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1.
GMS J Med Educ ; 38(1): Doc19, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33659624

RESUMO

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.


Assuntos
/epidemiologia , Educação a Distância/organização & administração , Educação Médica/organização & administração , Anamnese/métodos , Alemanha , Humanos , Aprendizagem , Pandemias , Ensino/organização & administração
2.
GMS J Med Educ ; 38(1): Doc21, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33659626

RESUMO

Objective: Medical conversation plays a central role in disease management and therapy. In teaching, standardized patients (SPs) are increasingly being used to present conversation situations with students and provide feedback afterwards. In order to maintain this teaching concept under pandemic conditions, a digital model was developed that should offer both high security and high authenticity. Methodology: A total of 176 teaching units of 45 minutes each were conducted digitally from May to August 2020. During the teaching units, medical students conducted interviews with SPs portraying various patients. The online conference software "HeiConf" was used for this purpose. During the teaching units, a total of 354 students were able to practice conversation techniques such as NURSE and SPIKES. After the teaching units, feedback was provided by students and SPs. Results: The digital lessons about medical conversation with SPs received positive feedback from SPs and students. The authenticity of the role portrayal of SPs seemed to be unaffected by the new format. Students were successful in training and observing conversation techniques. However, aspects of non-verbal communication, atmosphere and group dynamics as well as further discussions could not be carried out to the same extent as in the usual classroom teaching. Conclusion: The conversion of SP-based teaching to a digital format was successful in a short period of time and was able to prevent a cancellation of teaching units about medical conversation. Concrete conversation techniques could be tried out digitally by students. Due to the deficits of digital teaching in terms of non-verbal communication and atmosphere, a blended-learning format is planned for the future. In the first instance, concrete conversation techniques will be learned online in order to focus more on profound aspects of communication and discussions in a later physical teaching unit with SPs, thus enabling a learning experience that is as authentic as possible.


Assuntos
/epidemiologia , Educação Médica/organização & administração , Simulação de Paciente , Competência Clínica , Feedback Formativo , Humanos , Anamnese/métodos , Pandemias , Relações Médico-Paciente
3.
N Z Med J ; 134(1531): 83-85, 2021 03 26.
Artigo em Inglês | MEDLINE | ID: mdl-33767480

RESUMO

We report the earliest known cluster of SARS-CoV-2 infection so far reported, which occurred in New Zealand in late February 2020. The cluster includes one confirmed and five probable cases. The cluster was identified while investigating a weak positive nasopharyngeal swab (NPS) polymerase chain reaction (PCR) test that was returned by a male in his 60s in September 2020. The PCR result, combined with a clear clinical and epidemiological history of a COVID-19 like illness in late February 2020, prompted serological testing. SARS-CoV-2 IgG antibodies were detected and supported historical infection. Serology was also reactive for five close contacts who had also experienced a COVID-19 like illness in February 2020. Combined case histories and investigations suggest that this local cluster was import related, with the index case identified as a family member visiting from Italy in February. Case investigation also suggests this cluster was active in New Zealand prior to any previously documented local cases, indicating that SARS-CoV-2 was present and local transmission was occurring earlier than initially suspected. A weak positive PCR result, six months after acute infection, supports international evidence that SARS-CoV-2 genetic material can be detected for several months after initial COVID-19 infection, and that this is not necessarily indicative of infectivity.


Assuntos
/métodos , Busca de Comunicante/métodos , Anticorpos Antivirais/isolamento & purificação , /epidemiologia , /transmissão , Feminino , Humanos , Itália , Masculino , Anamnese/métodos , Pessoa de Meia-Idade , Nova Zelândia/epidemiologia , /isolamento & purificação , Avaliação de Sintomas , Doença Relacionada a Viagens
4.
Anticancer Res ; 41(3): 1459-1469, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33788738

RESUMO

BACKGROUND/AIM: Although acute appendicitis (AA) in elderly patients is different from AA in younger patients, the accuracy of diagnostic scores (DSs) in detecting AA is rarely considered. PATIENTS AND METHODS: A cohort of 470 AAP (acute abdominal pain) patients older than 50 years, including 224 women (53.7%) and 193 men (46.3%), were included in the study. The most significant diagnostic predictors were used to construct DS formulas for AA diagnosis with (Tax+) and without body temperature (Tax-). Meta-analytical techniques were used to calculate the summary Se and Sp estimates for each data sets (history-taking, findings, and DS formulas). RESULTS: In SROC analysis, the AUC values for i) symptoms ii) signs and tests iii) DSTax- and iv) DSTax+ were as follows: i) AUC=0.658 (95%CI=0.601-0.709); ii) AUC=0.751 (95%CI=0.701-0.800), iii) AUC=0.977 (95%CI=0.942-1.000), and for iv) AUC=0.980 (95%CI=0.956-1.000). Using roccomp analysis for these AUC values, the differences were significant as follows: between i) and ii) p=0.0358; between i) and iii) p<0.0001; between i) and iv) p<0.0001; between ii) and iii) p<0.0001; between ii) and iv) p<0.0001; and between iii) and iv) p=0.682. CONCLUSION: Similar to younger AA patients, the DS formula was superior to both the clinical history-taking and findings, and therefore, the use of DS should be an important part of the diagnostic decision tree of AA also in the elderly patients presenting with AAP.


Assuntos
Dor Abdominal/diagnóstico , Apendicite/diagnóstico , Temperatura Corporal , Anamnese/métodos , Doença Aguda , Idoso , Apendicite/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Curva ROC
5.
Postgrad Med ; 133(2): 154-159, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33522353

RESUMO

OBJECTIVES: Alcohol consumption is a risk factor for stroke. However, there are no available data on the effect of alcohol consumption on the long-term outcome of ischemic stroke in China. Therefore, this study aimed to explore the association of alcohol consumption with the prognosis of ischemic stroke by subtype in different follow-up periods after stroke. METHODS: This 12-month follow-up study recruited 3830 acute ischemic stroke patients from Tianjin, China, between 2016 and 2018. Patients were categorized into two groups according to their consumption of alcohol. Differences in mortality, recurrence, and dependency rates at 3 and 12 months after stroke were compared between both groups. RESULTS: The mortality, recurrence, and dependency rates at 12 months after stroke were significantly higher in patients who previously consumed alcohol than in those without previous alcohol consumption (all P < 0.005). A similar trend was observed for mortality rate at 3 months after stroke (P < 0.001). The risk of death at 3 months after an atherothrombotic stroke decreased by 63.4% (relative risk [RR], 0.366; 95% confidence interval [CI], 0.144-0.935) among patients who previously consumed alcohol compared with those who never consumed alcohol. Moreover, for patients with small artery disease classified according to the Trial of ORG 10,172 in Acute Stroke Treatment (TOAST), the recurrence and dependency rates at 12 months after stroke decreased by 49.2% (RR, 0.508; 95% CI, 0.259-0.996) and 49.5% (RR, 0.505; 95% CI, 0.258-0.990), respectively, among patients who consumed alcohol. CONCLUSIONS: Previous alcohol consumption decreased the risk of death at 3 months after stroke among patients with atherothrombotic stroke according to the TOAST classification. Furthermore, for patients with small artery disease (according to TOAST classification), alcohol consumption significantly decreased the risk of recurrence and dependency at 12 months after stroke. This study highlights an urgent need to quantify the association of alcohol consumption with outcomes after stroke in China to improve stroke prognosis.


Assuntos
Consumo de Bebidas Alcoólicas , Serviços Preventivos de Saúde/métodos , Medição de Risco/métodos , Consumo de Bebidas Alcoólicas/epidemiologia , Consumo de Bebidas Alcoólicas/fisiopatologia , China/epidemiologia , Feminino , Hospitalização/estatística & dados numéricos , Humanos , /fisiopatologia , /terapia , Masculino , Anamnese/métodos , Anamnese/estatística & dados numéricos , Pessoa de Meia-Idade , Mortalidade , Prognóstico , Recidiva , /epidemiologia
6.
Medicine (Baltimore) ; 100(7): e24757, 2021 Feb 19.
Artigo em Inglês | MEDLINE | ID: mdl-33607822

RESUMO

ABSTRACT: This study aimed to assess the impact of family history (FH) on prostate cancer (PCa) development among a general Korean population. We conducted a prospective cohort study based on the registry records of 211,789 participants in the database of the Korean Genome and Epidemiology Study from 2001 to 2013. A total of 69,693 men with appropriate records were evaluated by being categorizing into 2 groups; a PCa group (100) and control group (69,593). FH of PCa was also categorized as FH of total, father, or brother. Odds ratios (ORs) of PCa development were calculated by using stratified logistic regression models. The adjusted OR of PCa history of father was 27.7 (95% confidence interval [CI] = 9.7-79.2, P < .001) in PCa patients compared to control, and that of PCa history of brother was 15.8 (95% CI = 3.6-69.6, P < .001). Among the adjusted variables, age (OR, 1.17; 95% CI, 1.14-1.21; P < .001), and hyperlipidemia (OR, 2.25; CI, 1.32-3.84; P = .003) were also identified as significant predictors of PCa development. There was no difference in the impact of FH on PCa development between different age groups at PCa diagnosis (<60 vs ≥60 years). To our knowledge, this study represents the first prospective cohort study based on the registry data of a Korean population showing the significance of FH on PCa development. Additionally, the effect of FH on the early onset of PCa has not been confirmed in our analysis.


Assuntos
Genoma/genética , Anamnese/métodos , Neoplasias da Próstata/diagnóstico , Adulto , Idoso , Estudos de Casos e Controles , Gerenciamento de Dados , Humanos , Hiperlipidemias/epidemiologia , Modelos Logísticos , Masculino , Anamnese/estatística & dados numéricos , Pessoa de Meia-Idade , Estudos Prospectivos , Neoplasias da Próstata/epidemiologia , Sistema de Registros , República da Coreia/epidemiologia
7.
Rev Bras Enferm ; 74(suppl 1): e20200687, 2021.
Artigo em Inglês, Português | MEDLINE | ID: mdl-33566955

RESUMO

OBJECTIVE: To analyze the change in the clinical-epidemiological profile of patients attended at the specialized triage service for COVID-19 (COVID-19 tent) in the first three months of operation. METHODS: Cross-sectional study, with users attended from March 2020 to May 2020 (n=379) at the COVID-19 tent in the city of Ponta Grossa, Paraná. Data collection was retrieved from an electronic form fed by tent professionals, which included sociodemographic characteristics, symptoms, risk factors of exposure, means of search and clinical conduct. Trend tests and chi-square tests were performed. RESULTS: March showed a greater demand (n=197), motivated by mild symptoms and direct search (p<0.05). In the following months, there was a decrease in demand (n=93; n=89), however the search for referrals, ambulances and conditions that required medical attention, observation and hospitalization increased (p<0.05). The search resulting from exposure to risk factors has not changed (p>0.05). CONCLUSION: the profile has changed over time, reflecting, in the end, severe and critical symptoms, requiring intervention.


Assuntos
/diagnóstico , Serviço Hospitalar de Emergência/organização & administração , Serviço Hospitalar de Emergência/estatística & dados numéricos , Anamnese/métodos , Anamnese/estatística & dados numéricos , Triagem/métodos , Triagem/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Brasil , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
8.
South Med J ; 114(1): 17-22, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33398355

RESUMO

OBJECTIVES: Previous negative experiences with the medical community often leave transgender people reluctant to seek medical care. Inadequate teaching and exposure to transgender health during medical training perpetuates the health disparities experienced by this community. Although undergraduate medical education is uniquely positioned to address these disparities, curricular coverage of these topics remains inadequate. METHODS: The second-year clinical skills course at the Florida International University Herbert Wertheim College of Medicine includes a workshop consisting of a 1-hour lecture about the inclusive sexual history, followed by a 1.5-hour small group during which students interview a standardized patient playing the role of a transgender man and participate in a faculty-facilitated debriefing. To evaluate the 2019 workshop, students were provided with an optional, anonymous, pre- and postsession survey consisting of multiple choice and Likert-type questions. RESULTS: After the session, there was a statistically significant increase in students' knowledge of the components of an inclusive sexual history, in the number of students who believed that their medical training had prepared them to effectively provide care for transgender patients, and in the number who reported feeling comfortable taking a sexual history from a patient who identifies as transgender. Most students thought the standardized patient case was realistic and found the postencounter debriefing session helpful in identifying their own strengths and weaknesses. CONCLUSIONS: Our findings suggest that students found this brief, interactive sexual history workshop, which included a lecture and standardized patient case, to be an effective component of their medical training. Although our transgender patient case was acted primarily by cis-gender people, students perceived this as a realistic opportunity to actively explore the nuances of obtaining a history from a transgender patient. In addition, our findings suggest that it is possible to merge teaching on sexual history and transgender health care, which is important in time-limited undergraduate medical education curricula.


Assuntos
Assistência à Saúde Culturalmente Competente/métodos , Anamnese/métodos , Simulação de Paciente , Ensino/normas , Pessoas Transgênero/educação , Assistência à Saúde Culturalmente Competente/estatística & dados numéricos , Educação/métodos , Humanos , Ensino/estatística & dados numéricos , Pessoas Transgênero/psicologia
9.
Am Fam Physician ; 102(12): 732-739, 2020 12 15.
Artigo em Inglês | MEDLINE | ID: mdl-33320513

RESUMO

Peripheral neuropathy, a common neurologic problem encountered by family physicians, can be classified clinically by the anatomic pattern of presenting symptoms and, if indicated, by results of electrodiagnostic studies for axonal and demyelinating disease. The prevalence of peripheral neuropathy in the general population ranges from 1% to 7%, with higher rates among those older than 50 years. Common identifiable causes include diabetes mellitus, nerve compression or injury, alcohol use, toxin exposure, hereditary diseases, and nutritional deficiencies. Peripheral neuropathy is idiopathic in 25% to 46% of cases. Diagnosis requires a comprehensive history, physical examination, and judicious laboratory testing. Early peripheral neuropathy may present as sensory alterations that are often progressive, including sensory loss, numbness, pain, or burning sensations in a "stocking and glove" distribution of the extremities. Later stages may involve proximal numbness, distal weakness, or atrophy. Physical examination should include a comprehensive neurologic and musculoskeletal evaluation. If the peripheral nervous system is identified as the likely source of the patient's symptoms, evaluation for potential underlying etiologies should initially focus on treatable causes. Initial laboratory evaluation includes a complete blood count; a comprehensive metabolic profile; fasting blood glucose, vitamin B12, and thyroid-stimulating hormone levels; and serum protein electrophoresis with immunofixation. If the initial evaluation is inconclusive, referral to a neurologist for additional testing (e.g., electrodiagnostic studies, specific antibody assays, nerve biopsy) should be considered. Treatment of peripheral neuropathy focuses on managing the underlying etiology. Several classes of medications, including gabapentinoids and antidepressants, can help alleviate neuropathic pain.


Assuntos
Medicina de Família e Comunidade/métodos , Anamnese/métodos , Doenças do Sistema Nervoso Periférico/diagnóstico , Exame Físico/métodos , Neuropatias Diabéticas/diagnóstico , Diagnóstico Diferencial , Humanos , Doenças do Sistema Nervoso Periférico/prevenção & controle
10.
Obstet Gynecol ; 136(4): 811-822, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32925633

RESUMO

Nine percent of adult women experience episodes of fecal incontinence at least monthly. Fecal incontinence is more common in older women and those with chronic bowel disturbance, diabetes, obesity, prior anal sphincter injury, or urinary incontinence. Fecal incontinence negatively affects quality of life and mental health and is associated with increased risk of nursing home placement. Fewer than 30% of women with fecal incontinence seek care, and lack of information about effective solutions is an important barrier for both patients and health care professionals. Even among women with both urinary and fecal incontinence presenting for urogynecologic care, the rate of verbal disclosure of fecal incontinence symptoms remains low. This article provides an overview of the evaluation and management of fecal incontinence for the busy obstetrician-gynecologist, incorporating existing guidance from the American College of Obstetricians and Gynecologists, the American College of Gastroenterology, and the American Society of Colon and Rectal Surgeons. The initial clinical evaluation of fecal incontinence requires a focused history and physical examination. Recording patient symptoms using a standard diary or questionnaire can help document symptoms and response to treatment. Invasive diagnostic testing and imaging generally are not needed to initiate treatment but may be considered in complex cases. Most women have mild symptoms that will improve with optimized stool consistency and medications. Additional treatment options include pelvic floor muscle strengthening with or without biofeedback, devices placed anally or vaginally, and surgery, including sacral neurostimulation, anal sphincteroplasty, and, for severely affected individuals for whom other interventions fail, colonic diversion.


Assuntos
Tratamento Conservador , Incontinência Fecal , Procedimentos Cirúrgicos em Ginecologia/métodos , Qualidade de Vida , Idoso , Comorbidade , Tratamento Conservador/instrumentação , Tratamento Conservador/métodos , Incontinência Fecal/etiologia , Incontinência Fecal/fisiopatologia , Incontinência Fecal/psicologia , Incontinência Fecal/terapia , Feminino , Humanos , Anamnese/métodos , Administração dos Cuidados ao Paciente/métodos , Seleção de Pacientes
11.
Rev. cuba. hematol. inmunol. hemoter ; 36(2): e1102, abr.-jun. 2020. tab, graf
Artigo em Espanhol | LILACS, CUMED | ID: biblio-1149897

RESUMO

Introducción: La enfermedad granulomatosa crónica es una inmunodeficiencia primaria causada por mutaciones en la enzima NADPH oxidasa. Esta compromete la producción de especies reactivas del oxígeno, que son importantes contra patógenos. La prueba de la oxidación de la dihidrorodamina es un método eficaz para diagnosticar la enfermedad. Objetivo: Demostrar la utilidad de la prueba de la oxidación de la dihidrorodamina y del patrón de herencia en la confirmación del diagnóstico de la enfermedad granulomatosa crónica de un paciente. Métodos: Estudio de caso de una familia con diagnóstico de enfermedad granulomatosa crónica. Se tomó muestra de sangre periférica para citometría de flujo a tres individuos. Se realizó la prueba de la oxidación de la dihidrorodamina bajo estímulo con acetato de forbolmiristato y se evaluaron las subpoblaciones linfocitarias. Las muestras se leyeron en un citómetro GALLIOS, Beckman Coulter. Los datos obtenidos se analizaron en el programa informático Kaluza. Resultados: El paciente masculino tuvo un valor de oxidación de la dihidrorodamina positiva de 0,87 por ciento, que confirmó un patrón de herencia ligado al cromosoma X; mientras que la madre y hermana gemela portadoras tuvieron valores de 46,76 por ciento y 37,32 por ciento, respectivamente. Se encontraron alteraciones en las subpoblaciones linfocitarias. Conclusiones: La prueba de la oxidación de la dihidrorodamina es un método muy efectivo, rápido y sencillo que confirma el diagnóstico de la enfermedad granulomatosa crónica y determina el patrón de herencia y fenotipo de la enfermedad. Además, permite identificar a las mujeres portadoras según la distribución de los neutrófilos normales y los que tienen el gen CYBB mutado(AU)


Introduction: Chronic granulomatous disease is a primary immunodeficiency caused by mutations in the NADPH oxidase enzymes. This compromises the production of oxygen reactive species, which are important against pathogens. The dihydrorhodamine oxidation test is an effective method for diagnosing the disease. Objective: To demonstrate the usefulness of the dihydrorhodamine oxidation test and the inheritance pattern in confirming the diagnosis of chronic granulomatous disease in a patient. Methods: A case study of a family with a diagnosis of chronic granulomatous disease. A peripheral blood sample was taken from three individuals and by flow cytometry. The dihydrorhodamine oxidation test was performed under stimulation with phorbolmyristate acetate, and lymphocyte subpopulations were evaluated. The samples were read on a GALLIOS, Beckman Coulter cytometer. The data obtained were analyzed using the computer program Kaluza. Results: The male patient had a positive dihydrorhodamine oxidation value of 0.87 percent, which confirmed an inheritance pattern linked to the X chromosome; while the carrier mother and twin sister had values 8203;8203;of 46.76 percent and 37.32 percent, respectively. Alterations were found in the lymphocyte subpopulations. Conclusions: The dihydrorhodamine oxidation test is a very effective, fast and simple method that confirms the diagnosis of chronic granulomatous disease and determines the inheritance pattern and phenotype of the disease. In addition, it allows the identification of female carriers according to the distribution of normal neutrophils and those with the CYBB mutation(AU)


Assuntos
Humanos , Portador Sadio/congênito , NADPH Oxidases/análise , Padrões de Herança/genética , Doença Granulomatosa Crônica/diagnóstico , Relatos de Casos , Cuba , Triagem de Portadores Genéticos/métodos , Anamnese/métodos
13.
J Pediatr ; 222: 180-185.e1, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32417076

RESUMO

OBJECTIVE: To investigate the utility of a detailed medical history in the interpretation of chromosomal microarray results for pediatric patients with a constitutional disease. STUDY DESIGN: A retrospective review and reinterpretation of test results from chromosomal microarrays performed from 2011 to 2013. Previously reported genetic variants were reanalyzed after review of the patient's complete electronic medical record (cEMR). A 3-tier system was used for reclassification of variants: pathogenic or likely pathogenic (P/LP); variant of uncertain significance (VUS); or benign or likely benign (B/LB). RESULTS: Over an 18-month period, 998 patients with chromosomal microarray results were identified. The most common reasons for chromosomal microarray testing were developmental delay (n = 336), autism spectrum disorder (n = 241), and seizures (n = 143). Chromosomal microarray testing identified 1 or more variants in 48% (482 of 998) of patients; 516 patients had a negative report. For the 482 patients with variants, the original interpretations were composed of 19.3% P/LP (93 of 482), 44.8% VUS (216 of 482), and 35.9% B/LB (173 of 482) variants. After review of the cEMR, 34% of patient results (164 of 482) were changed in interpretation. One case changed from B/LB to VUS, 7 VUS were upgraded to P/LP, and 156 VUS were downgraded to B/LB. No P/LP variants had a change in interpretation. CONCLUSIONS: Overall, 16.4% (164 of 998) of patients with chromosomal microarray testing had a change in interpretation. Access to the patient's cEMR improves the interpretation of chromosomal microarrays by decreasing the number of uncertain (VUS) interpretations.


Assuntos
Transtorno do Espectro Autista/diagnóstico , Cromossomos/genética , Predisposição Genética para Doença , Testes Genéticos/métodos , Anamnese/métodos , Transtorno do Espectro Autista/genética , Criança , Feminino , Humanos , Masculino , Estudos Retrospectivos
14.
Rev Med Suisse ; 16(691): 784-788, 2020 Apr 22.
Artigo em Francês | MEDLINE | ID: mdl-32320154

RESUMO

Digital media are central in our modern society and, as such, have an impact not only on teenagers but on most of us. Adolescents are among the most observed and stigmatized in terms of screens use. The encounter between the crucial developmental phase they cross and the neurobiological changes in their brains can be relatively «â€…noisy ¼. Because of the pervasive nature of screens in our daily lives and the potential effect on adolescent health, it is essential for health professionals to offer a systematic assessment of media use when consulting with an adolescent. This article provides practical tools for screening the use of media in consultation with the -adolescent and illustrates with a clinical story what lies behind the screens.


Assuntos
Comportamento do Adolescente , Internet/estatística & dados numéricos , Anamnese/métodos , Encaminhamento e Consulta , Tempo de Tela , Adolescente , Saúde do Adolescente , Humanos
16.
Dermatol Online J ; 26(2)2020 Feb 15.
Artigo em Inglês | MEDLINE | ID: mdl-32239886

RESUMO

A morbilliform drug eruption is the most common condition leading to a dermatology consultation for a patient in the hospital. Timing is an important diagnostic tool since the onset of a skin rash usually takes place within days-to-weeks of the start of the implicated drug. A comprehensive, thorough, and reliable drug history by the clinician is essential. Therefore, to assist in the task of determining the causative medication of a new skin rash in a hospitalized patient, the creation of a drug calendar is recommended. The development of an electronic version of the drug calendar offers several benefits over the manual version. As the use of electronic medical records continues to become the standard in medicine, the electronic drug calendar will serve as an invaluable tool for the diagnosis of drug hypersensitivity.


Assuntos
Erupção por Droga/diagnóstico , Registros Eletrônicos de Saúde , Anamnese/métodos , Esquema de Medicação , Erupção por Droga/fisiopatologia , Exantema/etiologia , Humanos , Fatores de Tempo
17.
Rev. inf. cient ; 99(2): 150-159, mar.-abr. 2020.
Artigo em Espanhol | LILACS | ID: biblio-1126931

RESUMO

RESUMEN Introducción: La anamnesis médica es el proceso de comunicación interactiva entre el médico, el paciente, su familia o ambos, con el propósito de identificar y caracterizar los síntomas que expresan la realidad del estado de salud del paciente, para establecer el diagnóstico y la intervención médica. Objetivo: Diseñar un sistema de acciones didácticas que faciliten a los estudiantes de la carrera de Medicina el aprendizaje de la anamnesis. Método: En el Hospital General Docente "Dr. Agostinho Neto" se desarrolló un estudio de tipo pedagógico con dicho objetivo, donde se utilizaron los métodos: histórico- lógico, análisis y síntesis e inducción-deducción. Se empleó, además, la modelación para la elaboración del modelo de preguntas y el enfoque sistémico para determinar su estructura y establecer las relaciones entre ellas. Resultados: El empleo de procedimientos (trasmisión de experiencias, ejemplos prácticos, modelos memorísticos basados en la imitación), sin un sustrato teórico estructurado, dificulta la aplicación plena de los contenidos médicos en pacientes concretos en condiciones reales semejantes o diferentes a las aprendidas, lo que constituye una limitación para la formación de esta habilidad en la asignatura Propedéutica Clínica y Semiología Médica. Conclusiones: Se ofrece un modelo de aprendizaje por preguntas, con el cual se dota al estudiante de un recurso didáctico-metodológico para la comunicación interactiva con el paciente, lo que facilita el aprendizaje de la escucha activa y la comprensión del paciente por el estudiante. Contribuye, además, con la calidad de la confección de la historia clínica.


ABSTRACT Introduction: Medical anamnesis is the process of interactive communication between the physician, the patient, his or her family, or both, for the purpose of identifying and characterizing the symptoms that express the reality of the patient's state of health, in order to establish the diagnosis and medical intervention. Objective: To design a system of didactic actions that will make it easier for medical students to learn the anamnesis. Method: At the General Teaching Hospital "Dr. Agostinho Neto" a pedagogical study was developed with this objective, where the methods used were: historical-logical, analysis and synthesis and induction-deduction. In addition, a modeling was used to develop the question model and the systemic approach to determine its structure and establish the relationships between them. Results: The use of procedures (transmission of experiences, practical examples, memory models based on imitation), without a structured theoretical support, makes it difficult to fully apply the medical content to specific patients in real conditions similar to or different from those learned, which constitutes a limitation for the training of this skill in the subject Clinical Propedeutics and Medical Semiology. Conclusions: A question-based learning model is offered, in which the student is equipped with a didactic-methodological resource for interactive communication with the patient, which facilitates the learning of active listening and the understanding of the patient by the student. It also contributes to the quality of the preparation of the clinical record.


Assuntos
Aprendizagem , Anamnese/métodos , Estudantes de Medicina , Materiais de Ensino , Competência Clínica
19.
Artigo em Inglês | MEDLINE | ID: mdl-32093286

RESUMO

BACKGROUND: Language barriers play a critical role in the treatment of migrant and refugeepatients. In Germany, primary care interpreters are often not available especially in rural areas or ifpatients demand spontaneous or urgent consultations. Methods: In order to enable patients and theirphysicians to communicate effectively about the current illness history, we developed a digitalcommunication assistance tool (DCAT) for 19 different languages and dialects. This paper reportsthe multidisciplinary process of the conceptual design and the iterative development of this crossculturaluser-centered application in an action-oriented approach. Results: We piloted our app with36 refugee patients prior to a clinical study and used the results for further development. Theacceptance and usability of the app by patients was high. Conclusion: Using digital tools forovercoming language barriers can be a feasible approach when providing health care to foreignlanguagepatients.


Assuntos
Barreiras de Comunicação , Anamnese/métodos , Aplicativos Móveis , Refugiados , Comunicação , Assistência à Saúde , Alemanha , Humanos , Idioma , Projetos Piloto
20.
Int J Med Inform ; 136: 104095, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32058265

RESUMO

Clinicians write a billion free text notes per year. These notes are typically replete with errors of all types. No established automated method can extract data from this treasure trove. The practice of medicine therefore remains haphazard and chaotic, resulting in vast economic waste. The lexeme hypotheses are based on our analysis of how records are created. They enable a computer system to predict what issue a clinician will need to address next, based on the environment in which the clinician is working, and what responses the clinician has selected to date. The system uses a lexicon storing the issues (queries) and a range of responses to the issues. When the clinician selects a response, a text fragment is added to the output file. In the first phase of this work, the notes of 69 returning hemophilia patients were scrutinized, and the lexicon was expanded to 847 lexeme queries and 7995 responses to enable the construction of completed notes. The quality of lexeme-generated notes from 20 consecutive subjects was then compared to the clinicians' conventional clinic notes. The system generated grammatically correct notes. In comparison to the traditional clinic note, the lexeme-generated notes were more complete (88 % compared with 62 %), and had less typographical and grammatical errors (0.8 versus 3.5 errors per note). The system notes and traditional notes averaged about 800 words, but the traditional notes had a much wider distribution of lengths. The note-creation rate from marshalling the data to completion using the system averaged 80 wpm, twice as fast as the typical clinician can type. The lexeme method generates more complete, grammatical and organized notes faster than traditional methods. The notes are completely computerized at inception, and they incorporate prompts for clinicians to address otherwise overlooked items. This pilot justifies further exploration of this methodology.


Assuntos
Curadoria de Dados/normas , Documentação/métodos , Armazenamento e Recuperação da Informação/métodos , Anamnese/métodos , Padrões de Prática Médica/normas , Processamento de Texto/estatística & dados numéricos , Redação/normas , Adulto , Automação , Competência Clínica , Hemofilia A/diagnóstico , Hemofilia A/terapia , Humanos , Registros Médicos , Projetos Piloto , Adulto Jovem
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