This document provides guidance on conducting comprehensive health histories and interviews. It outlines the standard format for a health history, including identifying data, chief complaint, history of present illness, past medical history, family history, social history and review of systems. It describes the ideal sequence of an interview, including establishing rapport, inviting the patient's story, and creating a shared understanding. The document also reviews techniques for skilled interviewing, guidelines for using interpreters, exploring the patient's perspective, and addressing sensitive topics. It provides models for assessing symptoms and screening for alcohol use. Overall, the document aims to instruct healthcare providers on best practices for obtaining full health histories through effective patient interviews.
IVMS is the ultimate medical student Web 2.0 companion. This SDL-Face to Face hybrid courseware is a digitally tagged and content enhanced replication of the United States Medical Licensing Examination's Cognitive Learning Objectives (Steps 1, 2 or 3). Including authoritative reusable learning object (RLO) integration and scholarly Web Interactive PowerPoint-driven multimedia shows/ PDFs. Comprehensive hypermedia BMS learning outcomes and detailed, content enriched learning objectives.
IVMS is the ultimate medical student Web 2.0 companion. This SDL-Face to Face hybrid courseware is a digitally tagged and content enhanced replication of the United States Medical Licensing Examination's Cognitive Learning Objectives (Steps 1, 2 or 3). Including authoritative reusable learning object (RLO) integration and scholarly Web Interactive PowerPoint-driven multimedia shows/ PDFs. Comprehensive hypermedia BMS learning outcomes and detailed, content enriched learning objectives.
This is the handout for a 60 minute workshop with roleplay for the KUMC Palliative Medicine Fellowship lecture series. There is no accompanying slideset as this was a small group workshop.
Please contact with questions and see this disclaimer. This is not medical advice.
Senior Healthcare Consultant (Geriatric) class at Piedmont Hospitalsnomadicnurse
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Communication: Empathy and How To Give Bad News -Journal Article and Discussionflasco_org
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micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?
Interviewing and Medical History-Rapid Review
1. Interviewing and the Health History
Rapid Review
Prepared and presented by
Marc Imhotep Cray, M.D.1
2. Marc Imhotep Cray, M.D.
Format of Comprehensive Health History
Identifying Data
Source and Reliability of History
Chief Complaint22
History of Present Illness
o Medications, Allergies, Tobacco, Alcohol and Drugs
Past History
o Childhood Illness
o Adult Illness: Medical, Surgical, Ob/Gyn, Psychiatric, Health
Maintenance
Family History
Personal and Social History
Review of Systems
2
3. Marc Imhotep Cray, M.D.
Sequence of the Interview
Greeting the patient and establishing rapport
Inviting the patient’s story
Establishing the agenda for the interview
Expanding and clarifying the patient’s story; generating and testing
diagnostic hypotheses
Creating a shared understanding of the problem(s)
Negotiating a plan (includes further evaluation, treatment, and
patient education)
Planning for follow-up and closing the interview
3
4. Marc Imhotep Cray, M.D.
The Seven Attributes of A Symptom
4
1. Location. Where is it? Does it radiate?
2. Quality. What is it like?
3. Quantity or severity. How bad is it? (For pain, ask for a
rating on a scale of 1 to 10.)
4. Timing. When did (does) it start? How long did (does) it
last? How often did (does) it come?
5. Setting in which it occurs. Include environmental factors,
personal activities, emotional reactions, or other
circumstances that may have contributed to the illness.
6. Remitting or exacerbating factors. Does anything make it
better or worse?
7. Associated manifestations. Have you noticed anything else
that accompanies it?
5. Marc Imhotep Cray, M.D.
Exploring the Patient’s Perspective
5
The patient’s thoughts about the nature and the cause of the problem
The patient’s feelings, especially fears, about the problem
The patient’s expectations of the clinician and health care
The effect of the problem on the patient’s life
Prior personal or family experiences that are similar
Therapeutic responses the patient has already tried
6. Marc Imhotep Cray, M.D.
Techniques of Skilled Interviewing
6
See Bates, pgs. 68-74
Active listening
Adaptive questioning
Nonverbal communication
Facilitation
Echoing
Empathic responses
Validation
Reassurance
Summarization
Highlighting transitions
7. Marc Imhotep Cray, M.D.
Adaptive Questioning:
Options for Clarifying Patient’s Story
7
See Bates, pgs. 68-74
Directed questioning-from general to specific
Questioning to elicit a graded response
Asking a series of questions, one at a time
Offering multiple choices for answers
Clarifying what the patient means
8. Marc Imhotep Cray, M.D.
Guidelines for Working with an Interpreter
8
Choose a professional interpreter in preference to a
hospital worker, volunteer, or family member. Use
interpreter as a resource for cultural information.
Orient interpreter to components you plan to cover
in interview; include reminders to translate
everything patient says.
Arrange room so that you and patient have eye
contact and can read each other’s nonverbal cues.
9. Marc Imhotep Cray, M.D.
Working with an Interpreter cont.
9
Seat interpreter next to you and allow interpreter
and patient to establish rapport.
Address patient directly. Reinforce your questions
with nonverbal behaviors.
Keep sentences short and simple. Focus on most
important concepts to communicate.
Verify mutual understanding by asking patient to
repeat back what he or she has heard.
Be patient. The interview will take more time and
may provide less information.
10. Marc Imhotep Cray, M.D.
Guidelines For Broaching Sensitive Topics
(Sexual Hx, Mental Health Hx, AOD Hx & Family Violence)
10
Single most important rule is to be nonjudgmental
o Clinician’s role is to learn about patient and help patient achieve better health
• Disapproval of behaviors or elements in health history will interfere with this goal
Explain why you need to know certain information This makes patients less
apprehensive
o For example, say to patients, “Because sexual practices put people at risk for certain
diseases, I ask all of my patients the following questions.”
Find opening questions for sensitive topics and learn specific kinds of information needed
for your assessments
Finally, consciously acknowledge whatever discomfort you are feeling
o Denying your discomfort may lead you to avoid topic altogether
11. Marc Imhotep Cray, M.D.
The Cage Questionnaire
11
THE CAGE QUESTIONNAIRE
Have you ever felt the need to Cut down on drinking?
Have you ever felt Annoyed by criticism of your drinking?
Have you ever felt Guilty about drinking?
Have you ever taken a drink first thing in the morning (Eye-opener) to
steady your nerves or get rid of a hangover?
(Mayfield D, McCleod G, Hall P. The CAGE questionnaire: validation of a new alcoholism screening instrument.
Am J Psychiatry 131:1121–1123, 1974.)
Abstract
The CAGE questionnaire, a new brief alcoholism screening test, was administered to all patients (N = 366; 39
percent alcoholic) admitted to a psychiatric service over a one-year period. The authors indicate that the CAGE
questionnaire is not a sensitive alcoholism detector if a four-item positive response is the criterion; however, if a
two- or three-item criterion is used, it becomes a viable rapid alcoholism screening technique for large groups.
12. Marc Imhotep Cray, M.D.
Family Violence
12
Physical abuse--often not mentioned by either victim or perpetrator--
should be considered in following settings:
Clues To Possible Physical Abuse
If injuries are unexplained, seem inconsistent with the patient’s story,
are concealed by the patient, or cause embarrassment
If the patient has delayed getting treatment for trauma
If there is a past history of repeated injuries or “accidents”
If the patient or person close to the patient has a history of alcohol or
drug abuse
If the partner tries to dominate the interview, will not leave the room,
or seems unusually anxious or solicitous
13. Marc Imhotep Cray, M.D.
Death and the Dying Patient
13
Many clinicians avoid subject of death b/c of their own discomforts
and anxieties
You will need to work through your own feelings with help of reading and discussion
Kubler-Ross model has described five stages in a person’s response to loss or the
anticipatory grief of impending death:
o Denial and isolation
o Anger
o Bargaining
o Depression or sadness
o Acceptance
These stages may occur sequentially or overlap in different combinations
At each stage, follow the same approach…See Bates Chapter 20, The Older Adult, p. 909.
14. Marc Imhotep Cray, M.D.
Societal Aspects of Interviewing
14
Demonstrating Cultural Humility—A Changing Paradigm
Communicating effectively with patients from every background/ culture is a highly
important professional skill Nonetheless, disparities in risks of disease, morbidity,
and mortality are marked and well documented across different population groups
reflecting inequities in
health care access
income level
type of insurance
educational level
language proficiency, and
provider decision making
To level these disparities, clinicians are urged to focus on their own attributes and
responsiveness as they experience diversity in their clinical practices
15. Marc Imhotep Cray, M.D.
Cultural humility
15
Students and clinicians are now increasingly being trained
to move toward the precepts of cultural humility
Cultural humility is defined as a “process that requires humility as individuals
continually engage in self-reflection and self-critique as lifelong learners and
reflective practitioners”
Tervalon M, Murray-Garcia J. Cultural humility versus cultural competence: a critical distinction in defining
physician training outcomes in multicultural education. J Health Care Poor Underserved 9(2):117–125, 1998.
It is a process that includes “the difficult work of examining cultural
beliefs and cultural systems of both patients and providers to locate the
points of cultural dissonance or synergy that contribute to patients’ health
outcomes.”
Tervalon M. Components of culture in health for medical students’ education. Acad Med 78(6):570–576, 2003.
16. Marc Imhotep Cray, M.D.
Clinician Goals for Cultural Competence
16
Self-awareness. Learn about your own biases . . . we all have them.
Enhanced communication. Work to eliminate assumptions about what
is “normal.” Learn directly from your patients—they are the experts on
their culture and illness.
Collaborative partnerships. Build your relationships with patients on
respect and mutually acceptable plans.
18. Marc Imhotep Cray, M.D.
Recommended textbook reading:
18
Bickley LS & Szilagyi PG. Interviewing and the Health History,
Ch. 3 (Pgs. 55-96). In: Bates’ Guide to Physical Examination and
History Taking. 10th ed. Wolters Kluwer-Lippincott Williams &
Wilkins, 2010.