A Detailed Review of Systems: An Educational Feature

Phillips, Angela; Frank, Arthur W.; Loftin, Collette; Shepherd, Sara

doi:10.1016/j.nurpra.2017.08.012

Cited by 58 publications

(2 citation statements)

References 10 publications

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“…Figure 3 and Supplemental Table 8 demonstrate the change of prevalence and burden for all 30 individual symptoms during the year before and after dialysis initiation ( n =456). We present symptoms grouped in nine symptom systems according to the review of systems (Supplemental Table 2) (25). “Fatigue,” “decreased interest in sex,” and “difficulty becoming sexually aroused” had the highest prevalence and burden during the year before and after dialysis, which peaked at dialysis initiation with a prevalence of 81%, 69%, and 68%, respectively, and a mean burden of 2.7, 2.4, and 2.3, respectively.…”

Section: Resultsmentioning

confidence: 99%

Symptom Burden before and after Dialysis Initiation in Older Patients

Rooij

Meuleman

Fijter

et al. 2022

CJASN

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Background and objectivesFor older patients with kidney failure, lowering symptom burden may be more important than prolonging life. Dialysis initiation may affect individual kidney failure–related symptoms differently, but the change in symptoms before and after start of dialysis has not been studied. Therefore, we investigated the course of total and individual symptom number and burden before and after starting dialysis in older patients.Design, setting, participants, & measurementsThe European Quality (EQUAL) study is an ongoing, prospective, multicenter study in patients ≥65 years with an incident eGFR ≤20 ml/min per 1.73 m2. Using the dialysis symptom index (DSI), 30 symptoms were assessed every 3–6 months between 2012 and 2021. Scores for symptom number range from zero to 30 and, for burden, from zero to 150, with higher scores indicating more severity. Using mixed effects models, we studied symptoms during the year preceding and the year after dialysis initiation.ResultsWe included 456 incident patients on dialysis who filled out at least one DSI during the year before or after dialysis. At dialysis initiation, mean (SD) participant age was 76 (6) years, 75% were men, mean (SD) eGFR was 8 (3) ml/min per 1.73 m2, 44% had diabetes, and 46% had cardiovascular disease. In the year before dialysis initiation, symptom number increased +3.6 (95% confidence interval [95% CI], +2.5 to +4.6) and symptom burden increased +13.3 (95% CI, +9.5 to +17.0). In the year after, symptom number changed −0.9 (95% CI, −3.4 to +1.5) and burden decreased −5.9 (95% CI, −14.9 to −3.0). At dialysis initiation, “fatigue,” “decreased interest in sex,” and “difficulty becoming sexually aroused” had the highest prevalence of 81%, 69%, and 68%, respectively, with a burden of 2.7, 2.4, and 2.3, respectively. “Fatigue” somewhat improved after dialysis initiation, whereas the prevalence and burden of sexual symptoms further increased.ConclusionsSymptom burden worsened considerably before and stabilized after dialysis initiation. “Fatigue,” “decreased interest in sex,” and “difficulty becoming sexually aroused” were considered most burdensome, of which only “fatigue” somewhat improved after dialysis initiation.

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Section: Resultsmentioning

confidence: 99%

Symptom Burden before and after Dialysis Initiation in Older Patients

Rooij

Meuleman

Fijter

et al. 2022

CJASN

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“…The overuse of duplication also indicates the gap in clinical communication. For example, review of system (ROS) provides a complete list, other than chief complaints and present illnesses, and helps doctors make clinical decisions [24]. In this study, the ndings show that our residents may lack a comprehensive review of patients.…”

Section: Pedagogical Suggestionmentioning

confidence: 75%

Optimizing Quality of Electronic Medical Records as a Platform for Resident Education

Hung¹,

Kueh

Tseng

et al. 2021

Preprint

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Background Electronic medical records (EMRs) are becoming a predominant feature of health care and an important tool in residents’ medical education. Few studies have examined and compared the EMR performance of residents from different departments. This study explores the quality of EMRs in residency and offers pedagogical implications.Method Authors developed an EMR checklist which examined fundamental EMR requirement through six dimensions and 20 items. A total of 149 records created by residents from 32 departments/stations were randomly chosen. Seven senior physicians rated the EMRs using the checklist. Medical records were grouped as General Medicine, Surgery, Pediatric, Obstetrics and Gynecology and Other Departments. Overall and grouped performances were analyzed by ANOVA.Results Overall performance was rated as fair to good. Regarding the six dimensions, the discharge note (0.81) gained the highest scores, followed by the admission note (0.79), problem list (0.73), overall performance (0.73), progress note (0.71), and weekly summary (0.66).Among the five groups, Other Departments (80.20) gained the highest total score, followed by Obstetrics and Gynecology (78.02), Pediatrics (77.47), General Medicine (75.58), and Surgery (73.92).Conclusions The quality of EMRs, core competencies, and clinical reasoning skills are deeply interconnected in resident education. This study suggested that the use of duplication in EMR, and the communication abilities of residents are associated with the variable quality of medical records in different departments. Further study is required to apply the insights obtained in this study to improve the quality of EMRs, and thereby the effectiveness of resident training.

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Teaching & learning focused physical assessments: An innovative clinical support tool

Huber

Epp

2022

Nurse Education in Practice

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A Detailed Review of Systems: An Educational Feature

Cited by 58 publications

References 10 publications

Symptom Burden before and after Dialysis Initiation in Older Patients

Symptom Burden before and after Dialysis Initiation in Older Patients

Optimizing Quality of Electronic Medical Records as a Platform for Resident Education

Teaching & learning focused physical assessments: An innovative clinical support tool

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