Chapter 7 Body Systems
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The Stethoscope: Some Preliminary Investigations
695 ORIGINAL ARTICLE The stethoscope: some preliminary investigations P D Welsby, G Parry, D Smith Postgrad Med J: first published as on 5 January 2004. Downloaded from ............................................................................................................................... See end of article for Postgrad Med J 2003;79:695–698 authors’ affiliations ....................... Correspondence to: Dr Philip D Welsby, Western General Hospital, Edinburgh EH4 2XU, UK; [email protected] Submitted 21 April 2003 Textbooks, clinicians, and medical teachers differ as to whether the stethoscope bell or diaphragm should Accepted 30 June 2003 be used for auscultating respiratory sounds at the chest wall. Logic and our results suggest that stethoscope ....................... diaphragms are more appropriate. HISTORICAL ASPECTS note is increased as the amplitude of the sound rises, Hippocrates advised ‘‘immediate auscultation’’ (the applica- resulting in masking of higher frequency components by tion of the ear to the patient’s chest) to hear ‘‘transmitted lower frequencies—‘‘turning up the volume accentuates the sounds from within’’. However, in 1816 a French doctor, base’’ as anyone with teenage children will have noted. Rene´The´ophile Hyacinth Laennec invented the stethoscope,1 Breath sounds are generated by turbulent air flow in the which thereafter became the identity symbol of the physician. trachea and proximal bronchi. Airflow in the small airways Laennec apparently had observed two children sending and alveoli is of lower velocity and laminar in type and is 6 signals to each other by scraping one end of a long piece of therefore silent. What is heard at the chest wall depends on solid wood with a pin, and listening with an ear pressed to the conductive and filtering effect of lung tissue and the the other end.2 Later, in 1816, Laennec was called to a young characteristics of the chest wall. -
Improving the Accuracy of Medical Diagnosis with Causal Machine Learning ✉ Jonathan G
ARTICLE https://doi.org/10.1038/s41467-020-17419-7 OPEN Improving the accuracy of medical diagnosis with causal machine learning ✉ Jonathan G. Richens 1 , Ciarán M. Lee1,2 & Saurabh Johri 1 Machine learning promises to revolutionize clinical decision making and diagnosis. In medical diagnosis a doctor aims to explain a patient’s symptoms by determining the diseases causing them. However, existing machine learning approaches to diagnosis are purely associative, 1234567890():,; identifying diseases that are strongly correlated with a patients symptoms. We show that this inability to disentangle correlation from causation can result in sub-optimal or dangerous diagnoses. To overcome this, we reformulate diagnosis as a counterfactual inference task and derive counterfactual diagnostic algorithms. We compare our counterfactual algorithms to the standard associative algorithm and 44 doctors using a test set of clinical vignettes. While the associative algorithm achieves an accuracy placing in the top 48% of doctors in our cohort, our counterfactual algorithm places in the top 25% of doctors, achieving expert clinical accuracy. Our results show that causal reasoning is a vital missing ingredient for applying machine learning to medical diagnosis. 1 Babylon Health, 60 Sloane Ave, Chelsea, London SW3 3DD, UK. 2 University College London, Gower St, Bloomsbury, London WC1E 6BT, UK. ✉ email: [email protected] NATURE COMMUNICATIONS | (2020)11:3923 | https://doi.org/10.1038/s41467-020-17419-7 | www.nature.com/naturecommunications 1 ARTICLE NATURE COMMUNICATIONS | https://doi.org/10.1038/s41467-020-17419-7 roviding accurate and accessible diagnoses is a fundamental Since its formal definition31, model-based diagnosis has been challenge for global healthcare systems. -
Use of Nursing Diagnosis in CA Nursing Schools
USE OF NURSING DIAGNOSIS IN CALIFORNIA NURSING SCHOOLS AND HOSPITALS January 2018 Funded by generous support from the California Hospital Association (CHA) Copyright 2018 by HealthImpact. All rights reserved. HealthImpact 663 – 13th Street, Suite 300 Oakland, CA 94612 www.healthimpact.org USE OF NURSING DIAGNOSIS IN CALIFORNIA NURSING SCHOOLS AND HOSPITALS INTRODUCTION As part of the effort to define the value of nursing, a common language continues to arise as a central issue in understanding, communicating, and carrying out nursing's unique role in identifying and treating patient response to illness. The diagnostic process and evidence-based interventions developed and subsequently implemented by a practice discipline describe its unique contribution, scope of accountability, and value. The specific responsibility registered nurses (RN) have in assessing patient response to health and illness and determining evidence-based etiology is within the realm of nursing’s autonomous scope of practice, and is referred to as nursing diagnosis. It is an essential element of the nursing process and is followed by implementing specific interventions within nursing’s scope of practice, providing evidence that links professional practice to health outcomes. Conducting a comprehensive nursing assessment leading to the accurate identification of nursing diagnoses guides the development of the plan of care and specific interventions to be carried out. Assessing the patient’s response to health and illness encompasses a wide range of potential problems and actual concerns to be addressed, many of which may not arise from the medical diagnosis and provider orders alone, yet can impede recovery and impact health outcomes. Further, it is critically important to communicate those problems, potential vulnerabilities and related plans of care through broadly understood language unique to nursing. -
Nursing Documentation in Clinical Practice
From the Department of Nursing, Karolinska Institutet, Stockholm, Sweden Nursing Documentation in Clinical Practice Instrument development and evaluation of a comprehensive intervention programme Catrin Björvell Stockholm 2002 Nursing Documentation in Clinical Practice Instrument development and effects of a comprehensive education programme By: Catrin Björvell Cover layout: Tommy Säflund Printed at: ReproPrint AB, Stockholm ISBN 91-7349-297-3 NURSING DOCUMENTATION IN CLINICAL PRACTICE There is nothing more difficult to carry out, nor more doubtful of success, nor more dangerous to handle than to initiate a new order of thing. Machiavelli, The Prince Nursing documentation in clinical practice Instrument development and evaluation of a comprehensive intervention programme Catrin Björvell, Department of Nursing, Karolinska Institutet, Stockholm, Sweden Abstract The purpose of this study was to describe and analyse effects of a two-year comprehensive intervention concerning nursing documentation in patient records when using the VIPS model - a model designed to structure nursing documentation. Registered Nurses (RNs) from three acute care hospital wards participated in a two-year intervention programme, in addition, a fourth ward was used for comparison. The intervention consisted of education about nursing documentation in accordance with the VIPS model and organisational changes. To evaluate effects of the intervention patient records (n=269) were audited on three occasions: before the intervention, immediately after the intervention and three years after the intervention. For this purpose, a patient record audit instrument, the Cat-ch-Ing, was constructed and tested. The instrument aims at measuring both quantitatively and qualitatively to what extent the content of the nursing process is documented in the patient record. -
GUIDELINES for WRITING SOAP NOTES and HISTORY and PHYSICALS
GUIDELINES FOR WRITING SOAP NOTES and HISTORY AND PHYSICALS by Lois E. Brenneman, M.S.N, C.S., A.N.P, F.N.P. © 2001 NPCEU Inc. all rights reserved NPCEU INC. PO Box 246 Glen Gardner, NJ 08826 908-537-9767 - FAX 908-537-6409 www.npceu.com Copyright © 2001 NPCEU Inc. All rights reserved No part of this book may be reproduced in any manner whatever, including information storage, or retrieval, in whole or in part (except for brief quotations in critical articles or reviews), without written permission of the publisher: NPCEU, Inc. PO Box 246, Glen Gardner, NJ 08826 908-527-9767, Fax 908-527-6409. Bulk Purchase Discounts. For discounts on orders of 20 copies or more, please fax the number above or write the address above. Please state if you are a non-profit organization and the number of copies you are interested in purchasing. 2 GUIDELINES FOR WRITING SOAP NOTES and HISTORY AND PHYSICALS Lois E. Brenneman, M.S.N., C.S., A.N.P., F.N.P. Written documentation for clinical management of patients within health care settings usually include one or more of the following components. - Problem Statement (Chief Complaint) - Subjective (History) - Objective (Physical Exam/Diagnostics) - Assessment (Diagnoses) - Plan (Orders) - Rationale (Clinical Decision Making) Expertise and quality in clinical write-ups is somewhat of an art-form which develops over time as the student/practitioner gains practice and professional experience. In general, students are encouraged to review patient charts, reading as many H/Ps, progress notes and consult reports, as possible. In so doing, one gains insight into a variety of writing styles and methods of conveying clinical information. -
Diagnosing Diagnosis Errors: Lessons from a Multi-Institutional Collaborative Project
Diagnosing Diagnosis Errors: Lessons from a Multi-institutional Collaborative Project Gordon D. Schiff, Seijeoung Kim, Richard Abrams, Karen Cosby, Bruce Lambert, Arthur S. Elstein, Scott Hasler, Nela Krosnjar, Richard Odwazny, Mary F. Wisniewski, Robert A. McNutt Abstract Background: Diagnosis errors are frequent and important, but represent an underemphasized and understudied area of patient safety. Diagnosis errors are challenging to detect and dissect. It is often difficult to agree whether an error has occurred, and even harder to determine with certainty its causes and consequence. The authors applied four safety paradigms: (1) diagnosis as part of a system, (2) less reliance on human memory, (3) need to open “breathing space” to reflect and discuss, (4) multidisciplinary perspectives and collaboration. Methods: The authors reviewed literature on diagnosis errors and developed a taxonomy delineating stages in the diagnostic process: (1) access and presentation, (2) history taking/collection, (3) the physical exam, (4) testing, (5) assessment, (6) referral, and (7) followup. The taxonomy identifies where in the diagnostic process the failures occur. The authors used this approach to analyze diagnosis errors collected over a 3-year period of weekly case conferences and by a survey of physicians. Results: The authors summarize challenges encountered from their review of diagnosis error cases, presenting lessons learned using four prototypical cases. A recurring issue is the sorting-out of relationships among errors in the diagnostic process, delay and misdiagnosis, and adverse patient outcomes. To help understand these relationships, the authors present a model that identifies four key challenges in assessing potential diagnosis error cases: (1) uncertainties about diagnosis and findings, (2) the relationship between diagnosis failure and adverse outcomes, (3) challenges in reconstructing clinician assessment of the patient and clinician actions, and (4) global assessment of improvement opportunities. -
Professional Practice Medical Record Documentation Guidelines
Professional Practice Medical Record Documentation Guidelines INTRODUCTION Consistent and complete documentation in the medical record is an essential component of quality patient care. All Participating Providers, defined as primary care and specialist practitioners, are required to keep medical records that contain patient demographics and current, detailed, medical information regarding services rendered to Members to facilitate communication and promote efficient and effective treatment. Medical records must be maintained in an organized medical record-keeping system and in compliance with Capital BlueCross’ documentation standards for Traditional, Comprehensive, PPO, POS, Keystone Health Plan® Central, SeniorBlue® PPO and SeniorBlue® HMO Members. Complete medical records must be maintained for every Member in accordance with accepted professional practice standards, State and Federal requirements. In addition, they must meet the Pennsylvania Department of Health’s guidelines for managed care organizations. Medical records and information must be protected from public access and any information released must comply with HIPAA guidelines. Upon request, all participating practitioners’ medical records must be available for utilization and quality improvement review studies, retrospective review of claims, as well as regulatory agencies’ requests and member relations’ inquiries, as stated in the Provider agreement. Medical records must be available at the practice site for other Providers who provide care and services to the patient. Guidelines have been developed for medical record review that are intended to assist Providers in maintaining complete medical records for all Members. Each provider must meet a minimum 70% compliance with medical record guidelines. If this level of compliance is not met, a corrective action plan will be required. The guidelines, included in Exhibit 3 of this Manual, were developed to comply with state and national regulatory requirements. -
Some of the Research Tools on Allied Health Available in the Mesa College Library **************************************************************
************************************************************** SOME OF THE RESEARCH TOOLS ON ALLIED HEALTH AVAILABLE IN THE MESA COLLEGE LIBRARY ************************************************************** AHA GUIDE TO THE HEALTH CARE FIELD - Hospitals, health care systems, networks, alliances, organizations, agencies, and providers. Code chart, abbreviations list, and index. REF. RA 977 A1 A46 ALTERNATIVE MEDICINE: THE DEFINITIVE GUIDE – Specific diseases and alternative remedies. Drawings, tables, charts, recommended readings, notes, and index. REF. R 733 A46 AMERICAN MEDICAL ASSOCIATION COMPLETE GUIDE TO WOMEN’S HEALTH - Information on women’s health issues, supplemented by illustrations, tables, charts, graphs, diagrams, and index. REF. RA 778 A485 AMERICAN MEDICAL ASSOCIATION FAMILY MEDICAL GUIDE – Six parts cover such topics as “information to keep you healthy,” the body, first aid, symptoms, diseases and disorders, and health issues are supplemented by color photos and diagrams and b&w illustrations, terminology and drug glossaries, and an index. REF. RC 81 A543 AMERICAN MEDICAL ASSOCIATION INTERNATIONAL CLASSIFICATION OF DISEASES. CLINICAL MODIFICATION (ICD-CM) – All codes used for coding of illnesses by doctors writing diagnoses and medical staff preparing insurance forms. REF. RB 115 I343 ATLAS OF HUMAN ANATOMY – Contains detailed color diagrams of all parts of the human body, with labels. Eight sections cover the head and neck, back and spinal cord, thorax, abdomen, pelvis and perineum, upper and lower limbs, and cross-sectional anatomy. An index is at the back. REF. QM 25 N46 CIBA COLLECTION OF MEDICAL ILLUSTRATIONS - 8 vols./13 books - Detailed color illustrations, diagrams, and cross-sections of the entire human body along with text. Alphabetically arranged subject indexes in each book. REF. QM 25 N472 CLINICAL LABORATORY TESTS - Short descriptions of laboratory tests, what they are for, and what the results mean. -
Nurse Practice Act
Georgia Board of Nursing O.C.G.A. § 43-26 Nurse Practice Act Revised July 2019 Table of Contents Article One Registered Nurses Page Title Code Section Number Short Title O.C.G.A. § 43-26-1 Page 5 Legislative Intent O.C.G.A. § 43-26-2 Page 5 Definitions O.C.G.A. § 43-26-3 Page 5 Georgia Board of Nursing; Membership; Meetings; Officers O.C.G.A. § 43-26-4 Page 8 General Powers and Responsibilities of the Board O.C.G.A. § 43-26-5 Page 9 Use of Certain Titles and Abbreviations by Licensed Nurses O.C.G.A. § 43-26-6 Page 11 Requirements for Licensure as a Registered Professional Nurse O.C.G.A. § 43-26-7 Page 12 Temporary Permits O.C.G.A. § 43-26-8 Page 16 Biennial Renewal of Licenses; Continuing Competency O.C.G.A. § 43-26-9 Page 17 Requirements Inactive Status O.C.G.A. § 43-26-9.1 Page 18 Practicing as a Registered Professional Nurse Without a License O.C.G.A. § 43-26-10 Page 18 Prohibited Denial or Revocation of Licenses; Other Discipline O.C.G.A. § 43-26-11 Page 19 Administration of Anesthesia By Certified Registered Nurse O.C.G.A. § 43-26-11.1 Page 20 Anesthetist Exceptions to Licensure O.C.G.A. § 43-26-12 Page 20 Certain Information Given to the Board by Licensees O.C.G.A. § 43-26-13 Page 23 Article Two Licensed Practical Nurses Page Title Code Section Number Short Title O.C.G.A. -
The Benefits of Using Standardized Nursing Terminology
Page 1 of 20 Selecting a Standardized Terminology for the Electronic Health Record that Reveals the Impact of Nursing on Patient Care By Cynthia B. Lundberg, R.N., BSN; SNOMED Terminology Solutions; Judith J. Warren, PhD, RN, BC, FAAN, FACMI; University of Kansas; Jane Brokel, PhD, RN, NANDA International; Gloria M. Bulechek, PhD, RN, FAAN; Nursing Interventions Classification; Howard K. Butcher, PhD, RN, APRN, BC; Nursing Interventions Classification; Joanne McCloskey Dochterman, PhD, RN, FAAN; Nursing Interventions Classification; Marion Johnson, PhD, RN; Nursing Outcomes Classification; Meridean Maas PhD, RN; Nursing Outcomes Classification; Karen S. Martin, RN, NSN, FAAN; Omaha System; Sue Moorhead PhD, RN, Nursing Outcomes Classification; Christine Spisla, RN, MSN; SNOMED Terminology Solutions; Elizabeth Swanson, PhD, RN; Nursing Outcomes Classification, Sharon Giarrizzo-Wilson, RN, BSN/MS, CNOR, Association of PeriOperative Registered Nurses Citation: Lundberg, C., Warren, J.., Brokel, J., Bulechek, G., Butcher, H., McCloskey Dochterman, J., Johnson, M., Mass, M., Martin, K., Moorhead, S., Spisla, C., Swanson, E., & Giarrizzo-Wilson, S. (June, 2008). Selecting a Standardized Terminology for the Electronic Health Record that Reveals the Impact of Nursing on Patient Care. Online Journal of Nursing Informatics (OJNI), 12, (2). Available at http:ojni.org/12_2/lundberg.pdf Page 2 of 20 Abstract Using standardized terminology within electronic health records is critical for nurses to communicate their impact on patient care to the multidisciplinary team. The universal requirement for quality patient care, internal control, efficiency and cost containment, has made it imperative to express nursing knowledge in a meaningful way that can be shared across disciplines and care settings. The documentation of nursing care, using an electronic health record, demonstrates the impact of nursing care on patient care and validates the significance of nursing practice. -
Informed Consent and the Differential Diagnosis: How the Law Overestimates Patient Autonomy and Compromises Health Care, 60 Wayne L
UIC School of Law UIC Law Open Access Repository UIC Law Open Access Faculty Scholarship 2014 Informed Consent and The Differential Diagnosis: How the Law Overestimates Patient Autonomy and Compromises Health Care, 60 Wayne L. Rev. 349 (2014) Marc Ginsberg The John Marshall Law School, [email protected] Follow this and additional works at: https://repository.law.uic.edu/facpubs Part of the Health Law and Policy Commons, Medical Jurisprudence Commons, and the State and Local Government Law Commons Recommended Citation Marc Ginsberg, Informed Consent and The Differential Diagnosis: How the Law Overestimates Patient Autonomy and Compromises Health Care, 60 Wayne L. Rev. 349 (2014) https://repository.law.uic.edu/facpubs/582 This Article is brought to you for free and open access by UIC Law Open Access Repository. It has been accepted for inclusion in UIC Law Open Access Faculty Scholarship by an authorized administrator of UIC Law Open Access Repository. For more information, please contact [email protected]. INFORMED CONSENT AND THE DIFFERENTIAL DIAGNOSIS: HOW THE LAW CAN OVERESTIMATE PATIENT AUTONOMY AND COMPROMISE HEALTH CARE MARC D. GINSBERG' I. INTRODUCTION .............................................. 350 II. A BRIEF HISTORY AND BACKGROUND ......................... 351 III. A PROCEDURE (OR TREATMENT) BASED DOCTRINE...... ..... 352 IV. THE WISCONSIN EXPERIENCE ............................... 355 A. Trogun v. Fruchtman ....................... ...... 356 B. Scaria v. St. Paul Fire & Marine Insurance Co.......................... 357 C. The Original Wisconsin "Informed Consent" Statute...............360 D. Martin v. Richards (Court ofAppeals) ........... ....... 362 E. McGeshick v. Choucair ...................... ..... 363 F. Martin v. Richards (Supreme Court) ............. ..... 365 G. Hannemann v. Boyson.. ............................ 366 H. Bubb v. Brusky ....................... ............... 367 I. Jandre v. Wisconsin Injured Patients & Families Compensation Fund .................................. -
Proctor: Psychiatric Diagnostic Interview Examination (PDE)
Proctor: Psychiatric Diagnostic Interview Examination (PDE) According to the Utah Medicaid Provider Manual (April 2015), 2-2: Psychiatric Diagnostic Evaluation, Psychiatric diagnostic evaluation means a face-to-face evaluation with the individual for the purpose of identifying the need for behavioral health services. The evaluation is an integrated biopsychosocial assessment, including history, mental status, and recommendations, with interpretation and report. The evaluation may include communication with family or other sources and review and ordering of diagnostic studies. In certain circumstances one or more other informants (family members, guardians or significant others) may be seen in lieu of the individual. Psychiatric diagnostic evaluation with medical services also includes medical assessment and other physical examination elements as indicated and may be performed only by qualified medical providers specified in the ‘Who’ section of this chapter below. In accordance with the Current Procedural Terminology (CPT) manual, codes 90791 (psychiatric diagnostic evaluation) and 90792 (psychiatric diagnostic evaluation with medical services) are used for the diagnostic assessment(s) or reassessment(s), if required. Because ongoing assessment and adjustment of psychotherapeutic interventions are part of psychotherapy, reassessments including treatment plan reviews occurring in psychotherapy session may be coded as such. (See definition of psychotherapy and the ‘Record’ section of Chapter 2-5, Psychotherapy. If based on the evaluation it is determined behavioral health services are medically necessary, an individual qualified to perform this service is responsible for the development of an individualized treatment plan. An individual qualified to perform this service also is responsible to conduct reassessments/treatment plan reviews with the client as clinically indicated to ensure the client’s treatment plan is current and accurately reflects the client’s rehabilitative goals and needed behavioral health services.