essay on history of patient

• - Google Chrome

Intended for healthcare professionals

• Access provided by Google Indexer
• My email alerts
• BMA member login
• Username * Password * Forgot your log in details? Need to activate BMA Member Log In Log in via OpenAthens Log in via your institution

Search form

• Advanced search
• Search responses
• Search blogs
• Taking a history:...

Taking a history: Introduction and the presenting complaint

• Related content
• Peer review
• Nayankumar Shah , senior lecturer in general practice 1
• 1 Newcastle, Australia

In the first of a two part series about taking a medical history, Nayankumar Shah takes a look at the introduction and the presenting complaint

The clinical encounter usually consists of the steps shown in fig 1. A good history is very important for making a diagnosis. Examination and investigations may help to confirm or refute the diagnosis made from the history.

The history will also tell you about the illness as well as the disease. The illness is the subjective component and describes the patient's experience of the disease.

Try to follow the sequence history, examination, investigation when you see a patient. A common mistake is to rush into investigations before considering the history or examination.

It is easy to mindlessly order a battery of tests. There are many problems with this approach:

Investigations cannot be used in isolation—is the x ray finding or blood test result relevant or an incidental finding?

Investigations can be inaccurate—there can be problems with technique, reagents, or interpretation of the findings

Investigations pose risks—radiation exposure, unnecessary further procedures, and so on

Investigations can be costly, to the patient and to society.

Always remember to treat the patient and not the investigation. And remember that although we talk about “the patient,” you should consider “the person.”

Fig 1: Steps in a clinical encounter

• Download figure
• Open in new tab
• Download powerpoint

You should use the following as a guide until you develop your own style and one that you feel comfortable with. You are at liberty to reorganise the order. For instance, you could go to the systems review after the history of the presenting complaint. Whatever order you use, however, you need to ensure that you get all components of the history (fig 2).

Components in taking a medical history

Introduction and details

You should always begin by introducing yourself. This should include your status as well as the educational reason for the encounter. For example, “My name is… I am a… year medical student, and I have come to talk to you to learn how to take a medical history.”

It is then useful to obtain some background information about the patient including their name, age, marital status, and occupation.

To establish rapport, and to put the patient at ease, it often helps to continue the interview by considering issues such as:

How they would like to be addressed (forename or surname)

Their physical comfort

That you will treat all information as confidential

How the patient may end the consultation: “If at any time you wish to stop this interview then please let me know.”

Presenting complaint

GARO/PHANIE/REX

Nobody likes being disturbed at lunch, come back later

Ask the patient to describe the symptom or problem that brought them to hospital by using an open ended question: “What has happened to bring you to hospital?” or “What seems to be the problem?” You should show interest to facilitate this. Clearly, you want answers but you also wish to develop a rapport with the patient as well as understand him or her (and you will not do this through a series of closed questions).

The patient's narrative gives important clues as to the diagnosis and the patient's perspective of their illness. You should not interrupt. Most patients' initial response will last fewer than two minutes. So it is worth while to give this amount of time to let the patient describe in their own words the problem that has led to their present situation.

Thus, history taking involves the use of communication skills. You need to develop your skills in:

Opening and closing a consultation

The use of open and closed questions

The use of non-verbal language

Active listening

Showing respect and courtesy

Showing empathy

Being culturally sensitive.

This is not just an academic exercise—management of the patient is dependent on these aspects. If you do not communicate properly you will become increasingly frustrated and the patient will get suboptimal care. So, when you are taking a history, listen to the patient. Do they know what is wrong with them? Do they understand the implications of this? What are their concerns and expectations?

Once you have determined what the presenting complaint is, it must be evaluated in detail. Some of the information required includes:

When did the problem start (date and time)?

Who noticed the problem (patient, relative, caregiver, health professional)?

What initial action was taken by the patient (any self treatment)?

When was medical help sought and why?

What action was taken by the health professional?

What has happened since then?

What investigations have been undertaken and what are planned?

What treatment has been given?

What has the patient been told about their problem?

This is not as easy as it sounds, especially in the beginning. You need to be patient and practice taking histories. In the early years there is a tendency to concentrate on events (investigations, treatments, etc) undertaken after the patient has been admitted to hospital. Although this is useful, what you should be aiming to do is defining the problem. In other words, what history would you take if you were the first person to see the patient and had to make a differential diagnosis? To a large extent, this means making sense of the symptoms that the patient presents with.

Sometimes the patient will tell you the diagnosis: “The doctor said that I've got pneumonia.” Despite the presumed diagnosis, it is worthwhile to determine the symptoms or problems that led to this diagnosis: “So, what symptoms did you have?”

This is important as:

You can then attempt to link the symptoms to the diagnosis

The patient may have misheard or misunderstood the discussions, and the diagnosis might be incorrect or only partly correct.

This leads to the rule that you should always make your own judgment.

You will find a great variety in patients' account of their illnesses. Some keep meticulous details and can recall dates and times without hesitation; others are vague even about details of their hospital stay. This in itself is important:

Does the patient understand their illness?

Have they been given sufficient information?

Do they have dementia, delirium, or confusion?

Often, the patient will complain of pain and there are specific characteristics of pain that need to be elicited:

Exact site or location of pain

Nature of pain (dull, sharp, etc)

Onset of pain (sudden, gradual, etc)

Severity of pain (can use a scale 1-10)

Duration of pain (seconds, minutes, hours, or days)

Progress, including frequency and timing of the pain (constant, intermittent, etc)

Radiation of the pain

Aggravating and relieving factors

Previous occurrences

Associated symptoms (nausea, vomiting, etc)

The patient's notion of what is causing the pain.

An attempt should be made to link the presenting complaint with the related systems review or inquiry (see the second part in next month's Student BMJ). For instance, a patient presenting with chest pain should be asked questions covering the cardiovascular and respiratory systems such as cough, shortness of breath, palpitations, ankle swelling, etc.

Likewise, it is worthwhile to try and determine any risk factors for the probable diagnosis. For example, a patient presenting with chest pain, and suspected of having a myocardial infarction, should be asked questions about smoking, hypertension, diabetes, family history, etc. The aim of this is to integrate your history, make a correct diagnosis, and ensure that management takes into account all the available information.

Originally published as: Student BMJ 2005;13:314

A brief historical and theoretical perspective on patient autonomy and medical decision making: Part II: The autonomy model

Affiliation.

• 1 Bioethics and Health Law Center, Mississippi College School of Law, Jackson, MS. Electronic address: [email protected].
• PMID: 21652559
• DOI: 10.1378/chest.11-0516

As part of a larger series addressing the intersection of law and medicine, this essay is the second of two introductory pieces. Beginning with the Hippocratic tradition and lasting for the next 2,400 years, the physician-patient relationship remained relatively unchanged under the beneficence model, a paternalistic framework characterized by the authoritative physician being afforded maximum discretion by the trusting, obedient patient. Over the last 100 years or so, in response to certain changes taking place in both research and clinical practice, the bioethics movement ushered in the autonomy model, and with it, a profoundly different way of approaching decision making in medicine. The shift from the beneficence model to the autonomy model is governed legally by the informed consent doctrine, which emphasizes disclosure to patients of information sufficient to permit them to make intelligent choices regarding treatment alternatives. As this legal doctrine became established, philosophers identified an inherent value in respecting patients as autonomous agents, even where patient choice seems to conflict with the physician's duty to act in the patient's best interests. Whereas the beneficence model presumed that the physician knew what was in the patient's best interests, the autonomy model starts from the premise that the patient knows what treatment decision is in line with his or her true sense of well-being, even where that decision is the refusal of treatment and the result is the patient's death.

Publication types

• Historical Article
• History, 19th Century
• History, 20th Century
• Informed Consent / ethics
• Informed Consent / history*
• Informed Consent / legislation & jurisprudence
• Patient Participation / history*
• Patient Participation / legislation & jurisprudence
• Patient Rights / ethics
• Patient Rights / history*
• Patient Rights / legislation & jurisprudence
• Personal Autonomy*
• United States

• PRO Courses Guides New Tech Help Pro Expert Videos About wikiHow Pro Upgrade Sign In
• EDIT Edit this Article
• EXPLORE Tech Help Pro About Us Random Article Quizzes Request a New Article Community Dashboard This Or That Game Popular Categories Arts and Entertainment Artwork Books Movies Computers and Electronics Computers Phone Skills Technology Hacks Health Men's Health Mental Health Women's Health Relationships Dating Love Relationship Issues Hobbies and Crafts Crafts Drawing Games Education & Communication Communication Skills Personal Development Studying Personal Care and Style Fashion Hair Care Personal Hygiene Youth Personal Care School Stuff Dating All Categories Arts and Entertainment Finance and Business Home and Garden Relationship Quizzes Cars & Other Vehicles Food and Entertaining Personal Care and Style Sports and Fitness Computers and Electronics Health Pets and Animals Travel Education & Communication Hobbies and Crafts Philosophy and Religion Work World Family Life Holidays and Traditions Relationships Youth
• Browse Articles
• Learn Something New
• Quizzes Hot
• This Or That Game
• Train Your Brain
• Explore More
• Support wikiHow
• About wikiHow
• Log in / Sign up
• Healthcare Careers
• Interacting with Patients

How to Write a Good Medical History

Last Updated: May 10, 2024 References

wikiHow is a “wiki,” similar to Wikipedia, which means that many of our articles are co-written by multiple authors. To create this article, 9 people, some anonymous, worked to edit and improve it over time. This article has been viewed 96,801 times. Learn more...

Nearly every encounter between medical personnel and a patient includes taking a medical history. The level of detail the history contains depends on the patient's chief complaint and whether time is a factor. When there is time for a complete history, it can include primary, secondary and tertiary histories of the chief complaint, a review of the patient's symptoms, and a past medical history.

• Ask the patient to expand on the chief complaint or complaints. In particular, ask about anything that the patient was unclear about or that you don't understand.
• Get specific numbers for things like how long the patient has had the symptoms or how much pain, on a scale of 0 to 10, the patient is experiencing.
• Record, as accurately as you can, what the patient tells you. Don't add your interpretation to what you hear. [2] X Research source
• Reader Poll: We asked 175 wikiHow readers who've interviewed patients, and 47% of them agreed that the best way to make them feel at ease is by practicing active listening. [Take Poll]

• The patient may not recognize that associated symptoms are related to the chief complaint and may not even view them as symptoms. You will have to interpret what you hear to complete this section of the medical history.

• General constitution
• Skin and breasts
• Eyes, ears, nose, throat and mouth
• Cardiovascular system
• Respiratory system
• Gastrointestinal system
• Genitals and urinary system
• Musculoskeletal system
• Neurological or psychological symptoms
• Immunologic, lymphatic and endocrine system

• Allergies and drug reactions
• Current medications, including over-the-counter drugs
• Current and past medical or psychiatric illnesses or conditions
• Past hospitalizations
• Immunization status
• Use of tobacco, alcohol or recreational drugs
• Reproductive status (if female), including date of last menstrual period, last gynecological exam, pregnancies and contraception method
• Information on children
• Family status, including whether the patient is married, who the patient lives with and other relationships. Include questions about the patient's current sexual activity and history.
• Occupation, particularly if it includes exposure to hazardous materials

Expert Q&A

You might also like.

• ↑ https://meded.ucsd.edu/clinicalmed/write.htm
• ↑ https://med.ucf.edu/media/2018/08/Guide-to-the-Comprehensive-Pediatric-H-and-P-Write-up.pdf
• ↑ https://meded.ucsd.edu/clinicalmed/ros.htm
• ↑ https://www.rch.org.au/clinicalguide/guideline_index/Writing_a_good_medical_report/
• https://en.wikipedia.org/wiki/Medical_history

About This Article

Medical Disclaimer

The content of this article is not intended to be a substitute for professional medical advice, examination, diagnosis, or treatment. You should always contact your doctor or other qualified healthcare professional before starting, changing, or stopping any kind of health treatment.

Read More...

• Send fan mail to authors

Did this article help you?

Featured Articles

Trending Articles

Watch Articles

• Terms of Use
• Privacy Policy
• Do Not Sell or Share My Info
• Not Selling Info

Get all the best how-tos!

Sign up for wikiHow's weekly email newsletter

Want to create or adapt books like this? Learn more about how Pressbooks supports open publishing practices.

2 Health History

Learning objectives.

• Describe the purpose of a health history
• Enumerate the components of a health history.
• Discuss how culture, age and ethnicity influence obtaining a health history.
• Demonstrates therapeutic communication when obtaining a  health history.
• Obtain a comprehensive health history
• Document the results of the health history

Overview of this chapter

This chapter presents the importance of a health history as a component of health assessment and the value of a health history obtained from the perspective of a nurse. This chapter will provide information on components of a health history, considerations in obtaining a health history and documentation.

Health History

The purpose of obtaining a health history is to gather subjective data from the patient and/or the patient’s family so that the health care team and the patient can collaboratively create a plan that will promote health, address acute health problems, and minimize chronic health conditions. The health history is typically done on admission to hospital, but a health history may be taken whenever additional subjective information from the patient may be helpful to inform care (Wilson & Giddens, 2013).

Subjective Data

Data gathered may be subjective or objective in nature. Subjective data is information reported by the patient and may include signs and symptoms described by the patient but not noticeable to others. Subjective data also includes demographic information, patient and family information about past and current medical conditions, and patient information about surgical procedures and social history. Objective data is information that the health care professional gathers during a physical examination and consists of information that can be seen, felt, smelled, or heard by the health care professional. Taken together, the data collected provides a health history that gives the health care professional an opportunity to assess health promotion practices and offer patient education (Stephen et al., 2012). The health history is the subjective data collection portion of the health assessment.

Components of a Health History

The health history obtained by nurses is framed from holistic perspectives of all factors that contributes to the patient’s current health status. The most common way of obtaining information is through an interview, primarily of the patient. When the patient is unable to provide information for various reasons, the nurse may obtain it from secondary sources.

Knowledge Check:

The checklist below provides steps of obtaining a nursing history based that reflects its components such as biographical data, reason for seeking care, history of present illness, past health history, family history, functional assessment, developmental functions and cultural assessment.  Each healthcare facility will have electronic and/or paper forms based on these components.

Interview Guide

Introductory Information: Demographic and Biographic Data

Name/contact information and emergency information

• What is your full name?
• What name do you prefer to be called by?
• What is your address?
• What is your phone number?
• Who can we contact in an emergency? What is their relationship to you? What number can we reach them at?

Birthdate and age

• What is your birthdate?
• What is your age?
• Tell me what gender you identify with.
• What pronouns do you use? (If the person asks you to use a pronoun that you are not familiar with, it is okay for you to respectfully respond, “I am not familiar with that pronoun. Can you tell me more about it?”)
• Do you have any allergies?
• If so, what are you allergic to?
• How do you react to the allergy?
• What do you do to prevent or treat the allergy?

Note: You may need to prompt for information on medications, foods, etc.

Languages spoken and preferred language

• What languages do you speak?
• What language do you prefer to communicate in (verbally and written)?

Note: You may need to inquire and document if the client requires an interpreter.

Relationship status

• Tell me about your relationship status?

Occupation/school status

• What is your occupation? Where do you work?
• Do you go to school?

Resuscitation status

• We ask all clients about their resuscitation status, which refers to medical interventions that are used or not used in the case of an emergency (such as if your heart or breathing stops). You may need more time to think about this, and you may want to speak with someone you trust like a family member or friend. You should also know that you can change your mind. At this point, if any of this happens, would you like us to intervene?  

Main Health Needs (Reasons for Seeking Care)

Presenting to a clinic or a hospital emergency or urgent care (first point of contact)

• Tell me about what brought you here today.
• Tell me more.
• How is that affecting you?

Already admitted, and you are starting your shift

• Tell me about your main health concerns today.

The PQRSTU Mnemonic

Provocative

• What makes your pain worse?
• What makes your pain feel better?
• What does the pain feel like?
• How bad is your pain?
• Where do you feel the pain?
• Point to where you feel the pain.
• Does the pain move around?
• Do you feel the pain elsewhere?
• How would you rate your pain on a scale of 0 to 10, with 0 being no pain and 10 being the worst pain you’ve ever experienced?
• When did the pain start?
• What were you doing when the pain started?
• Where were you when the pain started?
• Is the pain constant or does it come and go?
• If the pain is intermittent, when did it last occur?
• How long does the pain last?
• Have you taken anything to help relieve the pain?
• Have you tried any treatments at home for the pain?

Understanding

• What do you think is causing the pain?

Current and Past Health

Current health

• Are there any other issues affecting your current health?

Childhood illnesses

• Tell me about any significant childhood illnesses that you had.
• When did it occur?
• How did it affect you?
• How did it affect your day-to-day life?
• Were you hospitalized? Where? How was it treated?
• Who was the treating practitioner?
• Did you experience any complications?
• Did it result in a disability?

Chronic illnesses

• Tell me about any chronic illnesses you currently have or have had (e.g., cancer, cardiac, hypertension, diabetes, respiratory, arthritis).
• How has the illness affected you?
• How do you cope with the illness?
• When were you diagnosed?
• How was the illness being treated?
• Have you been hospitalized? Where?
• Have you experienced any complications?
• Has the illness resulted in a disability?
• How does the illness affect your day-to-day life?

Acute illnesses, accidents, or injuries

• Tell me about any acute illnesses that you have had.
• Tell me about any accidents or injuries you currently have or have had.
• Were you hospitalized? Where?
• How was it treated?
• Has it resulted in a disability?

Obstetrical health

• Have you ever been pregnant?
• Do you have plans to get pregnant in the future?
• Tell me about your pregnancies.
• Have you ever had difficulty conceiving?
• How was your labour and delivery?
• Tell me about your postpartum experience.
• Were there any issues or complications?

Mental Health and Mental Illnesses

Mental health is an important part of our lives and so I ask all clients about their mental health and any concerns or illnesses they may have.

Mental health

• Tell me about your mental health.
• Tell me about the stress in your life.
• How does stress affect you?
• How do you cope with this stress? (this may include positive or negative coping strategies.)
• Have you experienced a loss in your life or a death that is meaningful to you?
• Have you had a recent breakup or divorce?
• Have you recently lost your job or been off work?
• Have you recently had any legal issues?
• Have you purchased any weapons?

Mental illness

• How does that illness affect you?
• How does that illness affect your day-to-day life?
• What resources do you draw upon to cope with your illness?
• Tell me about your treatment (e.g., medications, counselling).
• Do you have any concerns that have not been addressed related to your illness?

Functional Health

• Tell me about your diet.
• What foods do you eat?
• What fluids do you drink? (Probe about caffeinated beverages, pop, and energy drinks.)
• What have you consumed in the last 24 hours? Is this typical of your usual eating pattern?
• Do you purchase and prepare your own meals?
• Tell me about your appetite. Have you had any changes in your appetite?
• Do you have any goals related to your nutrition?
• Do you have the financial capacity to purchase the foods you want to eat?
• Do you have the knowledge and time to prepare the meals you want to eat?

Elimination

• How often do you urinate each day?
• What colour is it (amber, clear, dark)?
• Have you noticed a strong odour?
• How often do you have a bowel movement?
• What colour is it (brown, black, grey)?
• Is it hard or soft?
• Do you have any problems with constipation or diarrhea? If so, how do you treat it?
• Do you take laxatives or stool softeners?

Sleep and rest

• Tell me about your sleep routine.
• How much do you sleep?
• Do you wake up at all?
• Do you feel rested when you wake? What do you do before you go to bed (e.g., use the phone, watch TV, read)?
• Do you take any sleep aids?
• Do you have any rests during the day?

Mobility, activity, exercise

• Tell me about your ability to move around.
• Do you have any problems sitting up, standing up or walking?
• Do you use any mobility aids (e.g., cane, walker, wheelchair)?
• Tell me about the activity and/or exercise that you engage in. What type? How frequent? For how long?

Violence and trauma

• Many clients experience violence or trauma in their lives. Can you tell me about any violence or trauma in your life?
• How has it affected you?
• Tell me about the ways you have coped with it.
• Have you ever talked with anyone about it before?
• Would you like to talk with someone?

Relationships and resources

• Tell me about the most influential relationships in your life.
• Tell me about the relationships you have with your family.
• Tell me about the relationships you have with your friends.
• Tell me about the relationships you have with any other people.
• How do these relationships influence your day-to-day life? Your health and illness?
• Who are the people that you talk to when you require support or are struggling in your life?

Intimate and sexual relationships

• I always ask clients about their intimate and sexual relationships. To start, tell me about what you think is important for me to know about your intimate and sexual relationships.
• Tell me about the ways that you ensure your safety when engaging in intimate and sexual practices.
• Do you have any concerns about your safety?

Substance use and abuse

• To better understand a client’s overall health, I ask everyone about substance use such as tobacco, herbal shisha, alcohol, cannabis, and illegal drugs.
• Do you or have you ever used any tobacco products (e.g., cigarettes, pipes, vaporizers, hookah)? If so, how much?
• When did you first start? If you used to use, when did you quit?
• Do you drink alcohol or have you ever? If so, how often do you drink?
• How many drinks do you have when you drink?
• When did you first start drinking? If you used to drink, when did you quit?
• Do you use or have you used any cannabis products? If so, how do you use them? How often do you use them?
• When did you first start using them?
• Do you purchase them from a regulated or unregulated place?
• If you used to use cannabis, when did you quit?
• Do you use any illegal drugs? If so, what type? How often do you use them?
• Tell me about the ways that you ensure your safety when using any of these substances.
• Have you ever felt you had a problem with any of these substances?
• Do you want to quit any of these substances?
• Have you ever tried to quit?

Environmental health and home/occupational/school health

• Tell me about any factors in your environment that may affect your health. Do you have any concerns about how your environment is affecting your health?
• Tell me about your home. Do you have any concerns about safety in your home or neighbourhood?
• Tell me about your workplace and/or school environment.
• What activities are you involved in or what does your day look like?

Self-concept and self-esteem

• Tell me what makes you who you are.
• Are you satisfied about where you are in your life?
• Can you share with me your life goals?
• Please explain.
• Tell me about how you take care of yourself and manage your home.
• Do you have sufficient finances to pay your bills and purchase food, medications, and other needed items?
• Do you have any current or future concerns about being able to function independently?

Preventive Treatments and Examinations  

Medications

• Do you have the most current list of your medications?
• Do you have your medications with you? (If not, you should ask them to list each medication they are prescribed and if they know, the dose and frequency.)
• Can you tell me why you take this medication?
• How long have you been taking this medication?
• Do you take the medications as prescribed? (If they answer “no” or “sometimes,” ask them to tell you the reasons for not taking the medications as prescribed.)

Examination and diagnostic dates

• When was the last time you saw [name the primary care provider, nurse or specialist]?
• Can you share with me why you saw them?
• When was the last time you had your [name screening] tested?
• Do you know what the results were?

Vaccinations

• Can you tell me about your immunization status?
• Can you tell me what immunizations you have had, the dates you received them, and any significant reactions?
• Do you have your immunization record?
• When was your last flu vaccine?

If the client’s immunizations are not up-to-date or you noted vaccination hesitancy, you may ask:

• Can you tell me the reasons that your immunizations are not up-to-date?
• Can you tell me why you are hesitant to receive immunizations. (You may need to explore this further.)  

Family Health

• Do they have any chronic or acute diseases (e.g., cardiac, cancer, mental health issues)?
• If so, do you know the cause of death?
• And at what age did they die?
• Has anyone been sick recently?
• If so, do you know the cause?
• What symptoms have they had?
• Have you been around anyone else who was sick recently (e.g., at work, at school, in a location that involved a close encounter such as a plane or an office)?

Cultural Health

• I am interested in your cultural background as it relates to your health. Can you share with me what is important about your cultural background that will help me care for you?
• How does that affect your health and illnesses?
• Is there anything else you want to share about how these factors act as resources in your life?

Learning Resource:  Open the link below for more detailed information.

The Complete Subjective Health Assessment

Cultural factors in obtaining a health history

When interviewing a patient the nurse must be aware of cultural barriers and preferences in order to collect significant and complete subjective data.. For example due  to age, culture, or ethnicity, some patients may believe that pain is to be expected and endured. The patient may not identify their pain as worthy of report unless the nurse is sensitive to this potential barrier of care. Due to age, culture or ethnicity, some patients may feel uncomfortable discussing sexual health. For example, where HIV is epidemic, it is the nurse’s responsibility (along with all other healthcare personal) to uncover risk factors that can address safety and early treatment for STIs (sexually transmitted diseases). Culture can have many meanings. Some of the many aspects that nurses need to be aware of that will impact information obtained in a health history include gender  identity,  religion,  geographical region, and many diverse factors.   The nurse must be open to learning about various cultures and ethnicity and be comfortable in initiating a cultural assessment, and use this knowledge to enhance communication to obtain the most accurate health history.

Health history and therapeutic communication

Needless to say, therapeutic communication techniques are essential in obtaining a health history. However, due to many reasons, healthcare professionals, including nurses, oftentimes fail to establish a therapeutic relationship or to deliver therapeutic communication. The following are examples :

• Have you ever been to see a healthcare provider and when they walk in the room they are not looking at you but are looking at the chart, or tapping on a computer.
• Have you ever felt rushed by their questions, like they are in a hurry and need to move on to the next patient?
• Have you ever had the healthcare provider give you a diagnosis, provide you with a treatment and you left with a prescription but you didn’t grasp the entire explanation?

The nurse should apply communication and interpersonal skills to create, maintain, and terminate a nurse-client relationship. [] Nurses and other healthcare professionals need to use therapeutic communication techniques at all times.

Open the link below for more detailed information

Therapeutic Communication

Documentation of Health History:

The patient’s health history is initially obtained during admission or initial visit, and constantly updated with subsequent interactions or visits. Documentation of information obtained during the nurse-patient interview, and/or secondary sources will need to be documented on a format that the healthcare facility uses. Nowadays, most healthcare facilities use electronic health records (EHR). EHRs are accessed by various members of the healthcare team in real-time, and this indicates that information obtained can be recorded during the interview process as well. The nurse needs to develop the competency to maintain therapeutic communication techniques while attending to the electronic health record keeping.  Healthcare facilities use different documentation systems. Nurses will need to learn facility specific documentation system, whether electronic or paper, but the contents of a patient history will largely be similar.

Learning Exercises

LaPierre, D. (2010). Clinical assessment. Sharing in health.ca:open access training in healthcare.Retrieved at http://www.sharinginhealth.ca/clinical_assessment/clinical_assessment.html

Nursing Documentation https://hhs.texas.gov/sites/default/files/documents/doing-business-with-hhs/provider-portal/QMP/NurseDocumentationPPT.pdf

Sharma, N and Gupta, V ( 2021). Therapeutic Communication. https://www.statpearls.com/articlelibrary/viewarticle/127665/?utm_source=pubmed&utm_campaign=reviews&utm_content=127665#

Taylor, C., Lillis, C., Lynn, P., & LeMone, P. (2015). Fundamentals of nursing: The art and science of person-centered nursing care(8th ed.). Philadelphia: Wolters Kluwer Health.

Wilson, S., Giddens, J., (2013). Health assessment for nursing

https://pressbooks.library.ryerson.ca/documentation/

Health Assessment Guide for Nurses Copyright © by Ching-Chuen Feng; Michelle Agostini; and Raquel Bertiz is licensed under a Creative Commons Attribution 4.0 International License , except where otherwise noted.

Share This Book

• Undergraduate
• High School
• Architecture
• American History
• Asian History
• Antique Literature
• American Literature
• Asian Literature
• Classic English Literature
• World Literature
• Creative Writing
• Linguistics
• Criminal Justice
• Legal Issues
• Anthropology
• Archaeology
• Political Science
• World Affairs
• African-American Studies
• East European Studies
• Latin-American Studies
• Native-American Studies
• West European Studies
• Family and Consumer Science
• Social Issues
• Women and Gender Studies
• Social Work
• Natural Sciences
• Pharmacology
• Earth science
• Agriculture
• Agricultural Studies
• Computer Science
• IT Management
• Mathematics
• Investments
• Engineering and Technology
• Engineering
• Aeronautics
• Medicine and Health
• Alternative Medicine
• Communications and Media
• Advertising
• Communication Strategies
• Public Relations
• Educational Theories
• Teacher's Career
• Chicago/Turabian
• Company Analysis
• Education Theories
• Shakespeare
• Canadian Studies
• Food Safety
• Relation of Global Warming and Extreme Weather Condition
• Movie Review
• Admission Essay
• Annotated Bibliography
• Application Essay

Article Critique

• Article Review
• Article Writing
• Book Review
• Business Plan
• Business Proposal
• Capstone Project
• Cover Letter
• Creative Essay
• Dissertation
• Dissertation - Abstract
• Dissertation - Conclusion
• Dissertation - Discussion
• Dissertation - Hypothesis
• Dissertation - Introduction
• Dissertation - Literature
• Dissertation - Methodology
• Dissertation - Results
• GCSE Coursework
• Grant Proposal
• Marketing Plan
• Multiple Choice Quiz
• Personal Statement
• Power Point Presentation
• Power Point Presentation With Speaker Notes
• Questionnaire
• Reaction Paper

Research Paper

• Research Proposal
• SWOT analysis
• Thesis Paper
• Online Quiz
• Literature Review
• Movie Analysis
• Statistics problem
• Math Problem
• All papers examples
• How It Works
• Money Back Policy
• Terms of Use
• Privacy Policy
• We Are Hiring

Taking a Patient History, Article Critique Example

Pages: 5

Words: 1268

Hire a Writer for Custom Article Critique

Use 10% Off Discount: "custom10" in 1 Click 👇

You are free to use it as an inspiration or a source for your own work.

Introduction

The article “A guide to taking a patient’s history” by Lloyd and Craig (2007) in the journal Nursing Standard, presents an outline of the process of taking a patient history. The process as described by Lloyd and Craig includes key aspects of establishing an appropriate environment, using correct communication skills, and taking the history in an appropriate order. The article additionally explains the importance behind taking an accurate patient history. This critique of the Lloyd and Craig journal article first summarizes the content of the article, then provides a critique of it.

Summary of Article

Lloyd and Craig (2007) offers an explanation for why the patient history is such a critically important part of assessing a patient. This is the patient’s opportunity to describe the problems they are having as well as previous problems they have experienced, and in so doing provide the healthcare provider with essential information. Increasingly, the task of taking the patient history is delegated to nurses, nurse practitioners, or nurse specialists. The purpose of this article is to provide a framework for taking such patient histories.

Lloyd and Craig (2007) suggest three keys to taking a comprehensive patient history include establishing an appropriate environment in which to take the history, using excellent communication skills, and taking the history in an appropriate order. In terms of the environment, Lloyd and Craig suggest that the elements that make the environment appropriate are that it be accessible, equipped properly, free from distractions as much as possible, and a safe place for both the patient and the nurse (Lloyd & Craig, 2007). One vital element is also that the patient, and his or her beliefs, be treated with respect. This includes, for example, staying non-judgmental, and providing a private place with no interruptions. This may not be possible in the cases of emergency situations, but all efforts to maintain patient confidentiality should be taken. Finally, the nurse needs to allow enough time to take a complete history.

Lloyd and Craig (2007) also note the essential aspect of using good communications skills to allow the patient to explain the problem in their own words. Establishing a rapport, showing interest, and using direct words instead of jargon are part of this skill set. Nonverbal communication skills include such specifics as eye contact, nodding to encourage the patient to continue, and showing appropriate hand and facial responses and gestures. Of course, the first part of such a patient history is to gather informed consent. This means that the patient must be capable of providing such consent.

Lloyd and Craig (2007) explain that the patient history is most effective when taken in an organized fashion starting with an introduction that explains what the nurse is doing, followed by obtaining consent. Then the specific problem or issue that is causing this visit should be addressed. The next step is to identify prior medical problems and chronic conditions, followed by questions about mental health conditions. The patient should then be asked about any medications, whether prescription or over-the-counter. The next parts of the history include asking about family history (for familial conditions), social history (such issues as housing, alcohol and tobacco use, for example), and sexual history if this is appropriate. This is followed by asking about work history. The history ends with a set of systemic questions to make sure everything has been covered; this includes asking about major body systems not discussed elsewhere, such as respiratory or gastrointestinal system; these questions generally receive negative responses at this point, but if any positive answers are encountered, those issues should be probed for additional information. It may also be helpful to get additional information from the patient’s friend or relative, particularly if there is a loss of consciousness or cognitive problems.

In addition to these basics, Lloyd and Craig (2007) provide general guidelines for how to assess alcohol usage, a useful list of cardinal symptoms to ask about, and a discussion of the types of questions to ask and also to avoid in taking a history. This paper’s discussion of taking patient histories is not patient-specific, in that it could be applied to any adult or young adults, and, with some modification, with children old enough to describe their problems. The authors do point out that for those unable to answer comprehensive questions, it is appropriate to obtain the information from third parties such as parents or other relatives.

Critique of Article

Lloyd and Craig (2007) offered a comprehensive discussion of taking a patient history. Many things were done well in this article. Certainly, the discussion of what to include in a comprehensive patient critique seems both clear and very complete. In the discussion of how to ask questions, however, the differentiation between closed questions and clarification seemed a little too specific. Also, the communication skills described seem unnecessarily complex. This may be due to a need on the part of the authors to be complete, but for a new nurse, trying to recall everything in this article would seem to be a very difficult task. The authors do note that it takes time to develop good history-taking skills, so new nurses would benefit from reading it.

Another point was that the nurse was described as needing to allow enough time to do a complete patient history, yet to do the process as described in Lloyd and Craig (2007) would require quite a lot of time for any patient with a significant medical history or chronic conditions. Lloyd and Craig are based in Britain, with its National Health Service, instead of in the U.S. with its third-party payer medical coverage, and where many patients have no coverage at all. Many of these questions may be better answered via accessing a patient’s medical records. However, on many occasions medical records may not be available, such as in emergency situations, or in cases where the patient is new to a clinical practice.

Another issue is that many U.S. healthcare facilities take patient histories first by asking patients (or their companions/relatives) to fill out forms that ask the critical questions. In today’s healthcare environment, allowing time for nurses to take such a comprehensive history may be financially and practically unreasonable; this is, no doubt, why patients often fill out forms as the primary means of presenting their medical history. It is unclear whether the nurse’s time to take such a complete history would be compensated by medical payers in the U.S. A patient in pain or uncomfortable for any reason, seems unlikely to have the patience to answer the same questions verbally that they’ve just answered on a form. It would be interesting to have U.S. based senior nurse address this topic from the perspective of the U.S. healthcare environment.

Overall, Lloyd and Craig (2007) presented a helpful, useful article that described a way to take a comprehensive patient history. The keys to this skill are to establish an appropriate environment, to use excellent and effective communication skills, and to take the history in an organized fashion. Taking a proper patient history is a vitally important aspect of health care because it forms the core of the patient assessment and offers the patient a forum to describe their problems and offer supporting information to guide the practitioner’s understanding of the issue at hand. The description of the patient history presented by Lloyd and Craig (2007) offers extremely useful guidance for understanding the skill of taking patient histories. It also explains that being incomplete in such histories can lead to incomplete information which may ultimately lead to less than ideal patient outcomes.

Lloyd, H. & Craig, S. (2007). A guide to taking a patient’s history. Nursing Standard, 22 (13), 42-48.

Stuck with your Article Critique?

Get in touch with one of our experts for instant help!

Assessing the Use of the Family Child Care Environmental Rating Scale (FCCER), Essay Example

Multi-Channel Retailing-Diesel, Research Paper Example

Time is precious

don’t waste it!

Plagiarism-free guarantee

Privacy guarantee

Secure checkout

Money back guarantee

Related Article Critique Samples & Examples

Providing high quality and safe nursing care in adult nursing, article critique example.

Pages: 8

Words: 2284

Critical Thinking Paper, Article Critique Example

Words: 1241

Acquisition of Literacy in Bilingual Children, Article Critique Example

Words: 2282

Trouble in Paradise, Article Critique Example

Pages: 3

Words: 818

Penal Voluntary Services (PVS) Organizations and the Criminal Justice Domain, Article Critique Example

Words: 1286

Impact of PVS Organizations on Criminalized Individuals and Their Communities, Article Critique Example

Words: 1336

An official website of the United States government

The .gov means it’s official. Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

The site is secure. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

• Publications
• Account settings

Preview improvements coming to the PMC website in October 2024. Learn More or Try it out now .

• Advanced Search
• Journal List
• BMC Med Educ

Teaching history taking to medical students: a systematic review

Katharina e. keifenheim.

1 Department for Psychosomatic Medicine and Psychotherapy, University Hospital of Tuebingen, Osianderstr. 5, 72076 Tübingen, Germany

Martin Teufel

Julianne ip.

2 Clinical Associate Professor of Family Medicine, Associate Dean of Medicine, Brown University, Providence, RI USA

Natalie Speiser

Elisabeth j. leehr, stephan zipfel.

3 Dean of Medical Education, Medical Faculty, University of Tuebingen, Tuebingen, Germany

Anne Herrmann-Werner

This paper is an up-to-date systematic review on educational interventions addressing history taking. The authors noted that despite the plethora of specialized training programs designed to enhance students‘ interviewing skills there had not been a review of the literature to assess the quality of each published method of teaching history taking in undergraduate medical education based on the evidence of the program’s efficacy.

The databases PubMed, PsycINFO, Google Scholar, opengrey, opendoar and SSRN were searched using key words related to medical education and history taking. Articles that described an educational intervention to improve medical students’ history-taking skills were selected and reviewed. Included studies had to evaluate learning progress. Study quality was assessed using the Medical Education Research Study Quality Instrument (MERSQI).

Seventy-eight full-text articles were identified and reviewed; of these, 23 studies met the final inclusion criteria. Three studies applied an instructional approach using scripts, lectures, demonstrations and an online course. Seventeen studies applied a more experiential approach by implementing small group workshops including role-play, interviews with patients and feedback. Three studies applied a creative approach. Two of these studies made use of improvisational theatre and one introduced a simulation using Lego® building blocks. Twenty-two studies reported an improvement in students’ history taking skills. Mean MERSQI score was 10.4 (range 6.5 to 14; SD = 2.65).

Conclusions

These findings suggest that several different educational interventions are effective in teaching history taking skills to medical students. Small group workshops including role-play and interviews with real patients, followed by feedback and discussion, are widespread and best investigated. Feedback using videotape review was also reported as particularly instructive. Students in the early preclinical state might profit from approaches helping them to focus on interview skills and not being distracted by thinking about differential diagnoses or clinical management. The heterogeneity of outcome data and the varied ways of assessment strongly suggest the need for further research as many studies did not meet basic methodological criteria. Randomized controlled trials using external assessment methods, standardized measurement tools and reporting long-term data are recommended to evaluate the efficacy of courses on history taking.

In the course of his or her professional life, a clinician will conduct between 100,000 and 200,000 patient interviews [ 1 , 2 ]. The medical interview is the most common task performed by physicians. Thus, for good reason, Engel and Morgan called it “the most powerful and sensitive and most versatile instrument available to the physician” [ 3 ]. Scientific discoveries and technological innovations of the last decades fundamentally changed diagnostics and treatment of diseases. Imaging studies and laboratory tests seem crucial for an accurate diagnosis, all the more in times of multidisciplinary treatments and overall availability of instrument-based examinations. But neither scientific nor technological advances in medicine have changed the fact that a physician’s core clinical skills are interpersonal [ 4 – 6 ]. Interview skills contribute significantly to problem detection, diagnostic accuracy, patient and physician satisfaction, patient adjustment to stress and illness, patient recall of information, patient adherence to therapy and patient health outcomes [ 7 – 11 ]. Accuracy of diagnoses and the establishment of a good physician-patient relationship depend on effective communication within the medical interview [ 12 , 13 ]. By the medical history, physicians garner 60–80 % of the information that is relevant for a diagnosis [ 13 – 17 ] and the history alone can lead to the final diagnosis in 76 % [ 13 ].

There are different definitions and models of history taking in the international literature, suggesting a limited shared understanding of the medical interview. Several statements and checklists try to define what qualifies a medical interview as “good” and come to divergent results. One reason might be that history taking is highly contextual, depending on situation, patient and physician attributes, cultural characteristics and other factors. For example, a “good” medical interview in an emergency ward would differ distinctly from a “good” first interview in a psychiatric medical practice. Several authors refer to the “three-function model” [ 18 ] that highlights gathering data (1), responding to patients’ emotions (2) and educating patients and influencing their behaviour (3) as main functions of the medical interview. Each function is served by a separate set of skills. Other models focus on risk assessment, collection of data to make a diagnosis and assessment of patients’ available support system [ 19 ] as main tasks within the medical interview. The “five step model” [ 20 ] links physicians’ patient-centred skills with a more focused proceeding within the interview. Other models emphasise patient-centeredness even more, describing an equal exchange of information and shared decision-making [ 21 , 22 ]. Despite this heterogeneity, there seems to be an agreement that in a “good” medical interview, patient-centered techniques must at least complement the traditional clinician-centred focused questioning style.

Being a successful communicator has long been seen as part of the “art” of medicine, implying that communication skills were a natural gift with which one was or was not born [ 23 ]. However, some researchers described that basic communication skills deteriorate during medical education if they are not particularly activated and practised [ 24 , 25 ]. Students’ psychosocial interviewing skills especially seem to decline without targeted interventions [ 7 , 19 , 25 ]. This has often been associated with students’ growing medical knowledge and concentration on clinical reasoning and diagnostic skills. On the other hand, many studies have shown that students, having passed specialized history taking skills training, ask relevant questions and structure their interviews well. They are better at responding appropriately to patients’ verbal and non-verbal cues [ 26 ] as well as being able to elicit greater quantity and quality of information [ 27 , 28 ].

History taking and communication skills programmes have become cornerstones in medical education over the past 30 years and are implemented in most US [ 6 ],Canadian [ 8 ], German [ 29 ] and UK [ 30 ] medical schools. National accreditations and expert panel consensus guidelines have stressed the importance of educational interventions addressing history taking [ 31 , 32 ]. Today, it is a proven fact that interview skills can be taught if effective methods are used. Even 25 years ago, articles and consensus statements outlined the assumed essential elements of effective interview skills courses [ 33 , 34 ], despite not having much experiential evidence for their recommendations. Since then, many studies investigated the effectiveness of a multitude of different educational methods for teaching history taking. But there is still an uncertainty about: which of these methods are particularly effective; when in the curriculum they should be implemented; or which method is especially helpful for certain subgroups, for example, male or female students or not being a native speaker. In view of this uncertainty, the present systematic review of the literature has been undertaken to collect the currently reported knowledge in the field of teaching history taking in order to make recommendations for curriculum planners, medical teachers and future investigators.

Review objectives

This review aims to answer the following questions: (1) What interventions to teach history taking to medical students exist? (2) How has the effectiveness of these interventions been measured? (3) What is the quality of evidence for these interventions?

Information sources and search

This review process was conducted according to the PRISMA statement [ 35 , 36 ]. The databases PubMed, PsycINFO and GoogleScholar were searched for articles published between January 1990 and June 2014. Hand searches were performed in the reference lists of the search results. Additionally, the “grey literature” databases opengrey, opendoar and SSRN were searched.

Search terms were related to history taking and medical education, using combinations of the following: medical history taking, history-taking, medical communication, medical interview, anamnesis, medical students, medical education and teaching . Search was narrowed to titles and abstracts and terms were searched as MeSH-Terms in PubMed. It was ensured that the search terms captured the previously published reviews [ 37 , 38 ] and all relevant studies included in these reviews.

Underlying definition of “history-taking”

The authors of this review understand “history-taking” as a way of eliciting relevant personal, psychosocial and symptom information from a patient with the aim of obtaining information useful in formulating a diagnosis and providing medical care to the patient. The medical interview is seen as an encounter between physician and patient, both contributing to the results.

Inclusion criteria

Articles were included if the following criteria were met:

• Description of an educational intervention concerning history taking: This review investigates (introductory) workshops teaching history-taking in general, considering content, completeness, verbal and non-verbal interviewing techniques and rapport.
• Evaluation of learning progress (at least a self-evaluation of students)
• Reporting on undergraduate medical education (i.e. “medical students”)
• Publication dates between January 1, 1990 and June 30, 2014
• English- or German-language articles

We also included articles that described teaching units addressing other clinical skills (e.g. physical examination or clinical reasoning) in addition to history taking if intervention and outcomes concerning history taking were reported in detail and separately from the results regarding the other objectives.

Exclusion criteria

The following results were excluded in this review:

• Teaching units concerning only specific aspects of the medical history (e.g. taking a sexual history or an occupational history). Specific aspects of the medical interview are usually taught later in medical education and after an introductory course in medical interviewing has taken place, which is why interventions with regard to these specific aspects were excluded in this review.
• Teaching units addressing communication skills in general, patient-centred behaviour or empathy without regard to history taking
• Articles describing only the assessment of interview skills without describing a teaching unit
• Articles with no measured outcome at all, e.g. project descriptions with course evaluation only and without any assessment of learning progress

Article selection and data collection

The literature search yielded 1254 potential publications on teaching units addressing history taking for medical students (see flowchart in Fig.  1 for complete search and study selection strategy). Following an initial review for relevancy by title and abstract (KEK and NS) and removal of duplicate results, 78 studies were left for full-text review, of these, 23 studies finally met the inclusion criteria. Interrater reliability was excellent with к = 0.84. In case of differing judgement, EJL was consulted as independent evaluator.

Flow chart of the literature search and study selection process

Relevant data was extracted from the included articles using an a priori developed data extraction form composed for this review (KEK, NS). Data extraction fields included (1) authors and year of publication, (2) description of study design and (3) participants, (4) description of the educational intervention, (5) assessment techniques and measurement tools, (6) reported change in history taking ability and (7) MERSQI score. Discussion with EJL resolved differences in data extraction.

Quality assessment

Study quality was considered using the Medical Education Research Study Quality Instrument (MERSQI), a tool developed especially to assess educational studies [ 39 ]. The 10-item scale (possible range 5 to 18) surveys the following domains: study design, sampling, type of data, validity of the evaluation instrument, data analysis and outcomes. Patient or health care outcomes are assessed higher than students’ satisfaction, attitudes or opinions. The MERSQI domains are very similar to the required methodical standards that Sanson-Fisher suggested for educational studies [ 40 ]. Neither the authors of the MERSQI scale nor Sanson-Fisher and colleagues defined a cut-off value to differ methodically “good” studies from “less good studies”.

This systematic review includes 23 studies. Table  1 describes these studies in detail, reporting basic data concerning study design and participants, teaching methods and training procedures, assessment of learning progress, use of measurement tools and the calculated MERSQI score of the study (see Table  1 ).

Characteristics of 23 studies of educational interventions concerning history-taking skills

SP simulated patient, OSCE Objective Structured Clinical Examination, IGS Information Gathering Scale, CSS Communication Skills Scale, MIRS Medical Interview Rating Scale, HTRS History-Taking Rating Scale, ISIE International Analysis System for Interview Evaluation, MAAS Maastricht History-Taking and Advice Checklist

Study characteristics

The study design of the 23 finally selected articles was heterogeneous. There were randomized, two-group, pre-post comparisons ( n  = 4) as well as randomized and non-randomized two-group post-tests ( n  = 6). Five studies were single-group pre-post comparisons and five were single-group post-test evaluations only. Two were modified cohort controlled studies and one a non-randomized, three-group post-test. Of those studies reporting the duration of their educational interventions, the shortest intervention took two hours and the longest took seven 4-hour sessions (28 h).

Outcome measures

Assessment methods and measurement tools, much like the study designs, also were very heterogeneous. In eight studies [ 9 , 10 , 24 , 26 , 28 , 41 – 43 ] out of 22, trained observers assessed an interaction between a student and a simulated patient (SP) using a standardized history taking measurement tool. Seven of the applied scales were specific to history taking, but only one had a proven reliability and validity and all of them had been developed especially to assess the published intervention. The remaining 15 studies used either non-validated, self-report questionnaires developed by the respective study investigators, course evaluation questionnaires or qualitative analyses of students’ comments. One of the studies used a written examination; one used focus groups. Twenty-two studies out of 23 found positive effects of their educational interventions on students’ history-taking skills. For a full overview of the results see Table  1 .

Study quality

The mean MERSQI score for the 23 included studies was 10.36 (SD 2.65) [ 39 ]. The range was from 6.5 to 14 (possible range 5 to 18). Scores were limited especially by: deficiencies in the field of study design (ex: no control group, missing baseline measurements or lack of randomization); by missing validity of the outcome measurement tools; and by measurement of students’ attitudes or skills rather than by patient or health care outcomes.

Interventions

Instructional (traditional) approaches, focus scripts.

Students in the multi-institutional RCT of Peltier [ 44 ] received “focused history and physical exam scripts” (Focus Scripts). The authors developed one generic acute patient script template and one template for a focused chronic illness history. The organizational structure of the scripts was aimed to support students’ collection of data on any symptom. Students’ written progress notes were scored by a blind rater using a standardized scale. Five of 11 variables were statistically higher in the group that learned with the focused scripts. These included history taking, clarity of diagnosis and overall score. This intervention focuses on content and completeness of the medical interview and does not take verbal or non-verbal interview skills into account.

Videotape review: Communication benchmarks

Losh [ 45 ] held a lecture introducing communication benchmarks for inpatient history and then showed short videotaped scenarios that illustrated segments of a student history, contrasting an acceptable version of communication with a better version. The better version demonstrated the appropriate benchmarked skills. The scenarios were used in teaching sessions to help students identify effective communication techniques within the medical interview. Participants were medical students doing their first medical interview. After the sessions, 76 % of the students felt that this design helped them to understand the introduced communication benchmarks and 92 % felt that the videotape helped to point out subtle communication issues that might otherwise have been missed. The intervention imparted both knowledge about content and structure of the medical interview and particular communication skills.

Online course

Wiecha [ 46 ] reported on an online course developed to teach the cognitive basis for interviewing skills. The authors provided video demonstrations of patient interviews, text modules presenting communication concepts (not further clarified by the authors) and a moderated, asynchronous discussion board asking students to post their observations. The authors addressed questioning techniques, affect and nonverbal cues, eliciting the cardinal features of a symptom, and stages and transitions. Students received individual feedback on their participation and performance by personal e-mail. They reported improvement in self-awareness, increased understanding of interviewing concepts and benefits of online learning. Self-reported knowledge scores also increased significantly.

Experiential (“learning by doing”) approaches

Small group workshops including role-play and feedback.

In two studies [ 28 , 41 ], students participated in small group workshops practising history taking by role-play. Feedback was provided by facilitator and group members. Evans [ 28 ] implemented a specialized history-taking training programme consisting of lectures and skills workshops. Trained students were significantly more efficient on all areas covered by the applied scale (commencement of the interview, problem processing, communication, summary and overall effectiveness). In a non-randomized, controlled study, Mukohara [ 41 ] implemented a 2-day seminar on communication process skills and content aspects of the medical interview. Learning activities were a trigger videotape critique followed by role-play with videotape review and feedback by facilitator and group. The authors found an improvement for students’ ability to assess “how the illness affects the patient’s life”. No differences were observed between intervention group and waiting control group in the other 15 core communication skills.

Small group workshops including simulated patients

Ten studies [ 7 , 24 , 28 , 42 , 43 , 47 – 52 ] reported on interventions using simulated patients (SP). SP interviews were conducted by one of the participating students and were usually combined with a feedback session and discussion. Feedback was given by the group and/or the facilitator. SP interviews in these workshops were often supplemented by lectures, demonstrations, small group exercises including role-play and self-reflection. Battles [ 47 ] used SPs with abnormal medical histories to demonstrate pathology. Utting [ 43 ] compared two skills courses using an active “learning by doing” approach with one course and applying instructional methods in the other. The authors found no differences in students’ interview skills, which were assessed using standardized scales. Eoaskoon [ 48 ] conducted a three-group post-test. SP interview and feedback (1) were compared with role-play and feedback in front of the group (2) and role-play and feedback within the group (3). The group that trained with SP interviews gained the highest scores with regard to interview skills. Five studies [ 24 , 42 , 49 – 51 ] used videotape review for feedback. Kraan [ 24 ] investigated a graded teaching program of medical interviewing skills. Each year a different set of skills was highlighted. In the first years, basic interviewing skills, medical history-taking skills and psychosocial issues were emphasized. Effective exchange of information and difficult situations such as dealing with aggressive patients or sexual problems were topics for advanced learners. Each small group had both a physician and a behavioural scientist as facilitators. Ozcakar [ 42 ] found that students having both verbal and visual (videotape review) feedback were more successful than those having verbal feedback alone. Although self-assessment of the students did not improve significantly, feedback based on videotaped interviews was superior to the feedback given solely based on the observation of assessors. Hulsman [ 49 ] showed that students valued SP interviews, video observation and feedback as instructive and helpful to develop their own strengths and to identify certain kinds of behaviour to improve. Nestel and Kidd [ 50 ] used peer tutors and reported no differences regarding patient-centred interview skills between groups taught by peers and those taught by faculty. Von Lengerke [ 51 ] and Fortin [ 7 ] found that SP interviews were evaluated as one of the most effective teaching methods. Von Lengerke performed a pre-post comparison of students’ self-assessed competencies and had participants evaluate key teaching methods. In addition to history taking, disclosure of diagnosis was taught in this course. Fortin [ 7 ] focused on integrating patient-centred skills (listening, negotiating, responding to emotion empathetically, focusing the patient’s story) into a medical interview skills course. Mini-lectures, demonstrations by faculty and role-play preceded the SP interviews.

Using virtual patients

One RCT by Vash [ 53 ] reported on small groups working on virtual surgical patients in a computer lab. The patient was initially introduced to them, and then the students worked through eight sections including interview (chief complaint), medical history and review of systems. Students had to ask relevant questions by typing them. Students in the lab performed better than their colleagues in the control group, which had seen patients in the surgery clinic instead. Significant differences were only found in the history taking area.

Small group workshops including real patients

Four interventions [ 9 , 10 , 26 , 54 ] provided real patients. Fischer [ 54 ] included real patient interviews at the end of a course including role-play and simulated patients as well. Students interviewed real patients and videotaped the interviews. One aspect of the intervention was that the students visited the real patients in their homes. The interviews were watched back in the classroom and the students received feedback from facilitators and group members. The authors reported a significant learning progress and improvement in taking a case history. Results of self-reported questionnaires corresponded well with the results of the Objective Structured Clinical Examination (OSCE). Windish [ 10 ] compared a communication skills course applying SPs to a control group interviewing inpatients. Students in the intervention group were better at establishing rapport and were able to list more psychosocial history items. Evans [ 26 ] used real patients in the context of a communication skills course. The authors applied lectures, role-play, SP interviews and discussion as well. All three studies made use of videotape review. Novack [ 9 ] included interviews with real patients in a course using lectures, role-play and discussion as well as textbooks with additional information. Students were supposed to follow a chronically ill patient for 1 year and after regular interviews, write up progress notes.

Creative approaches

Improvisational theatre.

Watson [ 55 ], as well as Shochet [ 56 ], implemented elective courses including improvisational theatre techniques to improve specific communication skills. In Shochet’s study, students practised specific skills including listening, affirmation, non-verbal communication and other skills. Students discussed the relevance of these skills in communication with their patients. The authors showed that students felt more confident in their role as future physicians after the course and that they improved their ability to be flexible in communication styles and “respond in the moment”. Most students thought that the concepts that were addressed in the course were highly relevant to the care of patients. Students in Watson’s classes felt they became better listeners and observers.

Lego® simulation

Harding and D’Eon [ 57 ] implemented a Lego® simulation in their interactive lecture to improve patient-centred interviewing skills. Student volunteers took on the roles of doctor and patient. The doctor had to query the patient and through his responses replicate the patient’s Lego® construction without looking at it. The authors found this intervention helped preclinical students to concentrate on interviewing skills without being preoccupied with medical knowledge.

Heterogeneity of interventions

One clear finding of the literature review is that the included studies applied very heterogeneous teaching methods and determined different core areas to teach. While some interventions focused on content or structure of the medical interview and imparted techniques on “how to ask the right questions”, others highlighted non-verbal communication skills, patient-centeredness and establishing rapport. There is no accordance on when in medical education certain skills should be taught, leading to interventions that were taught for students at very different levels of training. While some studies evaluated long existing training programmes extending over several semesters, others investigated innovative approaches sometimes lasting only a few hours.

Fourteen studies included medical students in the preclinical years, eight studies included students in the clinical years and one study included both. Authors of the studies investigating improvisational theatre and Lego® simulation presumed that preclinical students might especially benefit from creative approaches where no significant medical knowledge was required. Not being preoccupied with complicated clinical reasoning may facilitate history-taking exercises for this subgroup and enhance patient-centred approaches.

Heterogeneity might also be due to the context dependence of the medical interview itself. Goals of the included studies were to enable students to attain a set of basic knowledge and skills in the medical interview. But encounters with patients are highly complex events and no simple approach can do justice to all possible processes and challenges in such interactions. No single course can comprehensively address all the communication problems that a physician will encounter, nor will skills be effective in every imaginable clinical situation.

Most articles in the field of history taking don’t differentiate between interview skills, interpersonal skills and communication skills – this conceptual mixture also contributed to the heterogeneity of interventions. Very often, specific interpersonal and communication skills (e.g. nonverbal behaviour, communication of empathy) are taught within the context of medical interview courses. Maybe an exact separation of these terms and definitions is neither even possible nor desirable as there is a continuum from communication skills to interview skills to history taking.

Assessment of history taking skills

Six different methods of assessing learning progress were applied in the included studies. Many studies used more than one of the following:

• Self-evaluation questionnaires
• Free-text response on what students learned from the workshop
• Written examinations
• Qualitative analysis of students’ reflections and write-ups
• Assessment of (videotaped) interviews by either trained observers, SPs or student tutors, either using a checklist/validated measurement tool or just giving a global impression
• OSCE-stations and assessment of the interviews by trained observers or SPs, using a checklist/validated measurement tool.

Studies with a higher MERSQI score (>11.5) mostly used the latter methods (numbers 4, 5, 6) of assessing learners’ progress. Very often, they combined different methods and had self-report course evaluation forms as well as formal assessments of students’ interviews with SPs.

Findings from the MERSQI score

If articles are sub-divided by methodological quality, it becomes apparent that studies with a higher MERSQI score (>11,5) often report on small-group skills workshops using role-play, simulated patients, virtual patients and/or real patients. In these courses, teachers and group, sometimes also SPs or peer tutors, give feedback. Mostly, interviews are videotaped to facilitate and enhance feedback. Studies with a lower MERSQI score (<9) frequently apply a more traditional approach using demonstrations, theoretical sessions and self-study. As creative approaches also tend to achieve a lower MERSQI score, innovative approaches don’t seem to be associated with a better study quality. Experiential approaches (“learning by doing”, see Table  1 ) achieved the highest MERSQI scores. Differences in MERSQI scores are primarily explicable by implementation of control groups, objective assessment of (videotaped) interviews and use of assessment tools. Limitations of the MERSQI score could be that the scale is based on a quantitative experimental study design paradigm that might underestimate qualitative or observational studies. Reliance on the MERSQI score only might therefore be biased towards particular forms of research.

Implications for future research

With regard to content, the included interventions were often innovative, mostly well-thought-out and substantiated. Many of them were descriptive studies that relied on students’ self-evaluation and didn’t provide evidence that the intervention was effective in improving history-taking skills. Though there is a well-established methodology for adequate evaluative research that should be used if the effectiveness of history-taking courses is to be properly determined, studies mostly lack baseline measurement, randomization, adequate control groups, external measurement, blinded raters or standardized measurement scales. Often self-developed assessment scales were used although proven scales for external assessment do exist (for example the History-Taking Rating Scale (HTRS) [ 28 ], the Maastricht History-taking and Advice Checklist (MAAS) [ 24 ] or the Brown Interviewing Checklist (BIC) [ 6 ]). And although essential elements of effective history taking courses were defined in the 80s and 90s [ 33 , 34 ], there is still no evidence-based gold standard that could serve as control group for an innovative new approach. Of course innovative ideas should be described in articles to provoke and stimulate discussion with colleagues but there is still a need for substantiated not just experiential studies. Innovative new concepts must be welcomed, but they should be coupled with acceptable methodology to examine and demonstrate their effectiveness [ 40 ].

An effort should always be made to question if certain interventions provide a more significant improvement for certain groups of students. There may be circumstances that predispose students to require more specific interventions, for example a non-native speaker of a language may need training in appropriate phrasing of questions as well as non-verbal cues to be most effective at history taking.

Implications for curriculum planners and medical teachers

Small group workshops including interview simulations (role-play, SP interviews, virtual patients) and interviews with real patients, followed by feedback and discussion, are widespread and have been most thoroughly investigated and reported on. Feedback using videotape review seems to be particularly successful in providing students with instructive techniques in history taking. Students in the early preclinical state might profit from creative approaches helping them to focus on the interview skills and not being preoccupied by attempts to make diagnoses beyond their abilities. There is no evidence on when history-taking workshops should take place in the curriculum. Some authors recommend implementing them in the clinical clerkships, others favour implementation in preclinical years. Curriculum planners should consider addressing the reported decline in history-taking skills over time when medical interviewing is taught early in the curriculum, especially concerning psychosocial issues. This might be achieved by implementing a long-term “communication skills” course or by offering booster sessions later in the clinical years.

Limitations of this review

It is possible that our search strategy may have missed some papers, especially those published in different languages as we only included articles written in English or German. However, it is unlikely that we missed a substantial number of relevant publications, especially as this review covers such a long period. But more important than that, this review only included published studies while it is recognized that many training programs do teach history taking in a variety of ways world wide that may not be mentioned in this review as they have not been published.

History taking is an essential skill of every physician and has to be taught in the course of their medical education. Today, there are many studies demonstrating that students can acquire interview skills by specific workshops. There seems to be little evidence noting the superiority of one specific method however, there is a broad scope of interventions that all seem to provide history taking skills. It is not known if the acquired skills can be generalized across situations or maintained over time.

Important formal goals for this research area are to meet acceptable methodological standards for evaluative research. External measurement of students’ skills – either by a clinician, a SP or student/peer tutor utilizing established proven scales – is an important objective for the evaluation of future methods of teaching history taking. Practical examinations involving SPs, especially OSCE stations, should be gold standard in assessing history taking skills.

We acknowledge support by Deutsche Forschungsgemeinschaft and Open Access Publishing Fund of University of Tübingen.

Competing interests

The authors declare that they have no competing interests.

Authors’ contributions

KEK: literature review concept design, analysis and interpretation of data, drafting of manuscript. JI: critique for revision of manuscript and editing. MT: literature review concept design, critical revision of manuscript. NS: analysis and interpretation of data. EJL: literature review concept design, analysis and interpretation of data. SZ: literature review concept design and coordination AHW: literature review concept design, critical revision of manuscript. All authors read and approved the final manuscript.

Contributor Information

Katharina E. Keifenheim, Email: [email protected] .

Martin Teufel, Email: [email protected] .

Julianne Ip, Email: ude.nworb@pi_ennailuj .

Natalie Speiser, Email: [email protected] .

Elisabeth J. Leehr, Email: [email protected] .

Stephan Zipfel, Email: [email protected] .

Anne Herrmann-Werner, Email: [email protected] .

Home — Essay Samples — Nursing & Health — Nursing — Foundation And History Of Nursing

Foundation and History of Nursing

• Categories: Art History Nursing

About this sample

Words: 608 |

Published: Mar 16, 2024

Words: 608 | Page: 1 | 4 min read

Table of contents

Foundation of nursing, history of nursing, modern nursing.

Cite this Essay

Let us write you an essay from scratch

• 450+ experts on 30 subjects ready to help
• Custom essay delivered in as few as 3 hours

Get high-quality help

Verified writer

• Expert in: Arts & Culture Nursing & Health

+ 120 experts online

By clicking “Check Writers’ Offers”, you agree to our terms of service and privacy policy . We’ll occasionally send you promo and account related email

No need to pay just yet!

Related Essays

2 pages / 872 words

1 pages / 599 words

4 pages / 1784 words

4 pages / 2141 words

Remember! This is just a sample.

You can get your custom paper by one of our expert writers.

121 writers online

Still can’t find what you need?

Browse our vast selection of original essay samples, each expertly formatted and styled

Related Essays on Nursing

When driving around Miami, FL there are a copious number of billboards that I see advertising for people to become nurses throughout the city. When doing research, I’ve only come across a couple of news articles, advertising on [...]

Gagnon, K., & Sabus, C. (2015). Professionalism in a Digital Age: Opportunities and Considerations for Using Social Media in Health Care. Physical Therapy, 95(3), 406–414.Nayak, S. G. (2018). Time Management in Nursing -- Hour [...]

Clinical learning experiences hold a paramount role in nursing education, serving as a bridge between theoretical knowledge and practical application. This essay explores the essential role of clinical placements in developing [...]

A Better NHS. (2011). Patient autonomy and choice. Retrieved from 71-77.

Postpartum hemorrhage is a significant risk in the postpartum period, requiring prompt recognition, assessment, prevention, and management. Nursing care plays a pivotal role in ensuring the well-being of women experiencing [...]

In the world of healthcare, professionalism is the cornerstone of nursing practice. It encompasses a set of qualities and behaviors that not only uphold the standards of the profession but also ensure the delivery of safe and [...]

Related Topics

By clicking “Send”, you agree to our Terms of service and Privacy statement . We will occasionally send you account related emails.

Where do you want us to send this sample?

By clicking “Continue”, you agree to our terms of service and privacy policy.

Be careful. This essay is not unique

This essay was donated by a student and is likely to have been used and submitted before

Download this Sample

Free samples may contain mistakes and not unique parts

Sorry, we could not paraphrase this essay. Our professional writers can rewrite it and get you a unique paper.

Please check your inbox.

We can write you a custom essay that will follow your exact instructions and meet the deadlines. Let's fix your grades together!

Get Your Personalized Essay in 3 Hours or Less!

We use cookies to personalyze your web-site experience. By continuing we’ll assume you board with our cookie policy .

• Instructions Followed To The Letter
• Deadlines Met At Every Stage
• Unique And Plagiarism Free

Fall Accident: Nursing Process Essay

History of present illness.

Jose Crixell, an 85-year-old male, is hospitalized following a fall accident at his residence that inflicted a deep cut and inflammation on the bottom of his right leg. Since his wife passed away two years ago, Jose has been living with his daughter and her family. The client had been pre-diagnosed with hypertension and depends on a cane for stability. Although the departing nurse noted Jose’s physiological parameters as being “within normal norms,” the Unlicensed Assistive Personnel (UAP) interprets his contemporary signs as follows: Blood Pressure 165/94, Pulse 101; Respiratory Rate 28, and Temperature 101.8 o F (“Differential diagnosis,” 2013). Moreover, compared to the previous day, the patient reports feeling weak and generally worse due to feelings of pain on a scale of 5/10 and swelling on the lower side of his right leg. Besides the IV antibiotics prescription to contain the infection, Jose is taking an antipyretic for pain. The antipyretic acetaminophen dosage administered to Jose increased from 1200 to 1800. Although Jose’s prescription recommends 650 mg of acetaminophen at four hours intervals, he took his last dose at 0900 and expects the next at 2200.

Pathophysiology of Admitting Diagnosis

Pathophysiology.

• Drawing from the UAP reports, Jose presents elevated blood pressure and pulse rate at 165/94 and 101, respectively. Additionally, he has a peak temperature of 101.8F and acute injury on the wound with minimal presiding leakage.
• On the lateral aspect of his right lower thigh, there is an approximately 1 cm round wound. According to Baker et al. (2019), a high pulse is related to blood pressure and is a vital factor in physicians’ judgment during diagnosis. Therefore, the above-average pulse and blood pressure rates recorded by the patient are signs of an infection. The lower right leg of the client has an injury on the lateral side, which is a frequent site for illnesses. Jose’s wound is characterized by an open incision with serosanguinous discharge and a high body temperature which are signs of an infection.
• The etiology of the open incision on Jose’s wound is a fall at his home that led to a puncture on his lower right leg that has caused active pain, bleeding, and inflammation on the injured spot. In a study by Patel et al. (2019), patients affected by lower-limb cellulitis with prolonged wound drainage face the most significant rate of contamination and necrosis that derail wound healing. Bleeding wounds host bacteria, such as streptococcus or staphylococcus, and cause cellulitis (Gordon & Phelps, 2020). The patients’ wounds have taken longer to heal and exhibited prolonged pain and bleeding, influencing the adjustment of the preceding acetaminophen dosage. Conclusively, Jose’s slow healing process and unending pain are influenced by bacterial contamination from bleeding.
• Moreover, the patient has exhibited high blood pressure and pulse rates. Notably, Jose has a history of hypertension, characterized by above-normal blood pressure and pulse rates.

Risk factors

• Open wound and hypertension comorbidity are risk factors facing Jose. First, hypertension influences high blood pressure and pulse rates, inhibiting wound healing. The client’s blood pressure is 165/94, moreover, Jose’s pulse rate is 101, above the normal range. Aside from the high blood pressure influencing tenacious wound drainage, hypertension interrupts the injury oxygenation critical to healing.
• Consequently, open and swollen wounds pose hazards to hypertension patients by triggering high blood pressure and subsequent health conditions. Wound infections that are swollen elevate C- reactive protein (CRP) levels that influence atherosclerosis hence unregulated blood pressure (Thomas & Aguh, 2021). Escalated demand for white blood cells following excessive bleeding triggers high blood pressure.

Signs and Symptoms

• The patient’s abnormal vital signs and worsening bleeding and pain symptoms suggest that the cellulitis is progressing. Possibly due to comorbidity infection, the client’s temperature, blood circulation, and heart rates have increased. Correspondingly the patients’ respiratory rates have escalated to match the high blood pressure.
• The priority problems are cellulitis and pain. The patient’s white blood cell count is elevated, suggesting that there is an infection present. Cellulitis is a severe skin infection and underlying tissue infection (Gordon & Phelps, 2020). It most often occurs on the legs but can occur on any body part. Signs and symptoms include redness, warmth, swelling, and pain.

Complications

• The patient reports that he is weak overall and getting worse than before. The patient claims his right lower leg is more painful, rating it a 5 out of 10, and more swollen and red. Hypertension implicates the wound-healing process exposing Jose to risks of necrosis, periwound dermatitis, and edema. Very high blood pressure is influenced by hypertension and potentially exposes the patient to risks of heart attack or stroke (Orgambídez & Almeida., 2020). Jose is also at risk for developing pneumonia due to the increased respiratory rate and difficulty breathing.

Priority Nursing problem #1

Problem #1: A puncture wound is a deep cut or hole in the skin caused by a sharp object influencing cellulitis, a bacterial infection of the skin and underlying tissues.

Patient Goal #1: The patient will manage vital signs, including swelling, oozing, and pain in the wound, within normal limits during the 2200hrs check-up and administration.

Implementation/Intervention #1:

• Evaluate signs such as the inflammation and hygiene of the wound.

Rationale: Drawing from Patel et al. (2019), open wounds with scant drainage influence bacteria, causing cellulitis. The client’s wound is swollen and painful due to a blood clot caused by cellulitis (Patel et al., 2019). Therefore, Jose’s wound is infected by cellulitis influenced by poor hygiene of the wound.

• Start Wound Care Bacterial treatment.

Rationale: Proper wound care measures such as regular cleaning, disinfection, inspection, and re-dressing are elemental to enhanced healing and limited bacterial infection. Moreover, facilitating appropriate bed rest for minimal wound disturbance is a necessary wound care procedure. Continuous oral administration of intravenous IV antibiotics will prevent further bacterial infection and enable the patient to combat cellulitis.

Evaluation #1: GOAL MET: Facilitate an improved healing process to reduce wound size, pain, and inflammation by improving bruise care and cellulitis management.

Priority Nursing problem #2

Problem #2: John was previously diagnosed with hypertension, a risk factor for high blood pressure, fever, and elevated respiration rates.

Patient Goal #2: The patient will reduce his blood pressure to less than 120/80mmHg from 165/94 mmHg.

Implementation/Intervention #2:

• Start blood pressure treatment with Angiotensin-converting enzyme (ACE) inhibitors.

Rationale: According to Gabel et al. (2021), medical treatment of hypertension with critical threats is necessary. ACE inhibitors cause vasodilation of blood vessels to regulate pressure. Considering Jose’s hypertension is developing, ACE inhibitors will help relax veins and arteries to lower blood pressure.

• Educate the patient on non-pharmacological measures for inhibiting hypertension.

Rationale: Another critical intervention for Jose’s education about cellulitis. He should be taught the importance of seeking medical attention immediately if he experiences worsening symptoms. Non-pharmacological treatments for hypertension, such as limited alcohol consumption, cigarette smoking, and salt intake, will help Jose navigate his high blood pressure. Moreover, he should also be instructed on the importance of taking his antibiotic as prescribed and completing the entire course of therapy.

Evaluation #2: GOAL MET: The patient lowers his blood pressure to recommended levels of less than 120/80mmHg after implementing medical and non-pharmacological approaches to controlling hypertension.

Priority Nursing Risk for Problem #1

Risk of allergic reaction to the antibiotics.

Implementation/Intervention for Risk #1:

• Terminate the intravenous IV antibiotics after diagnosing an allergic reaction

Rationale: According to Barker et al. (2019), antibiotic prescriptions are subjective to allergic reactions, and nurses ought to monitor and terminate antibiotic medications that trigger allergic reactions in patients. Even after intravenous IV treatment, advancing patients’ inflammation could be influenced by an allergic reaction.

• Administer antihistamines and epinephrine to manage allergic reactions

Rationale: HI antihistamines and Epinephrine medication seems to be the most effective treatment for anaphylaxis influenced by an allergic reaction. Pharmacological treatment of allergic reactions prevents progression to life-threatening respiratory, inflammatory, and cardiovascular symptoms.

Evaluation Risk for #1: GOAL MET: John will recover from an allergic response to intravenous IV antibiotics and prevent adverse effects.

Nursing Application Assessment

• Regular patient inspection
• Assist with therapeutic methods of mitigating pain

Safety and Infection Control

• Wound hygiene procedures
• Environmental checks for the patient
• Education on non-pharmacological methods of hypertension treatment
• Patient positioning to minimize injury

Barker, J. H., Kane, R., & Linsley, P. (2019). Evidence-based practice for nurses and healthcare professionals . Evidence-based Practice for Nurses and Healthcare Professionals , pp. 1–264. Web.

“ Differential diagnosis ” (2013) Practice Nursing , 24(9), pp. 447–447. Web.

Gabel, C., Ko, L. N., Dobry, A. S., Garza-Mayers, A. C., Milne, L. W., Nguyen, E., & Kroshinsky, D. (2021). Patient preference for cellulitis treatment: At-home care is preferred to hospital-based treatment . Journal of the American Academy of Dermatology , 85 (3), 767–768. Web.

Gordon, A. A., & Phelps, P. O. (2020). Management of preseptal and orbital cellulitis for the primary care physician . Disease-a-month , 66 (10), 101044. Web.

Orgambídez, A., & Almeida, H. (2020). Social support, role clarity, and job satisfaction: a successful combination for nurses . International Nursing Review , 67 (3), 380-386. Web.

Patel, M., Lee, S. I., Thomas, K. S., & Kai, J. (2019). The red leg dilemma: a scoping review of the challenges of diagnosing lower‐limb cellulitis . British Journal of Dermatology , 180 (5), 993-1000. Web.

Thomas, J., & Aguh, C. (2021). Approach to treatment of refractory dissecting cellulitis of the scalp: a systematic review . Journal of Dermatological Treatment , 32 (2), 144-149. Web.

• Chicago (A-D)
• Chicago (N-B)

IvyPanda. (2024, May 19). Fall Accident: Nursing Process. https://ivypanda.com/essays/fall-accident-nursing-process/

"Fall Accident: Nursing Process." IvyPanda , 19 May 2024, ivypanda.com/essays/fall-accident-nursing-process/.

IvyPanda . (2024) 'Fall Accident: Nursing Process'. 19 May.

IvyPanda . 2024. "Fall Accident: Nursing Process." May 19, 2024. https://ivypanda.com/essays/fall-accident-nursing-process/.

1. IvyPanda . "Fall Accident: Nursing Process." May 19, 2024. https://ivypanda.com/essays/fall-accident-nursing-process/.

Bibliography

IvyPanda . "Fall Accident: Nursing Process." May 19, 2024. https://ivypanda.com/essays/fall-accident-nursing-process/.

• Wounds, Their Types and Healing Stages
• Non- and Pharmacological Dementia Care Methods
• Non-Pharmacological Interventions in Palliative Care
• The General Surgery Unit: Nursing Deficit
• Patient Falls Prevention: Nurses' Hourly Rounding
• Nurse Shortage, Retention and Patient Satisfaction
• Grand Canyon University's Doctor of Nursing Practice Program
• Nursing: Health Policy Issue Paper

• Share full article

Advertisement

Supported by

Patient Dies Weeks After Kidney Transplant From Genetically Modified Pig

Richard Slayman received the historic procedure in March. The hospital said it had “no indication” his death was related to the transplant.

By Virginia Hughes

Richard “Rick” Slayman, who made history at age 62 as the first person to receive a kidney from a genetically modified pig, has died about two months after the procedure.

Massachusetts General Hospital, where Mr. Slayman had the operation, said in a statement on Saturday that its transplant team was “deeply saddened” at his death. The hospital said it had “no indication that it was the result of his recent transplant.”

Mr. Slayman, who was Black, had end-stage kidney disease, a condition that affects more than 800,000 people in the United States, according to the federal government, with disproportionately higher rates among Black people.

There are far too few kidneys available for donation. Nearly 90,000 people are on the national waiting list for a kidney.

Mr. Slayman, a supervisor for the state transportation department from Weymouth, Mass., had received a human kidney in 2018. When it began to fail in 2023 and he developed congestive heart failure, his doctors suggested he try one from a modified pig.

“I saw it not only as a way to help me, but a way to provide hope for the thousands of people who need a transplant to survive,” he said in a hospital news release in March.

His surgery, which lasted four hours, was a medical milestone. For decades, proponents of so-called xenotransplantation have proposed replacing ailing human organs with those from animals. The main problem with the approach is the human immune system, which rejects animal tissue as foreign, often leading to serious complications.

Recent advances in genetic engineering have allowed researchers to tweak the genes of the animal organs to make them more compatible with their recipients.

The pig kidney that was transplanted into Mr. Slayman was engineered by eGenesis, a biotech company based in Cambridge, Mass. Scientists there removed three genes and added seven others to improve compatibility. The company also inactivated retroviruses that pigs carry and could be harmful to humans.

“Mr. Slayman was a true pioneer,” eGenesis said in a statement on social media on Saturday. “His courage has helped to forge a path forward for current and future patients suffering from kidney failure.”

Mr. Slayman was discharged from the hospital two weeks after his surgery, with “one of the cleanest bills of health I’ve had in a long time,” he said at the time.

In a statement published by the hospital, Mr. Slayman’s family said he was kind, quick-witted and “fiercely dedicated to his family, friends and co-workers.” They said they had taken great comfort in knowing that his case had inspired so many people.

“Millions of people worldwide have come to know Rick’s story,” they said in the statement. “We felt — and still feel — comforted by the optimism he provided patients desperately waiting for a transplant.”

Virginia Hughes is an editor on the Health and Science desk. More about Virginia Hughes

• Open access
• Published: 18 May 2024

Medical radiation exposure in inflammatory bowel disease: an updated meta-analysis

• Chao Lu 1 ,
• Xin Yao 1 ,
• Mosang Yu 1 &
• Xinjue He 1  

BMC Gastroenterology volume  24 , Article number:  173 ( 2024 ) Cite this article

Metrics details

There have been previous studies and earlier systematic review on the relationship between inflammatory bowel disease (IBD) and radiation exposure. With the diversification of current test methods, this study intended to conduct a meta-analysis to evaluate the IBD radiation exposure in recent years.

Three databases (PUBMED, EMBASE, and MEDICINE) for relevant literature up to May 1, 2023 were searched. The statistical data meeting requirements were collated and extracted.

20 papers were enrolled. The overall high radiation exposure rate was 15% (95% CI = [12%, 19%]) for CD and 5% (95% CI = [3%, 7%]) for UC. The pooled result found that high radiation exposure rate was 3.44 times higher in CD than in UC (OR = 3.44, 95% CI = [2.35, 5.02]). Moreover, the average radiation exposure level in CD was 12.77 mSv higher than that in UC (WMD = 12.77, 95% CI = [9.93, 15.62] mSv). Furthermore, radiation exposure level of CD after 2012 was higher than those before 2012 (26.42 ± 39.61vs. 23.76 ± 38.46 mSv, P  = 0.016), while UC did not show similar result (11.99 ± 27.66 vs. 10.01 ± 30.76 mSv, P  = 0.1). Through subgroup analysis, it was found that disease duration (WMD = 2.75, 95% CI = [0.10, 5.40] mSv), complications (OR = 5.09, 95% CI = [1.50, 17.29]), and surgical history (OR = 5.46, 95% CI = [1.51, 19.69]) significantly increased the proportion of high radiation exposure.

This study found that radiation exposure level of IBD patients was high, which revealed the radiation risk in the process of diagnosis and treatment of IBD patients. In the future, longer follow-up and prospective studies are needed to reveal the relationship between high radiation exposure and solid tumorigenesis.

Peer Review reports

Inflammatory bowel disease (IBD), including Crohn’s disease (CD) and ulcerative colitis (UC), refers to a group of lifelong idiopathic disorders characterized by gastrointestinal inflammation and extra-intestinal manifestations [ 1 ]. The incidence and prevalence of IBD is increasing worldwide especially in Asia, while it is still highest among developed countries in Europe and America [ 2 ]. Due to the unclear pathogenesis and the complexity of treatment, IBD has a significant disease and economic burden [ 3 ]. The diagnosis of IBD is a difficult and complicated process. In addition to gastrointestinal endoscopy, repeated imaging tests are also required, especially for the diagnosis of CD, which needs to assess the extent and severity of the disease, and the presence of complications [ 4 ]. Therefore, the assessment of radiation exposure is very important.

IBD itself increases the risk of intestinal tumors [ 5 , 6 ], and the use of drugs such as azathioprine, other immunosuppressive agents and biological agents will increase the risk of malignant tumors such as lymphoma [ 7 ]. In addition, exposure to ionizing radiation may potentially increase the risk of malignancy [ 8 ]. Radiation exposure as low as 50 millisieverts (mSv) has been associated with the development of certain solid tumors such as colon, bladder cancer [ 9 ]. Globally, up to 2% of malignancies can be attributed to diagnostic medical radiation (DMR) [ 10 ]. Although some clinicians believe that DMR exposure is indeed a potential risk, the actual exposure of IBD patients in clinical practice still lacks sufficient multicenter large sample data to support, that leads to many concerns for patients, such as whether they are exposed to excessive DMR. Previous meta-analysis study have shown that IBD patients do have higher DMR [ 11 ]. With the continuous development of medical technology, such as the application of MRI and intestinal ultrasound, it is not clear whether DMR has changed from before.

Therefore, it is important to conduct this study to update our current knowledge by meta-analysis to analyze relevant studies found to date, especially recent studies, to determine the pooled prevalence of increased exposure in IBD patients and risk factors associated with exposure to potentially harmful ionizing levels.

Data selection

We searched three databases (PUBMED, EMBASE, and MEDICINE) for relevant literature up to May 1, 2023. Literature search limited to human studies and English version, including prospective and retrospective studies. The following search terms were used to retrieve potential articles: ((Inflammatory Bowel Disease) OR (IBD) OR (Crohn’s disease) OR (CD) OR (ulcerative colitis) OR (UC)) AND ((radiation exposure) OR (radiation injuries) OR (medical radiation)).

The search was independently performed by 2 authors according to title and abstract, and full text was retrieved if it met the requirement. In addition, disagreement would be evaluated by a third author independently.

Inclusion criteria and quality assessment

The diagnosis of IBD was based on symptoms, imaging, and histopathology [ 12 ]. High diagnostic medical radiation exposure was defined as ≥ 50 mSv. In addition, sufficient data for calculation were needed for inclusion in the study. STROBE checklist was used to assess Quality assessment and risk of bias for the studies included [ 13 ]. Moreover, the work was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement [ 14 ].

Data extraction

Relevant data from every included study according to the unified standard were extracted by two independent authors and then they proceeded to cross-check the results. The extracted data contained author, country or region, published year, number of subjects, radiation exposure dose, number of high diagnostic medical radiation exposure and factors affecting radiation exposure. Agreement between the investigators was greater than 95%, and differences between the datasets were resolved by discussion.

Statistical analysis

Continuous variables were expressed as mean and standard deviation, and dichotomous variables were described by odds ratio (OR) and 95% confidence interval (CI). Heterogeneity of the data was quantified with the I 2 statistic and assessed by Cochran’s Q statistic. In this study, when heterogeneity was less than 50%, the pooled estimates were obtained using the fixed-model (Mantel and Haenszel) method. On the contrary, the random-model (M-H heterology) method was chosen if heterogeneity was more than 50% [ 15 ]. This study compared the following: difference in radiation exposure between CD and UC; difference in high diagnostic medical radiation exposure between CD and UC; difference in radiation exposure of CD and UC patients before and after 2012 (According to the articles, it can be basically determined that articles after 2012 did not overlap the count of CT before), and the difference in radiation exposure under different influencing factors including disease duration, gender, complications, surgical history and medication. In addition, sensitivity analysis was used to evaluate whether the results were reliable. Begg’s test was conducted to estimate publication bias with a value of P  > 0.05 suggesting no publication bias. All data analysis methods involved in this study were implemented through STATA 15 (StataCorp., College Station, Tex, USA).

Basic characteristics

A total of 3894 relevant articles were screened, of which 20 papers were enrolled finally according to inclusion criteria. The flowchart has been schematically outlined in Fig.  1 which described the process of the study selection. 20 articles all referred to CD, and 15 of them referred to radiation exposure of UC. The included population of 17 articles came from Europe and the United States. Of the 20 articles reporting on CD, 17 mentioned average radiation exposure values, 16 mentioned numbers of high diagnostic medical radiation exposure, and 13 articles were published after 2012. Of the 15 articles reporting on UC, 13 mentioned average radiation exposure values, 12 mentioned numbers of high diagnostic medical radiation exposure, and 9 articles were published after 2012. UC did not perform subgroup analysis on influencing factors due to lack of literature support. About CD, 3 referred to disease duration, 3 referred to gender, 3 referred to complications, 4 referred to surgical history, and 3 referred to medication.

Flowchart of articles selected

Radiation exposure in CD and UC patients

The total number and number of individuals with high radiation exposure of CD was 32,963 and 5181 respectively, and the average radiation exposure level was 26.31 mSv (Table  1 ). At the same time, The total number and number of individuals with high radiation exposure of UC was 34,854 and 2147 respectively, and the average radiation exposure level was 11.97 mSv (Table  2 ). Combining rates by meta-analysis found that the overall high radiation exposure rate was 15% (95% CI = [12%, 19%]) for CD (Fig.  2 A) and 5% (95% CI = [3%, 7%]) for UC (Fig.  2 B). The pooled result of meta-analysis found that high radiation exposure rate was 3.44 times higher in CD than in UC (OR = 3.44, 95% CI = [2.35, 5.02]) (Fig.  3 A). Moreover, the pooled results of meta-analysis showed that the average radiation exposure level in CD was 12.77 mSv higher than that in UC (WMD = 12.77, 95% CI = [9.93, 15.62] mSv) (Fig.  3 B).

Forest plot showed event rate defined as proportion of patients exposed to high diagnostic medical radiation exposure ≥ 50 mSv in CD and UC patients

Forest plot showed the difference between radiation exposure level and high radiation exposure odds ratios between CD and UC

Furthermore, we compared whether there was a difference in radiation exposure level before and after 2012 in order to judge whether the increase in imaging methods in recent years has affected radiation exposure. 11 articles on CD were published after 2012, while 6 articles were published before 2012 (Table  1 ). The pooled radiation exposure level was 26.42 ± 39.61 mSv after 2012 and 23.76 ± 38.46 mSv before 2012, and there was a statistical difference between two groups ( P  = 0.016). In addition, high radiation exposure rate was 16.10% after 2012 and 12.25% before 2012, and it also had statistical difference ( P  < 0.01). However, UC did not show similar results. 8 articles were published after 2012, while 5 articles were published before 2012 (Table  2 ). The pooled radiation exposure level was 11.99 ± 27.66 mSv after 2012 and 10.01 ± 30.76 mSv before 2012, and high radiation exposure rate was 6.64% after 2012 and 4.30% before 2012. Neither parameter had statistical difference ( P  = 0.1 and P  = 0.62, respectively).

Finally, the study analyzed factors affecting radiation exposure. Due to lack of data, we only analyzed the influencing factors of CD. Disease duration, gender, complications, surgical history, and medication were the factors for our analysis. Through subgroup analysis, it was found that disease duration (WMD = 2.75, 95% CI = [0.10, 5.40] mSv), complications (OR = 5.09, 95% CI = [1.50, 17.29]), and surgical history (OR = 5.46, 95% CI = [1.51, 19.69]) significantly increased the proportion of high radiation exposure, while gender (OR = 1.16, 95% CI = [0.76, 1.77]) and medication (OR = 1.75, 95% CI = [0.99, 3.11]) had no effect. (Fig.  4 )

Forest plot showed odds ratio of risk factors of high radiation exposure grouped according to exposure

Funnel plot analyses of studies assessing radiation exposure revealed no significant publication bias ( P  > 0.05). Sensitivity analysis showed that although some results were fluctuant, the overall results were stable and reliable.

This updated meta-analysis showed that radiation exposure of IBD patients was significantly increased, and the proportion of patients with high radiation exposure was also significantly increased. In addition, radiation exposure level of CD patients was significantly higher than that of UC patients, and the high radiation exposure of CD was related to disease duration, complications and surgical history.

Radiation exposure in IBD patients was significantly higher, which was depended on the course of diagnosis and treatment of the disease. Especially for CD patients, because the entire digestive tract may be involved, doctors need to conduct a comprehensive evaluation, especially the evaluation of the small intestine, which requires the use of small intestine CT and abdominal CT. It reported that incidence and mortality of solid cancer were positively associated with higher radiation dose and younger age of exposure [ 16 ]. And it has been reported that ionising radiation levels as low as 50 mSv have been contributed to the development of solid tumors [ 9 ]. Based on the results of this study and the characteristics of IBD patients with young age of onset and high radiation exposure [ 17 ], we believed that IBD patients may be exposed to an environment with a higher tumor incidence. So what can be done to reduce the risk of solid tumors in patients with IBD? First, we could propose the creation of an IBD patient radiation diary to record total radiation exposure and increase physician awareness of patient exposure to ionizing radiation [ 18 ]. Second, in tertiary care institutions, the frequency of magnetic resonance enterography (MRE) examinations can be increased to replace CT enterography (CTE). MRE is used to obtain cross-sectional imaging of small bowel without exposure to DMR, which can show the inflammation and fibrotic bowel wall in detail [ 19 ]. In a prospective study, Fiorino et al. found that MRE and CTE were similar accuracy in localizing CD, bowel wall enhancement, enteroenteric fistula, and MRE was superior to CTE for assessing strictures and bowel wall thickening [ 20 ]. Therefore, European Crohn’s and Colitis Organisation advocate increased routine usage of MRI for the assessment of small bowel CD [ 21 ]. According to the results of this study, why do the articles published in recent years showed that radiation exposure dose of IBD was higher than before. The authors believed that there were many reasons for this. First, the popularity of MRE is still only available in large general hospitals. Therefore, CTE remains the primary usage of IBD examination. Second, with the tense medical environment, doctors are more careful to deal with complications that may occur at any time during the diagnosis and treatment of patients and pay more attention to the efficacy of patients, so the frequency of examinations may be increased. Finally, Although the article was published in recent years, the patients included in the article may go back several years.

The results of this study showed that disease duration, complications and surgical history were associated with high radiation exposure, which was clearly closely related to the diagnosis and follow-up of the disease. The earlier the onset, the earlier the initial exposure. In addition, complications and surgical history have also added additional imaging tests to assess the severity of the disease. CT imaging offers advantages of rapid acquisition of images, high sensitivity, widespread availability, and specificity for the detection of intestinal and extra-intestinal disease [ 22 ]. Combined with the improved visualization of the small bowel mucosa by CTE, the assessment of small bowel disease activity is more accurate [ 23 ]. However, previous studies have shown that the role of CT in assessing intestinal disease activity may be limited [ 24 ]. In turn, radiation-induced cancer occurs in 1/1000 patients who undergo at least10 mSv CT scan [ 25 ]. Therefore, the appropriate imaging examination methods and frequency in the process of IBD diagnosis and treatment still require doctors to pay close attention.

On the basis of previous studies, this study has carried out a more detailed and systematic study and obtained more convincing results, but there were still some shortcomings needed to be pointed out. First, this study included data from multiple centers, which can lead to patient heterogeneity. Although sensitivity analysis showed the overall results were stable and reliable, the existence of heterogeneity still made this study only select random effect model for data analysis. The inconsistency of equipment models in different centers, the inconsistency of doctors’ cognition of diseases, and the compliance of patients would all affect the total radiation exposure. Moreover, this study has conducted extensive screening of papers. But based on the data provided by the published papers, the data of some included papers was not complete. We also asked the authors about the data through email, but unfortunately there was no reply. Additionally, the estimated radiation dose may be greater or less than the actual exposure. It is also possible that tests performed at other centers may not have been captured, leading to underestimate the total radiation dose. Second, we lacked studies with large sample data. Some studies included limited patients, which affected the reliability of the results. In particular, in the subgroup analysis of high exposure risk factors, the number of articles and patients included was limited, so the reliability of the results was limited. Finally, we lacked longer-term follow-up and prospective studies to analyze the risk of solid tumor development in high radiation exposure patients. The emergence of such results will have important guiding significance for the selection of imaging examinations in the process of IBD diagnosis and treatment.

In conclusion, this study found that radiation exposure level of IBD patients was high, and exposure level of CD patients was higher than UC, which revealed the radiation risk in the process of diagnosis and treatment of IBD patients. In the future, longer follow-up and prospective studies are needed to reveal the relationship between high radiation exposure and solid tumorigenesis.

Data availability

The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.

Abbreviations

• Inflammatory bowel disease
• Crohn’s disease
• Ulcerative colitis

Diagnostic medical radiation

Millisieverts

Confidence interval

Magnetic resonance enterography

CT enterography

Li L, Xu P, Zhang Z, Zhou X, Chen C, Lu C. Platelets can reflect the severity of Crohn’s disease without the effect of anemia. Clinics (Sao Paulo) (2020) 75:e1596. Epub 2020/07/16. https://doi.org/10.6061/clinics/2020/e1596 . PubMed PMID: 32667493; PubMed Central PMCID: PMCPMC7337217.

Molodecky NA, Soon IS, Rabi DM, Ghali WA, Ferris M, Chernoff G, et al. Increasing incidence and prevalence of the inflammatory bowel diseases with time, based on systematic review. Gastroenterology. 2012;142(1):46–54.e42. https://doi.org/10.1053/j.gastro.2011.10.001 ; quiz e30. Epub 2011/10/18.

Article   PubMed   Google Scholar  

Sairenji T, Collins KL, Evans DV. An update on inflammatory bowel disease. Prim Care. 2017;44(4):673–92. https://doi.org/10.1016/j.pop.2017.07.010 . Epub 2017/11/15.

Flynn S, Eisenstein S. Inflammatory bowel disease presentation and diagnosis. Surg Clin North Am. 2019;99(6):1051–62. https://doi.org/10.1016/j.suc.2019.08.001 . Epub 2019/11/05.

Jess T, Gamborg M, Matzen P, Munkholm P, Sørensen TI. Increased risk of intestinal cancer in Crohn’s disease: a meta-analysis of population-based cohort studies. Am J Gastroenterol (2005) 100(12):2724-9. Epub 2006/01/06. https://doi.org/10.1111/j.1572-0241.2005.00287.x . PubMed PMID: 16393226.

Loftus EV. Jr. Epidemiology and risk factors for colorectal dysplasia and cancer in ulcerative colitis. Gastroenterol Clin North Am. 2006;35(3):517–31. https://doi.org/10.1016/j.gtc.2006.07.005 . Epub 2006/09/06.

Carvalho D, Russo P, Bernardes C, Saiote J, Ramos G, Mascarenhas L, et al. Hodgkin’s lymphoma in Crohn’s Disease treated with Infliximab. GE Port J Gastroenterol. 2017;24(6):279–84. https://doi.org/10.1159/000455180 . Epub 2017/12/20.

Article   PubMed   PubMed Central   Google Scholar  

Kroeker KI, Lam S, Birchall I, Fedorak RN. Patients with IBD are exposed to high levels of ionizing radiation through CT scan diagnostic imaging: a five-year study. J Clin Gastroenterol (2011) 45(1):34 – 9. Epub 2010/08/04. https://doi.org/10.1097/MCG.0b013e3181e5d1c5 . PubMed PMID: 20679907.

Brenner DJ, Doll R, Goodhead DT, Hall EJ, Land CE, Little JB, et al. Cancer risks attributable to low doses of ionizing radiation: assessing what we really know. Proc Natl Acad Sci U S A. 2003;100(24):13761–6. https://doi.org/10.1073/pnas.2235592100 . Epub 2003/11/12.

Article   CAS   PubMed   PubMed Central   Google Scholar  

Tanooka H. Radiation cancer risk at different dose rates: new dose-rate effectiveness factors derived from revised A-bomb radiation dosimetry data and non-tumor doses. J Radiat Res. 2022;63(1):1–7. https://doi.org/10.1093/jrr/rrab109 . Epub 2021/12/21.

Chatu S, Subramanian V, Pollok RC. Meta-analysis: diagnostic medical radiation exposure in inflammatory bowel disease. Aliment Pharmacol Ther. 2012;35(5):529–39. https://doi.org/10.1111/j.1365-2036.2011.04975 . Epub 2012/01/14.

Article   CAS   PubMed   Google Scholar  

Lu C, Yang J, Yu W, Li D, Xiang Z, Lin Y, et al. Association between 25(OH)D Level, Ultraviolet exposure, geographical location, and inflammatory bowel Disease Activity: a systematic review and Meta-analysis. PLoS ONE. 2015;10(7):e0132036. https://doi.org/10.1371/journal.pone.0132036 . Epub 2015/07/15.

Vandenbroucke JP, von Elm E, Altman DG, Gøtzsche PC, Mulrow CD, Pocock SJ, et al. Strengthening the reporting of Observational studies in Epidemiology (STROBE): explanation and elaboration. PLoS Med. 2007;4(10):e297. https://doi.org/10.1371/journal.pmed.0040297 . Epub 2007/10/19.

Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC, Ioannidis JP, the National Institute for Health Research in England. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. PLoS Med (2009) 6(7):e1000100. Epub 2009/07/22. https://doi.org/10.1371/journal.pmed.1000100 . PubMed PMID: 19621070; PubMed Central PMCID: PMCPMC2707010 Oxford Radcliffe Hospitals Trust on behalf of the Department of Health and. This is a fixed term contract, the renewal of which is dependent upon the value placed upon his work, that of the UK Cochrane Centre, and of The Cochrane Collaboration more widely by the Department of Health. His work involves the conduct of systematic reviews and the support of the conduct and use of systematic reviews. Therefore, work–such as this manuscript–relating to systematic reviews might have an impact on his employment.

Higgins JP, Thompson SG. Quantifying heterogeneity in a meta-analysis. Stat Med (2002) 21(11):1539-58. Epub 2002/07/12. https://doi.org/10.1002/sim.1186 . PubMed PMID: 12111919.

Ozasa K, Shimizu Y, Suyama A, Kasagi F, Soda M, Grant EJ, et al. Studies of the mortality of atomic bomb survivors, Report 14, 1950–2003: an overview of cancer and noncancer diseases. Radiat Res. 2012;177(3):229–43. https://doi.org/10.1667/rr2629.1 . Epub 2011/12/17.

Seyedian SS, Nokhostin F, Malamir MD. A review of the diagnosis, prevention, and treatment methods of inflammatory bowel disease. J Med Life. 2019;12(2):113–22. https://doi.org/10.25122/jml-2018-0075 . Epub 2019/08/14.

Herfarth H, Palmer L. Risk of radiation and choice of imaging. Dig Dis. 2009;27(3):278–84. Epub 2009/09/30. doi: 10.1159/000228561. PubMed PMID: 19786752.

Amitai MM, Ben-Horin S, Eliakim R, Kopylov U. Magnetic resonance enterography in Crohn’s disease: a guide to common imaging manifestations for the IBD physician. J Crohns Colitis. 2013;7(8):603–15. https://doi.org/10.1016/j.crohns.2012.10.005 . Epub 2012/11/06.

Fiorino G, Bonifacio C, Peyrin-Biroulet L, Minuti F, Repici A, Spinelli A, et al. Prospective comparison of computed tomography enterography and magnetic resonance enterography for assessment of disease activity and complications in ileocolonic Crohn’s disease. Inflamm Bowel Dis. 2011;17(5):1073–80. https://doi.org/10.1002/ibd.21533 . Epub 2011/04/13.

Kucharzik T, Tielbeek J, Carter D, Taylor SA, Tolan D, Wilkens R et al. ECCO-ESGAR Topical Review on Optimizing Reporting for Cross-Sectional Imaging in Inflammatory Bowel Disease. J Crohns Colitis (2022) 16(4): 523–543. Epub 2022/05/10. https://doi.org/10.1093/ecco-jcc/jjab180 . PubMed PMID: 34628504.

Brenner DJ, Hall EJ. Computed tomography–an increasing source of radiation exposure. N Engl J Med. 2007;357(22):2277–84. https://doi.org/10.1056/NEJMra072149 . Epub 2007/11/30.

Nguyen GC, Low D, Chong RY, Diong C, Chawla T. Utilization of Diagnostic Imaging and Ionization Radiation exposure among an inflammatory bowel Disease Inception Cohort. Inflamm Bowel Dis. 2020;26(6):898–906. https://doi.org/10.1093/ibd/izz219 . Epub 2019/09/29.

Patel B, Mottola J, Sahni VA, Cantisani V, Ertruk M, Friedman S et al. MDCT assessment of ulcerative colitis: radiologic analysis with clinicndoscopic, and pathologic correlation. Abdom Imaging (2012) 37(1):61 – 9. Epub 2011/05/24. https://doi.org/10.1007/s00261-011-9741-x . PubMed PMID: 21603899.

Zakeri N, Pollok RC. Diagnostic imaging and radiation exposure in inflammatory bowel disease. World J Gastroenterol. 2016;22(7):2165–78. https://doi.org/10.3748/wjg.v22.i7.2165 . Epub 2016/02/24.

Download references

Acknowledgements

Not applicable.

Author information

Authors and affiliations.

Department of Gastroenterology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, China

Chao Lu, Xin Yao, Mosang Yu & Xinjue He

You can also search for this author in PubMed   Google Scholar

Contributions

Chao Lu designed research; Chao Lu and Xin Yao searched articles and collected data; Mosang Yu performed the statistical analysis; Chao Lu wrote the paper; Xinjue He revised the paper.

Corresponding author

Correspondence to Xinjue He .

Ethics declarations

Ethics approval and consent to participate, consent for publication, competing interests.

The authors declare no competing interests.

Additional information

Publisher’s note.

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary Material 1

Rights and permissions.

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ . The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/ ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and permissions

About this article

Cite this article.

Lu, C., Yao, X., Yu, M. et al. Medical radiation exposure in inflammatory bowel disease: an updated meta-analysis. BMC Gastroenterol 24 , 173 (2024). https://doi.org/10.1186/s12876-024-03264-1

Download citation

Received : 09 October 2023

Accepted : 14 May 2024

Published : 18 May 2024

DOI : https://doi.org/10.1186/s12876-024-03264-1

Share this article

Anyone you share the following link with will be able to read this content:

Sorry, a shareable link is not currently available for this article.

Provided by the Springer Nature SharedIt content-sharing initiative

• Radiation exposure

BMC Gastroenterology

ISSN: 1471-230X

• Submission enquiries: [email protected]
• General enquiries: [email protected]