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2.
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
3.
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
4.
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
6.
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 , Anamnese/normas , Estudantes de Medicina , Atitude do Pessoal de Saúde , Avaliação Educacional , Retroalimentação , Feminino , Humanos , Masculino , Estudos Retrospectivos , Autoavaliação , Tailândia , Adulto Jovem
7.
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
9.
BMC Med Educ ; 19(1): 108, 2019 Apr 15.
Artigo em Inglês | MEDLINE | ID: mdl-30987621

RESUMO

BACKGROUND: Many foreign students have difficulty taking histories from Chinese patients, especially in clinical context of the Department of Obstetrics and Gynaecology. The efficacy of using standardized patients to prepare foreign students for communicating with Chinese patients and taking their histories was evaluated in this study. METHODS: Ninety-four four-year foreign students were assigned to one of three clinical sub-departments (gynaecology, obstetrics, and reproductive endocrinology) to practice history-taking; after practicing in one sub-department, the students were then crossed over to a different department. The histories were taken from real patients in the sub-departments of obstetrics and reproductive endocrinology and from standardized patients in the sub-department of gynaecology. Prior to contact with real patients in the sub-department of reproductive endocrinology, the students practised with standardized patients. The quality levels of the case reports generated in the three departments were compared by repeated measures ANOVA. The attitudes, satisfaction and suggestions of the students were also investigated through a questionnaire. RESULTS: The local Chinese language spoken by the patients was thought to be the most common difficulty students (76.7%) encountered while taking patient histories. Two-thirds and one-third of the students were interested in taking histories from standardized and real patients, respectively. Most students (94.2%) thought that working with standardized patients was useful for practising communication skills with Chinese patients. The total scores of the case reports were significantly different among the three groups (P < 0.001), and compared with case reports collected from real patients, case reports collected from standardized patients were of better quality. However, the quality of the case reports taken from real patients was better when the case reports were generated by students who had previous practice with standardized patients than when they were generated by students lacking such experience (P < 0.001). CONCLUSIONS: Standardized patient training for practising history-taking can be included as part of the clinical training curriculum for foreign medical undergraduates in the Department of Obstetrics and Gynaecology in China.


Assuntos
Educação de Graduação em Medicina/normas , Médicos Graduados Estrangeiros , Ginecologia/educação , Anamnese/normas , Obstetrícia/educação , China , Comunicação , Barreiras de Comunicação , Médicos Graduados Estrangeiros/psicologia , Médicos Graduados Estrangeiros/normas , Humanos , Relações Médico-Paciente
10.
BMC Med Res Methodol ; 19(1): 56, 2019 03 12.
Artigo em Inglês | MEDLINE | ID: mdl-30871571

RESUMO

BACKGROUND: Family health history (FHH) inherently involves collecting proxy reports of health statuses of related family members. Traditionally, such information has been collected from a single informant. More recently, research has suggested that a multiple informant approach to collecting FHH results in improved individual risk assessments. Likewise, recent work has emphasized the importance of incorporating health-related behaviors into FHH-based risk calculations. Integrating both multiple accounts of FHH with behavioral information on family members represents a significant methodological challenge as such FHH data is hierarchical in nature and arises from potentially error-prone processes. METHODS: In this paper, we introduce a statistical model that addresses these challenges using informative priors for background variation in disease prevalence and the effect of other, potentially correlated, variables while accounting for the nested structure of these data. Our empirical example is drawn from previously published data on families with a history of diabetes. RESULTS: The results of the comparative model assessment suggest that simply accounting for the structured nature of multiple informant FHH data improves classification accuracy over the baseline and that incorporating family member health-related behavioral information into the model is preferred over alternative specifications. CONCLUSIONS: The proposed modelling framework is a flexible solution to integrate multiple informant FHH for risk prediction purposes.


Assuntos
Algoritmos , Teorema de Bayes , Modelos Logísticos , Anamnese/estatística & dados numéricos , Modelos Teóricos , Análise por Conglomerados , Coleta de Dados/métodos , Coleta de Dados/estatística & dados numéricos , Diabetes Mellitus Tipo 2/classificação , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/terapia , Família , Saúde da Família/estatística & dados numéricos , Feminino , Humanos , Masculino , Anamnese/métodos , Anamnese/normas , Medição de Risco/métodos , Medição de Risco/estatística & dados numéricos
12.
Clin Pediatr (Phila) ; 58(5): 547-554, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30788982

RESUMO

The preparticipation sports examination (PPE) is required for US high school athletes. We queried members of the Illinois Chapter of the American Academy of Pediatrics (ICAAP) about what they actually include in a PPE, allotted PPE time, and counseling about full contact sports participation. Of 2300 ICAAP members contacted electronically, 228 (10%) responded, yielding 205 usable surveys. When performing a PPE, 34 (25%) always complete all of 6 selected AAP-recommended PPE components and 102 (74%) always get a concussion history. In contrast, 29 (21%) always complete all of the 6 selected AAP PPE components and 70 (49%) always get a concussion history as part of well-child checkup. Main interferences with clinician proficiency are lack of time and training cited by 49% and 37%, respectively. Pediatricians were evenly divided about whether or not to counsel against full contact sports, but were more likely to do so after the athlete sustained a first concussion.


Assuntos
Fidelidade a Diretrizes/estatística & dados numéricos , Anamnese/métodos , Pediatras/estatística & dados numéricos , Exame Físico/métodos , Padrões de Prática Médica/estatística & dados numéricos , Esportes Juvenis , Adolescente , Traumatismos em Atletas/diagnóstico , Traumatismos em Atletas/etiologia , Traumatismos em Atletas/prevenção & controle , Atitude do Pessoal de Saúde , Concussão Encefálica/diagnóstico , Concussão Encefálica/etiologia , Concussão Encefálica/prevenção & controle , Criança , Aconselhamento Diretivo/estatística & dados numéricos , Feminino , Pesquisas sobre Serviços de Saúde , Humanos , Illinois , Masculino , Anamnese/normas , Anamnese/estatística & dados numéricos , Pediatras/normas , Exame Físico/normas , Exame Físico/estatística & dados numéricos , Guias de Prática Clínica como Assunto , Medição de Risco , Esportes Juvenis/lesões
13.
Nurs Clin North Am ; 54(1): 33-51, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30712544

RESUMO

Fast tracks are widely used in emergency departments to increase patient throughput as annual visits continue to rise in the United States. A modified triage process known as QuickLook, which omits patients' past medical history, is used in some hospitals to further increase throughput. This article discusses the effects of QuickLook on patient placement, reviews the role of past medical history in triage, and discusses the impact of integrating a targeted history question into the QuickLook process of an emergency department in Arizona.


Assuntos
Comunicação , Enfermagem em Emergência/normas , Serviço Hospitalar de Emergência/normas , Anamnese/normas , Guias de Prática Clínica como Assunto , Triagem/normas , Arizona , Humanos , Relações Enfermeiro-Paciente
14.
J Bone Joint Surg Am ; 101(1): e1, 2019 Jan 02.
Artigo em Inglês | MEDLINE | ID: mdl-30601421
15.
J Emerg Med ; 56(2): 153-165, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30598296

RESUMO

BACKGROUND: Delayed diagnoses of unstable thoracolumbar spine (TL-spine) fractures can result in neurologic deficits and avoidable pain, so it is important for clinicians to reach prompt diagnostic decisions. There are no validated decision aids for determining which trauma patients warrant TL-spine imaging. OBJECTIVE: Our aim was to quantify the diagnostic accuracy of the injury mechanism, physical examination, associated injuries, clinical decision aids, and imaging for evaluating blunt TL-spine trauma patients. METHODS: A search strategy for studies including adult blunt TL-spine trauma using PubMed, Embase, Scopus, CENTRAL, Cochrane Database of Systematic Reviews, and ClinicalTrials.gov was performed. Excluded studies lacked data to construct 2 × 2 tables, were duplicates, were not primary research, did not focus on blunt trauma, examined associated injuries without any utility in identifying TL-spine injuries, only studied cervical-spine fractures, were non-English, had a pediatric setting, or were cadaver/autopsy reports. Risk of bias was assessed using the Quality Assessment Tool for Diagnostic Accuracy Studies. Diagnostic predictors were analyzed with a meta-analysis of sensitivity, specificity, and likelihood ratios. RESULTS: In blunt trauma patients in the emergency department, the weighted pretest probability of a TL-spine fracture was 15%. The estimates for detection of TL-spine fractures with plain film were: positive likelihood ratio (+LR) = 25.0 (95% confidence interval [CI] 4.1-152.2; I2 = 94%; p < 0.001) and negative likelihood ratio (-LR) = 0.43 (95% CI 0.32-0.59; I2 = 84%; p < 0.001), and for computed tomography (CT) were: +LR = 81.1 (95% CI 14.1-467.9; I2 = 87%; p < 0.001) and -LR = 0.04 (95% CI 0.02-0.08; I2 = 23%; p = 0.26). CONCLUSIONS: CT is more accurate than plain films for detecting TL-spine fractures. Injury mechanism, physical examination, and associated injuries alone are not accurate to rule-in or rule-out TL-spine fractures.


Assuntos
Diagnóstico por Imagem/normas , Testes Diagnósticos de Rotina/normas , Vértebras Lombares/lesões , Vértebras Torácicas/lesões , Ferimentos e Lesões/diagnóstico , Diagnóstico Tardio/efeitos adversos , Diagnóstico por Imagem/tendências , Testes Diagnósticos de Rotina/tendências , Humanos , Vértebras Lombares/anormalidades , Anamnese/métodos , Anamnese/normas , Exame Físico/métodos , Exame Físico/normas , Radiografia/métodos , Radiografia/normas , Vértebras Torácicas/anormalidades , Tomografia Computadorizada por Raios X/métodos , Tomografia Computadorizada por Raios X/normas
16.
Spine J ; 19(1): 65-70, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-29730459

RESUMO

BACKGROUND CONTEXT: Long-term follow-up of patient-reported outcome measures (PROM) is essential in both modern spinal care and research. Lack of time and staff are commonly reported barriers to implementing long-term follow-up of PROM. Automated and digital follow-up systems for PROM collection are seeing widespread use, yet their validity and comparative effectiveness have never been evaluated. PURPOSE: The present study aimed to assess the validity of digital follow-up systems in comparison with the conventional paper-based follow-up (PB-FU). STUDY DESIGN: This is a retrospective analysis of prospectively collected double follow-up data. PATIENT SAMPLE: Patients who underwent lumbar spinal fusion for spondylolisthesis or degenerative disc disease between 2013 and 2016 were included in the study. OUTCOME MEASURES: The study determined the Oswestry Disability Index (ODI) and Numeric Rating Scale (NRS) for back and leg pain severity at baseline, 6 weeks, 12 months, and 24 months. MATERIALS AND METHODS: After lumbar spinal fusion surgery, a double follow-up of PROM was carried out by conventional PB-FU during clinical visits, while simultaneously completing an automatically dispatched digital follow-up questionnaire. As the primary end point, we assessed the intraindividual discrepancy in PROM between PB-FU and automated digital follow-up (AD-FU). RESULTS: Forty patients completed all parts of the dual follow-up trajectory and were analyzed. We detected no discrepancy in ODI or NRS for back and leg pain severity at any of the baseline, 6-week, 12-month, or 24 month follow-ups (all p>.05). This was confirmed in a sensitivity analysis. CONCLUSIONS: In an analysis of dual paper-based and digital follow-up after lumbar fusion surgery, patients report highly similar values using either method of follow-up. It appears that AD-FU without incentives produces lower response rates. To reassess the validity of these systems for data collection in spinal patient care, a prospective validation with higher statistical power is warranted.


Assuntos
Degeneração do Disco Intervertebral/cirurgia , Anamnese/métodos , Medidas de Resultados Relatados pelo Paciente , Complicações Pós-Operatórias/epidemiologia , Fusão Vertebral/efeitos adversos , Espondilolistese/cirurgia , Adulto , Idoso , Viés , Feminino , Seguimentos , Humanos , Região Lombossacral/cirurgia , Masculino , Anamnese/normas , Pessoa de Meia-Idade , Fusão Vertebral/métodos , Inquéritos e Questionários/normas , Resultado do Tratamento
17.
Teach Learn Med ; 31(1): 87-98, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30216097

RESUMO

PROBLEM: The traditional approach to physicians' history taking is designed to facilitate diagnosis and treatment of biomedical conditions. However, in the 21st century, health is critically influenced by the interaction of biomedical conditions and nonbiomedical factors such as patient's ability to manage chronic disease and the social determinants of health. Interventions to expand routine history taking to include nonbiomedical factors have not been widely adopted, possibly due to the difficultly of incorporating long checklists into routine care and the inability to achieve consensus on the relevant behavioral or social determinants of health content applicable to all patients. INTERVENTION: In 2015-2016, we introduced medical students to a 6-domain (biomedical and psychiatric conditions, behavioral health, living environment/resources, social support, and functional status) approach to history taking and instructed them to elicit information from each domain alongside the traditional approach. Students were required to obtain information from each domain in one admitting history or one daily progress note, discuss their findings with the attending physician, and involve members of the medical team in addressing concerns and barriers in the care of that patient. Students' history notes were reviewed for completeness and compared to those from a student control group. Students also completed a 10-question evaluation of the model. CONTEXT: The intervention was conducted during a 1-month rotation on a hospitalist general medicine service from May 2015 through August 2016. OUTCOME: Patient history and daily progress notes were collected from 38 fourth-year intervention students and compared to 24 control students on the same service from the previous year. Compared to control students, intervention students provided more patient information (p ≤ .001) in all nonbiomedical domains except behavioral health. Intervention students reported that the 6-domain model helped them identify clinical information that could be addressed with existing resources and prompted involvement of social workers, pharmacists, and nurses in care planning. They also indicated the framework added clinically valuable information and enhanced team-based care. LESSONS LEARNED: A domain-based framework can be used by medical students to identify clinically relevant behavioral conditions and social determinants of health tailored to individual patients while avoiding long standardized checklists. Arguably, routine collection of behavioral and social determinants of health is a necessary first step in enhancing physicians' awareness and skills in working with health care teams to address nonbiomedical determinants of patients' health.


Assuntos
Anamnese , Estudantes de Medicina/psicologia , Lista de Checagem , Currículo , Educação de Graduação em Medicina , Estudos de Viabilidade , Disparidades nos Níveis de Saúde , Humanos , Anamnese/métodos , Anamnese/normas , Determinantes Sociais da Saúde , Inquéritos e Questionários
18.
Adv Health Sci Educ Theory Pract ; 24(1): 85-102, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30302670

RESUMO

The increasing use of direct observation tools to assess routine performance has resulted in the growing reliance on assessor-based judgements in the workplace. However, we have a limited understanding of how assessors make judgements and formulate ratings in real world contexts. The current research on assessor cognition has largely focused on the cognitive domain but the contextual factors are equally important, and both are closely interconnected. This study aimed to explore the perceived cognitive and contextual factors influencing Mini-CEX assessor judgements in the Emergency Department setting. We used a conceptual framework of assessor-based judgement to develop a sequential mixed methods study. We analysed and integrated survey and focus group results to illustrate self-reported cognitive and contextual factors influencing assessor judgements. We used situated cognition theory as a sensitizing lens to explore the interactions between people and their environment. The major factors highlighted through our mixed methods study were: clarity of the assessment, reliance on and variable approach to overall impression (gestalt), role tension especially when giving constructive feedback, prior knowledge of the trainee and case complexity. We identified prevailing tensions between participants (assessors and trainees), interactions (assessment and feedback) and setting. The two practical implications of our research are the need to broaden assessor training to incorporate both cognitive and contextual domains, and the need to develop a more holistic understanding of assessor-based judgements in real world contexts to better inform future research and development in workplace-based assessments.


Assuntos
Competência Clínica , Cognição , Educação de Pós-Graduação em Medicina/métodos , Avaliação Educacional/métodos , Julgamento , Adulto , Comunicação , Educação Baseada em Competências/métodos , Educação de Pós-Graduação em Medicina/normas , Avaliação Educacional/normas , Serviço Hospitalar de Emergência/organização & administração , Feminino , Feedback Formativo , Humanos , Masculino , Anamnese/normas , Pessoa de Meia-Idade , Exame Físico/normas , Profissionalismo/normas , Teoria Psicológica , Pesquisa Qualitativa , Fatores de Tempo
19.
J Pharm Pract ; 32(1): 62-67, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29108459

RESUMO

PURPOSE:: To evaluate the differences in medication history errors made by pharmacy technicians, students, and pharmacists compared to nurses at a community hospital. METHODS:: One hundred medication histories completed by either pharmacy or nursing staff were repeated and evaluated for errors by a fourth-year pharmacy student. The histories were analyzed for differences in the rate of errors per medication. Errors were categorized by their clinical significance, which was determined by a panel of pharmacists, pharmacy students, and nurses. Errors were further categorized by their origin as either prescription (Rx) or over the counter (OTC). The primary outcome was the difference in the rate of clinically significant errors per medication. Secondary outcomes included the differences in the rate of clinically insignificant errors, Rx errors, and OTC errors. Differences in the types of errors for Rx and OTC medications were also analyzed. Additionally, the number of patients with no errors was compared between both groups. RESULTS:: The pharmacy group had a lower clinically significant error rate per medication (0.03 vs 0.09; relative risk [RR] = 0.66; 95% confidence interval [CI]: 0.020-0.093; P = .003). For secondary outcomes, the pharmacy group had a lower total error rate (0.21 vs 0.36, RR = 0.58; 95% CI: 0.041-0.255; P = .007), Rx error rate (0.09 vs 0.27, RR = 0.44; 95% CI: 0.071-0.292; P = .002), and OTC error rate (0.24 vs 0.46; RR = 0.52; 95% CI: 0.057-0.382; P = .009) per medication. The pharmacy group completed 20% more medication histories without Rx errors ( P = .045) and 25% more histories without OTC errors ( P = .041). CONCLUSION:: This study demonstrated that expanded use of pharmacy technicians and students improves the accuracy of medication histories in a community hospital.


Assuntos
Anamnese/normas , Enfermeiras e Enfermeiros/normas , Farmacêuticos/normas , Técnicos em Farmácia/normas , Estudantes de Farmácia/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Feminino , Humanos , Masculino , Erros de Medicação/estatística & dados numéricos , Pessoa de Meia-Idade , Medicamentos sem Prescrição/administração & dosagem , Enfermeiras e Enfermeiros/estatística & dados numéricos , Farmacêuticos/estatística & dados numéricos , Serviço de Farmácia Hospitalar/normas , Técnicos em Farmácia/estatística & dados numéricos , Medicamentos sob Prescrição/administração & dosagem , Estudos Prospectivos
20.
J Med Imaging Radiat Sci ; 49(4): 390-396, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30514556

RESUMO

INTRODUCTION: Hundreds of thousands of Ontario women receive breast screening imaging each year. The patient's medical history is a vital tool used to personalize breast screening approaches. This study evaluated the accuracy of self-reported medical and imaging history in patients about to receive breast imaging procedures in a large urban Canadian hospital. The patient experience with using a blank screening form vs. a novel prefilled screening form was also evaluated. METHODS AND MATERIALS: The study was conducted in two phases. Phase 1 compared patient-reported information (via the blank screening form) to information previously captured in the Radiology Information and Picture Archiving Communication Systems to assess data accuracy. In phase 2, study questionnaires were used to collect data on the patients' experience with the screening form in two cohorts (between the blank and a novel prefilled screening form). RESULTS: Data accuracy: for mammography (n = 60), 40% of the patients could accurately recall when and where their last mammogram was performed. For breast ultrasound (n = 43) and breast magnetic resonance imaging (n = 20), significantly fewer patients could accurately recall the date their last test was performed (14% and 10%, respectively). Of those who had previous breast surgery (n = 18), 100% were able to recall whether the surgery resulted in a benign or malignant diagnosis, and 61% were able to accurately recall the year they had the breast surgery. PATIENT EXPERIENCE: Of the returned questionnaires, 65 provided feedback on the blank screening form while 55 provided feedback on the prefilled form. Ninety percent preferred to fill out the new prefilled screening form. The themes acknowledged a general improvement in the screening form, a decrease in frustration associated with having to recall their medical history, and the patients felt that the institution better understood their medical history. CONCLUSIONS: The findings of this research indicate that asking patients to complete a blank medical screening form is a highly inaccurate method of gathering that important information. When that information was prefilled for the patient to review and update, patient frustration and stress were decreased, while satisfaction and confidence in the organization were increased.


Assuntos
Neoplasias da Mama/diagnóstico por imagem , Anamnese/normas , Rememoração Mental , Detecção Precoce de Câncer/métodos , Feminino , Humanos , Imagem por Ressonância Magnética , Mamografia , Anamnese/métodos , Projetos Piloto , Sistemas de Informação em Radiologia , Autorrelato , Inquéritos e Questionários , Ultrassonografia Mamária
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