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  1. Book: Clinical examination

    Garibaldi, Brian T.

    (Medical clinics of North America ; volume 102, number 3 (May 2018))

    2018  

    Author's details editor Brian T. Garibaldi
    Series title Medical clinics of North America ; volume 102, number 3 (May 2018)
    Collection
    Language English
    Size xviii Seiten, Seite 418-565, Illustrationen
    Publisher Elsevier
    Publishing place Philadelphia, Pennsylvania
    Publishing country United States
    Document type Book
    HBZ-ID HT019723061
    ISBN 978-0-323-58362-6 ; 0-323-58362-8
    Database Catalogue ZB MED Medicine, Health

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  2. Article ; Online: When Clinical Prediction Is Steering the Ship, Beware the Drift of Its Wake.

    Robinson, Matthew L / Garibaldi, Brian T / Lindquist, Martin A

    Annals of internal medicine

    2023  Volume 176, Issue 10, Page(s) 1424–1425

    MeSH term(s) Humans ; Ships
    Language English
    Publishing date 2023-10-10
    Publishing country United States
    Document type Journal Article
    ZDB-ID 336-0
    ISSN 1539-3704 ; 0003-4819
    ISSN (online) 1539-3704
    ISSN 0003-4819
    DOI 10.7326/M23-2345
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article ; Online: The Clinical Examination in Twenty-First Century Medicine.

    Garibaldi, Brian T

    The Medical clinics of North America

    2018  Volume 102, Issue 3, Page(s) xvii–xviii

    MeSH term(s) Diagnosis ; Humans ; Medical History Taking/methods ; Physical Examination/methods ; Physical Examination/trends ; Physician-Patient Relations
    Language English
    Publishing date 2018-03-12
    Publishing country United States
    Document type Editorial
    ZDB-ID 215710-x
    ISSN 1557-9859 ; 0025-7125
    ISSN (online) 1557-9859
    ISSN 0025-7125
    DOI 10.1016/j.mcna.2018.02.001
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article ; Online: Strategies to Improve Bedside Clinical Skills Teaching.

    Garibaldi, Brian T / Russell, Stephen W

    Chest

    2021  Volume 160, Issue 6, Page(s) 2187–2195

    Abstract: The bedside encounter between a patient and physician remains the cornerstone of the practice of medicine. However, physicians and trainees spend less time in direct contact with patients and families in the modern health care system. The current ... ...

    Abstract The bedside encounter between a patient and physician remains the cornerstone of the practice of medicine. However, physicians and trainees spend less time in direct contact with patients and families in the modern health care system. The current pandemic has further threatened time spent with patients. This lack of time has led to a decline in clinical skills and a decrease in the number of faculty members who are confident in teaching at the bedside. We offer several strategies to get physicians and trainees back to the bedside to engage in clinical skills teaching and assessment. We recommend that providers pause before bedside encounters to be present with patients and learners and to develop clear goals for a bedside teaching session. We suggest that clinical teachers practice an evidence-based approach, which includes an hypothesis-driven physical examination. We encourage the use of point-of-care technology to assist in diagnosis and to allow learners to calibrate traditional physical examination skills with real-time visualization of disease. Tools like point-of-care ultrasound can be powerful levers to get learners excited about bedside teaching and to engage patients in their clinical care. We value telemedicine visits as unique opportunities to engage with patients in their home environment and to participate in patient-directed physical examination maneuvers. Finally, we recommend that educators provide feedback to learners on specific clinical examination skills, whether in the clinic, the wards, or during dedicated clinical skills assessments.
    MeSH term(s) Attitude of Health Personnel ; Clinical Competence ; Education, Medical/methods ; Humans ; Internal Medicine/education ; Physical Examination ; Physician-Patient Relations ; Point-of-Care Testing ; Teaching ; Teaching Rounds
    Language English
    Publishing date 2021-07-06
    Publishing country United States
    Document type Journal Article ; Research Support, Non-U.S. Gov't ; Review
    ZDB-ID 1032552-9
    ISSN 1931-3543 ; 0012-3692
    ISSN (online) 1931-3543
    ISSN 0012-3692
    DOI 10.1016/j.chest.2021.06.055
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  5. Article ; Online: Internal medicine intern performance on the gastrointestinal physical exam.

    Gips, Julia R / Stein, Ariella Apfel / Luckin, Joyce / Garibaldi, Brian T

    Diagnosis (Berlin, Germany)

    2023  Volume 10, Issue 4, Page(s) 412–416

    Abstract: Objectives: The gastrointestinal (GI) physical exam provides critical information about underlying disease states. However, since assessment of physical examination skills is rarely conducted as part of internal medicine residency training, little is ... ...

    Abstract Objectives: The gastrointestinal (GI) physical exam provides critical information about underlying disease states. However, since assessment of physical examination skills is rarely conducted as part of internal medicine residency training, little is known about resident performance on the GI physical exam.
    Methods: During a clinical skills assessment that took place between November 2019 and February 2020, internal medicine interns examined the same patient with chronic liver disease while being observed by faculty preceptors. We compared the exam maneuvers performed with those expected by the faculty evaluators. We noted which maneuvers were performed incorrectly, whether physical exam technique correlated with identification of physical exam findings, and if performance on the physical exam was associated with building an appropriate differential diagnosis. This four-hour assessment was required for internal medicine interns within two different residency programs in the Baltimore area.
    Results: More than half of the 29 participating interns (n=17, 58.6 %) received a "needs improvement" score on their physical exam technique. Technique was highly correlated with identifying the correct physical signs (r=0.88, p<0.0001). The most commonly excluded maneuvers were assessing for splenomegaly and hepatomegaly. The most commonly missed findings were splenomegaly and hepatomegaly. Most interns included chronic liver disease as part of their differential diagnosis even if they received "needs improvement" scores on physical exam technique or identifying physical signs.
    Conclusions: Internal medicine interns would benefit from learning an organized approach to the gastrointestinal exam. This would likely lead to increased identification of important gastrointestinal findings.
    MeSH term(s) Humans ; Hepatomegaly ; Splenomegaly ; Internship and Residency ; Physical Examination ; Internal Medicine/education
    Language English
    Publishing date 2023-07-21
    Publishing country Germany
    Document type Journal Article
    ISSN 2194-802X
    ISSN (online) 2194-802X
    DOI 10.1515/dx-2023-0051
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  6. Article ; Online: Strategies to Avoid the "Hemolyzed" Physical Examination.

    Garibaldi, Brian T / Russell, Stephen W

    JAMA internal medicine

    2019  Volume 179, Issue 7, Page(s) 1000

    MeSH term(s) Physical Examination
    Language English
    Publishing date 2019-04-08
    Publishing country United States
    Document type Letter ; Comment
    ZDB-ID 2699338-7
    ISSN 2168-6114 ; 2168-6106
    ISSN (online) 2168-6114
    ISSN 2168-6106
    DOI 10.1001/jamainternmed.2019.1729
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  7. Article ; Online: The authors reply.

    Burnim, Michael S / Wang, Kunbo / Checkley, William / Nolley, Eric P / Xu, Yanxun / Garibaldi, Brian T

    Critical care medicine

    2022  Volume 50, Issue 6, Page(s) e592–e594

    Language English
    Publishing date 2022-03-08
    Publishing country United States
    Document type Letter ; Comment
    ZDB-ID 197890-1
    ISSN 1530-0293 ; 0090-3493
    ISSN (online) 1530-0293
    ISSN 0090-3493
    DOI 10.1097/CCM.0000000000005530
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  8. Article ; Online: Does nurse use of a standardized flowsheet to document communication with advanced providers provide a mechanism to detect pulse oximetry failures? A retrospective study of electronic health record data.

    Gleason, Kelly T / Tran, Alberta / Fawzy, Ashraf / Yan, Li / Farley, Holley / Garibaldi, Brian / Iwashyna, Theodore J

    International journal of nursing studies

    2024  Volume 155, Page(s) 104770

    Abstract: Background: Pulse oximetry guides clinical decisions, yet does not uniformly identify hypoxemia. We hypothesized that nursing documentation of notifying providers, facilitated by a standardized flowsheet for documenting communication to providers ( ... ...

    Abstract Background: Pulse oximetry guides clinical decisions, yet does not uniformly identify hypoxemia. We hypothesized that nursing documentation of notifying providers, facilitated by a standardized flowsheet for documenting communication to providers (physicians, nurse practitioners, and physician assistants), may increase when hypoxemia is present, but undetected by the pulse oximeter, in events termed "occult hypoxemia."
    Objective: To compare nurse documentation of provider notification in the 4 h preceding cases of occult hypoxemia, normal oxygenation, and evident hypoxemia confirmed by an arterial blood gas reading.
    Methods: We conducted a retrospective study using electronic health record data from patients with COVID-19 at five hospitals in a healthcare system with paired SpO
    Results: There were data from 1910 patients hospitalized with COVID-19 who had 44,972 paired readings and an average of 26.5 (34.5) nursing documentation of provider notification events. The mean age was 63.4 (16.2). Almost half (866/1910, 45.3 %) were White, 701 (36.7 %) were Black, and 239 (12.5 %) were Hispanic. Having any nursing documentation of provider notification was 46 % more common in the 4 h before an occult hypoxemia paired reading compared to a normal oxygen status paired reading (OR 1.46, 95 % CI: 1.28-1.67). Comparing the 4 h immediately before the reading to the 4 h one day preceding the paired reading, there was a higher likelihood of having any nursing documentation of provider notification for both evident (OR 1.45, 95 % CI 1.24-1.68) and occult paired readings (OR 1.26, 95 % CI 1.04-1.53).
    Conclusion: This study finds that nursing documentation of provider notification significantly increases prior to confirmed occult hypoxemia, which has potential in proactively identifying occult hypoxemia and other clinical issues. There is potential value to encouraging standardized documentation of nurse concern, including communication to providers, to facilitate its inclusion in clinical decision-making.
    Language English
    Publishing date 2024-04-06
    Publishing country England
    Document type Journal Article
    ZDB-ID 80148-3
    ISSN 1873-491X ; 0020-7489
    ISSN (online) 1873-491X
    ISSN 0020-7489
    DOI 10.1016/j.ijnurstu.2024.104770
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  9. Article ; Online: Information Challenges Associated With Accessing and Sharing of Patient Information in Disasters: A Qualitative Analysis.

    Sauer, Lauren M / Resnick, Beth / Links, Jonathan L / Garibaldi, Brian T / Rutkow, Lainie

    Health security

    2023  Volume 21, Issue 6, Page(s) 479–488

    Abstract: As disasters increase in frequency and severity, so too does the health impact on affected populations. Disasters exacerbate the already challenging health information-sharing landscape. A reduced capacity to access and share patient information may have ...

    Abstract As disasters increase in frequency and severity, so too does the health impact on affected populations. Disasters exacerbate the already challenging health information-sharing landscape. A reduced capacity to access and share patient information may have negative impacts on providers' ability to care for patients individually and to address disaster health outcomes at the population level. Between October 2018 and July 2019, we conducted 21 semistructured interviews with physicians experienced in providing healthcare during disasters to understand the challenges related to patient information sharing in disaster responses. Key informants noted challenges with patient information management-including accessing, sharing, and transferring information-and that it was a barrier to providing effective clinical care in disasters. Three major areas were identified as challenges: (1) lack of systematic mechanisms for patient information sharing during disaster handoffs, (2) lack of access to a patient's past medical history, and (3) population-level impacts of patient information-sharing breakdowns in disasters. Reducing barriers to effective patient information sharing is a critical need during disasters. Requirements generally fall to overburdened clinicians, and novel solutions that ease this responsibility and leverage existing infrastructure should be explored. Work conducted during the COVID-19 pandemic may inform new solutions. Integrated approaches that support information sharing in real time will improve patient care at the individual level and can support operational improvements to current and future disaster responses.
    MeSH term(s) Humans ; Pandemics ; Disasters ; Delivery of Health Care ; Information Dissemination ; Health Facilities ; Disaster Planning
    Language English
    Publishing date 2023-10-27
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2823049-8
    ISSN 2326-5108 ; 2326-5094
    ISSN (online) 2326-5108
    ISSN 2326-5094
    DOI 10.1089/hs.2023.0058
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  10. Article ; Online: The ethics of using COVID-19 host genomic information for clinical and public health decision-making: A survey of US health professionals.

    Jose, Sheethal / Geller, Gail / Bollinger, Juli / Mathews, Debra / Kahn, Jeffrey / Garibaldi, Brian T

    HGG advances

    2023  Volume 5, Issue 1, Page(s) 100255

    Abstract: Several genetic variants linked to COVID-19 have been identified by host genomics researchers. Further advances in this research will likely play a role in the clinical management and public health control of future infectious disease outbreaks. The ... ...

    Abstract Several genetic variants linked to COVID-19 have been identified by host genomics researchers. Further advances in this research will likely play a role in the clinical management and public health control of future infectious disease outbreaks. The implementation of genetic testing to identify host genomic risk factors associated with infectious diseases raises several ethical, legal, and social implications (ELSIs). As an important stakeholder group, health professionals can provide key insights into these ELSI issues. In 2021, a cross-sectional online survey was fielded to US health professionals. The survey explored how they view the value and ethical acceptability of using COVID-19 host genomic information in three main decision-making settings: (1) clinical, (2) public health, and (3) workforce. The survey also assessed participants' personal and professional experience with genomics and infectious diseases and collected key demographic data. A total of 603 participants completed the survey. A majority (84%) of participants agreed that it is ethically acceptable to use host genomics to make decisions about clinical care and 73% agreed that genetic screening has an important role to play in the public health control of COVID-19. However, more than 90% disagreed that it is ethically acceptable to use host genomics to deny resources or admission to individuals when hospital resources are scarce. Understanding stakeholder perspectives and anticipating ELSI issues will help inform policies for hospitals and public health departments to evaluate and perhaps adopt host genomic technologies in an ethically and socially responsible manner during future infectious disease outbreaks.
    MeSH term(s) Humans ; Public Health ; COVID-19/epidemiology ; Cross-Sectional Studies ; Genomics ; Communicable Diseases
    Language English
    Publishing date 2023-11-17
    Publishing country United States
    Document type Journal Article
    ISSN 2666-2477
    ISSN (online) 2666-2477
    DOI 10.1016/j.xhgg.2023.100255
    Database MEDical Literature Analysis and Retrieval System OnLINE

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