scholarly journals Open Notes and Closed-Loop Communication: A Case of Factitious Disorder in the Age of Transparent Medical Records

2021 ◽  
Vol 3 (1) ◽  
Author(s):  
Horwitz Elana ◽  
Lao Bryan ◽  
Robbins-Welty Gregg ◽  
Tuck Andrew ◽  
Gagliardi Jane
Keyword(s):  
Medical Records ◽  
Closed Loop ◽  
Factitious Disorder

scholarly journals 883 A Closed-Loop Audit to Improve Admissions Documentation in A Busy ENT Department

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
A Connelly ◽  
K Law ◽  
A Williamson
Keyword(s):  
Electronic Medical Records ◽  
Medical Records ◽  
Closed Loop ◽  
Vital Signs ◽  
P Value ◽  
Medication History ◽  
Admission Source ◽  
Effective Care ◽  
User Friendly ◽  
Pro Forma

Abstract Aim Accurate and thorough admissions documentation is crucial for patient safety and effective care. We amended the admissions pro-forma used on a busy adult ENT ward to improve adherence to a modified version of Royal College of Surgeons of England guidelines. Method Baseline documentation of the 25 parameters of interest was assessed using electronic medical records for all emergency and pre-operative admissions over a 4-week period (n = 75). A new pro-forma was introduced, and the documentation over the following 4 weeks (n = 75) was assessed in the same way. Statistical analysis was done using Excel and RStudio (z-test for two proportions, p-value ≤ 0.05). Results The two groups were similar in age, gender, length of stay, and presenting complaint. The new pro-forma was completed for more admissions than the prior version (91% vs 77%) and resulted in documentation improvements in 19 out of 25 parameters. 9 of these were statistically significant, including initial vital signs and differential diagnosis. Parameters that improved, but not significantly, include admission source, medication history, and cognitive assessment. Across the 8 weeks, using a pro-forma (n = 126) significantly improved documentation of 11 parameters compared to freehand clerking (n = 24). Conclusions Adequate documentation at admission can help with immediate patient care, and act as a point of reference during extended stays. We were able to increase use of a pro-forma and produce meaningful documentation improvements quickly. Further work is required to assess why certain parameters are infrequently completed, and how future pro-forma iterations can become more user-friendly.

Factitious Disorders

2016 ◽  
pp. 288-305
Author(s):  
Brenda Bursch ◽  
Robert Haskell
Keyword(s):  
Medical Records ◽  
Good Faith ◽  
Factitious Disorder ◽  
Munchausen Syndrome ◽  
Factitious Disorders ◽  
Important Data ◽  
Munchausen Syndrome By Proxy ◽  
Psychiatric Illnesses ◽  
Assessment Procedures ◽  
Medical Symptoms

In Factitious Disorders, the patient exaggerates, fabricates, simulates, and/or induces symptoms of medical and/or psychiatric illnesses—in himself or in another person—with no concrete incentive beyond the pleasure, consolation, or status conferred by being a patient (or by being closely identified with a patient). This condition can go unrecognized for years, as most physicians assume that descriptions of medical symptoms are presented in good faith. Variations have sometimes been termed factitious disorder imposed on another or Munchausen syndrome by proxy. The secretive and sometimes criminal nature of these behaviors provides numerous barriers to research, but important data have been collected. After discussing the available research base of the factitious disorders, potential assessment procedures using medical records are detailed.

scholarly journals Triparesis: an unusual presentation of factitious disorder

2019 ◽  
Vol 12 (5) ◽  
pp. e226869
Author(s):  
Susanta Kumar Padhy ◽  
Prabhat Sapkota ◽  
Aditya Somani
Keyword(s):  
Medical Records ◽  
Lower Limbs ◽  
Stressful Event ◽  
Factitious Disorder ◽  
Illness Management ◽  
Extensive Evaluation ◽  
Material Gain ◽  
Neurological Presentation ◽  
High Index Of Suspicion ◽  
Rule Out

Factitious disorder (FD) has diverse presentations but neurological presentation is unusual. In this report, we discuss a case of FD who presented with triparesis, that is, weakness of both lower limbs and right upper limb. Diagnosis of FD was made after detailed clinical evaluation, review of past medical records that revealed extensive evaluation to rule out physical illness, and inability to find any associated stressful event or material gain associated with illness. Management was largely supportive and was based on psychotherapy. Identification of FD depends on a high index of suspicion by the physician and the presence of atypical and medically unexplainable signs/symptoms.

Impairment Tutorial: Spinal Cord Stimulation and Intraspinal Opioids:Impairment Rating Issues

2000 ◽  
Vol 5 (5) ◽  
pp. 4-5
Author(s):  
James B. Talmage ◽  
Leon H. Ensalada
Keyword(s):  
Medical Records ◽  
Evaluation Process ◽  
Current Approach ◽  
Satisfaction Survey ◽  
Start Time ◽  
Medical Evaluation ◽  
Independent Medical Evaluation ◽  
Other Information ◽  
Physician Reviews ◽  
Written Informed Consent

Abstract Evaluators must understand the complex overall process that makes up an independent medical evaluation (IME), whether the purpose of the evaluation is to assess impairment or other care issues. Part 1 of this article provides an overview of the process, and Part 2 [in this issue] reviews the pre-evaluation process in detail. The IME process comprises three phases: pre-evaluation, evaluation, and postevaluation. Pre-evaluation begins when a client requests an IME and provides the physician with medical records and other information. The following steps occur at the time of an evaluation: 1) patient is greeted; arrival time is noted; 2) identity of the examinee is verified; 3) the evaluation process is explained and written informed consent is obtained; 4) questions or inventories are completed; 5) physician reviews radiographs or diagnostic studies; 6) physician records start time and interviews examinee; 7) physician may dictate the history in the presence of the examinee; 8) physician examines examinee with staff member in attendance, documenting negative, physical, and nonphysiologic findings; 9) physician concludes evaluation, records end time, and provides a satisfaction survey to examinee; 10) examinee returns satisfaction survey before departure. Postevaluation work includes preparing the IME report, which is best done immediately after the evaluation. To perfect the IME process, examiners can assess their current approach to IMEs, identify strengths and weaknesses, and consider what can be done to improve efficiency and quality.

Intestinal Bacteriology of Closed Loop, Strangulated Obstruction in Dogs.

1961 ◽  
Vol 41 (3) ◽  
pp. 245-250 ◽  
Author(s):  
George H. Bornside ◽  
Isidore Cohn
Keyword(s):  
Closed Loop

Abstract # P-1: Use of Type 2 Diabetes Screening Guidelines in Primary Care: Concordance Between Physician Survey and Medical Records

2016 ◽  
Vol 22 ◽  
pp. 14
Author(s):  
Michelle Mocarski ◽  
Sandhya Mehta ◽  
Karin Gillespie ◽  
Tami Wisniewski ◽  
K.M. Venkat Narayan ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Primary Care ◽  
Medical Records ◽  
Physician Survey ◽  
Diabetes Screening ◽  
Screening Guidelines

Percutaneous sclerotherapy for spongiform venous malformations – analysis of patient-evaluated outcome and satisfaction

VASA ◽  
2017 ◽  
Vol 46 (6) ◽  
pp. 477-483
Author(s):  
Robert Karl Clemens ◽  
Frederic Baumann ◽  
Marc Husmann ◽  
Thomas Oleg Meier ◽  
Christoph Thalhammer ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Medical Records ◽  
Venous Malformation ◽  
Primary Treatment ◽  
Venous Malformations ◽  
Treated Area ◽  
Item Questionnaire ◽  
Percutaneous Sclerotherapy ◽  
Multiple Treatments ◽  
Pain Improvement

Abstract. Background: Congenital venous malformations are frequently treated with sclerotherapy. Primary treatment goal is to control the often size-related symptoms. Functional impairment and aesthetical aspects as well as satisfaction have rarely been evaluated. Patients and methods: Medical records of patients who underwent sclerotherapy of spongiform venous malformations were reviewed and included in this retrospective study. The outcome of sclerotherapy as self-reported by patients was assessed in a 21 item questionnaire. Results: Questionnaires were sent to 166 patients with a total of 327 procedures. Seventy-seven patients (48 %) with a total of 159 procedures (50 %) responded to the survey. Fifty-seven percent of patients were male. The age ranged from 1 to 38.1 years with a median age of 16.4 years. The lower extremities were the most common treated area. Limitations caused by the venous malformation improved in the majority of patients (e.g. pain improvement 87 %, improvement of swelling 83 %) but also worsening of symptoms occurred in a minority of cases. Seventy-seven per cent would undergo sclerotherapy again. Conclusions: Sclerotherapy for treatment of venous malformations results in significant reduction of symptoms. Multiple treatments are often needed, but patients are willing to undergo them.

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