Annotation

The importance of the history in the medical clinic and the cost of unnecessary tests

la redacción de historias clínicas (HC) es una competencia básica en la formación del médico. Es el fundamento para construir hipótesis diagnósticas y garantizar una atención adecuada, segura y efectiva. Además, la HC tiene implicaciones legales, epidemiológicas y de calidad asistencial. Con este estudio pretendimos conocer la concordancia entre la información recogida del paciente en la consulta y la registrada en la HC por alumnos de Medicina.

estudio observacional descriptivo transversal sobre una consulta con pacientes simulados y la HC redactada posteriormente. Participaron 112 alumnos de 5.° año de Medicina. Los evaluadores comprobaron en las HC 59 ítems de anamnesis, anamnesis por órganos y aparatos, exploración física y juicio clínico, contrastándolos con las videograbaciones de las consultas y clasificando la concordancia entre ambas.

la población final fueron 109 alumnos (97,3%). El área competencial con mayor concordancia fue juicio clínico (94,1%). Todos los ítems superaron el 65% de concordancia. Más del 20% de los alumnos no habían registrado en sus HC algunos ítems, aunque los habían recogido en la consulta. Anamnesis por órganos y aparatos fue el área competencial con más ítems omitidos o incorrectos. El único ítem que ningún alumno olvidó recoger y registrar fue «antecedentes personales de dislipidemia». Exploración física fue el área donde más alumnos registraron hallazgos en la HC sin haberlos realizado en la entrevista.

el estudio demuestra la alta concordancia de la HC con la información recogida en la consulta y descubre aspectos que nos permitirán mejorar la formación en semiología médica de los alumnos.

Writing medical histories (MH) is a basic competence in the physician's training. It is the cornerstone for constructing diagnostic hypotheses and guaranteeing adequate, safe and effective care. In addition, MH has legal, epidemiological and quality of care implications. The aim of this study was to determine the concordance between the information collected from the patient in the consultation room and that recorded in the MH by medical students.

This is a cross-sectional descriptive observational study on a consultation with simulated patients and the subsequently written MH. A total of 112 5th-year medical students participated. The evaluators checked 59 items of anamnesis, anamnesis by organs and apparatus, physical examination and clinical judgment in the MH, contrasting them with the video recordings of the consultations, and classifying the concordance between both.

Final population was 109 students (97.3%). The competency area with the highest concordance was clinical judgment (94.1%). All items exceeded 65% agreement. More than 20% of the students had not recorded some items in their MH, although they had collected them in the consultation. Anamnesis by organs and apparatus was the competency area with the most omitted or incorrect items. The only item that no student forgot to collect and record was “personal history of dyslipidemia”. Physical examination was the area where most students recorded findings in the MH without having made them in the interview.

The study demonstrates high concordance in the MH with the information collected in the consultation and shows aspects that will allow us to improve the medical semiology training of students.

Las enfermedades musculoesqueléticas (ME) son la segunda causa de discapacidad mundial. Se presentan dificultades en el enfoque diagnóstico y terapéutico temprano de estas enfermedades, lo cual tiene un impacto negativo en sus desenlaces. El acceso a Reumatología es limitado, con una baja oferta frente a la creciente demanda, lo que convierte al médico general en el primer contacto de atención.

Describir la percepción y la confianza que tienen los médicos generales respecto a la formación en reumatología recibida en el pregrado.

Estudio observacional de corte transversal en el cual se indagó a médicos generales, egresados de programas de medicina colombianos entre el 2009 y 2019, mediante un cuestionario con respuesta tipo Likert, sobre variables relacionadas con el planteamiento curricular, los conocimientos o habilidades adquiridas y la suficiencia en el contenido en reumatología con respecto a la práctica. Se excluyó a los sujetos que cursaran algún programa de especialización o que tuvieran relación laboral con un centro especializado de Reumatología.

Se encuestó a 102 médicos; 86 encuestas fueron incluidas en el análisis final. El 83,4% de ellos eran egresados de universidades privadas, el 37% contó con una asignatura formal de reumatología, el 16% recibió formación con estrategias específicas, el 54% manifestó seguridad al realizar el examen físico musculoesquelético, el 47% expresó sentirse seguro en el enfoque diagnóstico y la prescripción de medicamentos modificadores de la enfermedad. Es necesario fortalecer la formación en Reumatología en el pregrado; se requiere un trabajo conjunto con las facultades de medicina en la definición de competencias del médico de Atención Primaria, alineado con las necesidades de salud y las estrategias educacionales disponibles.

Musculoskeletal disorders (MSD) are the second leading cause of disability worldwide. There are difficulties in the early diagnosis and therapeutic approach to these pathologies, with a negative impact on their outcomes. Access to rheumatology is limited, with a low supply in the face of growing demand, which makes the general practitioner the first contact for care.

Describe the perception and confidence that general practitioners have regarding the training in rheumatology received at undergraduate level.

Observational cross-sectional study, with a Likert-type survey tool being used. The study included general practitioners graduated from the Colombian Medicine program between 2009 and 2019. The variables studied were those related to the curriculum, acquired knowledge or skills, and proficiency in content in rheumatology compared to practice. Subjects who attended a specialist or who had an employment relationship with a specialist rheumatology centre were excluded.

A total of 102 physicians were surveyed, and 86 completed questionnaires were included in the final analysis. Of these, 83.4% were graduates of private universities. Over two-thirds (37%9) had a formal subject in rheumatology, 16% received training with specific strategies, 54% expressed security when performing the ME physical examination, and 47% were safe in the diagnostic approach, and prescription of disease-modifying drugs. In order to strengthen the training in rheumatology required by the undergraduate, a joint effort is required with the medical schools in defining the competencies and skills of the primary care physician, together with the health needs and available educational strategies.

Health emergencies occur in passenger cars where victims do not have immediate access to either layperson or professional, proper medical services, resulting in deterioration of their health or death. Installation of a robotic first aid system for passenger car occupants has been proposed. This research is part of a larger work of designing the system and identifies the existing hardware and software automotive infrastructure that the robotic first aid system can functionally use. These resources are reviewed in categories of sensing, connectivity, data analysis and information exchange, which form the internet of things. Consequently, the system’s design for internet of things mechanical requirements are identified in sensing. Finally, a preliminary framework for the system’s internet of things infrastructure is established to facilitate the development of a smart robot.

This study aimed to demonstrate the value of the chief compliant and patient history to accurately diagnose patient pathology without requiring ocular examination or imaging in an outpatient neuro-ophthalmology clinic.

We prospectively evaluated 115 consecutive patients at our institution from January to April 2009. The attending neuro-ophthalmologist committed to a single most likely diagnosis while solely being exposed to patient demographic information (age, gender, race) and chief complaint, but was otherwise blinded to ocular examination or imaging. The validity of the initial diagnosis was assessed by further acquiring subjective and objective findings and the percentage of correct diagnoses was determined.

Patient cases were categorized based on the neuro-ophthalmologic localization of the final diagnoses: afferent nervous system, central nervous system (CNS), efferent nervous system, orbital system, and pupillary system. Correct diagnoses by chief complaint and patient history were 84%, 100%, 86%, 80%, 50% and 100% for afferent, central, efferent, orbit, pupil, and other neuro-ophthalmic diseases, respectively. Over half the cases were correctly diagnosed by chief complaint alone, which improved to 88% when combined with the patient history.

A simple combination of patient history and chief complaint predicts an overall diagnostic accuracy in approximately 90% of cases. Our study demonstrates the remarkable diagnostic value of patient history in neuro-ophthalmologic clinic practice.

In an era of integrated and multimodality imaging, which undoubtedly have added great diagnostic value in our daily practice, Picture Archiving and Communication System (PACS) is still underrated and not fully exploited. We believe it bears an enormous potential, able to give us relevant clinical information and a rapid overview of a patient's past medical history through his/her "past imaging history." For this reason, we suggest that “Past Imaging History” should begin to represent an essential and integral part of a patient's medical history and its systematic acquisition should be encouraged and introduced from the very early years of medical education.