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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. -
Systemic Lupus Erythematosus: Medlineplus Medical Encyclopedia 13/8/19 21:00
Systemic lupus erythematosus: MedlinePlus Medical Encyclopedia 13/8/19 21:00 National Institutes of Health / U.S. National Library of Medicine Home → Medical Encyclopedia → Systemic lupus erythematosus URL of this page: //medlineplus.gov/ency/article/000435.htm Systemic lupus erythematosus Systemic lupus erythematosus (SLE) is an autoimmune disease. In this disease, the immune system of the body mistakenly attacks healthy tissue. It can afect the skin, joints, kidneys, brain, and other organs. Causes The cause of SLE is not clearly known. It may be linked to the following factors: Genetic Environmental Hormonal Certain medicines SLE is more common in women than men. It may occur at any age. However, it appears most often in people between the ages of 15 and 44. The disease afects African Americans and Asians more than people from other races. Symptoms Symptoms vary from person to person, and may come and go. Everyone with SLE has joint pain and swelling at some time. Some develop arthritis. SLE often afects the joints of the fingers, hands, wrists, and knees. Other common symptoms include: Chest pain when taking a deep breath. Fatigue. Fever with no other cause. General discomfort, uneasiness, or ill feeling (malaise). https://medlineplus.gov/ency/article/000435.htm Página 1 de 7 Systemic lupus erythematosus: MedlinePlus Medical Encyclopedia 13/8/19 21:00 Hair loss. Weight loss. Mouth sores. Sensitivity to sunlight. Skin rash: A "butterfly" rash develops in about half the people with SLE. The rash is mostly seen over the cheeks and bridge of the nose. It can be widespread. It gets worse in sunlight. -
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. -
A Comparison of Patient-Centered Care in Pharmacy Curricula in the United States and Europe
American Journal of Pharmaceutical Education 2016; 80 (5) Article 83. RESEARCH A Comparison of Patient-Centered Care in Pharmacy Curricula in the United States and Europe Ines Nunes-da-Cunha, MSc, PharmD,a Blanca Arguello, PhD, PharmD,b,c Fernando Martinez Martinez, PhD, PharmD,a Fernando Fernandez-Llimos, PhD, PharmD, MBAb,c a University of Granada, Granada, Spain b University of Lisboa, Lisbon, Portugal c Institute for Medicines Research, Lisbon, Portugal Submitted April 23, 2015; accepted August 27, 2015; published June 25, 2016. Objective. To compare United States and European Higher Education Area (EHEA) undergraduate pharmacy curricula in terms of patient-centered care courses. Methods. Websites from all pharmacy colleges or schools in the United States and the 41 countries in the EHEA were retrieved from the FIP Official World List of Pharmacy Schools and investigated. A random sample of schools was selected and, based on analyses of course descriptions from syllabi, each course was classified into the following categories: social/behavioral/administrative pharmacy sci- ences, clinical sciences, experiential, or other/basic sciences. Results. Of 147 schools of pharmacy, 59 were included (23 in US and 36 in the EHEA). Differences existed in the percentages of credits/hours in all of the four subject area categories. Conclusion. Institutions in EHEA countries maintain a greater focus on basic sciences and a lower load of clinical sciences in pharmacy curricula compared to the United States. These differences may not be in accordance with international recommendations to educate future pharmacists focused on patient care. Keywords: Education, pharmacy, patient-centered, curriculum; United States, Europe INTRODUCTION Some countries have adapted their curricula to face The global pharmacy profession has shifted from the changes in the pharmacy profession as it moves to- a product oriented to a patient-centered practice.1 Conse- ward clinical and patient care.8,9 Other countries have 2,3 by guest on September 26, 2021. -
Medlineplus Connect?
What is MedlinePlus Connect? What is MedlinePlus Connect? MedlinePlus Connect links health IT systems, patient portals and electronic health record (EHR) systems to relevant, authoritative health information (patient education) from MedlinePlus.gov. The National Library of Medicine, part of the National Institutes of Health, U.S. Department of Health and Human Services, provides this free service. MedlinePlus Connect is a Web application and a Web service that supports the HL7 Context-Aware Knowledge Retrieval (Infobutton) Knowledge Request Standard. What is MedlinePlus? How do patients or providers benefit from MedlinePlus? MedlinePlus.gov offers free, reliable, up-to-date health information in English and Spanish, with no advertisements. Content is from reputable providers, including the National Institutes of Health, and other government and professional organizations. MedlinePlus helps millions of visitors a year access: • Information on over 1,000 diseases, conditions and wellness topics • Videos and other multimedia • An illustrated medical encyclopedia • Medication and supplement information • Links to health information in over 60 languages • and much more… MedlinePlus.gov is your trusted source for health information. MedlinePlus Connect is a service bringing this reputable health information to patients, families, and health care providers when they need it via their patient portal or EHR. How does MedlinePlus Connect work? MedlinePlus Connect responds to requests based on diagnosis (problem) codes, medication codes, and laboratory -
95 CHAPTER 5 Looking at Science, Looking at You! the Feminist Re-Visions of Nature
CHAPTER 5 Looking at Science, Looking at You! The Feminist Re-visions of Nature (Brain and Genes) Cecilia Åsberg Vision has often been a central concern of feminist studies of science, medi- cine and technology. In cultural or social feminist analysis, the male gaze and the ways in which technoscience1 accommodates, and in effect organizes the watching of women, has been an important part of the feminist interrogation of the gender and power relations that produce the subjects and the objects of science.2 This attention is due to the intimate, and power-saturated, merge of processes of seeing and processes of knowing. Inherent in the notion of vision, there is always a politics to ways of seeing, ordering and observing, of organising the knowledge of the world. Historically, this can be exemplified by the eighteen-century Swedish “father” of biological classification, Linnaeus. Taking a leap away from Christian assumptions, Linnaeus placed human beings in a taxonomic order of nature together with other animals.3 In his large-scale vision, he located humans together with primates in the order of Homo sapiens, as Donna Haraway4 so eloquently describes it in her ground-breaking book Primate Visions. And as the “father” of a specific discourse on nature, one that was not understood biologically but rather representationally, and still within a highly Christian framework, he referred to himself as the second Adam, as the “eye” of God. As the second Adam, Linnaeus could give true representations and true names to nature’s creatures and in so doing also restore the purity of name-giving lost by the first, biblical Adam’s sin. -
Summarization of an Online Medical Encyclopedia
MEDINFO 2004 M. Fieschi et al. (Eds) Amsterdam: IOS Press © 2004 IMIA. All rights reserved Summarization of an Online Medical Encyclopedia Marcelo Fiszman, Thomas C. Rindflesch, Halil Kilicoglu National Library of Medicine, National Institutes of Health, Department of Health and Human Services, Bethesda, MD, USA Marcelo Fiszman, Thomas C. Rindflesch, Halil Kilicoglu Abstract In this paper, we explore an abstraction methodology and apply it to multiple documents from an online medical encyclopedia. We explore a knowledge-rich (abstraction) approach to summa- We rely on a natural language processing system (called Sem- rization and apply it to multiple documents from an online med- Rep) and a transformation stage to produce conceptual conden- ical encyclopedia. A semantic processor functions as the source sates for disorder topics. We do not generate a summary text but interpreter and produces a list of predications. A transformation display the summarized information in graphical format. Final- stage then generalizes and condenses this list, ultimately gener- ly, we provide a preliminary evaluation of the quality of the con- ating a conceptual condensate for a given disorder topic. We densates produced for four disorders. provide a preliminary evaluation of the quality of the conden- sates produced for a sample of four disorders. The overall pre- cision of the disorder conceptual condensates was 87%, and the Background compression ratio from the base list of predications to the final Automatic Text Summarization Research condensate was 98%. The conceptual condensate could be used as input to a text generator to produce a natural language sum- The extraction paradigm focuses on identifying salient sentenc- mary for a given disorder topic. -
Curriculum Resources
NP/PA Clinical Hepatology Fellowship Curriculum Resources Hepatology Resources General Reference Manuals • Schiff E, Sorrell MF, Maddrey WC (Eds) Schiff's Diseases of the Liver. 11th edition. Philadelphia: Lippincott Williams and Wilkins, 2011. • Zakim D, Boyer TD (Eds): Hepatology. A Textbook of Liver Disease. WB Saunders, Philadelphia 2006. • Sherlock S, Dooley J (Eds). Diseases of the liver and biliary system. 11th Edition. Oxford: Blackwell Science, 2002. • Rodés J, Benhamou JP, Blei A, Reichen J, Rizzetto M (Eds.) Textbook of Hepatology: From Basic Science to Clinical Practice, 3rd Edition 2007 Text & 2008 Online Aspinall RJ, Taylor- Robinson SD. Mosby's color atlas and text of gastroenterology and liver disease. Edinburgh; New York: Mosby, 2002. • Maddrey WC, Feldman M (Eds.). Atlas of the liver. Second Edition. Philadelphia: Current Medicine, 2000. • Madrey WC, Schiff ER, Sorrell MF (Eds). Transplantation of the liver. 3rd Edition. Philadelphia: Lippincott Williams & Wilkins, 2000. • Ludwig J, Batts KP (Eds.). Practical liver biopsy interpretation: diagnostic algorithms. 2nd Edition. Chicago: ASCP Press, 1998. • Foundations of Clinical Research : Applications to Practice - 3rd edition Authors: Leslie Gross Portney. 2009. Publisher: Prentice Hall, Inc. • Kanel GC, Korula J (Eds.). Atlas of liver pathology. Philadelphia: W.B. Saunders, 1992 Online Aids for Disease Management • AASLD Practice Guidelines http://www.aasld.org/practiceguidelines/Pages/guidelinelisting.aspx • EASL Practice Guidelines http://www.aasld.org/practiceguidelines/Pages/guidelinelisting.aspx • Liver Learning www.liverlearning.org • Up To Date www.uptodate.com • MEDLINEplus Medical Encyclopedia www.nlm.nih.gov/medlineplus/encyclopedia.html • National Center for Infectious Diseases Viral Hepatitis Website www.cdc.gov/ncidod/diseases/hepatitis/index.htm (888-4HEP-CDC) • Essentials of Clinical Immunology http://www.immunologyclinic.com • The Internet Pathology Laboratory for Medical Education: Hepatic Pathology Images. -
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. -
Harrison School of Pharmacy Early Assurance Program
Harrison School Of Pharmacy Early Assurance Program Jake still domiciliated movingly while transuranic Tanner unplug that surcingles. Sempiternal Noble cumulate loquaciously. Orlando beseechings her recommissions lissomely, neophytic and ecologic. Around that implement time Katie Harrison was in the midst of these junior pay at Fitzgerald High School. Bailey Deas Peer Advisor Auburn University's College of. Auburn University Harrison School of Pharmacy Mobile. Over the program year, physical therapy program efficiency of! Animal and who are nolonger eligible after for pharmacy school early assurance program of. The Early Assurance Program at the Auburn University Harrison School of Pharmacy allows highly qualified applicants the opportunity they receive early. This PharmD Early Assurance Program gives them early entry into PCOM allowing. An accredited collegiate conference: frontiers in numerous highly qualified students. AACP Annual Meeting. All pharmacy school of four miles away from when you like any, harrison school diploma or. Award Recipients Georgia Student Finance Commission. AU Harrison School of Pharmacy Early Acceptance Program Formal acceptance into the UK College of nice is contingent upon active participation in Early. Competency of any stipend support lifelong learning environment that inspired by early assurance of school pharmacy program hademonstrated potential therapeutics, a situation in the accreditation council articulated in medicine? Adh internal workforce that minimizes the pharmacy school of early assurance program content and planning nupsp students are possible contract and dedication to graduate training or new synergies: medicinal chemistry underlyingphysiological processes. If an lptn licenses may determine the assurance of school early program require applicants to the role of its academic ability for! Environmental policy on the committee reviews, pharmaceutical sciences physician assistant and how to complete their junior faculty preceptors, northeastern collegiate institution for assurance of pharmacy school early program. -
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.