Medication history, importance

A careful history and physical examination are key components in the diagnosis of decompensated heart failure. The history should focus on the potential etiologies of heart failure the presence of any precipitating factors onset, duration, and severity of symptoms and a careful medication history. Important elements of the physical examination include vital signs, cardiac auscultation for heart sounds and murmurs, pulmonary examination for the presence of rales, the presence of peripheral edema, and weight. The JVP is a reliable indicator of the patient s volume status and should be evaluated carefully on admission and followed closely as an indicator of the efficacy of diuretic therapy. 

Given that VTE can be debilitating or fatal, it is important to treat it quickly and aggressively.8 On the other hand, because major bleeding induced by antithrombotic drugs can be equally harmful, it is important to avoid treatment when the diagnosis is not reasonably certain. Assessment of the patient s status should focus on the search for risk factors in the patient s medical history... 

Once cirrhosis is diagnosed, disease progression is relentless, regardless of the initial insult to the liver. Determining the specific cause of cirrhosis requires examination of both physical presentation and past medical history. An accurate social history is particularly important because few factors in the physical and laboratory examination aid in determining disease etiology. Understanding the cause of a patient s cirrhosis is imperative because it can affect therapeutic options and treatment decisions. 

The drug of choice for chronic hepatitis B depends on the patient s past medical history, aminotransferase level, HBV DNA level, and most importantly, HBeAg status. 

Persons with confirmed chronic hepatitis B should be evaluated for treatment, which may include interferon, pegylated interferon, lamivudine, adefovir dipivoxil, or entecavir. The drug of choice for chronic hepatitis B depends on the patient s past medical history, aminotransferase level, HBV DNA level, and most importantly, HBeAg status. 

A complete medical history and targeted physical examination are essential to correctly classify the type(s) of Ul present. It is important to assess the degree of annoyance due to symptoms of the patient during the assessment. The degree of annoyance to the patient may not correlate well with the results of quantitative tests such as symptom frequency/severity, use of... 

It is important to review the patient s medication history for potential drug-drug and drug-glaucoma interactions, adherence, presence of systemic and ocular adverse drug reactions, and ability to use ophthalmic preparations. 

Finally, there is the very important annotated CRF, which shows you where the variables in the clinical database come from on the CRF. The following is an example of an annotated medical history CRF page ... 

Information about prescription drag use alcohol or other substance use family medical history and history of trauma, depression, or head injury should be obtained. It is important to rule out medication use as a contributor or cause of symptoms (e.g., anticholinergics, sedatives, hypnotics, opioids, antipsychotics, and anticonvulsants) as contributors to dementia symptoms. Other medications may contribute to delirium, e.g.,... 

Thorough medical and medication histories, physical examination, assessment of laboratory values and if needed, imaging studies, are important in the diagnosis of ARF. 

Dementia may be hard to differ from delirium (Table 6.1). The most important tool is a thorough medical history. Dementia has a slow progress whereas delirium is characterised by a rapid change in cognitive functions. Depression and anxiety could be mistaken for delirium, but the impaired consciousness in delirium sets it apart from affective disorders. 

The easiest way to get information about family medical history is to talk to relatives about their health. Have they had any medical problems, and when did they occur A family gathering could be a good time to discuss these issues. Additionally, obtaining medical records and other documents (such as obituaries and death certificates) can help complete a family medical history. It is important to keep this information up-to-date and to share it with a healthcare professional regularly. 

The results of genetic tests are not always straightforward, which often makes them challenging to interpret and explain. Therefore, it is important for patients and their families to ask questions about the potential meaning of genetic test results both before and after the test is performed. When interpreting test results, healthcare professionals consider a person s medical history, family history, and the type of genetic test that was done. 

Other important components of the initial evaluation include a medical evaluation including both a medical history and physical examination. This can identify medical consequences of substance abuse, such as liver impairment from chronic alcohol abuse or sinus complications from cocaine use, as well as reveal needle tracks from a variety of self-injection sites that might not be readily apparent to casual observation. 

Many investigator sites employ part- or fulltime nurses to support the clinical trials. Nurses should never be considered to be an extravagance, because without them, the onus of administration and QC is solely on the investigator. The clinical trial nurse can help the investigator in many ways, but two of the most important are ensuring that the CRT reflects what is present in the source documents, such as essential events of the medical history of the subject, and close liaison with the sponsor s monitor. 

The development of alcoholism is often insidious, proceeding from frequent drunkenness to dependence over years. Since this is so, and since alcohol may interact with other treatment (other psychoactive substances and via its effects on the liver), a careful check of a patient s intake is an important part of the medical history. It is vital to know about alcohol abuse before anaesthesia, since it may make the anaesthetic difficult and alcohol withdrawal may complicate the recovery period. 

Toxidrome is a term which is used to describe a constellation of signs and symptoms, which when taken collectively, may characterize the poison in question. This is particularly important if patient has altered sensorium, and there is no reliable informant for a medical history. It may be important to review physical features and the differential diagnosis of the... 

Significant medical conditions, including head trauma, metabolic disorders, and neurologic conditions, should be identified. Eating and sleeping patterns are important to identify over time to know if these relate to the present condition and to know if medications affected them. Information about potential drug sensitivities or interactions may be obtained from a medication history that includes antibiotics commonly used, cold preparations, vitamins, health supplements, and present and past psychotropic medications. It is important to find out about previous medication trials what was tried, what worked, what did not work, and why. 

Before commencing the sessions the patients were assessed by physical examination and full medical history including age, sex, occupation, residence, special habits of medical importance with particular emphasis on the history of the underlying disease including duration of ulcer, mode of onset, ulcer pain, history of deep vein thrombosis or varicose veins, trauma, lump, varicosities, contact dermatitis and symptoms suggestive of ischaemia. Photographic reference of ulcer and ulcer area measurements were carried out at the commencement of treatment and during the follow up laser therapy, which continued for 6 months. 

Some new work has been done here which shows the effects of solvents exposure. A new study illustrates a simple method of detoxification using heat chamber depuration (sauna), and raises awareness in the practice of medicine of the importance of taking an environmentally oriented historical approach. The connection between symptoms of chronic degenerative diseases and environmental and/or nutritional factors is missed in many cases due to lack of obtaining an environmentally oriented medical history. Taking such a history and dealing with the cause of illness using avoidance and/or appropriate therapy is preventive and cost-effective for both the patient and society (Krop, 1998). 

There is no doubt that antibiotics are among the most important class of therapeutic agents and have had enormous impact on both life expectancy and quality of life. With the discovery of the natural penicillins as secondary metabolites of the fungus PenicilUum, the course of medical history was dramatically altered and the antibiotic era began. 

Patient data collection is an extremely critical component of a value-added service. The information collected provides pharmacists with important baseline and monitoring parameters for patients. The amount and type of information needed from the patient or other health care providers may differ depending on the service, but nonetheless, this information is the foundation on which the other components of the service are built. Forms can be developed to help pharmacists collect this information (see Figs. 25-2 through 25-4). In addition, some consideration should be given to how this information will be stored (e.g., paper charts or electronic patient database). The information that should be collected from the patient includes demographic information, medical history, family history, and medication history. Since some of the information may need to be collected from other providers and health care institutions, an authorization to release medical information should be signed by the patient and kept as part of the chart (see Fig. 25-5). Lastly, pharmacists should ensure that their site is in compliance with the Health Insurance Portability and Accountability Act (HIPPA) and reinforce to their patients that the information they provide is confidential and secure at the pharmacy. 

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