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1.
J Pediatr ; 221: 207-214, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32446483

RESUMO

OBJECTIVE: To determine the interobserver agreement of history and physical examination findings in children undergoing evaluation in the emergency department (ED) for headaches. STUDY DESIGN: We conducted a prospective, cross-sectional study of children aged 2-17 years evaluated at 3 tertiary-care pediatric EDs for non-traumatic headaches. Two clinicians independently completed a standardized assessment of each child and documented the presence or absence of history and physical examination variables. Unweighted κ statistics were determined for 68 history and 24 physical examination variables. RESULTS: We analyzed 191 paired observations; median age was 12 years, with 19 (9.9%) children younger than 7 years. Interrater reliability was at least moderate (κ ≥ 0.41) for 41 (60.3%) patient history variables. Eleven (61.1%) of 18 physical examination variables for which κ statistics could be calculated had a κ that was at least moderate. CONCLUSIONS: A substantial number of history and physical examination findings demonstrated at least moderate κ statistic values when assessed in children with headaches in the ED. These variables may be generalizable across different types of clinicians for evaluation of children with headaches. If also found to predict the presence or absence of emergent intracranial abnormalities, the more reliable clinical findings may be helpful in the development of clinical prediction rules or risk stratification models that could be used across settings for children with headaches.


Assuntos
Cefaleia/epidemiologia , Anamnese/normas , Variações Dependentes do Observador , Exame Físico/normas , Adolescente , Criança , Pré-Escolar , Estudos Transversais , Medicina de Emergência , Serviço Hospitalar de Emergência , Feminino , Humanos , Masculino , Pediatria , Estudos Prospectivos , Reprodutibilidade dos Testes
5.
Obes Facts ; 13(1): 1-28, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31945762

RESUMO

Heterogeneity of interindividual and intraindividual responses to interventions is often observed in randomized, controlled trials for obesity. To address the global epidemic of obesity and move toward more personalized treatment regimens, the global research community must come together to identify factors that may drive these heterogeneous responses to interventions. This project, called OBEDIS (OBEsity Diverse Interventions Sharing - focusing on dietary and other interventions), provides a set of European guidelines for a minimal set of variables to include in future clinical trials on obesity, regardless of the specific endpoints. Broad adoption of these guidelines will enable researchers to harmonize and merge data from multiple intervention studies, allowing stratification of patients according to precise phenotyping criteria which are measured using standardized methods. In this way, studies across Europe may be pooled for better prediction of individuals' responses to an intervention for obesity - ultimately leading to better patient care and improved obesity outcomes.


Assuntos
Variação Biológica da População , Prova Pericial , Anamnese/normas , Obesidade/terapia , Ensaios Clínicos Controlados Aleatórios como Assunto/normas , Variação Biológica da População/fisiologia , Comportamento de Escolha , Dieta , Europa (Continente) , Humanos , Obesidade/diagnóstico , Prognóstico , Projetos de Pesquisa/normas
7.
Am J Emerg Med ; 38(1): 50-54, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31005394

RESUMO

OBJECTIVES: The primary objective of this study was to determine the proportion of patients with medication discrepancies when using a self-administered medication history form in the emergency department (ED). The secondary objectives were to identify predictors of medication discrepancies and determine the proportion of patients with a high-risk medication discrepancy. METHODS: This was a cross-sectional study conducted in an urban ED in Australia. Patients completed a self-administered medication history form while waiting to be seen by a physician. Subsequently, a best possible medication history was taken by a pharmacist to determine accuracy of the self-reported medication lists for patients with planned admissions. Discrepancies between the two medication lists were reported descriptively. A Poisson regression analysis was conducted to identify predictors of the rate of discrepancies. Associations were reported as incident rate ratios (IRR). RESULTS: A total of 138 patients were included in the study. The total number of discrepancies was as follows: 0 (25%, n = 34), 1 (34%, n = 47), 2 (11%, n = 15), and ≥3 (30%, n = 42). The number of medications (IRR 1.11, 95% CI 1.09 to 1.14, p < 0.001), female (IRR 1.51, 95% CI 1.18 to 1.92, p = 0.001), and missing community pharmacy information (IRR 2.10, 95% CI 1.64 to 2.68, p < 0.001) were significantly associated with rate of discrepancies. Overall, 20% (n = 28) of patients had one or more high-risk medication discrepancies. CONCLUSION: Patient self-administered medication history forms have a high rate of discrepancies and should be verified by a best possible medication history.


Assuntos
Serviço Hospitalar de Emergência/organização & administração , Reconciliação de Medicamentos/normas , Autorrelato , Adulto , Idoso , Austrália , Estudos Transversais , Feminino , Humanos , Masculino , Anamnese/normas , Erros de Medicação/prevenção & controle , Pessoa de Meia-Idade
8.
Gastroenterology ; 158(2): 389-403, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31759928

RESUMO

Approximately 35% of patients with colorectal cancer (CRC) have a family history of the disease attributed to genetic factors, common exposures, or both. Some families with a history of CRC carry genetic variants that cause CRC with high or moderate penetrance, but these account for only 5% to 10% of CRC cases. Most families with a history of CRC and/or adenomas do not carry genetic variants associated with cancer syndromes; this is called common familial CRC. Our understanding of familial predisposition to CRC and cancer syndromes has increased rapidly due to advances in next-generation sequencing technologies. As a result, there has been a shift from genetic testing for specific inherited cancer syndromes based on clinical criteria alone, to simultaneous testing of multiple genes for cancer-associated variants. We summarize current knowledge of common familial CRC, provide an update on syndromes associated with CRC (including the nonpolyposis and polyposis types), and review current recommendations for CRC screening and surveillance. We also provide an approach to genetic evaluation and testing in clinical practice. Determination of CRC risk based on family cancer history and results of genetic testing can provide a personalized approach to cancer screening and prevention, with optimal use of colonoscopy to effectively decrease CRC incidence and mortality.


Assuntos
Neoplasias Colorretais/diagnóstico , Detecção Precoce de Câncer/normas , Predisposição Genética para Doença , Testes Genéticos/normas , Anamnese/normas , Neoplasias Colorretais/epidemiologia , Neoplasias Colorretais/genética , Neoplasias Colorretais/prevenção & controle , Detecção Precoce de Câncer/métodos , Testes Genéticos/métodos , Sequenciamento de Nucleotídeos em Larga Escala , Humanos , Guias de Prática Clínica como Assunto , Medicina de Precisão/métodos , Medicina de Precisão/normas , Medição de Risco/métodos , Medição de Risco/normas , Fatores de Risco
9.
Obesity (Silver Spring) ; 28(1): 9-17, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31858735

RESUMO

Eliciting a weight history can provide clinically important information to aid in treatment decision-making. This view is consistent with the life course perspective of obesity and the aim of patient-centered care, one of six domains of health care quality. However, thus far, the value and practicality of including a weight history in the clinical assessment and treatment of patients with obesity have not been systematically explored. For these reasons, the Clinical Committee of The Obesity Society established a task force to review and assess the available evidence to address five key questions. It is concluded that weight history is an essential component of the medical history for patients presenting with overweight or obesity, and there are strong and emerging data that demonstrate the importance of life stage, duration of exposure to obesity, maximum BMI, and group-based trajectory modeling in predicting risk for increased morbidity and mortality. Consideration of these and other patient-specific factors may improve risk stratification and clinical decision-making for screening, counseling, and management. Recommendations are provided for the key elements that should be included in a weight history, and several needs for future clinical research are outlined.


Assuntos
Peso Corporal/fisiologia , Trajetória do Peso do Corpo , Anamnese , Obesidade/terapia , Assistência Centrada no Paciente/tendências , Aconselhamento , Tomada de Decisões , Humanos , Anamnese/métodos , Anamnese/normas , Morbidade , Mortalidade , Obesidade/epidemiologia , Obesidade/patologia , Sobrepeso/epidemiologia , Sobrepeso/patologia , Sobrepeso/terapia , Assistência Centrada no Paciente/métodos , Assistência Centrada no Paciente/normas , Padrões de Prática Médica/normas , Padrões de Prática Médica/tendências
10.
Obstet Gynecol ; 134(6): e143-e149, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31764758

RESUMO

A hereditary cancer syndrome is a genetic predisposition to certain types of cancer, often with onset at an early age, caused by inherited pathogenic variants in one or more genes. Most hereditary cancer syndromes exhibit autosomal dominant inheritance. The most common hereditary cancer syndromes related to women's cancer include hereditary breast and ovarian cancer syndrome, Lynch syndrome, Li-Fraumeni syndrome, Cowden syndrome, Peutz-Jeghers syndrome, and hereditary diffuse gastric cancer. A hereditary cancer risk assessment is the key to identifying patients and families who may be at increased risk of developing certain types of cancer. Assessments should be performed by obstetrician-gynecologists or other obstetric-gynecologic care providers and should be updated regularly. An assessment includes information on personal and family history, including pathology, imaging reports, and evaluation of other medical risk factors for cancer. If a hereditary cancer risk assessment suggests an increased risk of a hereditary cancer syndrome, referral to a specialist in cancer genetics or a health care provider with expertise in genetics is recommended for expanded gathering of family history information, risk assessment, education, and counseling, which may lead to genetic testing and tailored cancer screening or risk reduction measures, or both. Currently, genetic testing is guided by personal history, family history, pedigree analysis and, in some cases, risk models that may include pathology reports and confirmation of cancer diagnoses with medical records, death certificates, or both. Counseling before and after genetic testing is an important part of the process to discuss rationale for any genetic testing, disclose results, define other cancer risks, identify educational needs, and secure referrals if necessary for ongoing management. This revision includes updates related to hereditary breast and ovarian cancer, cascade testing, and referrals to genetics specialists.


Assuntos
Predisposição Genética para Doença , Anamnese/normas , Síndromes Neoplásicas Hereditárias/diagnóstico , Complicações Neoplásicas na Gravidez/diagnóstico , Diagnóstico Pré-Natal , Feminino , Aconselhamento Genético , Ginecologia , Humanos , Síndromes Neoplásicas Hereditárias/genética , Obstetrícia , Gravidez , Complicações Neoplásicas na Gravidez/genética , Sociedades Médicas , Estados Unidos
12.
Acad Med ; 94(11S Association of American Medical Colleges Learn Serve Lead: Proceedings of the 58th Annual Research in Medical Education Sessions): S21-S27, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31663941

RESUMO

PURPOSE: Clinical reasoning is often assessed through patient notes (PNs) following standardized patient (SP) encounters. While nonclinicians can score PNs using analytic tools such as checklists, these do not sufficiently encompass the holistic judgments of clinician faculty. To better model faculty judgments, the authors developed checklists with faculty-specified scoring formulas embedded in spreadsheets and studied the resulting interrater reliability (IRR) of nonclinician raters (SPs and medics) and student pass/fail status. METHOD: In Study 1, nonclinician and faculty raters rescored PNs of 55 third-year medical students across 5 cases of the 2017 Graduation Competency Examination (GCE) to determine IRR. In Study 2, nonclinician raters scored all notes of the 5-case 2018 GCE (178 students). Faculty rescored all notes of failing students and could modify formula-derived scores if faculty felt appropriate. Faculty also rescored and corrected scores of additional notes for a total of 90 notes (3 cases, including failing notes). RESULTS: Mean overall percent exact agreement between nonclinician and faculty ratings was 87% (weighted kappa, 0.86) and 83% (weighted kappa, 0.88) for Study 1 and Study 2, respectively. SP and medic IRRs did not differ significantly. Four students failed the note section in 2018; 3 passed after faculty corrections. Few corrections were made to nonfailing students' notes. CONCLUSIONS: Nonclinician PN raters using checklists and scoring rules may provide a feasible alternative to faculty raters for low-stakes assessments and for the bulk of well-performing students. Faculty effort can be targeted strategically at rescoring notes of low-performing students and providing more detailed feedback.


Assuntos
Competência Clínica/normas , Tomada de Decisão Clínica , Documentação/normas , Educação de Graduação em Medicina/métodos , Anamnese/estatística & dados numéricos , Anamnese/normas , Estudantes de Medicina/estatística & dados numéricos , Adulto , Lista de Checagem , Competência Clínica/estatística & dados numéricos , Avaliação Educacional , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Resolução de Problemas , Reprodutibilidade dos Testes
13.
Public Health Genomics ; 22(3-4): 110-118, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31661705

RESUMO

BACKGROUND: Family history (FH) is a risk factor for many conditions in pediatric practice. There is no standard of care regarding FH taking, and only a few published studies about current practice. OBJECTIVES: To explore in depth pediatricians' perceptions, attitudes, beliefs, and practices regarding FH taking. METHODS: The Theoretical Domains Framework (TDF) was used to develop a comprehensive interview scheme. Semi-structured interviews were conducted with community pediatricians. Interviews were audio-recorded, transcribed, and analyzed using a thematic approach and the constant comparison method. RESULTS: Eleven pediatricians were interviewed. FH was found to be a firmly embedded, complex, and important aspect of pediatric practice. Participants described FH as part of regular holistic care. FH and social history were linked and often appeared to be part of the same concept to participants. FH was used for a range of purposes. In addition to risk assessment, FH information helped clarify diagnosis and select medication, tailor overall patient management based on family circumstance, and provide psychosocial support for parents. Participants expressed confidence in their FH skills and reported tailoring their approach with experience. Most were not concerned about formal evidence for FH and would not change their practice except for "good reason." CONCLUSIONS: The use of the TDF helped ensure a comprehensive approach to FH taking in pediatric practice. The findings suggest that FH taking in this setting is a complex activity, embedded in routine care. Efforts to make FH taking more systematic may founder if they fail to take into account pediatricians' attitudes, perspectives, and practices.


Assuntos
Atitude do Pessoal de Saúde , Anamnese/normas , Pediatras/normas , Linhagem , Adolescente , Atitude Frente a Saúde , Criança , Competência Clínica/normas , Coleta de Dados , Feminino , Saúde Holística , Humanos , Masculino , Ontário , Pediatras/psicologia , Padrões de Prática Médica/normas , Pesquisa Qualitativa
14.
BMJ Case Rep ; 12(8)2019 Aug 10.
Artigo em Inglês | MEDLINE | ID: mdl-31401567

RESUMO

Orthostatic headache (OH) is a key symptom of spontaneous intracranial hypotension (SIH). However, there is no optimal history taking for OH. A 35-year-old man complained of headache that prevented him from performing routine physical activities, which was relieved on lying down. We initially considered migraine as the most likely diagnosis. However, detailed history taking revealed that his headache worsened on standing, and he was finally diagnosed with SIH. Headache relief on lying down is not a specific indicator of OH associated with SIH. Thus, with regard to headache history taking, we suggest it important to confirm headache aggravation on standing.


Assuntos
Cefaleia/etiologia , Hematoma Subdural Intracraniano/etiologia , Hipotensão Intracraniana/diagnóstico , Anamnese/normas , Adulto , Tratamento Conservador , Diagnóstico Tardio , Hematoma Subdural Intracraniano/diagnóstico por imagem , Humanos , Hipotensão Intracraniana/complicações , Hipotensão Intracraniana/terapia , Masculino , Posição Ortostática , Tomografia Computadorizada de Emissão de Fóton Único
15.
Clín. investig. arterioscler. (Ed. impr.) ; 31(supl.1): 1-43, jul. 2019. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-184300

RESUMO

La Sociedad Española de Arteriosclerosis tiene entre sus objetivos contribuir al mayor y mejor conocimiento de la enfermedad vascular, su prevención y su tratamiento. Las enfermedades cardiovasculares son la primera causa de muerte en nuestro país y conllevan además un elevado grado de discapacidad y de gasto sanitario. La arteriosclerosis es una enfermedad de causa multifactorial, y es por ello que su prevención exige un abordaje global que contemple los distintos factores de riesgo con los que se asocia. Así, este documento resume el nivel actual de conocimientos e integra recomendaciones y procedimientos a seguir ante el paciente que presenta enfermedad cardiovascular establecida o se encuentra con elevado riesgo vascular. En concreto, este documento revisa los principales síntomas y signos a evaluar durante la visita clínica, los procedimientos de laboratorio y de imagen a solicitar de forma rutinaria o aquellos en situaciones especiales; igualmente, incluye la estimación del riesgo vascular, los criterios diagnósticos de las distintas entidades que son factores de riesgo cardiovascular, plantea recomendaciones generales y específicas para el tratamiento de los distintos factores de riesgo cardiovascular, así como sus objetivos finales. Por último, el documento recoge aspectos habitualmente poco referidos en la literatura, como son la organización de una consulta de riesgo vascular


One of the main goals of the Spanish Society of Arteriosclerosis is to contribute to a wider and greater knowledge of vascular disease, its prevention and treatment. Cardiovascular diseases are the leading cause of death in our country and also lead to a high degree of disability and health expenditure. Arteriosclerosis is a multifactorial disease, this is why its prevention requires a global approach that takes into account the different risk factors with which it is associated. Thus, this document summarizes the current level of knowledge and integrates recommendations and procedures to be followed for patients with established cardiovascular disease or high vascular risk. Specifically, this document reviews the main symptoms and signs to be evaluated during the clinical visit, the laboratory and imaging procedures to be routinely requested or those in special situations. It also includes the estimation of vascular risk, the diagnostic criteria of the different entities that are cardiovascular risk factors, and presents general and specific recommendations for the treatment of the different cardiovascular risk factors and their final objectives. Finally, the document includes aspects that are not often mentioned in the literature, such as the organisation of a vascular risk consultation


Assuntos
Humanos , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/prevenção & controle , Sociedades Médicas/normas , Fatores de Risco , Doença da Artéria Coronariana/epidemiologia , Doença da Artéria Coronariana/prevenção & controle , Prevenção Secundária , Prevenção Primária , Anamnese/normas , Índice Tornozelo-Braço
16.
PLoS One ; 14(6): e0218703, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31226156

RESUMO

Biased transmission of health knowledge has far-reaching effects on information reproduction and health-related cognitions. We examined whether transmissions of different types of disorder and etiological information influence recollections of health knowledge and evaluations of patients, by simulating the digital transmission of information. Transmission chains of four non-interacting persons (i.e., four generations) were formed. The first generation read three vignettes describing fictitious patients with one of three disorders (physiological, psychological, culture-bound) uniquely paired with one of three etiologies (genetic, environmental, unknown etiology). Next, they evaluated patients' well-being, rated desired social distance, and recalled the vignettes. These written recollections replaced the original vignettes for a second-generation of participants, whose recollections were used for the third generation and so on. The framing of disorders affected recollections of etiology, in which culture-bound framings resulted in the poorest recall of etiologies. Participants also perceived the culture-bound disorder as the least serious but desired the most social distance from patients diagnosed with it, when compared to other disorders. The study showed that health information is selectively attended to and reproduced, possibly affected by perceived self-relevance. Faulty recollections and framing of disorders affect health cognitions, potentially instigating biased transmission of disorder- and patient-related narratives.


Assuntos
Cognição/fisiologia , Doença/etiologia , Disseminação de Informação , Rememoração Mental/fisiologia , Narração , Adolescente , Adulto , Viés de Atenção/fisiologia , Atitude Frente a Saúde , Viés , Comunicação , Cultura , Doença/psicologia , Feminino , Humanos , Disseminação de Informação/métodos , Conhecimento , Masculino , Anamnese/normas , Pessoa de Meia-Idade , Percepção , Inquéritos e Questionários , Adulto Jovem
19.
Comput Inform Nurs ; 37(5): 260-265, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31094915

RESUMO

The objective of this quality improvement study was to evaluate whether electronic health record system timers and event logs can measure the efficiency and quality of a clinical process in an electronic health record. Using an experimental pre- and post-nonrandomized prospective cohort design, the researchers introduced a newly defined admission patient history essential data set and examined the electronic health record event files and timers to analyze the nursing experience from an efficiency and quality perspective. The researchers evaluated efficiency by measuring the time and clicks required to complete an admission history. The average active time spent documenting the admission patient history decreased by 72% from the preintervention measure (mean = 9.30 minutes) to the postintervention measure (mean = 2.55 minutes). The number of clicks decreased by 76% from the preintervention number of clicks (mean = 151.5) to the postintervention number of clicks (mean = 35.93). The quality of documentation was measured as the proportion of completed essential items and the frequency of completing an assessment in one sequence. The capture of essential data elements improved by almost 6%, and admission patient history data completed in one sequence increased by 24%. These study results demonstrate that system timers and event logs can measure the preintervention and postintervention changes in efficiency and quality of a defined clinical workflow into an electronic health record.


Assuntos
Documentação/normas , Registros Eletrônicos de Saúde , Anamnese/métodos , Enfermeiras e Enfermeiros/normas , Conjuntos de Dados como Assunto , Documentação/métodos , Humanos , Anamnese/normas , Enfermeiras e Enfermeiros/estatística & dados numéricos , Admissão do Paciente/normas , Melhoria de Qualidade
20.
BMC Med Educ ; 19(1): 141, 2019 May 14.
Artigo em Inglês | MEDLINE | ID: mdl-31088550

RESUMO

BACKGROUND: Reflective practice (RP) plays a crucial role in encouraging learners to think critically and consciously about their performances. Providing constructive feedback can further enhance RP. But non-Western learners might face different learning barriers compared to learners in the West, where RP originated. METHODS: In this retrospective study, we assessed RP and feedback performances on Thai medical students' patient history-taking skills. We applied RP and peer feedback, along with feedback from the instructors, during the history-taking sessions of the ten-week introduction course for fourth-year medical students. Twelve history-taking sessions were used for the analysis. Two instructors assessed students' reflective performance and categorised them into one of the six stages of Gibbs' reflective cycle; their feedback performances were analysed using Pendleton's model. We investigated the correlations between students' overall grade point average (GPAX) and patient history-taking scores on the Objective Structured Clinical Examination (OSCE). Students' opinions of the RP teaching method were also collected. RESULTS: All (n = 48) students participated in our study. The students' mean age was 21.2 ± 0.5 years. The majority of the students were female (64.6%). The data indicated that 33 and 4% of the participants were categorised into the evaluation stage and action plan stage of Gibbs' reflective cycle, respectively. In addition, 22 and 15% of the participants were able to state what their peers did well and suggest how peers could improve their skills, respectively. All students passed the minimum passing level of four history-taking OSCE stations. Participants agreed that RP was a useful tool (mean 9.0, SD 0.1), which enhanced their thought processes (mean 8.4, SD 0.2) and future performances (mean 8.2, SD 0.2). However, there was no correlation between the students' highest Gibbs' reflection levels and their history-taking OSCE scores. CONCLUSIONS: RP, together with feedback, proved to be a useful technique to help fourth-year Thai medical students improve their reflection skills, enhance their medical knowledge, and improve patient history-taking skills. Further study with longer monitoring is required to further explore negative and positive influential factors affecting students' achievement of better reflection performances.


Assuntos
Competência Clínica/normas , Conhecimento Psicológico de Resultados , Anamnese/normas , Estudantes de Medicina , Atitude do Pessoal de Saúde , Avaliação Educacional , Retroalimentação , Feminino , Humanos , Masculino , Estudos Retrospectivos , Autoavaliação , Tailândia , Adulto Jovem
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