and Physical Examination Before Rapid Laboratory Test for Seasonal Influenza Virus: A Single-Center Multiple Logistic Analysis. Cureus 2023; 15:e50093. [PMID: 38186539 PMCID: PMC10770768 DOI: 10.7759/cureus.50093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2023] [Indexed: 01/09/2024] Open
Abstract
Background Despite several rapid influenza diagnostic tests (RIDTs), they are predicting whether a patient has influenza before rapid testing is important. Here, we assessed factors predictive of a positive flu test via RIDTs by combining interviews and physical examination. Methods We analyzed the relationship between interviews and physical findings and results of RIDTs using multivariable logistic regression. Results Two hundred seventy-six children were enrolled throughout the 2018-2019 flu season. Accordingly, 115 patients (41.7%) were positive for flu A. Our logistic regression model identified age, body temperature, and the existence of upper respiratory symptoms as significant factors for predicting positive for RIDTs, with odds ratios (OR) of 1.17 [95% CI (confidence interval): 1.08-1.25]/+Δ1year old, 1.70 (95% CI: 1.27-2.27)/+Δ1 ℃, and 5.08 (95% CI: 2.57-10.00) for respiratory symptoms. In addition, the OR for sick contact was 7.67 (95% CI: 3.96-14.90). Our logistic regression model showed an area under the curve (AUC) of 0.84. History of vaccination was not identified as a significant factor in positive RIDTs. Conclusions The existence of sick contact was associated with a positive flu test via RIDTs. Although RIDTs are an easy and quick method for detecting the flu virus, we should perform the appropriate identification of cases for RIDTs by combining interviews and physical findings.
Collapse
Affiliation(s)
- Yuko Tasaki
- Pediatrics, Kanazawa University, Kanazawa, JPN
| | | | - Mari Yamamiya
- Pediatrics, National Hospital Organization Kanazawa Medical Center, Kanazawa, JPN
| | | | | | - Taizo Wada
- Pediatrics, Kanazawa University, Kanazawa, JPN
| | - Kazuhide Ohta
- Pediatrics, National Hospital Organization Kanazawa Medical Center, Kanazawa, JPN
| |
Collapse
|
3
|
Ashizawa H, Iwanaga N, Kurohama H, Ito Y, Ashizawa N, Hirayama T, Takeda K, Ide S, Nagayoshi Y, Tashiro M, Takazono T, Tagawa T, Fukushima K, Ito M, Nakamura S, Izumikawa K, Yanagihara K, Miyazaki Y, Mukae H. Pulmonary Coccidioidomycosis Complicated by Nontuberculous Mycobacterial Pulmonary Diseases with a Literature Review. Jpn J Infect Dis 2023; 76:314-318. [PMID: 37258176 DOI: 10.7883/yoken.jjid.2023.073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Following an endobronchial examination, a young mine supervisor was treated with antibiotics for a pulmonary nontuberculous mycobacterial infection for approximately one year. However, a review of the radiological findings revealed a different possibility. Accordingly, pulmonary resection was performed, and histopathological analysis revealed numerous yeast-like fungi. Since the patient had stayed in the southwestern United States for two months in 2009, eight years previously, coccidioidomycosis was strongly suspected. The diagnosis of coccidioidomycosis was subsequently confirmed by serology and polymerase chain reaction testing of the excised specimen. Here, we report an educational case that emphasizes the importance of meticulous medical history-taking and awareness of endemic mycoses in other countries in the context of globalization.
Collapse
Affiliation(s)
- Hiroki Ashizawa
- Department of Respiratory Medicine, Nagasaki University Hospital, Japan
- Department of Respiratory Medicine, Nagasaki Medical Center, Japan
| | - Naoki Iwanaga
- Department of Respiratory Medicine, Nagasaki University Hospital, Japan
- Department of Respiratory Medicine, Nagasaki Medical Center, Japan
| | - Hirokazu Kurohama
- Department of Pathology, Nagasaki University Hospital, Japan
- Department of Pathology, National Hospital Organization, Nagasaki Medical Center, Japan
| | - Yuya Ito
- Department of Respiratory Medicine, Nagasaki University Hospital, Japan
| | - Nobuyuki Ashizawa
- Department of Respiratory Medicine, Nagasaki University Hospital, Japan
- Department of Infection Control and Education Center, Nagasaki University Hospital, Japan
| | - Tatsuro Hirayama
- Department of Pharmacotherapeutics, Nagasaki University Graduate School of Biomedical Sciences, Japan
| | - Kazuaki Takeda
- Department of Respiratory Medicine, Nagasaki University Hospital, Japan
| | - Shotaro Ide
- Department of Respiratory Medicine, Nagasaki University Hospital, Japan
- Infectious Diseases Experts Training Center, Nagasaki University Hospital, Japan
| | - Yohsuke Nagayoshi
- Department of Respiratory Medicine, Nagasaki Medical Center, Japan
- Division of Respiratory Medicine, Japanese Red Cross Nagasaki Genbaku Isahaya Hospital, Japan
| | - Masato Tashiro
- Department of Infection Control and Education Center, Nagasaki University Hospital, Japan
| | - Takahiro Takazono
- Department of Respiratory Medicine, Nagasaki University Hospital, Japan
- Department of Infectious Diseases, Nagasaki University Graduate School of Biomedical Sciences, Japan
| | - Tsutomu Tagawa
- Department of Thoracic Surgery, National Hospital Organization, Nagasaki Medical Center, Japan
| | - Kiyoyasu Fukushima
- Division of Respiratory Medicine, Japanese Red Cross Nagasaki Genbaku Isahaya Hospital, Japan
| | - Masahiro Ito
- Department of Pathology, National Hospital Organization, Nagasaki Medical Center, Japan
| | - Shigeki Nakamura
- Department of Microbiology, Tokyo Medical University, Japan
- Department of Fungal Infection, National Institute of Infectious Diseases, Japan
| | - Koichi Izumikawa
- Department of Infection Control and Education Center, Nagasaki University Hospital, Japan
- Department of Infectious Diseases, Nagasaki University Graduate School of Biomedical Sciences, Japan
| | | | - Yoshitsugu Miyazaki
- Department of Fungal Infection, National Institute of Infectious Diseases, Japan
| | - Hiroshi Mukae
- Department of Respiratory Medicine, Nagasaki University Hospital, Japan
| |
Collapse
|
4
|
Patel R. Enhancing History-Taking Skills in Medical Students: A Practical Guide. Cureus 2023; 15:e41861. [PMID: 37581148 PMCID: PMC10423320 DOI: 10.7759/cureus.41861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2023] [Indexed: 08/16/2023] Open
Abstract
History-taking skills are an essential part of the medical school curriculum. However, from the author's experience and available literature, students consistently report a lack of confidence in their history-taking abilities, and as a result, feel underprepared for upcoming summative communication skills assessments. Therefore, as medical students at the University of Cambridge, we used evidence-based education to create a history-taking teaching programme that aimed to increase confidence and preparedness for communication skills exams. This article outlines 12 tips to be used when teaching history-taking skills to medical students. These tips were created using student feedback, personal experience, and wider literature on the topic. Creating and teaching an effective history-taking course can take significant effort and time. However, we hope this guide provides a starting framework that can be quickly applied to allow users to create effective history-taking skills courses for their students.
Collapse
Affiliation(s)
- Reece Patel
- School of Clinical Medicine, University of Cambridge, Cambridge, GBR
| |
Collapse
|
5
|
Mathieu J, Pasquier M, Descarreaux M, Marchand AA. Diagnosis Value of Patient Evaluation Components Applicable in Primary Care Settings for the Diagnosis of Low Back Pain: A Scoping Review of Systematic Reviews. J Clin Med 2023; 12:jcm12103581. [PMID: 37240687 DOI: 10.3390/jcm12103581] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 05/16/2023] [Accepted: 05/20/2023] [Indexed: 05/28/2023] Open
Abstract
Low back pain ranks as the leading cause of years lived with disability worldwide. Although best practice guidelines share a consistent diagnostic approach for the evaluation of patients with low back pain, confusion remains as to what extent patient history and physical examination findings can inform management strategies. The aim of this study was to summarize evidence investigating the diagnostic value of patient evaluation components applicable in primary care settings for the diagnosis of low back pain. To this end, peer-reviewed systematic reviews were searched in MEDLINE, CINAHL, PsycINFO and Cochrane databases from 1 January 2000 to 10 April 2023. Paired reviewers independently reviewed all citations and articles using a two-phase screening process and independently extracted the data. Of the 2077 articles identified, 27 met the inclusion criteria, focusing on the diagnosis of lumbar spinal stenosis, radicular syndrome, non- specific low back pain and specific low back pain. Most patient evaluation components lack diagnostic accuracy for the diagnosis of low back pain when considered in isolation. Further research is needed to develop evidence-based and standardized evaluation procedures, especially for primary care settings where evidence is still scarce.
Collapse
Affiliation(s)
- Janny Mathieu
- Department of Anatomy, Université du Québec à Trois-Rivières, 3351, Boul. des Forges, C.P. 500, Trois-Rivieres, QC G8Z 4M3, Canada
| | - Mégane Pasquier
- Institut Franco-Européen de Chiropraxie, 72 Chemin de la Flambère, 31300 Toulouse, France
| | - Martin Descarreaux
- Department of Human Kinetics, Université du Québec à Trois-Rivières, 3351, Boul. des Forges, C.P. 500, Trois-Rivières, QC G8Z 4M3, Canada
| | - Andrée-Anne Marchand
- Department of Chiropractic, Université du Québec à Trois-Rivières, 3351, Boul. des Forges, C.P. 500, Trois-Rivières, QC G8Z 4M3, Canada
| |
Collapse
|
6
|
Kantar A, Marchant JM, Song WJ, Shields MD, Chatziparasidis G, Zacharasiewicz A, Moeller A, Chang AB. History Taking as a Diagnostic Tool in Children With Chronic Cough. Front Pediatr 2022; 10:850912. [PMID: 35498777 PMCID: PMC9051232 DOI: 10.3389/fped.2022.850912] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Accepted: 03/21/2022] [Indexed: 11/17/2022] Open
Abstract
Chronic cough is a common symptom of many underlying respiratory and non-respiratory disorders and may be associated with less serious causes, such as gastroesophageal reflux and nasal diseases. Chronic cough in children differs from that in adults with respect to its etiologies and management since it can indicate a symptom of an underlying disease in children. Guidelines for managing chronic cough in children are based on recording the history, followed by physical examination, chest radiography, and spirometry. Thus, taking accurate respiratory history for coughing helps delineate the pathophysiological basis of the cause of chronic cough. Detailed history taking enhances the evaluation and treatment, and facilitates a tailored diagnostic identification of likely diagnoses. While studies have described evidence-based red flags in children with chronic cough, the value of skilled physicians regarding history taking has received less attention for the best patient care. In the present article, we outline the major questions comprising a detailed history taking for chronic cough in children.
Collapse
Affiliation(s)
- Ahmad Kantar
- Paediatric Asthma and Cough Centre, Gruppo Ospedaliero San Donato, Bergamo, Italy.,Department of Paediatrics, University Vita Salute San Raffaele, Milano, Italy
| | - Julie M Marchant
- Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, QLD, Australia.,Center for Children's Health Research, Queensland University of Technology, Brisbane, QLD, Australia
| | - Woo-Jung Song
- Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Michael D Shields
- Medicine, Dentistry and Biomedical Science, Queen's University Belfast, Belfast, United Kingdom.,Royal Belfast Hospital for Sick Children, Belfast, United Kingdom
| | | | - Angela Zacharasiewicz
- Department of Pediatrics, Adolescent Medicine, Teaching Hospital of the University of Vienna, Wilhelminen Hospital, Klinikum Ottakring, Vienna, Austria
| | - Alexander Moeller
- Division of Respiratory Medicine and Childhood Research Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - Anne B Chang
- Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, QLD, Australia.,Center for Children's Health Research, Queensland University of Technology, Brisbane, QLD, Australia.,Child Health Division, Menzies School of Health Research, Darwin, NT, Australia
| |
Collapse
|
7
|
Menakuru SR, Priscu A, Salih A, Dhillon V. Disseminated Intravascular Coagulation Due to Drinking Tonic Water. Cureus 2021; 13:e20512. [PMID: 35070549 PMCID: PMC8765093 DOI: 10.7759/cureus.20512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2021] [Indexed: 11/05/2022] Open
Abstract
Quinine has been used worldwide to treat malaria; however, it is now used as an agent for night-time muscle cramping. The compound, derived from Cinchona tree bark, is found in antimalaria medication, supplements for leg cramping, and beverages such as tonic water and bitter lemon. Quinine, however, is not without its side effect profile which includes a wide range of ailments ranging from nausea to disseminated intravascular coagulation. The authors present a case of a 35-year-old man diagnosed with disseminated intravascular coagulation due to an excessive intake of tonic water because his friend told him that it would help alleviate nighttime leg cramping. We strive to inform physicians about the side effect profile of quinine and stress that a pertinent history must be elicited in patients with unknown causes of disseminated intravascular coagulation.
Collapse
Affiliation(s)
- Sasmith R Menakuru
- Internal Medicine, Indiana University Health Ball Memorial Hospital, Muncie, USA
| | - Adelina Priscu
- Internal Medicine, Indiana University Health Ball Memorial Hospital, Muncie, USA
| | - Ahmed Salih
- Internal Medicine, Indiana University Health Ball Memorial Hospital, Muncie, USA
| | - Vijaypal Dhillon
- Internal Medicine, Indiana University Health Ball Memorial Hospital, Muncie, USA
| |
Collapse
|
8
|
Paredis S, van Stiphout L, Remmen E, Strupp M, Gerards MC, Kingma H, Van Rompaey V, Fornos AP, Guinand N, van de Berg R. DISCOHAT: An Acronym to Describe the Spectrum of Symptoms Related to Bilateral Vestibulopathy. Front Neurol 2021; 12:771650. [PMID: 34867759 PMCID: PMC8633101 DOI: 10.3389/fneur.2021.771650] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 10/04/2021] [Indexed: 12/14/2022] Open
Abstract
Objective: To assess the prevalence of each symptom listed in the acronym DISCOHAT (worsening of symptoms in Darkness and/or uneven ground, Imbalance, Supermarket effect, Cognitive complaints, Oscillopsia, Head movements worsen symptoms, Autonomic complaints, and Tiredness) in patients with bilateral vestibulopathy (BVP), compared to patients with unilateral vestibulopathy (UVP). Methods: A descriptive case-control study was performed on BVP and UVP patients who were evaluated for their vestibular symptoms by two of the authors (RvdB, MCG) at a tertiary referral center, between 2017 and 2020. During history taking, the presence of each DISCOHAT symptom was checked and included in the electronic health record. Presence of a symptom was categorized into: "present," "not present," and "missing." Results: Sixty-six BVP patients and 144 UVP patients were included in this study. Prevalence of single DISCOHAT symptoms varied from 52 to 92% in BVP patients and 18-75% in UVP patients. Patients with BVP reported "worsening of symptoms in darkness," "imbalance," "oscillopsia," and "worsening of symptoms with fast head movements" significantly more than UVP patients (p ≤ 0.004). Conclusion: The DISCOHAT acronym is able to capture a wide spectrum of symptoms related to vestibulopathy, while it is easy and quickly to use in clinic. Application of this acronym might facilitate a more thorough and uniform assessment of bilateral vestibulopathy, within and between vestibular clinics worldwide.
Collapse
Affiliation(s)
- Sophie Paredis
- Maastricht University Medical Centre, Maastricht, Netherlands
| | | | - Eva Remmen
- Maastricht University Medical Centre, Maastricht, Netherlands
| | - Michael Strupp
- Department of Neurology and Neurological Intensive Care, Munich Hospital, Munich, Germany
| | | | - Herman Kingma
- Maastricht University Medical Centre, Maastricht, Netherlands
| | | | | | - Nils Guinand
- Centre Médical Universitaire, Université de Genève, Geneva, Switzerland
| | | |
Collapse
|
9
|
Flugelman MY. History-taking revisited: Simple techniques to foster patient collaboration, improve data attainment, and establish trust with the patient. GMS J Med Educ 2021; 38:Doc109. [PMID: 34651067 PMCID: PMC8493840 DOI: 10.3205/zma001505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 01/18/2021] [Accepted: 05/20/2021] [Indexed: 06/13/2023]
Abstract
The relevance and importance of the medical interview has been challenged with improved imaging technologies, web-based medicine, and use of artificial intelligence. The medical interview has three goals: Acquiring accurate medical data about the patient and the etiology of symptoms and signs, learning about the patient's personality, culture, and beliefs, and creating and building trust with the patient. Reduced human resources in the medical system and increased crowding in the interview setting, such as the emergency room and outpatient clinics, have strengthened the need for high quality and efficient interviews that fulfils the three goals of the interview. This manuscript proposes a structured six methods that contribute to the quality and efficiency of the medical interview with special focus on learning about the patients' life and creating trust with him.
Collapse
Affiliation(s)
- Moshe Y. Flugelman
- Lady Davis Carmel Medical Center, Department of Cardiovascular Medicine, Haifa, Israel
- Technion, Israel Institute of Technology, Rappaport Faculty of Medicine, Haifa, Israel
| |
Collapse
|
10
|
Abstract
This article offers a framework in history taking for functional gastrointestinal disorders (FGIDs). Clinicians rely on history taking and knowledge of the latest 'Rome IV criteria' rather than biomarkers to make a positive diagnosis of FGIDs. Improving one's history-taking skills is imperative, as early diagnosis can improve patient outcomes by avoiding over investigation and/or chronicity. Our suggested structure for history taking adopts the bio-psycho-social model of disease. We describe the assessment of gastrointestinal symptoms with open and closed questions, the importance of ruling out 'alarm' signs or symptoms, the use of a multi-system approach to identify coexisting functional disorders and eliciting patients' nutritional history. We explore the increased psychological comorbidity present in FGIDs and the significance of the social history in identify predisposing, precipitating, perpetuating and protective factors, which will ultimately guide treatment recommendations. We believe history taking should be used to build rapport with patients while, at the same time, validating their problems and reducing stigma. Reattribution of symptoms is then achieved through education of the gut-brain axis and can be used to provide reassurance to patients at the first encounter. Success of treatment depends on engagement and acceptance of such explanations.
Collapse
Affiliation(s)
- Megan Daly
- University College Hospital, London, UK.
| | | |
Collapse
|
11
|
Hallegraeff JM, Van Zweden L, Oostendorp RA, Van Trijffel E. Psychological assessments by manual physiotherapists in the Netherlands in patients with nonspecific low back pain. J Man Manip Ther 2021; 29:310-317. [PMID: 33908822 DOI: 10.1080/10669817.2021.1919283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Background: Clinical Practice Guidelines for low back pain emphasize implementing assessment and addressing of psychosocial context. It is unknown to what extent manual physiotherapists incorporate psychological factors in their diagnostic management of patients with nonspecific low back pain.Methods: An online survey among Dutch manual physiotherapists was conducted exploring the use of 10 psychological constructs. Frequencies of attention to psychological factors during history-taking and use of questionnaires were calculated. Associations between therapists characteristics and use of psychological questionnaires were analyzed using Spearmans rank correlation coefficient (r s) and logistic regression. In addition, a retrospective patient record review was conducted.Results: One hundred and twelve manual physiotherapists returned completed surveys. Although respondents indicated psychological factors were assessed, they rarely used psychological questionnaires. Significant but negligible associations were found for age and working hours and the use of specific questionnaires. From 95 patient records reviewed, seven were identified that mentioned one psychological factor each during history taking.Conclusions: Dutch MPTs, regardless of their age and work characteristics, rarely use psychological questionnaires in patients with LBP, although they report addressing these constructs implicitly during history taking. Educational and implementation strategies are needed to warrant the use of psychological constructs and validated psychological questionnaires at all phases of the clinical reasoning process.
Collapse
Affiliation(s)
- Joannes M Hallegraeff
- Department of Master Education, SOMT University of Physiotherapy, Amersfoort, The Netherlands
| | - Leonie Van Zweden
- Physiotherapy and Manual Therapy, SaFyR Physiotherapy, Krabbendijke, The Netherlands
| | - Rob Ab Oostendorp
- Scientific Institute for Quality of Healthcare, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.,Department of Manual Therapy, Faculty of Medicine and Pharmacy,Vrije Universiteit Brussel, Brussels, Belgium.,Pain in Motion International Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Emiel Van Trijffel
- Department of Master Education, SOMT University of Physiotherapy, Amersfoort, The Netherlands.,Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium.,Ziekenhuisgroep Twente, ZGT Academy, Almelo, The Netherlands
| |
Collapse
|
12
|
Abstract
The coronavirus 2019 (COVID-19) pandemic has led to an increase in the number of healthcare consultations being undertaken remotely rather than face to face, including telephone assessments with patients. When undertaking telephone assessments, the communication and clinical skills used in face-to-face consultations must be adapted to compensate for the loss of visual contact between the patient and the nurse. Specific techniques such as visualisation and managing silence can enable the nurse to develop trust and rapport with the patient, and contribute to effective telephone assessments.
Collapse
Affiliation(s)
- Ruth Burgess
- Leeds Teaching Hospitals NHS Trust, Leeds, West Yorkshire, England
| |
Collapse
|
13
|
Saikawa Y, Tsunoda A, Sata N, Anzai T. An incidental latent adult hemophilia case found after a tonsillectomy. SAGE Open Med Case Rep 2021; 9:2050313X20988410. [PMID: 33717485 PMCID: PMC7924005 DOI: 10.1177/2050313x20988410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 12/28/2020] [Indexed: 11/16/2022] Open
Abstract
Severe bleeding after a tonsillectomy may cause airway obstruction and be life-threatening. We report post-tonsillectomy bleeding in a 32-year-old patient with hemophilia A, who had not been aware of his disease for more than 30 years. He underwent tonsillectomy for recurrent tonsillitis. He denied episodes of bleeding tendency. The preoperative workup was normal, including platelet count, prothrombin time, and activated partial thromboplastin time. The surgery itself was uneventful, but severe bleeding from the inferior pole of the tonsillar bed developed 7 days after surgery. Emergency hemostasis was performed under general anesthesia in the operating room. The patient then remembered several episodes of bleeding tendency. Coagulation tests revealed a mild lack of coagulation factor VIII to 35%, and a diagnosis of hemophilia A was made. Hemophilia might only be found after surgery and can cause life-threatening complications. However, latent hemophilia detected after a tonsillectomy in a 32-year-old adult is very rare. A careful history of bleeding tendency is important to achieve a diagnosis of coagulopathy, perform a safer surgery, and prevent postoperative complications.
Collapse
Affiliation(s)
- Yuichiro Saikawa
- Department of Otolaryngology, Juntendo University Nerima Hospital, Tokyo, Japan
| | - Atsunobu Tsunoda
- Department of Otolaryngology, Juntendo University Nerima Hospital, Tokyo, Japan
| | - Naoko Sata
- Department of Otolaryngology, Juntendo University Nerima Hospital, Tokyo, Japan
| | - Takashi Anzai
- Department of Otolaryngology, Juntendo University Nerima Hospital, Tokyo, Japan
| |
Collapse
|
14
|
Spinazze P, Aardoom J, Chavannes N, Kasteleyn M. The Computer Will See You Now: Overcoming Barriers to Adoption of Computer-Assisted History Taking (CAHT) in Primary Care. J Med Internet Res 2021; 23:e19306. [PMID: 33625360 PMCID: PMC7946588 DOI: 10.2196/19306] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 12/23/2020] [Accepted: 01/24/2021] [Indexed: 01/10/2023] Open
Abstract
Patient health information is increasingly collected through multiple modalities, including electronic health records, wearables, and connected devices. Computer-assisted history taking could provide an additional channel to collect highly relevant, comprehensive, and accurate patient information while reducing the burden on clinicians and face-to-face consultation time. Considering restrictions to consultation time and the associated negative health outcomes, patient-provided health data outside of consultation can prove invaluable in health care delivery. Over the years, research has highlighted the numerous benefits of computer-assisted history taking; however, the limitations have proved an obstacle to adoption. In this viewpoint, we review these limitations under 4 main categories (accessibility, affordability, accuracy, and acceptability) and discuss how advances in technology, computing power, and ubiquity of personal devices offer solutions to overcoming these.
Collapse
Affiliation(s)
- Pier Spinazze
- Global Digital Health Unit, Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, United Kingdom
| | - Jiska Aardoom
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
| | - Niels Chavannes
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
| | - Marise Kasteleyn
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
| |
Collapse
|
15
|
Ullmann-Moskovits J, Farquharson M, Schwär M, Sennekamp M. Learning how to conduct medical interviews online for the first time - this is what we learned in Frankfurt am Main. GMS J Med Educ 2021; 38:Doc19. [PMID: 33659624 PMCID: PMC7899101 DOI: 10.3205/zma001415] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 11/03/2020] [Accepted: 11/24/2020] [Indexed: 05/19/2023]
Abstract
Objective: The COVID-19 pandemic made it necessary to convert a course on history taking, in theory and practice, to an online format over a very short time. A key question was whether, and if so to what extent, basic theory and, in particular, the practical skills required to conduct medical interviews can be learned online. Methodology/project description: The teaching program in basic theory was didactically redesigned and asynchronously placed on a learning platform, while the practical program, which consisted of training in conducting history-taking interviews, took place with the help of video conferencing software during synchronous sessions. For the practical sessions, the lecturers received organizational and technical support. Results: Based on initial evaluation results, a positive picture of the conversion has emerged since the course was completed. The need to restructure the course and use new teaching methods because of the COVID-19 pandemic was well accepted by lecturers and students, and the course content was successfully adapted to an online format. Conclusion: Overall, the online format enabled the learning objectives of the course to be successfully achieved. For topics such as non-verbal communication, the evaluation results indicated that a classroom format is preferable. Asynchronous theory teaching was generally very well received. Blended learning formats thus represent an appropriate means of teaching how to conduct medical interviews. Overall, online courses on conducting medical interviews provide students with the opportunity to become acquainted with the use of digital formats to conduct doctor-patient interviews, and to develop the relevant skills.
Collapse
Affiliation(s)
- Judith Ullmann-Moskovits
- Goethe-Universität Frankfurt am Main, Institut für Allgemeinmedizin, Frankfurt/Main, Germany
- *To whom correspondence should be addressed: Judith Ullmann-Moskovits, Goethe-Universität Frankfurt am Main, Institut für Allgemeinmedizin, Theodor-Stern-Kai 7, D-60590 Frankfurt/Main, Germany, E-mail:
| | - Maria Farquharson
- Goethe-Universität Frankfurt am Main, Institut für Allgemeinmedizin, Frankfurt/Main, Germany
| | - Miriam Schwär
- Goethe-Universität Frankfurt am Main, Institut für Allgemeinmedizin, Frankfurt/Main, Germany
| | - Monika Sennekamp
- Goethe-Universität Frankfurt am Main, Institut für Allgemeinmedizin, Frankfurt/Main, Germany
| |
Collapse
|
16
|
Abstract
INTRODUCTION Acute aortic dissection (AAD) is a time sensitive, difficult to diagnose, aortic emergency. We sought to explore the quality of history taking in AAD and assess its impact on misdiagnosis. METHODS We studied a retrospective cohort of patients >18 years old who presented to two tertiary care emergency departments from January 1st 2004 - December 31st 2012 and were diagnosed with an acute aortic dissection (AAD) on CT, MRI or TEE. Trained reviewers' extracted data using a standardized data collection form. The definitions of 5 pain characteristics - character, onset, duration, quality, and radiation were defined a priori. RESULTS Data were collected for 194 cases of acute aortic dissection with a mean age of 65(SD 14.1) and 66.7% male, 34(17.6%) missed on initial presentation. Only 20(14.8%) patients were asked all 5 questions. The most common initial incorrect diagnosis were acute coronary syndrome (16, 47%), pulmonary embolism (5, 14.7%) and stroke (4, 11.7%). If <2 questions were asked 1 in 5 cases were missed, 4 times greater than if >2 were asked (P < 0.01). CONCLUSION Clinicians should ask and document the character, onset, duration, radiation and severity of pain in any patient presenting with chest, abdominal or flank pain. A focused history still remains the keystone to reducing misdiagnosis.
Collapse
|
17
|
Vilela E, Fontes-Carvalho R. Alexander the Great Trusts Doctor Philip: The Patient-Physician Relationship as the First Step of the Healing Process. JACC Case Rep 2020; 2:1229-1231. [PMID: 34317456 PMCID: PMC8311878 DOI: 10.1016/j.jaccas.2020.05.080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Eduardo Vilela
- Department of Cardiology, Centro Hospitalar Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Ricardo Fontes-Carvalho
- Department of Cardiology, Centro Hospitalar Gaia/Espinho, Vila Nova de Gaia, Portugal.,Departamento de Cirurgia e Fisiologia, Unidade de Investigação Cardiovascular, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| |
Collapse
|
18
|
Kolarczyk E, Szydłowski L, Skierska A, Markiewicz-Łoskot G. The Differences in the Diagnostic Profile in Children with Vasovagal Syncope between the Result of Head-Up Tilt Table Test. Int J Environ Res Public Health 2020; 17:ijerph17124524. [PMID: 32586003 PMCID: PMC7345420 DOI: 10.3390/ijerph17124524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 06/17/2020] [Accepted: 06/19/2020] [Indexed: 11/16/2022]
Abstract
(1) Background: The features characterizing vasovagal syncope (VVS) are an important factor in the correct evaluation of diagnostic risk stratification in children and adolescents. The aim of the study was to determine the value of identifying the clinical characteristics in children with VVS. (2) Methods: We made a retrospective analysis of the medical records of 109 children with diagnosed VVS. We investigated the specific characteristics of syncope in children with VVS including the positive VVS (+) and negative VVS (−) result of the Head-Up Tilt Table Test (HUTT). (3) Results: We did not observe significant differences in the prodromal symptoms of VVS with HUTT response. In addition to typical prodromal symptoms, no difference in statistically reported palpitations (35/109 or 32.1%) and chest discomfort (27/109 or 27.7%) were recorded. Fear–pain–stress emotions as circumstances of syncope were more often reported by children with a negative HUTT (p = 0.02). Cramps–contractures (p = 0.016) and speech disorders (p = 0.038) were significantly higher in the group with negative HUTT. (4) Conclusions: There is a close relationship in the diagnostic profile between the negative and positive results of head-up tilt table test in children with vasovagal syncope.
Collapse
Affiliation(s)
- Ewelina Kolarczyk
- Department of Propaedeutics of Nursing, Faculty of Health Sciences in Katowice, Medical University of Silesia, 40-752 Katowice, Poland
- Correspondence: ; Tel.: +48-32-252-8006
| | - Lesław Szydłowski
- Department of Pediatric Cardiology, Faculty of Medical Sciences in Katowice, Medical University in Silesia, 40-752 Katowice, Poland; (L.S.); (A.S.)
| | - Agnieszka Skierska
- Department of Pediatric Cardiology, Faculty of Medical Sciences in Katowice, Medical University in Silesia, 40-752 Katowice, Poland; (L.S.); (A.S.)
| | - Grażyna Markiewicz-Łoskot
- Department of Nursing and Social Medical Problems, Faculty of Health Sciences in Katowice, Medical University of Silesia, 40-752 Katowice, Poland;
| |
Collapse
|
19
|
McLendon K, Wiggins M, Hunt D, Gauthier A, Thoppil D. Unsuspecting Dietary Factors in Hyperkalemia: A Case Report on Why History Matters. Clin Pract Cases Emerg Med 2020; 4:247-250. [PMID: 32426685 PMCID: PMC7220004 DOI: 10.5811/cpcem.2020.3.43095] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 01/28/2020] [Accepted: 03/10/2020] [Indexed: 11/11/2022] Open
Abstract
Introduction We present a case of hyperkalemia secondary to excessive dietary intake of hard caramel candies. Case Report An 88-year-old male who presented with acute abdominal pain and vomiting was found to have hyperkalemia of 6.9 milliequivalents per liter. He was stabilized, treated, and discharged the following day after resolution. The cause was identified as his daily consumption of 200 hard caramel candies. Discussion The patient had been consuming sugar-free candies, which induced a chronic diarrhea. This led to potassium wasting and augmentation of his home medications. When he transitioned to eating regular caramel candies, he retained too much potassium leading to his presentation. Conclusion While often overlooked, dietary history is a crucial part of history-taking to ensure that the underlying cause for illness is discovered and addressed.
Collapse
Affiliation(s)
- Kevin McLendon
- Merit Health Wesley, Department of Emergency Medicine, Hattiesburg, Mississippi.,William Carey University College of Osteopathic Medicine, Department of Emergency Medicine, Hattiesburg, Mississippi
| | - Matthew Wiggins
- Merit Health Wesley, Department of Emergency Medicine, Hattiesburg, Mississippi
| | - Derek Hunt
- Merit Health Wesley, Department of Emergency Medicine, Hattiesburg, Mississippi
| | - Alex Gauthier
- Merit Health Wesley, Department of Internal Medicine, Hattiesburg, Mississippi
| | - Deepu Thoppil
- Merit Health Wesley, Department of Internal Medicine, Hattiesburg, Mississippi
| |
Collapse
|
20
|
Abstract
Chest pain is a common reason for patient presentation to emergency departments and visits to primary care settings. While most causes of chest pain are not life-threatening, a small proportion require urgent intervention, particularly cardiac conditions such as acute coronary syndrome. Therefore, it is essential for healthcare practitioners, including nurses, to identify the cause of chest pain in a safe, timely and effective manner. This article outlines the main causes of chest pain and describes the aspects of chest pain assessment, including patient history-taking, physical examination and clinical investigations. Assessing chest pain requires healthcare practitioners to have knowledge of its causes and pathophysiology, the use of structured assessment tools and the latest evidence-based guidelines.
Collapse
Affiliation(s)
- George Stephens
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, England
| |
Collapse
|
21
|
Isono H, Ito Y, Takamura N. Development of polymyalgia rheumatica during hospitalization and diagnosis based on history taking by physical and occupational therapists. J Gen Fam Med 2019; 20:28-30. [PMID: 30631657 PMCID: PMC6321836 DOI: 10.1002/jgf2.224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Revised: 08/06/2018] [Accepted: 10/10/2018] [Indexed: 11/09/2022] Open
Abstract
Polymyalgia rheumatica (PMR) is frequently reported in the outpatient setting and presents with pain, morning stiffness, mild fever, and fatigue. However, the clinical course of PMR during hospitalization is unknown. We report a case of PMR that developed during hospitalization. PMR diagnosis should begin with an evaluation of core inclusion and exclusion criteria. However, when examining elderly patients, retrieving symptom information from the patient or their family is often difficult, especially during prolonged hospitalization. History taking by physical and occupational therapists or by other health care professionals is paramount in the symptomatic diagnoses of inpatients.
Collapse
Affiliation(s)
- Hiroki Isono
- Department of MedicineMito Kyodo General HospitalUniversity of TsukubaMitoIbarakiJapan
- Graduate School of Comprehensive Human SciencesUniversity of TsukubaTsukubaIbarakiJapan
| | - Yuri Ito
- Department of MedicineMito Kyodo General HospitalUniversity of TsukubaMitoIbarakiJapan
| | - Noriko Takamura
- Department of MedicineMito Kyodo General HospitalUniversity of TsukubaMitoIbarakiJapan
| |
Collapse
|
22
|
Williams BC, Ward DA, Chick DA, Johnson EL, Ross PT. Using a Six-Domain Framework to Include Biopsychosocial Information in the Standard Medical History. Teach Learn Med 2019; 31:87-98. [PMID: 30216097 DOI: 10.1080/10401334.2018.1480958] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2017] [Revised: 04/03/2018] [Accepted: 05/14/2018] [Indexed: 06/08/2023]
Abstract
PROBLEM The traditional approach to physicians' history taking is designed to facilitate diagnosis and treatment of biomedical conditions. However, in the 21st century, health is critically influenced by the interaction of biomedical conditions and nonbiomedical factors such as patient's ability to manage chronic disease and the social determinants of health. Interventions to expand routine history taking to include nonbiomedical factors have not been widely adopted, possibly due to the difficultly of incorporating long checklists into routine care and the inability to achieve consensus on the relevant behavioral or social determinants of health content applicable to all patients. INTERVENTION In 2015-2016, we introduced medical students to a 6-domain (biomedical and psychiatric conditions, behavioral health, living environment/resources, social support, and functional status) approach to history taking and instructed them to elicit information from each domain alongside the traditional approach. Students were required to obtain information from each domain in one admitting history or one daily progress note, discuss their findings with the attending physician, and involve members of the medical team in addressing concerns and barriers in the care of that patient. Students' history notes were reviewed for completeness and compared to those from a student control group. Students also completed a 10-question evaluation of the model. CONTEXT The intervention was conducted during a 1-month rotation on a hospitalist general medicine service from May 2015 through August 2016. OUTCOME Patient history and daily progress notes were collected from 38 fourth-year intervention students and compared to 24 control students on the same service from the previous year. Compared to control students, intervention students provided more patient information (p ≤ .001) in all nonbiomedical domains except behavioral health. Intervention students reported that the 6-domain model helped them identify clinical information that could be addressed with existing resources and prompted involvement of social workers, pharmacists, and nurses in care planning. They also indicated the framework added clinically valuable information and enhanced team-based care. LESSONS LEARNED A domain-based framework can be used by medical students to identify clinically relevant behavioral conditions and social determinants of health tailored to individual patients while avoiding long standardized checklists. Arguably, routine collection of behavioral and social determinants of health is a necessary first step in enhancing physicians' awareness and skills in working with health care teams to address nonbiomedical determinants of patients' health.
Collapse
Affiliation(s)
- Brent C Williams
- a Department of Internal Medicine , University of Michigan Medical School , Ann Arbor , Michigan , USA
| | - Denege A Ward
- a Department of Internal Medicine , University of Michigan Medical School , Ann Arbor , Michigan , USA
| | - Davoren A Chick
- a Department of Internal Medicine , University of Michigan Medical School , Ann Arbor , Michigan , USA
- b American College of Physicians , Philadelphia , Pennsylvania , USA
| | - Eric L Johnson
- c Department of Family and Community Medicine , University of North Dakota School of Medicine and Health Sciences , Grand Forks , North Dakota , USA
| | - Paula T Ross
- a Department of Internal Medicine , University of Michigan Medical School , Ann Arbor , Michigan , USA
| |
Collapse
|
23
|
Anuar N, Idris NS. Gonococcal conjunctivitis: A case report. Malays Fam Physician 2018; 13:27-28. [PMID: 30800230 PMCID: PMC6382084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
We report a case of acute gonococcal conjunctivitis in a 36-year-old woman who presented with eye redness and a history of discharge for one month. Prior to presenting to us, she was treated for bacterial conjunctivitis with three courses of local antibiotics by three different clinics after brief assessments and without improvement. The final diagnosis of gonococcal conjunctivitis was made after a complete history was elicited and supported by the presence of Neisseria Gonorrhoeae in the eye swab culture test. She and her sexual partner were treated successfully with intramuscular Ceftriaxone and oral Azithromycin. This case highlights the importance of complete history taking, including sexual history, which translates into early recognition and treatment, thus preventing complications.
Collapse
Affiliation(s)
- N Anuar
- MD RSMU, MMed (Family Medicine) Family Medicine Department Universiti Sains Malaysia Malaysia
| | - N S Idris
- MD USM, MMed (Family Medicine) Family Medicine Department Universiti Sains Malaysia Malaysia
| |
Collapse
|
24
|
Englar RE. Tracking Veterinary Students' Acquisition of Communication Skills and Clinical Communication Confidence by Comparing Student Performance in the First and Twenty-Seventh Standardized Client Encounters. J Vet Med Educ 2018; 46:235-257. [PMID: 30285598 DOI: 10.3138/jvme.0917-117r1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The American Veterinary Medical Association's Council on Education mandates that veterinary students graduate with competence in clinical communication. Communication competence facilitates the successful transition of students into clinical practice by improving veterinary client satisfaction and reducing the risk of litigation. Curricular experimentation with communications training has led to innovative approaches to this content area, including the adoption of standardized patients from human health care education. Although the use of standardized clients (SCs) is time and resource intensive, their use by veterinary educators has allowed students to work through authentic cases in a safe learning environment in which learner goals drive training. Despite the increasing popularity of SC-based communications curricula, outcomes assessment studies that track the resultant student growth are lacking. Ninety students in the inaugural class of 2018 at Midwestern University College of Veterinary Medicine participated in 27 SC encounters over eight consecutive quarters. Students' use of Calgary-Cambridge Guide communication skills was compared in the first and twenty-seventh encounters. On the basis of SC evaluations of student performance, students increased their use of all communication skills in the final encounter compared with baseline. Students were also more likely to take a comprehensive patient history, build rapport, and retain the client. Mean scores for pre- and post-encounter communication confidence, as self-reported by students, also increased. These findings support that a SC-rich curriculum facilitates student acquisition of communication skills and promotes confidence when students approach entry-level clinical tasks such as history taking.
Collapse
|
25
|
Anani S, Goldhaber G, Wasserstrum Y, Dagan A, Segal G. The 'SILENT Alarm': When History Taking Reveals a Potentially Fatal Toxicity. Eur J Case Rep Intern Med 2018; 5:000843. [PMID: 30756037 PMCID: PMC6346880 DOI: 10.12890/2018_000843] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 02/16/2018] [Indexed: 11/20/2022] Open
Abstract
Introduction The combination of acute/sub-acute neurological and metabolic derangements should always raise the suspicion of toxicity, either endogenous or exogenous. The adverse effects of psychiatric medications are especially difficult to determine since the psychiatric background of patients is often inaccessible. Clinical Presentation A 66-year-old man presented to the emergency department with dysarthria and uncontrolled tremor, rapidly deteriorating into a complex of severe neurological and metabolic derangements. Only after repeated attempts to take a thorough history was lithium toxicity identified. Conclusion Thorough, comprehensive history taking, including chronic medications and their substitutes, is essential and lifesaving when potentially lethal medications are involved. LEARNING POINTS
Collapse
Affiliation(s)
- Sapir Anani
- Internal Medicine 'T', Chaim Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel, affiliated to the Sackler School of Medicine, Tel-Aviv, Israel
| | - Gal Goldhaber
- Internal Medicine 'T', Chaim Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel, affiliated to the Sackler School of Medicine, Tel-Aviv, Israel
| | - Yishay Wasserstrum
- Internal Medicine 'T', Chaim Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel, affiliated to the Sackler School of Medicine, Tel-Aviv, Israel
| | - Amir Dagan
- Internal Medicine 'T', Chaim Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel, affiliated to the Sackler School of Medicine, Tel-Aviv, Israel
| | - Gad Segal
- Internal Medicine 'T', Chaim Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel, affiliated to the Sackler School of Medicine, Tel-Aviv, Israel.,St. Georges School of Medicine, London, program by the University of Nicosia in the Chaim Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
| |
Collapse
|
26
|
Abstract
History taking using a web-based, automated software module (Historian) was compared with standard outpatient initial assessment on a community sample of 27 new psychiatric outpatients. The comprehensiveness and acceptability of the computer interview was evaluated. Historian was found to take psychiatric histories comparable with regard to content and comprehensiveness with those taken by clinicians. Historian was found to be highly acceptable to patients on a wide range of measures. History-taking software may help to prioritise referrals, focus the initial assessment and reduce consultation time in a psychiatric outpatient setting. The availability of a comprehensive history (Historian) is likely to lead to a shorter face-to-face consultation which could then be better focused on diagnosis and treatment. Service users with special needs such as hearing impairment, poor mobility or with no command of the English language (but literate in their native tongue) may benefit from improved access to psychiatric services.
Collapse
|
27
|
Abstract
Taking a history is a key diagnostic instrument in paediatric consultations. Numerous issues potentially reduce the history's reliability. Therefore, paediatricians have always expressed ambivalence regarding history taking from parents, both valuing and distrusting it. In this review, we describe how parents build and present a description of their child's health issues in the conceptual framework of self-regulation theory. We performed a systematic review on the literature on the reliability of history taking. No studies examined the reliability of history taking from parents, but there is a considerable body of evidence on the issue of mutual trust in relationships between health care professionals and patients. Because trust is a dynamic relational phenomenon, taking a patient centred approach in consultations is likely to increase the patients' and parents' trust in the health care professional, and their willingness to follow the health care professional's treatment proposals. We provide evidence based recommendations on how to build and maintain trust in paediatric consultations by taking a patient centred approach in such consultations.
Collapse
Affiliation(s)
- Paul L P Brand
- Isala Women's and Children's Hospital, Zwolle, the Netherlands; UMCG Postgraduate School of Medicine, University Medical Centre and University of Groningen, Groningen, the Netherlands.
| | - Sandra van Dulmen
- Dept. of Primary and Community Care, Radboud University Medical Centre, Nijmegen, the Netherlands; NIVEL (Netherlands institute for health services research), Utrecht, the Netherlands; Faculty of Health Sciences, University College of Southeast Norway, Drammen, Norway
| |
Collapse
|
28
|
Igarashi R, Fujihara K, Heianza Y, Ishizawa M, Kodama S, Saito K, Hara S, Hanyu O, Honda R, Tsuji H, Arase Y, Sone H. Impact of individual components and their combinations within a family history of hypertension on the incidence of hypertension: Toranomon hospital health management center study 22. Medicine (Baltimore) 2016; 95:e4564. [PMID: 27661014 PMCID: PMC5044884 DOI: 10.1097/md.0000000000004564] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Although a family history (FH) of hypertension is a risk factor for the development of hypertension, only a few studies have investigated in detail the impact of individual components of an FH on incident hypertension. We investigated the impact of individual components and their combinations on the presence or development of hypertension considering obesity, smoking habits, physical activity, and other metabolic parameters.Studied were 12,222 Japanese individuals without hypertension (n = 9,766) and with hypertension (n = 2,456) at the baseline examination. The presence or incidence of hypertension during 5 years after a baseline examination was assessed by the presence of systolic blood pressure ≥140 mmHg and/or diastolic blood pressure ≥90 mmHg or a self-reported history of clinician-diagnosed hypertension. In this prospective study, the odds ratio for incident hypertension was 1.39 (95% confidence interval [CI], 1.22, 1.59) for individuals with any FH of hypertension compared with those without such an FH. Individuals with an FH of hypertension in both parents and one or more grandparents had an odds ratio of 3.05 (95% CI 1.74, 5.36) for hypertension compared with those without an FH of hypertension. FH was associated with incident hypertension independently of other modifiable risk factors such as obesity, smoking, physical inactivity, hyperglycemia, hyperuricemia, and hypertriglyceridemia.A parental history of hypertension was an essential component within an FH for incident hypertension. FH of hypertension over two generations with both parents affected was the most important risk factor for incident hypertension. Although an FH is not a modifiable risk factor, modifying other risk factors could contribute to reducing the risk of hypertension even among individuals with a family history of hypertension.
Collapse
Affiliation(s)
- Risa Igarashi
- Department of Internal Medicine, Niigata University Faculty of Medicine, Niigata
| | - Kazuya Fujihara
- Department of Internal Medicine, Niigata University Faculty of Medicine, Niigata
| | - Yoriko Heianza
- Department of Internal Medicine, Niigata University Faculty of Medicine, Niigata
| | - Masahiro Ishizawa
- Department of Internal Medicine, Niigata University Faculty of Medicine, Niigata
| | - Satoru Kodama
- Department of Internal Medicine, Niigata University Faculty of Medicine, Niigata
- Health Management Center, Toranomon Hospital
| | - Kazumi Saito
- Department of Internal Medicine, Niigata University Faculty of Medicine, Niigata
- Health Management Center, Toranomon Hospital
| | - Shigeko Hara
- Health Management Center, Toranomon Hospital
- Okinaka Memorial Institute for Medical Research, Tokyo, Japan
| | - Osamu Hanyu
- Department of Internal Medicine, Niigata University Faculty of Medicine, Niigata
| | | | - Hiroshi Tsuji
- Health Management Center, Toranomon Hospital
- Okinaka Memorial Institute for Medical Research, Tokyo, Japan
| | - Yasuji Arase
- Health Management Center, Toranomon Hospital
- Okinaka Memorial Institute for Medical Research, Tokyo, Japan
| | - Hirohito Sone
- Department of Internal Medicine, Niigata University Faculty of Medicine, Niigata
- Health Management Center, Toranomon Hospital
- Correspondence: Hirohito Sone, Health Management Center, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo 105-8470, Japan (e-mail: )
| |
Collapse
|
29
|
Abstract
The history taking of a dizzy patient is of utmost importance in order to differentiate the possible etiologies of vertigo. The key factors that allow a first approximation of diagnosis identification are based on the time profile, symptom profile, and trigger profile of the disease. Here, the proposed mnemonic “SO STONED” comprises eight different dimensions that characterize the vertigo-related complaints of the patient and guide the clinician in his or her decision scheme. All the letters “SO STONED” have a specific meaning: Symptoms, Often (Frequency), Since, Trigger, Otology, Neurology, Evolution, and Duration. Since the most common vestibular diseases have different fingerprints when all dimensions are considered, this tool can facilitate the identification of the appropriate vestibular diagnosis.
Collapse
Affiliation(s)
- Floris L Wuyts
- Antwerp University Research Centre for Equilibrium and Aerospace (AUREA), University of Antwerp, Antwerp, Belgium; Department of Biomedical Physics, Faculty of Science, University of Antwerp, Antwerp, Belgium
| | - Vincent Van Rompaey
- Department of Otorhinolaryngology and Head and Neck Surgery, Antwerp University Hospital, Antwerp, Belgium; Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Leen K Maes
- Department of Biomedical Physics, Faculty of Science, University of Antwerp, Antwerp, Belgium; Department of Speech, Language and Hearing Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| |
Collapse
|
30
|
Keifenheim KE, Teufel M, Ip J, Speiser N, Leehr EJ, Zipfel S, Herrmann-Werner A. Teaching history taking to medical students: a systematic review. BMC Med Educ 2015; 15:159. [PMID: 26415941 PMCID: PMC4587833 DOI: 10.1186/s12909-015-0443-x] [Citation(s) in RCA: 77] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Accepted: 09/14/2015] [Indexed: 05/04/2023]
Abstract
BACKGROUND This paper is an up-to-date systematic review on educational interventions addressing history taking. The authors noted that despite the plethora of specialized training programs designed to enhance students' interviewing skills there had not been a review of the literature to assess the quality of each published method of teaching history taking in undergraduate medical education based on the evidence of the program's efficacy. METHODS The databases PubMed, PsycINFO, Google Scholar, opengrey, opendoar and SSRN were searched using key words related to medical education and history taking. Articles that described an educational intervention to improve medical students' history-taking skills were selected and reviewed. Included studies had to evaluate learning progress. Study quality was assessed using the Medical Education Research Study Quality Instrument (MERSQI). RESULTS Seventy-eight full-text articles were identified and reviewed; of these, 23 studies met the final inclusion criteria. Three studies applied an instructional approach using scripts, lectures, demonstrations and an online course. Seventeen studies applied a more experiential approach by implementing small group workshops including role-play, interviews with patients and feedback. Three studies applied a creative approach. Two of these studies made use of improvisational theatre and one introduced a simulation using Lego® building blocks. Twenty-two studies reported an improvement in students' history taking skills. Mean MERSQI score was 10.4 (range 6.5 to 14; SD = 2.65). CONCLUSIONS These findings suggest that several different educational interventions are effective in teaching history taking skills to medical students. Small group workshops including role-play and interviews with real patients, followed by feedback and discussion, are widespread and best investigated. Feedback using videotape review was also reported as particularly instructive. Students in the early preclinical state might profit from approaches helping them to focus on interview skills and not being distracted by thinking about differential diagnoses or clinical management. The heterogeneity of outcome data and the varied ways of assessment strongly suggest the need for further research as many studies did not meet basic methodological criteria. Randomized controlled trials using external assessment methods, standardized measurement tools and reporting long-term data are recommended to evaluate the efficacy of courses on history taking.
Collapse
Affiliation(s)
- Katharina E Keifenheim
- Department for Psychosomatic Medicine and Psychotherapy, University Hospital of Tuebingen, Osianderstr. 5, 72076, Tübingen, Germany.
| | - Martin Teufel
- Department for Psychosomatic Medicine and Psychotherapy, University Hospital of Tuebingen, Osianderstr. 5, 72076, Tübingen, Germany.
| | - Julianne Ip
- Clinical Associate Professor of Family Medicine, Associate Dean of Medicine, Brown University, Providence, RI, USA.
| | - Natalie Speiser
- Department for Psychosomatic Medicine and Psychotherapy, University Hospital of Tuebingen, Osianderstr. 5, 72076, Tübingen, Germany.
| | - Elisabeth J Leehr
- Department for Psychosomatic Medicine and Psychotherapy, University Hospital of Tuebingen, Osianderstr. 5, 72076, Tübingen, Germany.
| | - Stephan Zipfel
- Department for Psychosomatic Medicine and Psychotherapy, University Hospital of Tuebingen, Osianderstr. 5, 72076, Tübingen, Germany.
- Dean of Medical Education, Medical Faculty, University of Tuebingen, Tuebingen, Germany.
| | - Anne Herrmann-Werner
- Department for Psychosomatic Medicine and Psychotherapy, University Hospital of Tuebingen, Osianderstr. 5, 72076, Tübingen, Germany.
| |
Collapse
|
31
|
Abstract
The aim of this article is to create a space for historical thinking in medical practice. To this end, we draw on the ideas of R.G. Collingwood (1889-1943), the renowned British philosopher of history, and explore the implications of his philosophy for clinical medicine. We show how Collingwood's philosophy provides a compelling argument for the re-centring of medical practice around the patient history as a means of restoring to the clinical encounter the human meaning that is too often lost in modern medicine. Furthermore, we examine how Collingwood's historical thinking offers a patient-centred epistemology and a more pluralistic concept of evidence that includes the qualitative, narrative evidence necessary for human understanding. We suggest that clinical medicine can benefit from Collingwood's historical thinking, and, more generally, illustrates how a philosophy of medicine that draws on diverse sources from the humanities offers a richer, more empathetic clinical practice.
Collapse
Affiliation(s)
- Benjamin H Chin-Yee
- Faculty of Medicine, and Institute for the History and Philosophy of Science and Technology, University of Toronto, Toronto, Ontario, Canada
| | | |
Collapse
|
32
|
Menakaya U, Lu C, Infante F, Lam A, Condous G. Relating historical variables at first presentation with operative findings at laparoscopy for endometriosis. Aust N Z J Obstet Gynaecol 2015; 54:480-6. [PMID: 25287566 DOI: 10.1111/ajo.12256] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Accepted: 08/14/2014] [Indexed: 01/24/2023]
Abstract
OBJECTIVES To determine the correlation between historical variables at presentation with the phenotype and location of biopsy proven endometriosis at laparoscopy. METHODS Prospective observational study. Consecutive women had laparoscopic surgery following clinical suspicion of endometriosis. Standardised history and clinical examination were taken, and the presenting complaints were evaluated within four subsets of women: (i) primary laparoscopy for endometriosis (ii) previous laparoscopically confirmed endometriosis (iii) biopsy positive for endometriosis and (iv) all biopsies negative for endometriosis. Historical pain variables within the four subsets were compared with disease location and phenotype (superficial, deep infiltrating, endometriomata) at laparoscopy. A stringent P-value of 0.01 was used as the cut-off for significance. RESULTS Overall 104 consecutive women were included: mean age 34.3 years, 66/104 (63.5%) had reoperation and 38/104 (36.5%) had primary laparoscopy. 89/104 (85.6%) were biopsy positive for endometriosis, and 11/104 (10.6%) were biopsy negative. Superficial endometriosis was most common phenotype. Site of pain did not correlate with ipsilateral location of disease. Significant correlations included as follows: dyspareunia and endometrioma (P = 0.0009) in women undergoing reoperation; dyspareunia and posterior compartment (P = 0.0086) and lateral compartment (P = 0.0004) disease in women with histology proven endometriosis; left iliac fossa pain and biopsy proven posterior compartment endometriosis (P = 0.0041). CONCLUSIONS Although a history of dyspareunia in women with previous endometriosis was significantly correlated with endometrioma, site-specific locations of pain symptoms did not correlate with ipsilateral locations of endometriosis at laparoscopy. The phenotype - combined deep and superficial endometriosis - was associated with dyspareunia among women with previous history of endometriosis.
Collapse
Affiliation(s)
- Uche Menakaya
- Acute Gynaecology and Early Pregnancy Unit, Nepean Centre for Perinatal Care, Nepean Clinical School, University of Sydney, Nepean Hospital, Sydney, New South Wales, Australia
| | | | | | | | | |
Collapse
|
33
|
Neary A, Pinson S. Cardiovascular examination in emergency departments. Emerg Nurse 2015; 23:32-39. [PMID: 25854743 DOI: 10.7748/en.23.1.32.e1348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
History taking and physical examination of patients who present with cardiac pain are not generally regarded as part of an emergency nurse's role in the UK. However, a good knowledge of the anatomy of the heart and cardiac disease, and the ability to undertake effective cardiovascular examination, could enable nurses to highlight adverse findings earlier in a patient's journey and improve patient outcomes. This article reviews the anatomy of the heart and cardiovascular disease, and describes how to pick out the subjective and objective information from patient histories and cardiac examination to make differential diagnoses.
Collapse
Affiliation(s)
- Anna Neary
- University of the West of England and the emergency department of the North Bristol NHS Trust
| | | |
Collapse
|
34
|
Malaty A, Sabharwal J, Lirette LS, Chaiban G, Eissa H, Tolba R. How to assess a new patient for a multidisciplinary chronic pain rehabilitation program: a review article. Ochsner J 2014; 14:96-100. [PMID: 24688340 PMCID: PMC3963061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
Abstract
BACKGROUND Chronic pain is a debilitating condition that affects people all over the world. To effectively treat chronic pain patients, assignment to patient-centered functional restoration and psychological pain rehabilitation programs at an early stage is essential. METHODS This article describes the initial patient screening and evaluation process for an interdisciplinary chronic pain rehabilitation program and highlights the relevant points that should be covered in each section of the initial assessment. RESULTS A thorough, detailed history that includes an evaluation of the patient's pain, functional limitations, prior medications, prior procedures/interventions, substance abuse, and psychiatric disorders, as well as the patient's social, legal, and developmental histories, are key to the proper screening and appropriate treatment of patients with chronic pain. CONCLUSION Thorough initial evaluation of patients is essential for proper enrollment in a chronic pain rehabilitation program. Such programs allow early treatment and reduce unnecessary health costs. Future prospective studies are needed to identify additional screening methods and triage tools to allow early admission of appropriate patients to these rehabilitation programs.
Collapse
Affiliation(s)
- Adham Malaty
- Department of Psychiatry, Cleveland Clinic, Cleveland, OH
| | | | | | - Gassan Chaiban
- Department of Pain Management, Ochsner Clinic Foundation, New Orleans, LA
| | - Hazem Eissa
- Department of Pain Management, Ochsner Clinic Foundation, New Orleans, LA
| | - Reda Tolba
- Department of Pain Management, Ochsner Clinic Foundation, New Orleans, LA
| |
Collapse
|
35
|
Munroe B, Curtis K, Considine J, Buckley T. The impact structured patient assessment frameworks have on patient care: an integrative review. J Clin Nurs 2013; 22:2991-3005. [PMID: 23656285 DOI: 10.1111/jocn.12226] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/09/2012] [Indexed: 11/30/2022]
Abstract
AIMS AND OBJECTIVES To evaluate structured patient assessment frameworks' impact on patient care. BACKGROUND Accurate patient assessment is imperative to determine the status and needs of the patient and the delivery of appropriate patient care. Nurses must be highly skilled in conducting timely and accurate patient assessments to overcome environmental obstacles and deliver quality and safe patient care. A structured approach to patient assessment is widely accepted in everyday clinical practice, yet little is known about the impact structured patient assessment frameworks have on patient care. DESIGN Integrative review. METHODS An electronic database search was conducted using Cumulative Index to Nursing and Allied Health Literature, Medical Literature Analysis and Retrieval System, PubMed and ProQuest Dissertations and Theses. The reference sections of textbooks and journal articles on patient assessment were manually searched for further studies. A comprehensive peer review screening process was undertaken. Research studies were selected that evaluated the impact structured patient assessment frameworks have on patient care. Studies were included if frameworks were designed for use by paramedics, nurses or medical practitioners working in prehospital or acute in-hospital settings. RESULTS Twelve studies met the inclusion criteria. There were no studies that evaluate the impact of a generic nursing assessment framework on patient care. The use of a structured patient assessment framework improved clinician performance of patient assessment. Limited evidence was found to support other aspects of patient care including documentation, communication, care implementation, patient and clinician satisfaction, and patient outcomes. CONCLUSION Structured patient assessment frameworks enhance clinician performance of patient assessment and hold the potential to improve patient care and outcomes; however, further research is required to address these evidence gaps, particularly in nursing. RELEVANCE TO CLINICAL PRACTICE Acute care clinicians should consider using structured patient assessment frameworks in clinical practice to enhance their performance of patient assessment.
Collapse
Affiliation(s)
- Belinda Munroe
- St George Hospital Trauma Department, Kogarah, NSW, Australia; The Wollongong Hospital Emergency Department, Wollongong, NSW, Australia; Sydney Nursing School, University of Sydney, Sydney, NSW , Australia
| | | | | | | |
Collapse
|
36
|
Ohm F, Vogel D, Sehner S, Wijnen-Meijer M, Harendza S. Details acquired from medical history and patients' experience of empathy--two sides of the same coin. BMC Med Educ 2013; 13:67. [PMID: 23659369 PMCID: PMC3661386 DOI: 10.1186/1472-6920-13-67] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2012] [Accepted: 05/06/2013] [Indexed: 05/14/2023]
Abstract
BACKGROUND History taking and empathetic communication are two important aspects in successful physician-patient interaction. Gathering important information from the patient's medical history is needed for effective clinical decision making while empathy is relevant for patient satisfaction. We wanted to investigate whether medical students near graduation are able to combine both skills as required in daily medical practice. METHODS Thirty near graduates from Hamburg Medical School participated in an assessment for clinical competences including a consultation hour with five standardized patients. Each patient interview was videotaped and standardized patients rated participants with the CARE questionnaire for consultation and relational empathy. All videotaped interviews were rated with a checklist based on the number of important medical aspects for each case. Data were analysed with the linear mixed model to correct for random effects. Regression analysis was performed to look for correlations between the number of questions asked by a participant and their respective empathy rating. RESULTS Of the 123 aspects that could have been gathered in total, students only requested 56.4% (95% CI 53.5-59.3). While no difference between male and female participants was found, a significant difference (p<.001) was observed between the two parts of the checklist with 61.1% (95% CI 57.9-64.3) of aspects asked for in part 1 (patient's symptoms) versus 52.0 (95 47.4-56.7) in part 2 (further history). All female standardized patients combined rated female participants (mean score 14.2, 95% CI 12.3-16.3) to be significantly (p<.01) more empathetic than male participants (mean score 19.2, 95% CI 16.3-22.6). Regression analysis revealed no correlation between the number of medical aspects gathered by a participant and his or her respective empathy score given by the standardized patient in the CARE questionnaire. CONCLUSION Gathering sufficient medical data from a patient's history and empathetic communication are two completely separate sides of the coin of history taking. While both skills have to be acquired during medical school training with particular focus on their respective learning objectives, medical students need to be provided with additional learning and feedback opportunities where they can be observed exercising both skills combined as required in physicians' daily practice.
Collapse
Affiliation(s)
- Friedemann Ohm
- University Medical Centre Hamburg-Eppendorf, Department of Internal Medicine, Martinistr. 52, 20246 Hamburg, Germany
| | - Daniela Vogel
- University Medical Centre Hamburg-Eppendorf, Department of Internal Medicine, Martinistr. 52, 20246 Hamburg, Germany
| | - Susanne Sehner
- University Medical Centre Hamburg-Eppendorf, Institute for Biometrics and Epidemiology, Martinistr. 52, 20246 Hamburg, Germany
| | - Marjo Wijnen-Meijer
- Center for Research and Development of Education, UMC Utrecht, P.O. Box 85500, Utrecht, GA 3508 The Netherlands
| | - Sigrid Harendza
- University Medical Centre Hamburg-Eppendorf, Department of Internal Medicine, Martinistr. 52, 20246 Hamburg, Germany
| |
Collapse
|
37
|
Mirzazadeh A, Bavarian B, Labaf A, Afshari A, Nikoo M, Meshkani ZS, Khashayar P. Curriculum gaps in teaching clinical skills to Iranian undergraduate medical students. Arch Med Sci 2013; 9:309-13. [PMID: 23671443 PMCID: PMC3648819 DOI: 10.5114/aoms.2013.33073] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2011] [Revised: 10/28/2011] [Accepted: 11/13/2011] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION The inefficacy of clinical skill education during the clerkship has been reported in several studies. The present study was conducted to evaluate the competency of medical students in performing several clinical skills through an Objective Structured Clinical Examination (OSCE), aiming to evaluate the quality of the existing curriculum in the clerkship phase. MATERIAL AND METHODS The cross sectional study was conducted at the end of the clerkship period, before the students had entered the internship. The OSCE exam was conducted in the morning (2 different tracts) and in the evening (2 similar tracts) and 86 students participated in the exam. Each tract consisted of seven stations. The students' points in the stations assessing history taking and clinical skills were compared. RESULTS The students gained the highest points in the history taking stations, whereas the procedure stations accounted for the lowest points; there was a significant difference between these stations (p < 0.001). The female students achieved higher scores in the OSCE exam compared to males (p = 0.004). CONCLUSIONS The OSCE exam revealed the inefficacy of the current medical curriculum in teaching the required clinical skill to undergraduate medical students during the clerkship.
Collapse
Affiliation(s)
- Azim Mirzazadeh
- Department of Internal Medicine, Imam Khomeini Hospital, Center for Educational Research in Medical Sciences (CERMS), Tehran University of Medical Sciences, Tehran, Iran
| | - Behrouz Bavarian
- Department of Pediatrics, Markaz e Tebbi Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Labaf
- Department of Emergency Medicine, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Afshari
- Department of Internal Medicine, Imam Khomeini Hospital, Center for Educational Research in Medical Sciences (CERMS), Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Nikoo
- Department of Internal Medicine, Imam Khomeini Hospital, Center for Educational Research in Medical Sciences (CERMS), Tehran University of Medical Sciences, Tehran, Iran
| | | | - Patricia Khashayar
- Endocrinology and Metabolism Research Center, Tehran University of Medical Sciences, Tehran, Iran
| |
Collapse
|