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Encounter History

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1. Dermatologic surgery on the chest wall in patients with a cardiac surgery history: a review of material that may be encountered intraoperatively, including potential complications and suggestions for proceeding safely (PubMed)

Dermatologic surgery on the chest wall in patients with a cardiac surgery history: a review of material that may be encountered intraoperatively, including potential complications and suggestions for proceeding safely Thoracic surgical procedures and the use of cardiac devices such as pacemakers are becoming increasingly prevalent in the population. As such, dermatologists may have a greater likelihood of encountering previously implanted or abandoned surgical material in the course (...) with a history of cardiac surgery as well as related dermatologic complications from these materials.Dermatologic surgeons should particularly be aware that temporary epicardial pacing wires and pacemaker leads are not uncommonly abandoned in the chest wall of many patients. All patients with a cardiac surgery history should be questioned about possible retained wires. If wire material is encountered intraoperatively, immediately stop the procedure and do not attempt further manipulation of the wire until

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2016 International journal of women's dermatology

2. History of CRISPR-Cas from Encounter with a Mysterious Repeated Sequence to Genome Editing Technology (PubMed)

History of CRISPR-Cas from Encounter with a Mysterious Repeated Sequence to Genome Editing Technology Clustered regularly interspaced short palindromic repeat (CRISPR)-Cas systems are well-known acquired immunity systems that are widespread in archaea and bacteria. The RNA-guided nucleases from CRISPR-Cas systems are currently regarded as the most reliable tools for genome editing and engineering. The first hint of their existence came in 1987, when an unusual repetitive DNA sequence, which (...) , this minireview briefly discusses the fascinating history of CRISPR-Cas systems, from the original observation of an enigmatic sequence in E. coli to genome editing in humans.Copyright © 2018 American Society for Microbiology.

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2018 Journal of bacteriology

3. Incidence and Significance of Adhesions Encountered during Epicardial Mapping and Ablation of Ventricular Tachycardia in Patients with no History of Prior Cardiac Surgery or Pericarditis. (PubMed)

Incidence and Significance of Adhesions Encountered during Epicardial Mapping and Ablation of Ventricular Tachycardia in Patients with no History of Prior Cardiac Surgery or Pericarditis. Pericardial adhesions can prevent epicardial access and restrict catheter movement during mapping and ablation of ventricular tachycardia (VT). The incidence of adhesions in patients without prior cardiac surgery or clinically evident pericarditis is not known.To describe the incidence of pericardial adhesions (...) < .001) and lower short-term procedural success (68% of patients without adhesions vs 46% of patients with adhesions, P = .02), but complication rates were similar. The presence of adhesions did not translate into lower VT-free survival (P = .64) or freedom from a combined end point of VT recurrence, death, or transplant at 1 year (P = .93).Adhesions may be unexpectedly encountered in patients without prior cardiac surgery or pericarditis. When present, they can limit mapping and may be associated

2017 Heart Rhythm

4. Encounter History

Encounter History Encounter History Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Encounter History Encounter History Aka: Encounter (...) History , PQRST Mnemonic II. History: Chief Complaint Reason for the encounter III. History: Present Illness (HPI) Components (8 HPI elements) Location Severity Timing Modifying factors Quality Duration Context Associated signs and symptoms Mnemonic: PQRST (plus context and associated factors) Palliative and Provocative (modifying factors) Quality Region and Radiation (location) Severity Timing (and duration) IV. History: Past Medical Current medications Drug allergies Prior surgeries Prior

2018 FP Notebook

5. Healthcare Options for People Experiencing Depression (HOPE*D): the development and pilot testing of an encounter-based decision aid for use in primary care. (PubMed)

Healthcare Options for People Experiencing Depression (HOPE*D): the development and pilot testing of an encounter-based decision aid for use in primary care. To develop and pilot an encounter-based decision aid (eDA) for people with depression for use in primary care.We developed an eDA for depression through cognitive interviews and pilot tested it using a one-group pretest, post-test design in primary care. Feasibility, fidelity of eDA use and acceptability were assessed using recruitment (...) the following stakeholder groups: history of depression, the public and clinicians. Patients with a Patient Health Questionnaire-9 score of ≥5 were recruited for piloting.Three stages of cognitive interviews were conducted (n=28). Changes to eDA included moving the combination therapy information and access to treatment information, adding colour, modifying pictograms and editing the talk-therapy description. Clinician concerns about patient health literacy were not reflected in patient interviews. Of 59

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2019 BMJ open

6. How a symbol influenced this patient encounter

How a symbol influenced this patient encounter How a symbol influenced this patient encounter How a symbol influenced this patient encounter | | February 1, 2018 151 Shares I lightly knocked on the door of the next patient that I was set to obtain a history from. It was late in the morning in the middle of the week, and my mind was becoming increasingly preoccupied with deciding what to eat for lunch. My preceptor had allowed me to practice my history-taking skills with every patient that had (...) in the room did just a few seconds ago. I simultaneously felt my stomach abruptly churn, and my face get warmer as my blood began to boil. Stitched on his forest-green cap was the symbol of the Confederate flag. I immediately became conscious of my reaction and quickly turned to his parents in order to appropriately introduce myself and to ask permission to interview both them and their son in order to practice my history-taking skills. They unenthusiastically agreed, and I sat down in a chair in order

2018 KevinMD blog

7. Cutaneous Leishmaniasis: Contribution of Routine Histopathology in Unexpected Encounters. (PubMed)

Cutaneous Leishmaniasis: Contribution of Routine Histopathology in Unexpected Encounters. The ulcerated papules of cutaneous leishmaniasis represent an unusual form of granulomatous dermatitis caused by Leishmania species, a protozoan transmitted by sandfly bites. As the disease is not native to North America, clinical suspicion is partially based on a compatible travel history and may result in a biopsy. The key role of standard morphology is the identification of Leishmania organisms (...) cases of cutaneous leishmaniasis without a travel history have been reported outside endemic areas. The present cases emphasize the importance of diagnostic awareness of unusual infections such as this in the context of political unrest, ease of international travel, climate change and the possible expansion of geographic vector distribution. In the morphologic absence of organisms, the diagnosis may require molecular techniques, currently available on a referral basis to pathologists without charge

2018 American Journal of Surgical Pathology

8. The Anesthesia Perioperative "Call for Help"-Experience at a Quaternary Pediatric Medical Center: Analysis of 67,564 Anesthesia Encounters. (PubMed)

The Anesthesia Perioperative "Call for Help"-Experience at a Quaternary Pediatric Medical Center: Analysis of 67,564 Anesthesia Encounters. During the past several decades, anesthesia has become increasingly safe. Truly major adverse events are rare, and anesthesia quality researchers have instituted programs to evaluate "near miss" or less critical adverse events to evaluate the safety of anesthesia delivery. In this study, we aimed to evaluate calls for emergency help in our institution (...) as a surrogate for pending critical events. We hypothesized that calls would be more common in patients with high American Society of Anesthesiologists (ASA) physical status, history of prematurity, and children with recent respiratory illness compared to those without these characteristics.We analyzed emergent calls for help initiated by perioperative personnel ("STAT" calls) between August 2011 and September 2015 at Boston Children's Hospital. Our analysis had 2 phases: (1) All 193 STAT calls that occurred

2018 Anesthesia and Analgesia

9. Development of the Combined Assessment of Risk Encountered in Surgery (CARES) surgical risk calculator for prediction of postsurgical mortality and need for intensive care unit admission risk: a single-center retrospective study. (PubMed)

Development of the Combined Assessment of Risk Encountered in Surgery (CARES) surgical risk calculator for prediction of postsurgical mortality and need for intensive care unit admission risk: a single-center retrospective study. Accurate surgical risk prediction is paramount in clinical shared decision making. Existing risk calculators have limited value in local practice due to lack of validation, complexities and inclusion of non-routine variables.We aim to develop a simple, locally derived (...) and validated surgical risk calculator predicting 30-day postsurgical mortality and need for intensive care unit (ICU) stay (>24 hours) based on routinely collected preoperative variables. We postulate that accuracy of a clinical history-based scoring tool could be improved by including readily available investigations, such as haemoglobin level and red cell distribution width.Electronic medical records of 90 785 patients, who underwent non-cardiac and non-neuro surgery between 1 January 2012 and 31 October

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2018 BMJ open

10. Infertility in the Moroccan population: major risk factors encountered in the reproductive health centre in Rabat (PubMed)

Infertility in the Moroccan population: major risk factors encountered in the reproductive health centre in Rabat Infertility is responsible for a major cost burden for patients and health care systems. Therefore identifying preventable risk factors for infertility may contribute to the development of more cost-effective approaches to solving the infertility problem. However, such investigations have never been conducted in Morocco. Thereby, the objective of the present study was to determine (...) in 25.8% of cases while men were overweight in 44.6% of cases and obese in 14.7% of cases. 18.9% of women and 17.5% of men had a previous abdominopelvic or urogenital surgery. A history of sexually transmitted infection was reported by 7% of men and 5.8% of women. A history of tuberculosis was found 9.3% of women and 4.8% of men. In addition, 31.7% of men were cigarette smokers and 8.4% consumed alcohol. The study showed that preventable risk factors of infertility are common among Moroccan infertile

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2018 The Pan African medical journal

11. Can Mobile Integrated Health Care Paramedics Safely Conduct Medical Clearance of Behavioral Health Patients in a Pilot Project? A Report of the First 1000 Consecutive Encounters. (PubMed)

Can Mobile Integrated Health Care Paramedics Safely Conduct Medical Clearance of Behavioral Health Patients in a Pilot Project? A Report of the First 1000 Consecutive Encounters. Mental health patients wait lengthy periods in emergency departments for disposition. This delay is secondary to the process of medical clearance and then placement in an appropriate psychiatric specialty center. ACEP clinical policy questions the necessity of laboratory investigation for medical clearance and favors (...) history and physical exam to determine safe disposition to mental health facilities. This manuscript explores if specially trained paramedics can effectively employ triage algorithms to determine proper disposition of patients suffering an acute mental health crisis in a 9-1-1 system.Six paramedics working for AMR in Stanislaus County, California underwent 180 hours of specialized training to become Mobile Integrated Healthcare Paramedics (MIHPs). Their training detailed the use of two algorithms

2018 Prehospital emergency care

12. Epistemic tensions between people living with asthma and healthcare professionals in clinical encounters. (PubMed)

Epistemic tensions between people living with asthma and healthcare professionals in clinical encounters. Asthma is a common respiratory condition with high prevalence rates globally. While there are effective treatments, asthma remains an important health concern as people continue to die from severe attacks. Improving the experiences of, and health outcomes for, people with asthma depends heavily on their interactions with healthcare professionals. Understanding negative clinical encounters (...) will benefit people with asthma and healthcare providers.To examine epistemic tensions in negative clinical encounters from a patient perspective, with an aim to better understand how patients respond to these tensions. Much of the scholarship on patient interactions with healthcare providers examines interpersonal or structural factors. Thus, focusing our analysis on tensions between lay and expert knowledge in negative clinical encounters provides a novel contribution to this body of scholarship.As part

2018 Social Science & Medicine

13. Substance Use and Psychosocial Status among People Living with HIV/AIDS Who Encountered HIV Stigma in China: Stratified Analyses by Socio-Economic Status. (PubMed)

Substance Use and Psychosocial Status among People Living with HIV/AIDS Who Encountered HIV Stigma in China: Stratified Analyses by Socio-Economic Status. This study examined whether the impact of HIV stigma on psychosocial status and substance use among people living with HIV/AIDS (PLWHA) differed by their socio-economic status (SES) in a Chinese setting. A total of 2,987 PLWHA were recruited from 12 sites with the highest number of cumulative HIV incidence in Guangxi, China. Participants were (...) asked to provide information regarding their psychosocial status (e.g., depression, anxiety), history of substance use (e.g., tobacco, alcohol and drug) and SES (e.g., education, monthly income, residence type, and job category). By employing stratified multivariate regression analyses, we assessed stratum-specific impacts of HIV stigma on PLWHA's psychosocial status and behaviors of substance use based upon participants' SES. The impact of HIV stigma differed significantly on psychosocial status

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2016 PLoS ONE

14. Pericardial Patch Graft Repair of Severe Localized Scleral Thinning Encountered During Strabismus Surgery. (PubMed)

Pericardial Patch Graft Repair of Severe Localized Scleral Thinning Encountered During Strabismus Surgery. This article presents a surgical technique using a pericardial patch for the permanent repair of severe scleral thinning encountered during strabismus surgery. In the present case scleral thinning resulted from buckle removal. Familiarity with this technique may prove important for the strabismus surgeon treating patients with a history of surface ocular hardware or disease-induced scleral

2017 JAAPOS - Journal of the American Association for Pediatric Ophthalmology and Strabismus

15. Simulated patient encounters to improve adolescent retention in HIV care in Kenya: study protocol of a stepped-wedge randomized controlled trial (PubMed)

Simulated patient encounters to improve adolescent retention in HIV care in Kenya: study protocol of a stepped-wedge randomized controlled trial Adolescent-friendly policies aim to tailor HIV services for adolescents and young adults aged 10-24 years (AYA) to promote health outcomes and improve retention in HIV care and treatment. However, few interventions focus on improving healthcare worker (HCW) competencies and skills for provision of high-quality adolescent care. Standardized patients (...) (SPs) are trained actors who work with HCWs in mock clinical encounters to improve clinical assessment, communication, and empathy skills. This stepped-wedge randomized controlled trial will evaluate a clinical training intervention utilizing SPs to improve HCW skills in caring for HIV-positive AYA, resulting in increased retention in care.The trial will utilize a stepped-wedge design to evaluate a training intervention using SPs to train HCWs in assessment, communication, and empathy skills

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2017 Trials

16. Motivations and Experiences Related to Women's First Same-sex Sexual Encounters (PubMed)

Motivations and Experiences Related to Women's First Same-sex Sexual Encounters Using women's self-identified sexual identity, the current study compares motivations for first same-sex sexual encounters as well as associated experiential outcomes. We also examine whether relations between sexual motivations and experiential outcomes differ as a function of women's sexual identity status. Participants were women (N=123), ages 18-to-29 (M=21.59, SD=3.33), who self-reported a history of same-sex (...) with their first same-sex partner. Intimacy and exploration motives were related to positive experiential outcomes during first same-sex contact. Associations between motivations and experiential outcomes were not moderated by sexual identity. Findings contribute to understanding motivations and experiences related to women's first same-sex sexual encounters and show that not all women with a history of same-sex sexual contact subsequently identify with a minority sexual identity label.

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2017 Psychology and sexuality

17. Delivery and Measurement of High-Value Care in Standardized Patient Encounters (PubMed)

Delivery and Measurement of High-Value Care in Standardized Patient Encounters Residencies have incorporated high-value care (HVC) training to contain health care expenditures. Assessment methods of HVC curricula are limited.In our clinical skills laboratory, we evaluated the effectiveness of HVC curricula using standardized patients (SPs) to determine if there is a correlation with performance in counseling, history and physical, HVC knowledge, and demographics.Through ambulatory cases, SPs (...) evaluated postgraduate year 2 (PGY-2) residents using checklists to determine if they obtained the chief complaint, medical and social history, focused physical examination, and conveyed information regarding patient management. Investigators scored knowledge-based questions on the need for imaging in low back pain, annual stress testing in coronary artery disease, and chest x-ray for gastroesophageal reflux disease. Univariate analysis was used to calculate percentage distribution of residents

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2017 Journal of graduate medical education

18. Tiny Tips: History taking in a returning traveler

Tiny Tips: History taking in a returning traveler Tiny Tips: History taking in a returning traveler - CanadiEM Tiny Tips: History taking in a returning traveler In , by Anali Maneshi August 16, 2016 Following a trip abroad, up to 8% of travelers will present for medical attention 1 . Many of these complaints are mild, but some are life-threatening. A detailed travel history and history of the presenting illness are essential in identifying serious illnesses and preventing over-investigation (...) of more common non-dangerous infectious complaints (i.e. URTI’s). An easy mnemonic to help you remember key aspects of the travel history is TRAVEL: T – Time of onset The timing of fever can help identify the cause (and rule out other diagnoses) 2 . Most infections present within a month of return. Rarely, illness can occur months or years after travel-related exposure. Knowing the incubation periods of specific pathogens and possible fever patterns may provide clues to the organism involved. R – Room

2016 CandiEM

19. Epidemiology and natural history of Pseudomonas aeruginosa airway infections in non-cystic fibrosis bronchiectasis (PubMed)

Epidemiology and natural history of Pseudomonas aeruginosa airway infections in non-cystic fibrosis bronchiectasis The natural history and epidemiology of Pseudomonas aeruginosa infections in non-cystic fibrosis (non-CF) bronchiectasis is not well understood. As such it was our intention to determine the evolution of airway infection and the transmission potential of P. aeruginosa in patients with non-CF bronchiectasis. A longitudinal cohort study was conducted from 1986-2011 using a biobank (...) of prospectively collected isolates from patients with non-CF bronchiectasis. Patients included were ≥18 years old and had ≥2 positive P. aeruginosa cultures over a minimum 6-month period. All isolates obtained at first and most recent clinical encounters, as well as during exacerbations, that were morphologically distinct on MacConkey agar were genotyped by pulsed-field gel electrophoresis (PFGE) and multilocus sequence typing (MLST). A total of 203 isolates from 39 patients were analysed. These were compared

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2018 ERJ open research

20. Improving police interventions during mental health-related encounters: Past, present and future (PubMed)

Improving police interventions during mental health-related encounters: Past, present and future There are calls across America for police to re-imagine themselves as "guardians" rather than "warriors" in the performance of their innumerable duties. The contentious history of police attitudes and practices surrounding encounters with people affected by mental illnesses can be understood through the lens of this wider push toward guardianship. At least as far back as the de-institutionalization (...) of mental health care and the profound lack of community-based resources to fill service deficits, the role of police as mental health interventionists has been controversial and complex. This paper reviews the first wave of reform efforts designed to re-shape police sensibilities and practices in the handling of mental health-related encounters. We argue that such efforts, centred on specialized training and cooperative agreements with the health care sector, have advanced a guardian mindset through

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2016 Policing & society

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