Structured Digital Self-Assessment of Patient Anamnesis Prior to Computed Tomography: Performance Evaluation and Added Value.

The aim of this study was to evaluate the performance of a tablet-based, digitized structured self-assessment (DSSA) of patient anamnesis (PA) prior to computed tomography (CT). Of the 317 patients consecutively referred for CT, the majority (n = 294) was able to complete the tablet-based questionnaire, which consisted of 67 items covering social anamnesis, lifestyle factors (e.g., tobacco abuse), medical history (e.g., kidney diseases), current symptoms, and the usability of the system. Patients were able to mark unclear questions for a subsequent discussion with the radiologist. Critical issues for the CT examination were structured and automatically highlighted as "red flags" (RFs) in order to improve patient interaction. RFs and marked questions were highly prevalent (69.5% and 26%). Missing creatinine values (33.3%), kidney diseases (14.4%), thyroid diseases (10.6%), metformin (5.5%), claustrophobia (4.1%), allergic reactions to contrast agents (2.4%), and pathological TSH values (2.0%) were highlighted most frequently as RFs. Patient feedback regarding the comprehensibility of the questionnaire and the tablet usability was mainly positive (90.9%; 86.2%). With advanced age, however, patients provided more negative feedback for both (p = 0.007; p = 0.039). The time effort was less than 20 min for 85.1% of patients, and faster patients were significantly younger (p = 0.046). Overall, the DSSA of PA prior to CT shows a high success rate and is well accepted by most patients. RFs and marked questions were common and helped to focus patients' interactions and reporting towards decisive aspects.

A model for diagnostics in neurological rehabilitation: an answer to 'the biopsychosocial disease consequence model in rehabilitation' of Talo et al.

In 1996, Talo et al. published their comprehensive version of a bio-psycho-social disease consequence model in rehabilitation, which deals with 'model development in the Finnish "Work hardening" programme for chronic pain'. The explanations given here serve to check the theoretical background of this model for certain basic assumptions as well as for the possibility to transfer it to other fields of rehabilitation. This is done from the viewpoint of neurological rehabilitation. The starting point is the consideration that the conceptions underlying the ICIDH are not suitable to serve as a mainstay of a model for diagnostics in rehabilitation because they do not reflect essential characteristics of the diagnostic process which is the basis for intervention. A model for diagnostics in neurological rehabilitation is contrasted to that of Talo et al. Regarding the theoretical background this model has different characteristics compared to that developed by the Finnish authors. It is guided by the process of gaining cognition in two different ways: (1) On the assumption that the diagnostic process reflects the same principles basically valid for theory-development in science, the basis of the model are conceptions for description and explanation of a patient's current condition. (2) Due to a holistic idea of disablement these conceptions are related to the individual's bio-psychosocial existence. As it relates to the model developed by Talo et al. this one represents a type of 'meta-level'. With regard to the long-term objective the main interest associated with the alternative model refers to its implications concerning the conception of the rehabilitation process as a prerequisite for internal quality management.