Person-based design and evaluation of MIA, a digital medical interview assistant for radiology.

Introduction: Radiologists frequently lack direct patient contact due to time constraints. Digital medical interview assistants aim to facilitate the collection of health information. In this paper, we propose leveraging conversational agents to realize a medical interview assistant to facilitate medical history taking, while at the same time offering patients the opportunity to ask questions on the examination. Methods: MIA, the digital medical interview assistant, was developed using a person-based design approach, involving patient opinions and expert knowledge during the design and development with a specific use case in collecting information before a mammography examination. MIA consists of two modules: the interview module and the question answering module (Q&A). To ensure interoperability with clinical information systems, we use HL7 FHIR to store and exchange the results collected by MIA during the patient interaction. The system was evaluated according to an existing evaluation framework that covers a broad range of aspects related to the technical quality of a conversational agent including usability, but also accessibility and security. Results: Thirty-six patients recruited from two Swiss hospitals (Lindenhof group and Inselspital, Bern) and two patient organizations conducted the usability test. MIA was favorably received by the participants, who particularly noted the clarity of communication. However, there is room for improvement in the perceived quality of the conversation, the information provided, and the protection of privacy. The Q&A module achieved a precision of 0.51, a recall of 0.87 and an F-Score of 0.64 based on 114 questions asked by the participants. Security and accessibility also require improvements. Conclusion: The applied person-based process described in this paper can provide best practices for future development of medical interview assistants. The application of a standardized evaluation framework helped in saving time and ensures comparability of results.

Transforming Health Care Through Chatbots for Medical History-Taking and Future Directions: Comprehensive Systematic Review.

BACKGROUND: The integration of artificial intelligence and chatbot technology in health care has attracted significant attention due to its potential to improve patient care and streamline history-taking. As artificial intelligence-driven conversational agents, chatbots offer the opportunity to revolutionize history-taking, necessitating a comprehensive examination of their impact on medical practice. OBJECTIVE: This systematic review aims to assess the role, effectiveness, usability, and patient acceptance of chatbots in medical history-taking. It also examines potential challenges and future opportunities for integration into clinical practice. METHODS: A systematic search included PubMed, Embase, MEDLINE (via Ovid), CENTRAL, Scopus, and Open Science and covered studies through July 2024. The inclusion and exclusion criteria for the studies reviewed were based on the PICOS (participants, interventions, comparators, outcomes, and study design) framework. The population included individuals using health care chatbots for medical history-taking. Interventions focused on chatbots designed to facilitate medical history-taking. The outcomes of interest were the feasibility, acceptance, and usability of chatbot-based medical history-taking. Studies not reporting on these outcomes were excluded. All study designs except conference papers were eligible for inclusion. Only English-language studies were considered. There were no specific restrictions on study duration. Key search terms included "chatbot*," "conversational agent*," "virtual assistant," "artificial intelligence chatbot," "medical history," and "history-taking." The quality of observational studies was classified using the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) criteria (eg, sample size, design, data collection, and follow-up). The RoB 2 (Risk of Bias) tool assessed areas and the levels of bias in randomized controlled trials (RCTs). RESULTS: The review included 15 observational studies and 3 RCTs and synthesized evidence from different medical fields and populations. Chatbots systematically collect information through targeted queries and data retrieval, improving patient engagement and satisfaction. The results show that chatbots have great potential for history-taking and that the efficiency and accessibility of the health care system can be improved by 24/7 automated data collection. Bias assessments revealed that of the 15 observational studies, 5 (33%) studies were of high quality, 5 (33%) studies were of moderate quality, and 5 (33%) studies were of low quality. Of the RCTs, 2 had a low risk of bias, while 1 had a high risk. CONCLUSIONS: This systematic review provides critical insights into the potential benefits and challenges of using chatbots for medical history-taking. The included studies showed that chatbots can increase patient engagement, streamline data collection, and improve health care decision-making. For effective integration into clinical practice, it is crucial to design user-friendly interfaces, ensure robust data security, and maintain empathetic patient-physician interactions. Future research should focus on refining chatbot algorithms, improving their emotional intelligence, and extending their application to different health care settings to realize their full potential in modern medicine. TRIAL REGISTRATION: PROSPERO CRD42023410312; www.crd.york.ac.uk/prospero.

Development of a clinical investigation protocol for occupational auditory health.

Introduction: Considering that noise is present in different work environments, occupational health regulations have been created that advocate for the care of employees' auditory system in these environments. Occupational hearing assessment should be performed by audiologists through audiological examinations, otoscopy, as well as an interview to assess possible risk factors for the development of hearing loss. However, up to the present moment, a standardized set of updated questions for this interview has not been defined. Objectives: To develop a clinical investigation instrument for occupational auditory health that provides support for clinical decision-making and differential diagnosis. Methods: The study was conducted using Design Thinking as a methodological approach in its stages of inspiration (problem identification), ideation (theoretical foundation and protocol design), and prototyping (protocol construction). Experience report: This study was conducted with the objective of providing support for clinical decision-making and differential diagnosis of the auditory aspects of the assisted population. The Protocolo de Investigação Clínica da Saúde Auditiva Ocupacional was developed, consisting of six main sections that address medical history, lifestyle habits, exposure to non-occupational noise, work history, extra-auditory symptoms, and auditory and vestibular signs and symptoms, aimed at investigating workers' auditory health and related aspects. Conclusions: The developed instrument can be used for data collection and assist audiologists in the occupational health teams in diagnosis and decision-making processes.

Introdução: Considerando que o ruído está presente em diferentes ambientes laborais, foram criadas normas regulamentadoras de saúde ocupacional que preconizam o cuidado com o sistema auditivo dos colaboradores destes ambientes. A avaliação auditiva ocupacional deve ser realizada pelo fonoaudiólogo através dos exames de audiometria e meatoscopia, além de uma entrevista para avaliar possíveis fatores de risco para o desenvolvimento de perdas auditivas. Entretanto, até o presente momento não foi definido um padrão de perguntas atualizado para esta entrevista. Objetivos: Desenvolver um instrumento de investigação clínica da saúde auditiva ocupacional que ofereça suporte para tomadas de decisões clínicas e diagnóstico diferencial. Métodos: O estudo foi desenvolvido utilizando o design thinking como abordagem metodológica em suas etapas de inspiração (observada a problemática), ideação (fundamentação e delineamento teórico do protocolo) e prototipação (construção do protocolo). Relato da experiência: Este estudo foi realizado objetivando oferecer suporte para tomadas de decisões clínicas e diagnóstico diferencial dos aspectos auditivos da população assistida. Foi desenvolvido o Protocolo de Investigação Clínica da Saúde Auditiva Ocupacional, composto de seis seções principais que abordam o histórico clínico, hábitos de vida, exposição a ruído extraocupacional, histórico laboral, sintomas extra-auditivos e sinais e sintomas auditivos e vestibulares, que visam investigar a saúde auditiva do trabalhador e aspectos relacionados a ela. Conclusões: O instrumento desenvolvido poderá servir para a coleta de dados e auxílio para diagnóstico e tomada de decisões dos fonoaudiólogos das equipes de saúde ocupacional.

Healthcare leaders' experiences of implementing artificial intelligence for medical history-taking and triage in Swedish primary care: an interview study.

BACKGROUND: Artificial intelligence (AI) holds significant promise for enhancing the efficiency and safety of medical history-taking and triage within primary care. However, there remains a dearth of knowledge concerning the practical implementation of AI systems for these purposes, particularly in the context of healthcare leadership. This study explores the experiences of healthcare leaders regarding the barriers to implementing an AI application for automating medical history-taking and triage in Swedish primary care, as well as the actions they took to overcome these barriers. Furthermore, the study seeks to provide insights that can inform the development of AI implementation strategies for healthcare. METHODS: We adopted an inductive qualitative approach, conducting semi-structured interviews with 13 healthcare leaders representing seven primary care units across three regions in Sweden. The collected data were subsequently analysed utilizing thematic analysis. Our study adhered to the Consolidated Criteria for Reporting Qualitative Research to ensure transparent and comprehensive reporting. RESULTS: The study identified implementation barriers encountered by healthcare leaders across three domains: (1) healthcare professionals, (2) organization, and (3) technology. The first domain involved professional scepticism and resistance, the second involved adapting traditional units for digital care, and the third inadequacies in AI application functionality and system integration. To navigate around these barriers, the leaders took steps to (1) address inexperience and fear and reduce professional scepticism, (2) align implementation with digital maturity and guide patients towards digital care, and (3) refine and improve the AI application and adapt to the current state of AI application development. CONCLUSION: The study provides valuable empirical insights into the implementation of AI for automating medical history-taking and triage in primary care as experienced by healthcare leaders. It identifies the barriers to this implementation and how healthcare leaders aligned their actions to overcome them. While progress was evident in overcoming professional-related and organizational-related barriers, unresolved technical complexities highlight the importance of AI implementation strategies that consider how leaders handle AI implementation in situ based on practical wisdom and tacit understanding. This underscores the necessity of a holistic approach for the successful implementation of AI in healthcare.

Unveiling a foreign body masquerading as periarticular calcification: a case report.

INTRODUCTION: Evaluating isolated extremity discomfort can be challenging when initial imaging and exams provide limited information. Though subtle patient history hints often underlie occult pathologies, benign symptoms are frequently miscategorized as idiopathic. CASE PRESENTATION: We present a case of retained glass obscuring as acute calcific periarthritis on imaging. A 48-year-old White male with vague fifth metacarpophalangeal joint pain had unrevealing exams, but radiographs showed periarticular calcification concerning inflammation. Surgical exploration unexpectedly revealed an encapsulated glass fragment eroding bone. Further history uncovered a forgotten glass laceration decade prior. The foreign body was removed, resolving symptoms. DISCUSSION: This case reveals two imperative diagnostic principles for nonspecific extremity pain: (1) advanced imaging lacks specificity to differentiate inflammatory arthropathies from alternate intra-articular processes such as foreign bodies, and (2) obscure patient history questions unearth causal subtleties that direct accurate diagnosis. Though initial scans suggested acute calcific periarthritis, exhaustive revisiting of the patient's subtle decade-old glass cut proved pivotal in illuminating the underlying driver of symptoms. CONCLUSION: Our findings underscore the critical limitations of imaging and the vital role that meticulous history-taking plays in clarifying ambiguous chronic limb presentations. They spotlight the imperative of probing even distant trauma when symptoms seem disconnected from causative events. This case reinforces the comprehensive evaluation of all subtle patient clues as key in illuminating elusive extremity pain etiologies.

Are medical history data fit for risk stratification of patients with chest pain in emergency care? Comparing data collected from patients using computerized history taking with data documented by physicians in the electronic health record in the CLEOS-CPDS prospective cohort study.

OBJECTIVE: In acute chest pain management, risk stratification tools, including medical history, are recommended. We compared the fraction of patients with sufficient clinical data obtained using computerized history taking software (CHT) versus physician-acquired medical history to calculate established risk scores and assessed the patient-by-patient agreement between these 2 ways of obtaining medical history information. MATERIALS AND METHODS: This was a prospective cohort study of clinically stable patients aged ≥ 18 years presenting to the emergency department (ED) at Danderyd University Hospital (Stockholm, Sweden) in 2017-2019 with acute chest pain and non-diagnostic ECG and serum markers. Medical histories were self-reported using CHT on a tablet. Observations on discrete variables in the risk scores were extracted from electronic health records (EHR) and the CHT database. The patient-by-patient agreement was described by Cohen's kappa statistics. RESULTS: Of the total 1000 patients included (mean age 55.3 ± 17.4 years; 54% women), HEART score, EDACS, and T-MACS could be calculated in 75%, 74%, and 83% by CHT and in 31%, 7%, and 25% by EHR, respectively. The agreement between CHT and EHR was slight to moderate (kappa 0.19-0.70) for chest pain characteristics and moderate to almost perfect (kappa 0.55-0.91) for risk factors. CONCLUSIONS: CHT can acquire and document data for chest pain risk stratification in most ED patients using established risk scores, achieving this goal for a substantially larger number of patients, as compared to EHR data. The agreement between CHT and physician-acquired history taking is high for traditional risk factors and lower for chest pain characteristics. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov NCT03439449.

Dental implant considerations in patients with systemic diseases: An updated comprehensive review.

BACKGROUND: Various medical conditions and the drugs used to treat them have been shown to impede or complicate dental implant surgery. It is crucial to carefully monitor the medical status and potential post-operative complications of patients with systemic diseases, particularly elderly patients, to minimize the risk of health complications that may arise. AIM: The purpose of this study was to review the existing evidence on the viability of dental implants in patients with systemic diseases and to provide practical recommendations to achieve the best possible results in the corresponding patient population. METHODS: The information for our study was compiled using data from PubMed, Scopus, Web of Science and Google Scholar databases and searched separately for each systemic disease included in our work until October 2023. An additional manual search was also performed to increase the search sensitivity. Only English-language publications were included and assessed according to titles, abstracts and full texts. RESULTS: In total, 6784 studies were found. After checking for duplicates and full-text availability, screening for the inclusion criteria and manually searching reference lists, 570 articles remained to be considered in this study. CONCLUSION: In treating patients with systemic conditions, the cost-benefit analysis should consider the patient's quality of life and expected lifespan. The success of dental implants depends heavily on ensuring appropriate maintenance therapy, ideal oral hygiene standards, no smoking and avoiding other risk factors. Indications and contraindications for dental implants in cases of systemic diseases are yet to be more understood; broader and hardcore research needs to be done for a guideline foundation.

[Diagnostic workup for polyneuropathy]. / Diagnostische Abklärung bei Polyneuropathie.

Polyneuropathy is a disease of the peripheral nervous system that usually results in distally emphasized, often symmetrical sensory and motor stimulation and deficits. These are often extremely painful. They can be divided into hereditary and acquired causes; inflammatory and infectious causes should be further differentiated among the acquired causes. A careful diagnostic workup is essential. Clinical signs and distribution patterns of symptoms can often already provide clues to the underlying aetiology. This review describes this workup, which in addition to the medical history and clinical examination always includes thorough laboratory diagnostics, electrophysiological examination and cerebrospinal fluid diagnostics. In individual cases, further diagnostic steps may be necessary in order to make the correct diagnosis.

Diagnostic Accuracy of Abdominal Point of Care Ultrasound in Primary Care: Study Design and Protocol.

The aim of this study is to estimate the diagnostic accuracy of abdominal point of care ultrasound (POCUS) performed by family physicians (FPs) in primary care (PC), in comparison with the findings in the medical record (MR) at 12 months of follow-up. This study is conducted entirely in PC healthcare centers in Spain. Abdominal ultrasound scans performed by FPs (selected on the basis of their ultrasound knowledge and experience) are compared with the findings, or not, in the patient's MR after a 12-month follow-up period. The study will involve 100 FPs in Spain and an estimated sample size of 1334 patients who are to undergo abdominal POCUS at the indication of their physician. The results of the abdominal POCUS will be collected and compared with the findings of the MR. This comparison will be performed by another physician of the research team, different from their FP after one year of follow-up. The diagnostic accuracy of abdominal POCUS has been addressed in the hospital setting but not in PC. This lack of evidence can begin to be resolved with studies such as the one we present, designed for unselected populations such as those treated in PC and taking the patient's MR as the gold standard, which will allow us to make comparisons with the patient's clinical course.

Sudden-Onset Severe Back Pain Caused by Acute Gastric Anisakiasis.

Anisakiasis is a parasitic disease that usually causes acute abdominal pain, nausea, and vomiting after the ingestion of raw seafood. We present a case of anisakiasis in an 80-year-old man who complained of sudden-onset severe back pain that was reminiscent of aortic dissection. This case shows that anisakiasis should be considered as a possible differential diagnosis in patients with not only abdominal pain but also back pain. In addition, for "diagnostic excellence," it is essential to return to a comprehensive medical history that allows the reassessment of the diagnosis even when it differs from the initial differential diagnosis.

Ventajas y desventajas de la modalidad virtual de enseñanza-aprendizaje percibidas en un curso de semiología en una facultad de medicina de Lima, Perú / Advantages and disadvantages of the virtual teaching modality perceived by the students in an introduction to clinical medicine course of a school of medicine in Lima, Peru

RESUMEN La pandemia de la Covid 19 forzó a las facultades de medicina a optar por una metodología virtual de enseñanza por la suspensión de las prácticas presenciales con pacientes reales en los establecimientos de salud, debido al confinamiento social y riesgo de contagio. Objetivo Determinar las ventajas y desventajas percibidas por los estudiantes de medicina en relación con la transición de las prácticas presenciales en hospitales a las sesiones virtuales de aprendizaje en un curso de semiología en una facultad de medicina de Lima, Perú. Material y métodos Estudio descriptivo de corte transversal realizado en estudiantes del 4to año de la carrera de Medicina. Los datos se recolectaron mediante una encuesta virtual no validada. Resultados 94 estudiantes respondieron la encuesta (tasa de respuesta: 51,1%). Las ventajas percibidas fueron: 57,4% tener mayor tiempo para estudio teórico y 38,3% en ahorro de tiempo en transporte y movilidad. Las desventajas fueron: 42,6% falta de contacto con pacientes reales y 39,4% no poder realizar una historia clínica adecuada. En cuanto al logro de objetivos de aprendizaje, el 72,3% consideró que logró identificar los problemas de salud del paciente, mientras que el 24,4% afirmó que logró realizar una adecuada historia clínica, y sólo el 9,6% que logró realizar un examen físico completo en pacientes. Conclusión La modalidad virtual de enseñanza permitió a los estudiantes tener más tiempo para revisar aspectos teóricos del curso, pero limitó la adquisición de habilidades prácticas, como realizar una anamnesis adecuada, presentar historias clínicas y examinar pacientes.

SUMMARY The COVID-19 pandemic forced the school of medicines to opt for a virtual teaching modality due to the suspension of face-to-face activities imposed by the lockdown. Objective To determine the advantages and disadvantages of the virtual teaching modality perceived by the students in an introduction to clinical medicine course of a school of medicine in Lima, Peru. Methods A virtual non-validated survey was circulated among fourth year medical students. Results 94 studentes answered the survey (51%). Perceived advantages were to have more time to study (57.4%) and saving time in transportation (39.4%). The disadvantages were lack of contact with real patients (42.6%) and not to be able to obtain a clinical history from patients (39.4%). The 72.3% of students were able to identify the medical problems of patients, but only 24.4% were able to obtain an adequate clinical history and just 9.6% performed an adequate physical examination. Conclusion The virtual teaching modality allowed the student to have more time for self-study but limited their abilities to obtain a clinical history and to perform a physical examination.

Usability of an App for Medical History Taking in General Practice From the Patients' Perspective: Cross-Sectional Study.

BACKGROUND: A future shortage of physicians, especially in general practice, will result in an increasing workload for health care providers as a whole. Therefore, it is important to optimize patient-encounter processes to increase time efficiency related to visits. Utilizing digital tools to record patients' medical histories prior to a consultation offers great potential to achieve this goal. The collected information can be stored into the practice's electronic medical record, allowing for the general practitioner to review structured information of the patients' complaints and related medical history beforehand, thereby saving time during the encounter. However, the low usability of new digital developments in this setting often hinders implementation. OBJECTIVE: The aim of this study was to evaluate the usability of an app designed for medical history taking in general practice to capture the patients' perspective. METHODS: Between November 2021 and January 2022, we recruited 406 patients with acute complaints in one out-of-hour urgent care and seven general practice clinics. These study participants used the app during their waiting time and subsequently assessed its usability by completing the System Usability Scale (SUS), a robust and well-established 10-question survey measuring the perceived usability of products and technologies. Additionally, we collected general participant information, including age, sex, media usage, health literacy, and native language. Descriptive and inferential statistics were applied to identify patient characteristics associated with low or high SUS scores. RESULTS: We analyzed data from 397 patients (56.7% female, 43.3% male). The mean total SUS score was 77.8 points; 54.4% (216/397) of participants had SUS scores of 80 points or higher, indicating high usability of the app. In a multiple linear regression predicting SUS score, male sex and higher age (65 years or older) were significantly negatively associated with the SUS score. Conversely, a higher health literacy score and German as the native language were significantly positively associated with the SUS score. CONCLUSIONS: Usability testing based on the SUS anticipates successful implementation of the app. However, not all patients will easily adapt to utilizing the app, as exemplified by the participants of older age in this study who reported lower perceived usability. Further research should examine these groups of people, identify the exact problems in operating such an app, and provide targeted solutions. TRIAL REGISTRATION: German Clinical Trials Register World Health Organization Trial Registration Data Set DRKS00026659; https://trialsearch.who.int/Trial2.aspx?TrialID=DRKS00026659.

Validade baseada nos processos de respostas - Protocolo MMBGR Lactentes e Pré-escolares: Instrutivo e História Clínica Miofuncional Orofacial / Validity based on the response processes of the MMBGR Protocol Infants and Preschoolers: Instructional and Orofacial Myofuncional Clinical History

RESUMO Objetivo Apresentar a etapa da evidência de validade baseada nos processos de respostas do Protocolo MMBGR Lactentes e Pré-escolares: Instrutivo e História Clínica Miofuncional Orofacial. Método Estudo desenvolvido conforme recomendações para validação de testes em Fonoaudiologia. Realizada análise da validade baseada nos processos de resposta do instrumento. Participaram dez fonoaudiólogos, que atuam em clínica e/ou pesquisa da Motricidade Orofacial com população entre 6 e 71 meses de idade, que aplicaram o Protocolo MMBGR Lactentes e Pré-escolares: Instrutivo e História Clínica Miofuncional Orofacial junto aos responsáveis pelas crianças. Os fonoaudiólogos emitiram apreciação sobre aplicabilidade do instrumento via formulário eletrônico do Google®, contendo questões dicóticas e/ou múltipla escolha, e escala likert com espaço para justificar respostas negativas. Os dados foram tabulados em planilhas Microsoft Excel 2016® e analisados pelo Índice de Validade de Conteúdo (IVC). Utilizado software R Core Team 2022 (Versão 4.2.2). Resultados Todos os itens do Protocolo MMBGR Lactentes e Pré-escolares: Instrutivo e História Clínica Miofuncional Orofacial foram válidos na aplicação em contexto real. Protocolo de História Clínica Miofuncional Orofacial - IVC 100% quanto à facilidade de aplicação e preenchimento, e uso na prática profissional; e IVC 90% quanto à utilidade para clínica fonoaudiológica. O Instrutivo obteve IVC 80% quanto à utilidade e 70% referente à necessidade de leitura prévia para preenchimento do Protocolo MMBGR Lactentes e Pré-escolares. Conclusão O Instrutivo e o Protocolo História Clínica Miofuncional Orofacial, pertencentes ao protocolo MMBGR - Lactentes e Pré-escolares tiveram comprovada validade baseada nos processos de resposta, para uso na clínica fonoaudiológica.

ABSTRACT Purpose Present the step of evidence of validity based on the responses to procedures of the MMBGR Protocol Infants and Preschoolers: Instructional and Orofacial Myofunctional Clinical History. Methods Study developed according to phonoaudiologic tests validations recommendations. Validity analysis performed based on the process of instrument response. Ten speech therapists, that work on phonoaudiology clinic and/or orofacial myofunctional research on the population with age between 6 to 71 months, participated and applied the MMBGR Protocol Infants and Preschoolers: Instructional and Orofacial Myofunctional Clinical History with those responsible for the children. The speech therapists appraised the instrument applicability via Google®️ electronic forms, containing dichotic and/or multiple-choice questions, and likert scale with space to justify negative answers. The data was tabulated on Microsoft Excel 2016®️ worksheets and analyzed by the content validity index (CVI). The software R Core Team 2022 (Versão 4.2.2) was used. Results All items from the MMBGR Protocol Infants and Preschoolers: Instructional and Orofacial Myofunctional Clinical History were valid when applied to real contexts. Orofacial Myofunctional Clinic history protocol- IVC 100% in terms of ease of application and filling and usage in professional practice; IVC 90% in terms of usefulness for phonoaudiology clinic. The instructional got IVC 80% in terms of clinic usefulness and 70% regarding to the prior reading necessity to fill the MMBGR Protocol Infants and Preschoolers. Conclusion The Instrucional and Orofacial Myofunctional Clinical History, in the MMBGR Protocol Infants and Preschoolers had its validity proven based on the processes of responses to the usage on phonoaudiology clinic.

Non-standard diagnostic assessment reliability in psychiatry: a study in a Brazilian outpatient setting using Kappa.

The use of Structured Diagnostic Assessments (SDAs) is a solution for unreliability in psychiatry and the gold standard for diagnosis. However, except for studies between the 50 s and 70 s, reliability without the use of Non-SDAs (NSDA) is seldom tested, especially in non-Western, Educated, Industrialized, Rich, and Democratic (WEIRD) countries. We aim to measure reliability between examiners with NSDAs for psychiatric disorders. We compared diagnostic agreement after clinician change, in an outpatient academic setting. We used inter-rater Kappa measuring 8 diagnostic groups: Depression (DD: F32, F33), Anxiety Related Disorders (ARD: F40-F49, F50-F59), Personality Disorders (PD: F60-F69), Bipolar Disorder (BD: F30, F31, F34.0, F38.1), Organic Mental Disorders (Org: F00-F09), Neurodevelopment Disorders (ND: F70-F99) and Schizophrenia Spectrum Disorders (SSD: F20-F29). Cohen's Kappa measured agreement between groups, and Baphkar's test assessed if any diagnostic group have a higher tendency to change after a new diagnostic assessment. We analyzed 739 reevaluation pairs, from 99 subjects who attended IPUB's outpatient clinic. Overall inter-rater Kappa was moderate, and none of the groups had a different tendency to change. NSDA evaluation was moderately reliable, but the lack of some prevalent hypothesis inside the pairs raised concerns about NSDA sensitivity to some diagnoses. Diagnostic momentum bias (that is, a tendency to keep the last diagnosis observed) may have inflated the observed agreement. This research was approved by IPUB's ethical committee, registered under the CAAE33603220.1.0000.5263, and the UTN-U1111-1260-1212.

Statistical Comparison Between Interview Questions and Rating Scales in Psychiatry.

Background: Psychiatric evaluations consist of both qualitative questions and quantitative assessments, sometimes questioning the same issue. The present study attempts to investigate the statistical equivalency of several close-ended questions of a procedural psychiatric examination and rating scales addressing a similar problem. Methods: The current retrospective analysis included 314 patients who made their first visit to a private psychiatry clinic. Subjects underwent a routine psychiatric examination, including close-ended questions and related clinical scales. Questions included sleep and sexual problems, problems in marriage, parent relationship problems, and childhood abuse. The related psychiatric scales were Jenkins Sleep Scale, Arizona Sexual Experience Scale, Dyadic Adjustment Scale, and Childhood Trauma Questionnaire, respectively. First, receiver operating curve analysis was conducted for each yes/no question and clinical scale. Then, area under curve sensitivity and specificity values were calculated. Multinomial logistic regression analysis was also performed to observe paired predictor variables. Results: Among clinical questionnaires, the receiver operating curve model provided good area under curve values as prediction criteria for Dyadic Adjustment Scale (0.78; P < .001), Childhood Trauma Questionnaire (0.74; P < .001), Childhood Trauma Questionnaire-physical abuse (0.826; P < .001), Childhood Trauma Questionnaire-sexual abuse (0.828; P < .001), Arizona Sexual Experience Scale (0.796; P < .001), and Jenkins Sleep Scale (0.920; P < .001). Multinomial logistic regression models also revealed good correct classification values for Dyadic Adjustment Scale-Childhood Trauma Questionnaire (61%), Childhood Trauma Questionnaire-Physical abuse-Childhood Trauma Questionnaire-Sexual abuse (87.6%), and Arizona Sexual Experience Scale-Jenkins Sleep Scale (67%). Conclusion: When the symptoms are investigated in general terms, the present study reveals that an experienced clinician could rely on clinical questions as much as the quantitative scales in both clinical and research domains.

Patient and Clinician Sociodemographics and Sexual History Screening at a Multisite Federally Qualified Health Center: A Mixed Methods Study.

PURPOSE: In 2018, there were 68 million sexually transmitted infections in the United States. Sexual history screening is an evidence-based practice endorsed by guidelines to identify risk of these infections and adverse sexual health outcomes. In this mixed methods study, we investigated patient- and clinician-level characteristics associated with receipt of sexual history screening, and contextualized these differences in more depth. METHODS: We collected sociodemographics of patients from the electronic health record and sociodemographics of their primary care clinicians via a census survey. Semistructured interviews were conducted with key practice staff. We conducted multilevel crossed random effects logistic regression analysis and thematic analysis on quantitative and qualitative data, respectively. RESULTS: A total of 53,246 patients and 56 clinicians from 13 clinical sites participated. Less than one-half (42.4%) of the patients had any sexual history screening documented in their health record. Patients had significantly higher odds of documented screening if they were gay or lesbian (OR = 1.23), were cisgender women (OR = 1.10), or had clinicians who were cisgender women (OR = 1.80). Conversely, patients' odds of documented screening fell significantly with age (OR per year = 0.99) and with the number of patients their clinicians had on their panels (OR per patient = 0.99), and their odds were significantly lower if their primary language was not English (OR = 0.91). In interviews, key staff expressed discomfort discussing sexual health and noted assumptions about patients who are older, in long-term relationships, or from other cultures. Discordance of patient-clinician gender and patients' sexual orientation were also noted as barriers. CONCLUSIONS: Interventions are needed to address the interplay between the social and contextual factors identified in this study, especially those that elicited discomfort, and the implementation of sexual history screening.

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)

A case of humidifier lung; the key diagnosis is detailed medical history taking.

A 74-year-old woman was admitted with a dry cough and dyspnea that had persisted for 2 weeks at the beginning of winter. Chest computed tomography revealed bilateral diffuse non-segmental ground-glass opacities without centrilobular nodules. Bronchoalveolar lavage fluid revealed a marked increase in the lymphocyte ratio. Her condition and chest radiographic findings improved spontaneously after admission. An additional interview conducted after admission revealed that the patient had started using a contaminated humidifier approximately 2 weeks before the onset of symptoms. Thus, the diagnosis of humidifier lung was established. Humidifier lung is a rare phenotype of hypersensitive pneumonitis that often occurs during dry winter when the use of humidifiers increases. Humidifier lung is an important differential diagnosis of bilateral pneumonia during dry winter, and detailed history-taking regarding the use of humidifiers, assuming a humidifier lung, is crucial for its diagnosis.

Proactive familial cancer risk assessment: a service development study in UK primary care.

BACKGROUND: Family history assessment can identify individuals above population-risk for cancer to enable targeted Screening, Prevention, and Early Detection (SPED). Family History Questionnaire Service (FHQS) is a resource-efficient patient-facing online tool to facilitate this. In the UK, cancer risk assessment is usually only offered to concerned individuals proactively self-presenting to their GP, leading to inequity in accessing SPED in the community. AIM: To improve access to community cancer genetic risk assessment and explore barriers to uptake. DESIGN & SETTING: Service development project of a digital pathway using the FHQS for cancer risk assessment across four general practices within the clinical remit of the South West Thames Centre for Genomics (SWTCG). METHOD: 3100 individuals aged 38-50 years were invited to complete the FHQS through either text message or email. A random selection of 100 non-responders were contacted to determine barriers to uptake. RESULTS: In total, n = 304/3100 (10%) registered for the FHQS. Responders were more likely to be British (63% vs 47%, P<0.001), speak English as their main language (92% vs 76%, P<0.001), and not require an interpreter (99.6% vs 94.9%, P = 0.001). Of 304 responders, 158 (52%) were automatically identified as at population-risk without full family history review. Of the remaining 146 responders, 52 (36%) required either additional screening referral (n = 23), genetics referral (n = 15), and/or advice to relatives (n = 18). Of 100 non-responders contacted, eight had incorrect contact details and 53 were contactable. Reasons for not responding included not receiving invitation details (n = 26), losing the invitation (n = 5), or forgetting (n = 4). CONCLUSION: The FHQS can be used as part of a low-resource primary care pathway to identify individuals in the community above population-risk for cancer requiring action. This study highlighted barriers to uptake requiring consideration to maximise impact and minimise inequity.