Patient History Information Research Articles

Evaluation and significance of a digital assistant for patient history-taking and physical examination in telemedicine

Introduction Assisted history-taking systems can be used in provider-to-provider teleconsultations to task-shift the collection of evidence-based medical history and physical exam information to a frontline health worker. We developed such a task-shifting digital assistant, called ‘Ayu’, for nurses in rural India to collect clinical information from a patient and share it with a remote doctor to arrive at an accurate diagnosis and triage decision. Materials & Methods We evaluated the ability of the task-shifting digital assistant to collect a comprehensive patient history by using 190 standardized patient case studies and evaluating the information recall of the assistant by a skilled clinician. Following this, we tested the ability of nurses to use the system by training and evaluating the system’s accuracy when used by 19 nurses in rural Gujarat, India. We also measured the diagnostic and triage accuracy based on the generated history note. Finally, we evaluated the system’s acceptability by using the Technology Acceptance Model framework. Results Ayu could capture 65% of patient history information and 42% of physical exam information from patient case studies. When used by nurses, the mean accuracy of the generated clinical note was 7.71 ± 2.42. Using the information collected by a nurse using Ayu, a primary care physician could arrive at the correct diagnosis in 74% of cases, and correct triage decision in 88% of cases. Overall, we saw a high acceptability from nurses to use the system. Conclusions Ayu can capture an acceptable proportion of clinical information and can aid in collecting an evidence-based medical history by task-shifting some of the early investigational steps. Further development of Ayu to increase its information retrieval ability and ease of use by health workers is needed.

The Benefits of Electronic Medical Records Reviewed from Economic, Clinical, and Clinical Information Benefits in Hospitals

The development and progress of information technology are advancing very rapidly, electronic medical records are one form of these developments and advances in the health sector. A hospital is a place of service in the health sector that performs services related to medical records. Medical records can be made in full and clearly in electronic (digital) form. The implementation of medical record technology can solve many problems in the economic field, clinical, and information of clinical in the hospital system. The high cost of operational and complicated procedures is a crucial problem in the hospital system. So, the advance of medical technology can press high costs, cutting off the manual process to faster and more effective system and efficiency costs of operational. The study uses Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA), with many articles on the same issue. The same issues that can be found at the same topics of articles are probably more than fifty topics of articles. Articles were taken from various sources and database references, including Scopus 2 journals, Science Direct 16 journals, ProQuest 10 journals, Springer Link 3 journals, Google Scholar 36 journals, Research Gate 21 journals, PubMed 31 journals, and Emerald Insight 31 journals. So the total journal database is 133 journals. Then filtering was carried out by identifying the suitability of the journal until it was narrow and 27 articles were selected to be used as a reference in this research.. The purpose of this study is to determine the benefits of applying Electronic Medical Records in terms of economic, clinical, and access to clinical information. Some of the economic benefits include cost savings, effectiveness, and cost efficiency. Clinical benefits include reducing medical errors, improving data readability, improving the quality of care services, and increasing the productivity of medical personnel. And the benefits of accessing clinical information include improving the accessibility of patient history information, improving patient confidentiality, and assisting the decision-making process.

DECLARE: A Comprehensive, Multifaceted Cognitive Forcing Strategy to Confront Complex Cases.

Diagnostic excellence is an important goal in medicine. The enhancement of clinical reasoning skills of physicians, which is at the core of this concept, is a significant challenge. To achieve this improvement, it is necessary to enhance the ability to collect patient history information and to integrate the information. Additionally, the complexity of diagnosis is confounded by biases, noise, uncertainty, and contextual factors, and the impact of these factors is particularly prominent in complex cases. In such cases, the dual process theory, which is a classical reasoning measure, alone is insufficient to cope with these challenges, and a multifaceted and comprehensive approach is required to supplement its limitations. Therefore, the author presents six concrete steps, represented by the acronym DECLARE (Decomposition, Extraction, Causation Link, Assessing Accountability, Recomposition, Explanation and Exploration), that implement the concept of cognitive forcing strategy that has been shown to be effective in bias control, and include reflection, meta-cognition, and the recently popularized decision hygiene procedure. DECLARE is a strategy that should be deployed when faced with more complex diagnostic scenarios. By examining each of the six steps that comprise DECLARE individually, cognitive load can be reduced. Furthermore, by verifying causation and accountability when constructing diagnostic hypotheses, biases can be mitigated, which can also help to address noise and uncertainty, leading to an improvement in the quality of diagnosis and effectiveness in medical education.

Evaluation of the Knowledge and Practices About Drug Prescribing and Adverse Reaction Reporting Among Turkish Dentists

Introduction: The purpose of this study was to assess dental care professionals' drug prescription knowledge, practices, and reporting of adverse drug reactions (ADRs). Methods: A cross-sectional exploratory study was conducted by using a face-to-face survey administered to a sample of dentists from tertiary care hospitals in Adana, Türkiye. A questionnaire consisted of six sections with closed-ended items including sociodemographic characteristics, knowledge about drugs, patient history information, counseling practices during prescribing, source of information and ADR reporting. Results: The study included 180 dentists, with a 95.3% response rate. More than half of the dentists (50.6%) stated their level of knowledge about drug price/cost as low. Most of the dentists (50.6%;n=91) claimed that they never/rarely asked about health insurance during patient history information. Moreover, most of the participants reported that they never/rarely and sometimes counsel the patients regarding drug mechanism of action, side effects of the drug, interaction of prescribed drug with other drugs/nutrients. It was determined that the dentists learned about the drugs from Vademecum (Turkish Medication Guidebook: 70%;n=126) and the internet (55%;n=99). A higher proportion (85.5%) of the dentists indicated that they did not report ADR during their clinical practice. Conclusion: This study showed a general improvement in dentists prescribing knowledge and practices, although they reported some lack of knowledge regarding drug cost, discussion about the possible side effect of a drug/interaction with other drugs/nutrients with patients and under-reporting of ADRs. Periodic education and training for dentists are critical to overcoming any problem related to prescribing errors and potential ADRs.

Before It Is Too Late: Implementation Strategies of an Efficient Opioid and Pain Stewardship Program.

Hospital pharmacies may not have the necessary resources, tools, or policies in place to implement a valuable opioid stewardship program. Meanwhile, the number of opioid prescriptions and medication use has increased nationwide. The overuse of opioids is due to the challenging nature of pain management, drug diversion prevention, and opioid abuse, as well as difficulty in recognizing and implementing best practices regarding opioid stewardship. The purpose of this review is to describe the components and executional strategy of an effective opioid and pain stewardship program. Opioid and pain stewardship programs can help identify opportunities for better adherence to best practice recommendations such as standardization of opioid dosing strategies, prescription of multimodal and opioid-sparing regimens, identification of substance misuse, review of patient history information, recognition of pain as a disease state, and increased dispensing of opioid reversal medications.

Repetition in the Health History Segment of Spanish Language Clinical Consultations: A Conversation Analysis.

Patient history-taking sequences may be repeated across medical speech events with different healthcare providers and subsequently co-constructed differently, which can lead to disparate patient history information with implications for patient care outcomes. Encounters that include language discordance between patients with limited English language proficiency and healthcare workers can also impact patient outcomes. We examined the repetition of patient history-taking sequences in consultations in which healthcare providers used Spanish as a first and second language with monolingual Spanish-speaking patients. The aim was to understand how repetition affects patient care processes and outcomes. Conversation analysis was used. The target population was bilingual healthcare providers and monolingual Spanish-speaking patients. The accessible population was composed of healthcare providers and patients from an urban, low-income, community health clinic in Southern California. In three exemplar cases from among 50 that were studied, instances of repetition in the history-taking segment of clinical consultations were located. We identified which aspects of patient reports were repeated across intake nurse-patient consultations and nurse practitioner-patient consultations, as well as how patient reports were differently co-constructed across these events. Information elicited during the intake nurse-patient history event may be elicited again when a nurse practitioner repeats the elicitation of particular aspects of the patient's complaints and health history. Repetition of patient history information was co-constructed differently by different healthcare providers, sometimes led to seamless teamwork, and sometimes led to time wasting. Healthcare provider second language use of Spanish did not substantially impact how patient history information was co-constructed. This analysis sheds light on the effects of repetition across medical events and assessed the effects of repetition on communication among members of a healthcare team and patient care outcomes. It also informs how medical provider second language use may affect how information is conveyed. Our study has implications for understandings of medical consultations that involve nurse triage prior to consultation time in multilingual settings.

Patterns of Patients Stopping Their Anti-Cancer Drug Due to Its Associated Side Effects in France, Germany, Italy, Spain and Uk (Eu5)

ABSTRACT Aim: Number of patients stopping their anticancer drug due to its side effects varies across several cancers and countries in EU5; this may influence patient outcomes. This study describes cessation of anticancer drugs due to its side effects in clinical practice across EU5. Methods: IMS Oncology Analyzer™ (OA) was used for this study, a patient database collected quarterly through a physician panel survey. OA reports on patient history information related to their treatment across all cancers. Most recent data (Jan-Dec 2013) was used. As patients can experience multiple side effects these numbers may be over 100%. Patients selected for this study have discontinued their therapy due to side effects exclusively. Results: From a sample of 7899 patients, 531 were identified as having their anti-cancer drug treatment stopped due to its side effects. Among them, 461 (87%) were on a cytotoxic drug and 70 (13%) on a hormonal. Overall, patients were mainly diagnosed with Breast (22%), Colorectal (CRC) (14%), and Non Small Cell Lung Cancer (NSCLC) (13%). Main side effects for those patients were neutropenia (36%), nausea/vomiting (23%), anaemia (21%), neuropathy (17%) and mucositis (15%). Among patients that stopped taking their anti-cancer drug due to side effects: · Breast cancer: 57% received cytotoxics and 43% hormonals. Common side effects for stopping cytotoxic drugs were neutropenia at 43% and pain for hormonals at 59%. Drugs causing cessation included anastrazole (16%), letrozole (11%) and tamoxifen (11%). · CRC: patients received capecitabine/oxaliplatin (29%), 5FU/oxaliplatin (16%) and capecitabine (14%). Main side effects included neutropenia (53%), diarrhea (39%), neuropathy (39%) and nausea/vomiting (24%). · NSCLC: patients received cisplatin/pemetrexed (29%), and cisplatin/vinorelbine (19%). The main reason for cessation was nausea/vomiting (37%), neutropenia (29%) and anaemia (22%). Conclusions: 7% of cancer patients across EU5 countries stopped taking their anti-cancer drug due to its side effects. Despite the availability of supportive care treatments, there is still a need to improve management of side effects to enable better patient outcomes. Disclosure: All authors have declared no conflicts of interest.

Practice Gaps in Patient Safety Among Dermatology Residents and Their Teachers

Curriculum and role modeling adjustments are necessary to address patient safety gaps occurring during dermatology residency. To identify the source of clinical practices among dermatology residents that affect patient safety and determine the best approach for overcoming gaps in knowledge and practice patterns that contribute to these practices. A survey-based study, performed at a national medical dermatology meeting in Itasca, Illinois, in 2012, included 142 dermatology residents from 44 residency programs in the United States and Canada. Self-reported rates of dermatology residents committing errors, identifying local systems errors, and identifying poor patient safety role modeling. Of surveyed dermatology residents, 45.2% have failed to report needle-stick injuries incurred during procedures, 82.8% reported cutting and pasting a previous author's patient history information into a medical record without confirming its validity, 96.7% reported right-left body part mislabeling during examination or biopsy, and 29.4% reported not incorporating clinical photographs of lesions sampled for biopsy in the medical record at their institution. Residents variably perform a purposeful pause ("time-out") when indicated to confirm patient, procedure, and site before biopsy, with 20.0% always doing so. In addition, 59.7% of residents work with at least 1 attending physician who intimidates the residents, reducing the likelihood of reporting safety issues they witness. Finally, 78.3% have witnessed attending physicians purposefully disregarding required safety steps. Our data reinforce the need for modified curricula, systems, and teacher development to reduce injuries, improve communication with patients and between physicians, residents, and other members of the health care team, and create an environment free of intimidation.

Sleep disorder diagnosis: the design and implications of online tools

Sleep disorders are a significant and growing problem, both for the economy of the nation and for the physical and psychological well-being of individual sufferers. The purpose of this research was to investigate the operational, administrative and medical environment within which sleep physicians currently diagnose patients with sleep disorders and develop an online support system that would more efficiently gather patient history data, and so improve the effectiveness of patient–physician consultations, the diagnoses, and patients’ self-management of any subsequent treatment plans. The development of the online tools used a design science approach and those tools evaluated for usefulness and ease of use by physicians and the general population. The physicians found that the patient history information was in a form that facilitated assimilation with the removal of routine data collection allowing a more targeted or shorter consultation. The users found the application easy to use and that it made them think about their sleep quality. The implications for future practice of sleep disorder diagnosis and the value of the collection of patient history which would be available for analysis is also discussed.

CT Imaging: Radiation Risk Reduction—Real-Life Experience in a Metropolitan Outpatient Imaging Network

The exponential growth of CT imaging has been fueled by recent technical advances, improved diagnostic accuracy, and medicolegal pressures. CT imaging has replaced many more invasive and expensive tests and has proven itself an indispensable part of diagnostic medicine. This growth in CT imaging, however, has also been accompanied by an unavoidable increased cumulative radiation exposure to the general public. It is important to fully understand the risks and benefits of and alternatives to CT imaging so that an informed decision can be made. A number of simple strategies may be used to minimize radiation exposure during CT imaging. These include protocol redesign and CT dose adjustments on the basis of each patient's body mass index, limiting length of coverage and multiphase examinations, and iterative reconstruction. At Imaging Healthcare Specialists, a highly successful program of radiation dose reduction was created, and dose savings of up to 90% have been achieved in select patients while maintaining diagnostic image quality. The approach is simple, reproducible, and inexpensive.

A novel primary care clinical prediction rule for early detection of osteoporosis

The effects of osteoporosis (OP) can be significantly slowed if disease is detected early. We report on a clinical risk prediction rule developed from patient histories taken in an orthopaedic outpatient clinic, before confirmatory testing for OP. Data were extracted from routine audits of consecutive records of patients with recent wrist fracture, comprising demographic details, medications, past and current disease, and fracture details. Clinical prediction rule elements were tested against clinical suspicion of OP. The clinical prediction elements comprised sex and age risk, medications that predispose patients to OP and/or falls, previous fractures and disease/medical conditions that are known OP risks. The best cut point (6.5) demonstrated 100% sensitivity with clinical suspicion of OP. Patient history information is often available before OP is clinically suspected or a definitive diagnosis is made. Our clinical prediction rule will be useful in primary care settings where objective measures of bone health are not readily available. It will raise OP awareness amongst health care providers and patients, particularly those not previously suspected of having OP. It will assist in identifying at-risk patients early and commencing them on appropriate management, without waiting for definitive bone health tests.

Electronic Medical Records in Long-Term Care

Long-term care (LTC) facilities possess unique characteristics in terms of implementation and utilization of electronic medical records (EMRs). The focus of LTC is on a population requiring care encompassing all aspects associated with quality of life rather than simply acute treatment. Because this focus is of a larger scale than traditional medical facilities, the priorities in the implementation and utilization of EMRs are higher in accessing patient history information. The purpose of this study was to determine the EMR utilization in the chronic care settings. In conclusion, the literature review performed does not support the fact that EMRs are currently being effectively and widely used in the LTC facilities.

THE DEVELOPMENT AND UTILIZATION OF TRIAGE PATHWAYS IN OUTPATIENT GASTROINTESTINAL CARE

The Division of Gastroenterology and Nutrition at our institution receives approximately 20 urgent/emergent patient referrals from community physicians on a daily basis. Outpatient GI care is provided at 10 sites located in the community. In an effort to triage severity of illness and to educate the staff in the community practices, pathways were developed recognizing that staff with varying levels of expertise and background accept and facilitate these calls. The goals of the project were: Acquire and review appropriate/specific patient history information including history growth data, previous testing; decrease the number of staff phone calls to acquire patient information; provide MD offices with testing suggestions/rationale prior to the visit; and provide consistent pathways for outpatient GI staff regarding triage, treatment, medications. Methods: We conducted an e-mail survey among the outpatient nurses, PNPs, physicians and clinical coordinators to identify common urgent referral diagnoses. The results identified gastroesophageal reflux, rectal bleeding, and failure to thrive as the three most common referral diagnoses. Triage pathways were devised and included triage questions, “red flags” that would warrant Emergency Department referrals, treatment goals and clinical reference data for clinicians. The triage pathways were reviewed by nurse/physician teams and the outpatient staff prior to use. Pathways were implemented in the outpatient network and were utilized by 4 RNs and 2 non-nursing clinic coordinators. Results: Pathways were evaluated at 3 intervals. Verbal feedback was solicited from staff at 2 and 4 months. A written evaluation at 6 months included a scale 1-5 with 5 being the most beneficial. Overall usefulness of the triage sheets was rated as 4-5. Evaluators identified decreased time spent in acquiring information and utilization as a resource as being most valuable. Conclusions: The goals of the project were met. The acquisition of information, and as a reference guide in providing patient care. This project facilitated collaboration between physicians, nurses and outpatient clinic coordinators. Staff found the triage pathways to be valuable and recommended the development of additional triage pathways for GI complaints such as abdominal pain, constipation and screening for celiac disease.

Classifying mammographic lesions using computerized image analysis

The classification of 3 common breast lesions, fibroadenomas, cysts, and cancers, was achieved using computerized image analysis of tumor shape in conjunction with patient age. The process involved the digitization of 69 mammographic images using a video camera and a commercial frame grabber on a PC-based computer system. An interactive segmentation procedure identified the tumor boundary using a thresholding technique which successfully segmented 57% of the lesions. Several features were chosen based on the gross and fine shape describing properties of the tumor boundaries as seen on the radiographs. Patient age was included as a significant feature in determining whether the tumor was a cyst, fibroadenoma, or cancer and was the only patient history information available for this study. The concept of a radial length measure provided a basis from which 6 of the 7 shape describing features were chosen, the seventh being tumor circularity. The feature selection process was accomplished using linear discriminant analysis and a Euclidean distance metric determined group membership. The effectiveness of the classification scheme was tested using both the apparent and the leaving-one-out test methods. The best results using the apparent test method resulted in correctly classifying 82% of the tumors segmented using the entire feature space and the highest classification rate using the leaving-one-out test method was 69% using a subset of the feature space. The results using only the shape descriptors, and excluding patient age resulted in correctly classifying 72% using the entire feature space (except age), and 51% using a subset of the feature space.