Your note, your way: how to write an inpatient progress note accurately and efficiently as an intern.

A physician's progress note is an essential piece of documentation regarding key events and the daily status of patients during their hospital stay. It serves not only as a communication tool between care team members, but also chronicles clinical status and pertinent updates to their medical care. Despite the importance of these documents, little literature exists on how to help residents to improve the quality of their daily progress notes. A narrative literature review of English language literature was performed and summated to provide recommendations on how to write an inpatient progress note more accurately and efficiently. In addition, the authors will also introduce a method to build a personal template with the goal of extracting relevant data automatically to reduce clicks for an inpatient progress note in the electronic medical record system.

Stroke literacy, behavior, and proficiency in a South Florida population.

BACKGROUND: Our goal was to assess stroke literacy, behavior, and proficiency in our South Florida service population. METHODS: Data were obtained from the 2006 to 2010 Cleveland Clinic Florida annual "stroke prevention screening" questionnaires. "Stroke risk factor awareness" was attributed to participants correctly identifying at least 5 out of the 7 stroke risk factors presented. "Stroke symptom awareness" was assigned if one correctly selected all 5 listed stroke symptoms and not any of the 3 inappropriate responses. Participants had "stroke literacy" if they: (1) demonstrated stroke risk factor awareness; (2) demonstrated stroke symptom awareness; and (3) they correctly identified the brain as where a stroke occurs. To assess appropriate "stroke behavior," respondents had to choose "call 911 immediately" if one were to experience stroke symptoms. "Stroke proficiency" was attributed to individuals showing both stroke literacy and appropriate stroke behavior. RESULTS: There were a total of 298 participants. Sixty-seven percent of participants correctly identified the brain as the organ where stroke occurs. Almost three-fourths (74.2%) demonstrated stroke risk factor awareness, 28.2% had stroke symptom awareness, 17.8% had stroke literacy, 87.9% declared appropriate stroke behavior, and 16.1% had stroke proficiency. CONCLUSIONS: Stroke behavior and stroke proficiency are useful novel concepts in stroke epidemiology. Although our South Florida community is relatively well-educated and affluent, there are tangible gaps in knowledge, attitudes, and behavior as it pertains to stroke, similar to that seen in less advantaged populations. We recommend intensified usage of the media with information provided by qualified health professionals in a variety of formats and languages appropriate to the ethnic and cultural diversities that define this population.

Prevalence and control of stroke risk factors in a South Florida population.

OBJECTIVE: To assess the prevalence and control of stroke risk factors in our South Florida service population. METHODS: We obtained data from the 2006-2010 Cleveland Clinic Florida annual "stroke prevention screening" questionnaires. Participants responded to questions regarding demographic information and stroke risk factors including pertinent comorbidity, alcohol consumption, and smoking. Onsite weight, height, blood pressure, and cholesterol levels were obtained. Our hospital's Director of Research did not identify any issues requiring formal institutional review board evaluation. Those with three or more modifiable risk factors breaching recommended targets met criteria for "poorly controlled." RESULTS: There were 298 participants, average age: 62.5 years, 65% were females. 36.9% had hypercholesterolemia, 32.9% hypertension, 14.4% diabetes mellitus, 8% transient ischemic attack/stroke, 7% coronary artery disease, 5.7% atrial fibrillation, and 2.7% carotid artery disease. 81.8% had a BMI of 25 or more and 37.8% had inadequate exercise. 38.3% had elevated cholesterol levels, 26.4% had blood pressures of 140/90mmHg or more, 6% were smokers, and 2.1% had excessive alcohol intake. 29.1% of the composite sample met the criteria outlined for "poorly controlled" stroke risk factors. CONCLUSION: Control of stroke risk factors especially obesity was worse compared to United States national data. Additionally, there is a higher prevalence of hypercholesterolemia and physical inactivity compared to statewide data. There is a definite need for local healthcare professionals to disseminate more stroke risk factor information. However, health promotion at the public policy or patient level should advocate personal responsibility especially pertaining to lifestyle and behavioral changes necessary for stroke prevention.

Recurrent Transcortical Motor Aphasia-Another CNS Infectious Syndrome Associated with Herpes Virus Infection.

Herpes simplex encephalitis is an acute/subacute illness that causes both general and focal signs of cerebral dysfunction with fever, headache, and confusion as cardinal features. Recurrent herpes simplex meningitis, also known as Mollaret's meningitis, is another manifestation of central nervous system herpetic infection with recurrent episodes of fever, headache, and nuchal rigidity associated with cerebrospinal fluid (CSF) evidence of active herpes simplex infection. Bell's palsy is yet another manifestation of a herpes virus infection in at least some reported cases documented by CSF analysis. We report a case of a 70-year-old male who presented with acute transcortical motor aphasia initiating a stroke work-up that was negative. Physical examination revealed genital vesicles, and the CSF was consistent with active herpes simplex infection.