Diagnostic utility of selected faecal biochemical parameters in the determination of acute diarrhoea and associated defecation stooling characteristics in dogs: An observational study.

Diarrhoea, which is a clinical manifestation of various illnesses, is frequently observed in dogs. Regrettably, many dog owners find it difficult to provide comprehensive case histories, primarily because of limited interaction with their canine companions. This study aimed to evaluate the potential of faecal biochemical analytes in detecting and characterizing acute diarrhoea in dogs. Sixty-two domestic dogs were selected using the proportionate stratified sample technique. A structured questionnaire was used to collect demographic and clinical data. Faecal stool specimens from the dogs were obtained using the colon flush technique. The specimens were taken through biochemical analysis to determine urea, creatinine, total bilirubin, total cholesterol, triglycerides, gamma-glutamyl transferase and uric acid levels. Results showed a significant association between the diarrhoea status of the participants and their age, weight, breed, body size, source of last diet, period of inappetence, and other gastrointestinal signs (p < 0.050, respectively). Dogs that had not eaten in at least three days were five times more likely (p < 0.05) to have diarrhoea. Furthermore, miniature breeds were about six times more likely to develop diarrhoea (p < 0.05). Of the seven selected biochemical parameters, total faecal cholesterol was the most predictive index in diagnosing acute diarrhoea in dogs, with a likelihood ratio of 6.5, and it was the most accurate in predicting defecation stooling frequency and texture. In summary, in situations of inadequate case histories, measuring total faecal cholesterol could assist veterinarians in detecting diarrhoea and predicting its faecal stooling texture and frequency in dogs.

Machine Learning Techniques for Canine Myxomatous Mitral Valve Disease Classification: Integrating Anamnesis, Quality of Life Survey, and Physical Examination.

Myxomatous mitral valve disease (MMVD) is a prevalent canine cardiac disease typically diagnosed and classified using echocardiography. However, accessibility to this technique can be limited in first-opinion clinics. This study aimed to determine if machine learning techniques can classify MMVD according to the ACVIM classification (B1, B2, C, and D) through a structured anamnesis, quality of life survey, and physical examination. This report encompassed 23 veterinary hospitals and assessed 1011 dogs for MMVD using the FETCH-Q quality of life survey, clinical history, physical examination, and basic echocardiography. Employing a classification tree and a random forest analysis, the complex model accurately identified 96.9% of control group dogs, 49.8% of B1, 62.2% of B2, 77.2% of C, and 7.7% of D cases. To enhance clinical utility, a simplified model grouping B1 and B2 and C and D into categories B and CD improved accuracy rates to 90.8% for stage B, 73.4% for stages CD, and 93.8% for the control group. In conclusion, the current machine-learning technique was able to stage healthy dogs and dogs with MMVD classified into stages B and CD in the majority of dogs using quality of life surveys, medical history, and physical examinations. However, the technique faces difficulties differentiating between stages B1 and B2 and determining between advanced stages of the disease.

[Telemedical anesthesia consent - Are the patients ready for it? : A comparative requirement analysis before and during the pandemic]. / Telemedizinische Narkoseaufklärung ­ Sind Patienten bereit dafür? : Eine vergleichende Bedarfsanalyse vor und während der Pandemie.

BACKGROUND: Comprehensive anesthesia preparation by means of the anamnesis and physical examination is considered an essential part of the quality criteria for anesthesia. Especially due to the shortage of specialists, there are usually long waiting times in anesthesia outpatient departments and patients must frequently return in cases of missing or pending findings. Telemedicine already offers alternatives in the context of video communication. These alternatives are now particularly prominent due to the currently existing COVID-19 pandemic and the resulting recommendations for digitalization. OBJECTIVES: This comparative cross-sectional study was carried out to show via a patient survey which patient groups are suitable for a telemedical anesthesia preparation and whether the patients are already technically sufficiently equipped. MATERIAL AND METHODS: For this purpose, a total of 2080 patients (1030 before and 1050 during the pandemic) were interviewed using a questionnaire. For matched paired analyses, 630 pairs were formed according to their age and gender. RESULTS: Before and after the pandemic, there was an increase in the percentage of patients already using video communication in their daily lives (30.4% vs. 41.8%). Before the pandemic, 31.7% of patients indicated that they considered this concept of communication to be a practical and appropriate method for an educational conversation and after the pandemic this number increased to 46.6%. For the majority of patients personal contact with a local anesthesiologist was important (80.7% before vs. 67.4% during the pandemic). The number of patients who had the necessary technical equipment for video communication also increased as a result of the COVID-19 pandemic (50.4% vs. 58.2%). DISCUSSION: Almost half of the patients already seem to be open to a telemedical preoperative evaluation. As digitalization progresses, older generations are more likely to recognize the benefits and be able to own and use the necessary technology in the near future. User acceptance should be the central goal of concept development. This must be followed by a randomized controlled study to evaluate the potentials but also the problems in the perioperative process.

Association between clinical history in the radiographic request and diagnostic accuracy of thorax radiographs in dogs: A retrospective case-control study.

BACKGROUND: The effect of clinical history on the interpretation of radiographs has been widely researched in human medicine. There is, however, no data on this topic in veterinary medicine. HYPOTHESIS/OBJECTIVES: Diagnostic accuracy would improve when history was supplied. ANIMALS: Thirty client-owned dogs with abnormal findings on thoracic radiographs and confirmation of the disease, and 30 healthy client-owned controls were drawn retrospectively. METHODS: Retrospective case-control study. Sixty radiographic studies of the thorax were randomized and interpreted by 6 radiologists; first, with no access to the clinical information; and a second time with access to all pertinent clinical information and signalment. RESULTS: A significant increase in diagnostic accuracy was noted when clinical information was provided (64.4% without and 75.2% with clinical information; P = .002). There was no significant difference in agreement between radiologists when comparing no clinical information and with clinical information (Kappa 0.313 and 0.300, respectively). CONCLUSIONS AND CLINICAL IMPORTANCE: The addition of pertinent clinical information to the radiographic request significantly improves the diagnostic accuracy of thorax radiographs of dogs and is recommended as standard practice.

Patient Query in Adolescent Testicular Torsion Cases: "Was it Necessary to Mention My Scrotal Pain?"

Objective This study investigates the reasons for the failure to diagnose testicular torsion (TT) in different healthcare facilities (HCFs) and by various physicians. Method We retrospectively analyzed all male patients who underwent TT surgery within the adolescent age group between 2015 and 2023. Healthy adolescent patients who initially presented or were referred to an HCF and were subsequently diagnosed at our hospital for TT surgery were analyzed, focusing on why they were not diagnosed earlier. Results A total of 11 patients aged 10 to 17 who were surgically confirmed to have TT at our hospital between 2015 and 2023 were analyzed retrospectively. These patients had been admitted to various public and private HCFs due to the sudden onset of symptoms such as abdominal pain, vomiting, fainting, sweating, and walking difficulties during and after working hours. Four patients had previously been admitted to one HCF, while seven had been admitted two to six times to an HCF. All patients were healthy, and all but one had received age-appropriate education. However, only two of them had reported experiencing scrotal pain. Laboratory tests and/or radiological examinations were conducted on eight patients, and nine patients received medical treatment and/or prescriptions. None of the patients were initially diagnosed with acute scrotum. Conclusion Despite having unrestricted and free access to well-equipped HCFs, the early diagnosis and treatment of TT are not ensured. Factors contributing to this delay include patients' concealment of, or failure to fully disclose, scrotal complaints, as well as physicians' incomplete history taking and genital examinations. The physician's male gender was not found to contribute to an earlier diagnosis of TT. A mandatory genital examination should be included in the emergency assessment protocol for male patients.

Adherencia a la rehabilitación pulmonar en pacientes con enfermedad pulmonar instersticial difusa (EPID) / Adherence to pulmonary rehabilitation in patients with diffuse interstitial pulmonary disease (DILD)

Introducción La enfermedad pulmonar intersticial difusa (EPID), a pesar de su baja prevalencia, presenta un curso progresivo y letal. Como estrategia secundaria al tratamiento farmacológico, los pacientes son remitidos a programas de rehabilitación pulmonar; no obstante, existe escasa evidencia con relación a la adherencia a dichos programas. Objetivo Analizar la adherencia de los pacientes diagnosticados con EPID a los programas de rehabilitación pulmonar en una clínica de Colombia en el año 2021. Materiales y métodos Estudio descriptivo observacional y prospectivo donde se vincularon 74 pacientes con EPID, que se dividieron en 2 grupos, adherencia baja/moderada y adherencia alta, tomando como referente el modelo de cumplimiento de Oates et al. Para la comparación de los dos grupos se realizó la prueba chi2 y la prueba T student para muestras independientes. Se tuvo en cuenta una significación del 95%, y se consideraron significativos valores p<0,05. Resultados Se obtuvo una adherencia alta en el 67,6% de los pacientes vinculados en el estudio. En las variables clínicas, diagnósticos, hospitalizaciones, días hospitalizados, y en el dominio síntomas del cuestionario de calidad de vida se presentaron diferencias significativas con un valor p≤0,05 entre los grupos de adherencia. La razón de motivo de abandono del programa de rehabilitación pulmonar en la mayoría de pacientes fue por exacerbación y no tener dinero para el transporte. Conclusiones Se presentó una alta adherencia en el 67,6% de los participantes. Pacientes con alta adherencia tenían mayor prevalencia de EPID clasificadas, hospitalizaciones, distancia recorrida y mejor calidad de vida (AU)

Introduction Diffuse interstitial lung disease (DILD), despite its low prevalence, has a progressive and lethal course. As a secondary strategy to pharmacological treatment, patients are referred to pulmonary rehabilitation programs; however, there is little evidence regarding adherence to these programs. Objective To analyze the adherence of patients diagnosed with ILD to pulmonary rehabilitation programs in a clinic in Colombia in the year 2021. Materials and methods Observational and prospective descriptive study where 74 patients with ILD were linked, who were divided into two groups, low/moderate adherence and high adherence, taking as reference the compliance model of Oates et al. For the comparison of the two groups, the chi2 test and the T student test for independent samples were performed. A significance of 95% was taken into account, and significant p-values<0.05 were considered. Results High adherence was obtained in 67.6% of the patients included in the study. In the clinical variables, diagnoses, hospitalizations, days hospitalized, and in the symptoms domain of the quality of life questionnaire, there were significant differences with a p-value≤0.05 between the adherence groups. The reason for abandonment of the pulmonary rehabilitation program in the majority of patients was due to exacerbation and not having money for transportation. Conclusions High adherence was present in 67.6% of the participants. Patients with high adherence had a higher prevalence of classified ILD, hospitalizations, distance traveled and better quality of life (AU)

Temporal uncertainty in disease diagnosis.

There is a profound paradox in modern medical knowledge production: The more we know, the more we know that we (still) do not know. Nowhere is this more visible than in diagnostics and early detection of disease. As we identify ever more markers, predictors, precursors, and risk factors of disease ever earlier, we realize that we need knowledge about whether they develop into something experienced by the person and threatening to the person's health. This study investigates how advancements in science and technology alter one type of uncertainty, i.e., temporal uncertainty of disease diagnosis. As diagnosis is related to anamnesis and prognosis it identifies how uncertainties in all these fields are interconnected. In particular, the study finds that uncertainty in disease diagnosis has become more subject to prognostic uncertainty because diagnosis is more connected to technologically detected indicators and less closely connected to manifest and experienced disease. These temporal uncertainties pose basic epistemological and ethical challenges as they can result in overdiagnosis, overtreatment, unnecessary anxiety and fear, useless and even harmful diagnostic odysseys, as well as vast opportunity costs. The point is not to stop our quest for knowledge about disease but to encourage real diagnostic improvements that help more people in ever better manner as early as possible. To do so, we need to pay careful attention to specific types of temporal uncertainty in modern diagnostics.

Sleep Bruxism in Children-What Can Be Learned from Anamnestic Information.

Sleep bruxism (SB) is a masticatory muscle activity during sleep, and its clinical manifestation in young children is still unclear. The aim of the present study was to evaluate the role of anamnestic information in predicting possible SB in children aged 4-12 years. In a cross-sectional retrospective exploratory study, the dental files of 521 children were examined with regard to the following anamnestic information: gender, age, medical conditions associated with ear, nose, and throat (ENT), respiratory disorders, use of methylphenidate (Ritalin), oral habits, and bruxing during sleep. A child was defined as presenting possible SB when a positive report was received from parents regarding such behavior (SB positive, No. = 84). There were no age- and/or gender-wise differences between SB-positive children and children whose parents did not report SB behavior (SB negative). SB-positive children suffered more from ENT and respiratory disorders than children without SB. Additionally, the use of pacifiers/finger sucking, as well as snoring, were more common among SB-positive children as compared to their SB-negative counterparts (Chi-square). The variables which were found to significantly increase the odds of possible SB in children were mouth breathing, ENT problems, and use of a pacifier or finger sucking (forward stepwise logistic regression). Clinicians should look for clinical signs of possible SB in children whose anamnesis reveals one or more of these anamnestic signals.

Characterisation of the management of patients with migraine in the primary care setting in Spain. Analysis of the results of the European My-LIFE anamnesis project.

INTRODUCTION: Migraine affects more than 4.5 million people in Spain, resulting in a considerable socioeconomic impact. Although national and international guidelines have been published, the management of patients with migraine, especially those with chronic migraine, is inadequate. SUBJECTS AND METHODS: We conducted a survey among 40 primary care (PC) physicians in Spain as part of a European project involving 201 physicians from 5 countries. RESULTS: Most participants issued diagnoses of episodic migraine and chronic migraine (93% vs 65%); 82.5% indicated that they did not refer these patients to specialists, and 100% of PC physicians stated that they were responsible for patient follow-up. The main tools used in PC for diagnosis and follow-up were clinical interviews, medical histories, and the patient diaries. Our data revealed that the treatments prescribed were not in accordance with the national and international guidelines. Participants who did not refer patients estimated that only 48% of patients received preventive treatment, and that the assessment of efficacy was based on patient perception. Seventy percent of respondents indicated a need for migraine training. Finally, 100% of participants considered that a guide for medical history taking and referral would be essential or useful for the management of migraine in PC. CONCLUSIONS: The survey results revealed a need for training and guidance in PC to improve the diagnosis and management of patients with migraine, particularly chronic migraine.

The Key Role of a Psychoactive Substance Use History in Comprehensive Cardiovascular Risk Assessment, Diagnosis, Treatment, and Prevention.

BACKGROUND: Psychoactive substances have toxic effects resulting different cardiovascular and non-cardiovascular organ damage. Through a variety of mechanisms, they can trigger the onset of various forms of cardiovascular disease: acute or chronic, transient or permanent, subclinical or symptomatic. Hence, a thorough knowledge of the patient's drug habits is essential for a more complete clinical-etiopathogenetic diagnosis and consequent therapeutic, preventive, and rehabilitative management. SUMMARY: The prime reason for taking a psychoactive substance use history in the cardiovascular context is to identify those people who use substances (whether habitual or occasional users, symptomatic or not) and adequately assess their overall cardiovascular risk profile in terms of "user status" and type of substance(s) used. A psychoactive substance history could also alert the physician to suspect, and eventually diagnose, cardiovascular disease related to the intake of psychoactive substances, so optimizing the medical management of users. This anamnesis could finally assess the likelihood of patients persisting in the habit as a user or relapse, while maintaining high their cardiovascular risk profile. Taking such a history should be mandatory when a causal connection is suspected between intake of psychoactive substances and the observed symptoms or pathology, regardless of whether the individual is a declared user or not. KEY MESSAGES: The purpose of this article was to provide practical information on when, how, and why to perform a psychoactive substance use history.

"And how am I going to ask about this?" - introducing the course "sexual anamnesis" in peer teaching for medical students in Würzburg.

Aim: A course on sexual anamnesis based on peer teaching was developed, piloted, and evaluated at the medical school of the University of Würzburg. The course is part of the expansion of the communication curriculum and in order to close existing gaps in medical education. An implementation of the course in the curriculum is meant to give all students the opportunity to acquire professional skills in this area. Method: The course consists of knowledge transfer, interactive exercises, role plays with structured feedback, and an exchange with practitioners. A standardized online evaluation of the course took place in regard to teaching quality, subjective learning success, and acceptance. The voluntary course was conducted online in the summer semester of 2021 and in person in the winter semester of 2021/22. A total of 68 students participated. The training of the tutors was realized in cooperation with the "Deutsche Aidshilfe" (DAH). Results: The course was successfully conducted online and in person. A total of 60 students participated in the evaluation. More than 80% of the students rated the course as structured. They assessed an adequate mix of knowledge transfer and practical exercises. More than half of the students reported that they were more confident in performing sexual anamnesis after they participated in the course. There was an open exchange among the students. More than 90% of the students found the peer teaching by the tutors helpful. Conclusion: The implementation of the course closes a relevant gap of the curriculum in Würzburg. Sexual anamnesis will be a regular part of the curriculum starting in the winter semester 2022/23. The concept can also be transferred to other universities.

Comparison of conventionally and digitally completed patient consent-anamnesis forms in terms of surface contamination.

BACKGROUND: With the development of modern technology, the use of software-based applications in the field of health has become increasingly widespread. For this reason, computer-assisted personal registration forms have been developed using software programs. OBJECTIVE: The aim of this study was to compare surface contamination during the filling of orthodontic anamnesis-consent forms, traditionally on paper and digitally on a tablet equipped with a software application, measured in confined spaces using the 3M Clean-Trace Luminometer device. METHODS: In order for the participants to complete the orthodontic anamnesis-consent forms, two separate identical cabins with standard flat surfaces were prepared. In the first cabin, the participants conventionally completed these forms on paper (conventional group), while in the second cabin, the other group used a tablet equipped with a software program for this purpose (digital group). After the form completion process, surface pollution of the predetermined areas was measured in both cabins using a 3M Clean-Trace Luminometer device. RESULTS: Surface contamination was found to be statistically significantly higher in all measurement areas in the conventional group than in the digital group. Despite a statistically significant difference between the two groups in relation to the measurements performed using the pens (conventional or electronic), this was not as strong as those found for the remaining surfaces. CONCLUSION: The completion of orthodontic anamnesis-consent forms over tablets significantly reduced surface contamination in the close environment. This study reflects the importance of digitization - which has become beneficial in many fields - in reducing the spread of infections.

The Clinical Picture and Fecundity of Primary and Recurrent Ovarian Endometriosis with Family History: A Retrospective Analysis.

This study aims to evaluate the role of endometriosis family history on the clinical manifestation and fertility performance of primary and recurrent endometriosis. In total, 312 primary and 323 recurrent endometrioma patients with a histological diagnosis were included in this study. Family history was significantly correlated with recurrent endometriosis (adjusted OR: 3.52, 95% CI: 1.09-9.46, p = 0.008). Patients with a family history showed a significantly higher proportion of recurrent endometriosis (75.76% vs. 49.50%), higher rASRM scores, higher incidence of severe dysmenorrhea, and severe pelvic pain than the sporadic cases. Recurrent endometrioma showed statistical increase in rASRM scores, percentage of rASRM Stage IV, dysmenorrhea, dyschezia, those undergoing semi-radical surgery or unilateral oophorosalpingectomy, postoperative medical treatment, e with a positive family history, while a decrease in the incidence of asymptomatic phenomena and those undergoing ovarian cystectomy compared to those with primary endometriosis. The naturally conceived pregnancy rate was higher in primary endometriosis compared to recurrent endometriosis. Compared to recurrent endometriosis with a negative family history, recurrent endometriosis with a positive family history had a higher incidence of severe dysmenorrhea, chronic pelvic pain, a higher spontaneous abortion rate, and a lower natural pregnancy rate. Primary endometriosis with a family history presented a higher incidence of severe dysmenorrhea than those without a family history. In conclusion, endometriosis patients with a positive family history presented a higher pain severity and lower conception probability compared to the sporadic cases. Recurrent endometriosis showed further-exacerbated clinical manifestations, more pronounced familial tendency, and lower pregnancy rates than primary endometriosis.

Identification of Pre-Renal and Intrinsic Acute Kidney Injury by Anamnestic and Biochemical Criteria: Distinct Association with Urinary Injury Biomarkers.

Acute kidney injury (AKI) is a syndrome of sudden renal excretory dysfunction with severe health consequences. AKI etiology influences prognosis, with pre-renal showing a more favorable evolution than intrinsic AKI. Because the international diagnostic criteria (i.e., based on plasma creatinine) provide no etiological distinction, anamnestic and additional biochemical criteria complement AKI diagnosis. Traditional, etiology-defining biochemical parameters, including the fractional excretion of sodium, the urinary-to-plasma creatinine ratio and the renal failure index are individually limited by confounding factors such as diuretics. To minimize distortion, we generated a composite biochemical criterion based on the congruency of at least two of the three biochemical ratios. Patients showing at least two ratios indicative of intrinsic AKI were classified within this category, and those with at least two pre-renal ratios were considered as pre-renal AKI patients. In this study, we demonstrate that the identification of intrinsic AKI by a collection of urinary injury biomarkers reflective of tubular damage, including NGAL and KIM-1, more closely and robustly coincide with the biochemical than with the anamnestic classification. Because there is no gold standard method for the etiological classification of AKI, the mutual reinforcement provided by the biochemical criterion and urinary biomarkers supports an etiological diagnosis based on objective diagnostic parameters.

[History and physycal examination]. / Anamnesis y examen físico.

The most effective method for diagnosing food allergy is the clinical history, which includes anamnesis and physical examination. The anamnesis must include a directed and detailed questioning, and together with the physical examination, it will provide the necessary data to guide the diagnosis and suggest whether the pathophysiology is mediated or not by IgE, which is relevant for the selection and interpretation of the tests. specific and establish the accurate diagnosis, in addition to evaluating the possibility of distinguishing between the different differential diagnoses. It is important to assess the clinical history, because no in vivo or in vitro test is relevant if it is not confirmed with it. Even if there is a strong history of food allergy detected in the history, positive tests can confirm the diagnosis without the need for oral challenge, thus avoiding the risk and cost of performing it. The expression of food allergy is influenced by non-modifiable risk factors that include sex, race and genetics (familial), and modifiable factors: atopic dermatitis, vitamin D deficiency, diet high in polyunsaturated fats and deficient in antioxidants, consumption of antacid drugs, obesity, increased hygiene, influence of the microbiota, time and route of food exposure (increased risk by delaying oral ingestion of allergens and concomitant environmental exposure of the same that leads to sensitization and allergy).

El método más efectivo para el diagnóstico de alergia alimentaria es la historia clínica, que comprende la anamnesis y el examen físico. La anamnesis debe incluir el interrogatorio dirigido y detallado, y junto con el examen físico aportarán los datos necesarios para orientar hacia el diagnóstica, y sugerir si la fisiopatología es mediada o no por IgE, lo que es pertinente para la selección e interpretación de las pruebas específicas y establecer el diagnóstico certero, además de evaluar la posibilidad de distinguir entre los distintos diagnósticos diferenciales. Es importante valorar la historia clínica, porque ninguna prueba in vivo o in vitro tienen relevancia de no ser confirmados con la misma. Incluso si existe un fuerte antecedente de alergia alimentaria detectado en la anamnesis, las pruebas positivas pueden confirmar el diagnóstico sin necesidad del desafío oral, y de esta forma evitarse el riesgo y costo de su realización. La expresión de la alergia alimentaria está influenciada por factores de riesgo no modificables que incluyen sexo, raza y genética (familiares), y factores modificables: dermatitis atópica, deficiencia de vitamina D, dieta con alta cantidad de grasas poliinsaturadas y deficiente de antioxidantes, consumo de fármacos antiácidos, obesidad, aumento de la higiene, influencia de la microbiota, tiempo y vía de exposición de los alimentos (mayor riesgo al retrasar la ingestión oral de alérgenos y concomitante exposición ambiental de los mismos que conduce a sensibilización y alergia).

Rehabilitación propioceptiva del síndrome de hombro doloroso / Proprioceptive rehabilitation of painful shoulder syndrome / Reabilitação proprioceptiva da síndrome do ombro doloroso

El hombro es una de las regiones anatómicas de mayor movilidad en la vida cotidiana, siendo una de las causas de consulta más frecuentes en el área de fisioterapia para su rehabilitación, pues la primera línea de acción es el tratamiento conservador del hombro; por ello, es de suma importancia conocer y evaluar el complejo articular del hombro, así como también de la región cervicotorácica, con los resultados de la valoración establecer una estrategia de tratamiento que pueden ir desde la terapia manual, el masaje terapéutico, cambios de temperatura hasta el empleo de otros agentes físicos. Paciente femenino de 42 años, con ocupación de asistente odontológica; no reporta discapacidad previa. Como antecedente médico se presenta accidente de tránsito en motocicleta sin producir fractura de hueso ni luxación, ocurrido ocho años antes de la consulta en fisiatría, la paciente tiene afectado el desarrollo de las actividades de la vida cotidiana. Recibió serie de tratamientos durante 10 sesiones, en las cuales se aplican agentes físicos, dado que anteriormente recibió tratamiento farmacológico sin resultados favorables. Se aplica protocolo de rehabilitación fundamentado en las técnicas de propiocepción y al finalizar la terapia la paciente reporta dolor leve, y mejora en la realización de actividades de la vida diaria.

The shoulder is one of the anatomical regions of greater mobility in daily life, being one of the most frequent causes of consultation in the area of physiotherapy for rehabilitation, since the first line of action is the conservative treatment of the shoulder; therefore, it is of utmost importance to know and evaluate the articular complex of the shoulder, as well as the cervicothoracic region, with the results of the assessment to establish a treatment strategy that can range from manual therapy, therapeutic massage, temperature changes to the use of other physical agents. Female patient, 42 years old, with occupation as a dental assistant; she reports no previous disability. As medical history, she had a traffic accident on a motorcycle without bone fracture or dislocation, which occurred eight years before the physiatry consultation, the patient has affected the development of activities of daily living. She received a series of treatments during 10 sessions, in which physical agents are applied, since she had previously received pharmacological treatment without favorable results. Rehabilitation protocol based on proprioception techniques is applied and at the end of therapy the patient reports mild pain and improvement in the performance of activities of daily living.

O ombro é uma das regiões anatômicas de maior mobilidade na vida diária, sendo uma das causas mais freqüentes de consulta na área de fisioterapia para reabilitação, pois a primeira linha de ação é o tratamento conservador do ombro; portanto, é extremamente importante conhecer e avaliar o complexo articular do ombro, bem como a região cervicotorácica, com os resultados da avaliação para estabelecer uma estratégia de tratamento que pode variar desde a terapia manual, massagem terapêutica, mudanças de temperatura até o uso de outros agentes físicos. Paciente do sexo feminino, 42 anos de idade, trabalhando como assistente odontológica; nenhuma deficiência anterior foi relatada. O histórico médico inclui um acidente de trânsito em uma motocicleta sem fratura ou deslocamento ósseo, que ocorreu oito anos antes da consulta ao fisiatra; as atividades de vida diária do paciente são afetadas. Ela recebeu uma série de tratamentos durante 10 sessões, nas quais foram aplicados agentes físicos, já que ela havia recebido anteriormente tratamento farmacológico sem resultados favoráveis. Um protocolo de reabilitação baseado em técnicas de propriocepção foi aplicado e ao final da terapia o paciente relatou dor leve e melhora no desempenho das atividades da vida diária.

Avaliação clínica por enfermeiros: desenvolvimento de e-book / Clinical evaluation by nurses: development of an e-book

Resumo: A pesquisa trata da criação de e-book para subsidiar a avaliação clínica realizada por enfermeiros a pacientes hospitalizados. A tecnologia desenvolvida contempla estrutura teórica, pautada em evidências científicas e no conteúdo, já validado, da série de aplicativos móveis, AVALIA TIS. Como método, seguiram-se os moldes da pesquisa metodológica, desenvolvida em duas fases: (I) exploratória que constituiu três etapas: revisão de literatura, desenvolvimento e aplicação de questionário a enfermeiros da prática assistencial; (II): criação do e-book, com seis etapas: definição do conteúdo; definição do editor de texto; seleção de imagens e produção vídeos; editoração do e-book; revisão do e-book; e edição final e-book. Como resultado, obteve-se e-book intitulado AVALIA TIS: avaliação clínica por enfermeiros, que aborda os principais conceitos da primeira etapa do processo de enfermagem e contém orientações para a prática destes profissionais. Esta tecnologia serve como ferramenta para educação em serviço de média complexidade, desenvolvida com apoio de outras áreas do conhecimento para o design, produção de vídeo e editoração de texto. A característica inovatória se pauta no conteúdo estruturado com informações e conhecimentos da avaliação clínica específica do enfermeiro centrada em subsídios para o cuidado e processo de enfermagem, com a inclusão de vídeos educativos, imagens referentes às manobras propedêuticas, instrumentos e escalas utilizados na avaliação. De abrangência nacional, tem impacto científico, social e na educação, com contribuição de novos conhecimentos para a área de enfermagem, assistência baseada em evidências, educação em serviço e formação de profissionais de enfermagem.

Abstract: The study focuses on the development of an e-book to assist nurses in their clinical assessments of hospitalized patients. The technologies developed includes a theoretical framework based on empirical data and the already verified content of the AVALIA TIS series of mobile applications. The methodological research was used as a method, and it was developed in two stages: (I) exploratory in three stages: literature review, development, and application of a questionnaire to nurses in care practice; II) development of the e-book, with six stages: content definition; text editor definition; images selection and video production; editing of the e-book; e-book review; and final e-book edition. As a result, an e-book entitled "AVALIA TIS: Avaliação clínica por enfermeiros" was obtained, which addresses the main concepts of the first stage of the nursing process and includes guidelines for these professionals' practice. This technology is a medium-complexity in-service education resource developed with the assistance of other areas of knowledge for design, video production, and text publishing. The innovative characteristic is that the content is organized with information and knowledge of the specific clinical evaluation of nurses centered on subsidies for nursing care and process, with the inclusion of educational videos, and images referring to propaedeutic maneuvers, instruments, and scales used in the evaluation. It has a national impact and affects science, society, and education through the inclusion of new knowledge to the nursing field, evidence-based care, in-service training, and nursing professional development.

Digital Tools Designed to Obtain the History of Present Illness From Patients: Scoping Review.

BACKGROUND: Many medical conditions, perhaps 80% of them, can be diagnosed by taking a thorough history of present illness (HPI). However, in the clinical setting, situational factors such as interruptions and time pressure may cause interactions with patients to be brief and fragmented. One solution for improving clinicians' ability to collect a thorough HPI and maximize efficiency and quality of care could be to use a digital tool to obtain the HPI before face-to-face evaluation by a clinician. OBJECTIVE: Our objective was to identify and characterize digital tools that have been designed to obtain the HPI directly from patients or caregivers and present this information to clinicians before a face-to-face encounter. We also sought to describe outcomes reported in testing of these tools, especially those related to usability, efficiency, and quality of care. METHODS: We conducted a scoping review using predefined search terms in the following databases: MEDLINE, CINAHL, PsycINFO, Web of Science, Embase, IEEE Xplore Digital Library, ACM Digital Library, and ProQuest Dissertations & Theses Global. Two reviewers screened titles and abstracts for relevance, performed full-text reviews of articles meeting the inclusion criteria, and used a pile-sorting procedure to identify distinguishing characteristics of the tools. Information describing the tools was primarily obtained from identified peer-reviewed sources; in addition, supplementary information was obtained from tool websites and through direct communications with tool creators. RESULTS: We identified 18 tools meeting the inclusion criteria. Of these 18 tools, 14 (78%) used primarily closed-ended and multiple-choice questions, 1 (6%) used free-text input, and 3 (17%) used conversational (chatbot) style. More than half (10/18, 56%) of the tools were tailored to specific patient subpopulations; the remaining (8/18, 44%) tools did not specify a target subpopulation. Of the 18 tools, 7 (39%) included multilingual support, and 12 (67%) had the capability to transfer data directly into the electronic health record. Studies of the tools reported on various outcome measures related to usability, efficiency, and quality of care. CONCLUSIONS: The HPI tools we identified (N=18) varied greatly in their purpose and functionality. There was no consensus on how patient-generated information should be collected or presented to clinicians. Existing tools have undergone inconsistent levels of testing, with a wide variety of different outcome measures used in evaluation, including some related to usability, efficiency, and quality of care. There is substantial interest in using digital tools to obtain the HPI from patients, but the outcomes measured have been inconsistent. Future research should focus on whether using HPI tools can lead to improved patient experience and health outcomes, although surrogate end points could instead be used so long as patient safety is monitored.