what is an integrated summary in writing research

Copyright © 2020 American Academy of Family Physicians. The integration of her flow sheet helps point out that her improved BP after last month’s medication augmentation is not adequate for the new target of 130/80 for DM, and the next column of the medication list shows that the angiotensin-converting-enzyme inhibitor (ACE-I) captopril is substituted for her HCTZ, a statin is added for her newly diagnosed suboptimal lipids and a hypoglycemic agent has been prescribed. Return to clinic in one month. Keys to High-Quality, Low-Cost Care: Empanelment, Attribution, and Risk Stratification Requiring only a little practice, the integrated summary is a valuable tool that can help physicians improve the quality and efficiency of patient care. Use strong and positive language. In writing a research paper it is needed to have the skill of summarizing more than two sources. The integrated summary requires minimal data entry at each visit, and it simplifies progress note documentation. Hypercholesterolemia medication: Monitoring labs per IS. Integrative reviews of research are a valuable part of the process of creating and organizing a body of literature. The screening section shows that an unremarkable general physical exam (PEx) including a normal breast exam was done, and colons (“:”) show pending results of her ordered BMP, mammogram, Pap smear cytology, cholesterol (chol) and triglycerides (tg), and diabetes screen. When she subsequently reports congestive heart failure, I can add this to the list above. Relatively static data (e.g., name) appears in the upper-left panel. Being too brief; Excluding data that do not support the effectiveness conclusions / Journals Research Writing Summary Tips (continuation) Clarity and organization. Demographic data that might change more frequently is entered on the right side of the integrated summary and includes the patient’s age and insurance. The problem list is further expanded to show that the patient heeded my recommendation to quit smoking. The integrated summary template presented here may not suit every physician’s work style or approach to primary care. More importantly, however, it is integrated in that the relationships between problems, medications and measured flowsheet parameter results are evident on a single page, and their changes (compensated or decompensated, improving or progressing) are readily apparent over time. Unfortunately, her paresis has not improved. Plan. Creation of clear links between the objectives of the research and the results from the raw data. Having a single page facilitates compulsively keeping my lists of problems, medications, lab results and screening tests due up-to-date. The patient follows up. “Expanded” problem list. However, because the integrated summary is a concept, not a fixed layout, it can be customized to suit physicians’ documentation preferences. Physicians may find it useful to expand upon each element of the problem list, adding date of onset, diagnostic criteria, extenuating circumstances at the time of diagnosis and dates of major quantifying test results (e.g., echocardiogram or computed tomography). To see the full article, log in or purchase access. The middle panel on the left is the problem list, where problems are organized by disease or organ system following some sensible order (see the box). When sending patients to consultants or the emergency room, or when giving records to patients who are moving away, I often copy just the integrated summary. At the very bottom of the lower right panel are a few lines to abbreviate the interventions done today, tests to follow up, next appointment interval and other plans. Flowsheet parameters of glucose, glycohemoglobin (HbA1c), urine dipsticks, ophthalmic and podiatric screens, as well as liver function tests (LFTs) to monitor statin therapy are added and ordered as indicated by the colons. The summary is integrated in that it includes data on one page from multiple (and now unnecessary) parts of a traditionally organized chart. Copyright (c) 2003 Michael Stelman, MD. The plan section shows a dietician referral was made, and the patient will follow up in one month. A document, prepared for inclusion in a new drug application (NDA) or biologics license application (BLA) in the United States, which includes a detailed set of integrated analyses of all relevant data from the clinical study reports. The patient presents for an initial visit. In the nineteenth century, students did not typically write analyses of what they read, but instead wrote themes on prescribed topics, such as Vanity, Democracy, Ethics, and so on. See FPM CME Quiz. What do ISS and ISE mean? Integrated Summary of Effectiveness. It takes only a few seconds during my interview to record today’s data into the flow sheet, write any medication adjustments into the medication list and record an abbreviated plan. Hospital admission lab results are added to the preceding column, and colons mark the pending results of tests ordered today. The problem list “Code Status” field reminds me to update her wishes following this change in her health status, and her Social Hx is updated for her disability. It can be easily and inexpensively implemented with nothing other than a photocopier and handwritten entries, or programmed as a component of an electronic medical record (EMR). Quanticate's Medical Writing Team have summarized tips for the preparation of comprehensive, well-written, and focused integrated summary documentation.. 4(Apr, 2003) She is on half a dozen medications, as documented on integrated summary (IS). On January 7, 2015 January 6, 2015 By E. Mack In Uncategorized . The statistical analy… The results of last month’s tests are recorded in the preceding column of the flow sheet after the colons, and the flowsheet parameters measured today are recorded in the current column. Integrated Summary Tips:. Opposite the problem list is a blank flow sheet. Worst practices for producing an integrated summary. This might span six weeks in a patient with severe hypertension whose medication is being aggressively titrated or six years in a healthy patient getting yearly mammograms. Patients’ charts are overflowing with information – problem lists, medication lists, disease-oriented flow sheets, laboratory flow sheets, preventive screening flow sheets, immunization lists, and previous histories and physicals. New medications and dosage changes are entered in the next visit column. Not providing one! These responses are all easily correlated to (and hence integrated with) the medication dosages immediately above and the problem or disease listed to the left. The clinical example on page 36 describes the case of a hypothetical middle-aged female patient with a fairly complicated set of problems and shows how the integrated summary would be completed over several visits. This example details the care of a hypothetical middle-aged female patient. The limited space forces me to be practical and limit the parameters I follow for any one disease to only the most important ones (see “A clinical example”). I also encode the number of months supply (M) and number of refills (RF) in an abbreviated fashion “M+RF” (e.g., “1+5” indicates a one-month supply with five refills). Screening and prevention. Then current symptoms, vital signs and other physical or in-office lab findings are entered into the column for the current visit (a colon “:” indicates pending results of outside labs or imaging studies). The problem list adds that diabetes mellitus (DM) has been diagnosed. Past medical history. Statisticians need to be involved in the planning stages of integrated summaries, Ideally, statisticians should attend pre-submission meetings with regulatory authorities to discuss the statistical analysis aspects of the integrated summary including sample size and trial design. HTN: Now compensated but intolerant of ACE-I. The three panels on the left side of the page contain relatively static data that rarely change; the three panels on the right contain more dynamic data that change with each visit. Being too brief; Excluding data that do not support the effectiveness conclusions Want to use this article elsewhere? UNA Center for Writing Excellence 1 Source integration is often an essential part of academic writing. The integrated summary organizes problems, medications and flowsheet parameters by disease or organ system and makes their relationships more evident over time. At each visit, the physician enters dynamic data into the integrated summary as follows: First, newly available outside test results for tests drawn at the previous visit are entered into the previous visit column. By introducing your sources within the text of your paper, you allow your reader to see that you have researched the topic and taken the works of experts in the field into consideration. I also document last menstrual period and lactation here to remind me of drug contraindications in patients who are at risk of conception or who are breast-feeding. Worst practices for producing an integrated summary. This content conforms to AAFP CME criteria. Integrated flowsheet values documenting bradycardia and restricted peak flow assist me in recognizing that atenolol is now contraindicated, for which I substitute hydroclorothiazide (HCTZ), and that albuterol is needed, as shown in the next column of the medication list. The integrated summary, a one-page, up-to-date summary of the patient’s health kept on the left side of the chart, makes it easier to provide high-quality, efficient care. The key sections of the integrated summary are as follows: Patient demographics. The integrated summary is a single concise page kept topmost on the left side of the chart, opposite the most recent progress note, readily available for quick review prior to evaluating the patient. This easy-to-use template enables you to see the full context of a patient’s health on a single page. For example, as I conduct a new patient history, if the patient tells me about chronic hepatitis first, I may enter this problem about one third of the way down the list. I use default conventions for “mg” and “qd” when units and frequency are not specified to further minimize data entry. The current increase in hesitancy about the safety and efficacy of vaccines has created an environment that calls for physicians’ urgent commitment to discussing the evidence-based benefits of vaccination with pregnant women. 10/No. An example of an integrated summary template useful for most adult patients in the author’s family practice can be viewed and downloaded below. Integrated Summary of Effectiveness Guidance for Industry U.S. Department of Health and Human Services Food and Drug Administration Center for Drug Evaluation and Research (CDER) Change to angiotensin receptor blocker per IS. Integrating Reading and Writing. The use of an integrated summary considerably reduces the time needed to address problems at every stage of the assessment. The Integrated Summary: A Documentation Tool to Improve Patient Care. Integrated flowsheet parameters for BP 160/100 and MDI use every six hours help me realize that neither her HTN nor COPD problems are compensated, and the next column shows prescriptions to increase her HCTZ and add an inhaled corticosteroid (beclomethasone). Also, make those links clear to others and how those links will fulfill the research objective. Published with permission. Listing problems in the temporal order of their diagnosis requires more mental integration of the data than ordering problems by disease or organ system. Not providing one! Previous: Anatomy of the Medicare Appeals Process, Next: Making Family Practice Doable in Everyday Life, Home The author finds it more efficient to order the patient data on his integrated summary by disease/organ system (see below), rather than chronologically. The patient returns to the office for follow-up after discharge from a stroke-rehabilitation center. The sample progress note on page 38 shows how references to the integrated summary can shorten documentation. See, How it works – template layout and integration, Ten EHR Strategies for Efficient Documentation, Making Family Practice Doable in Everyday Life. This is often performed while reading the literature review. / Vol. One-time prescriptions for antibiotics or episodic symptomatic medications are not recorded in the medication list but, instead, are briefly annotated in the “Plan” section at the bottom of the page. This allows the physician to follow, for example, the response of the glycohemoglobin (HbA1c) or blood pressure as a function of the number of drugs and their dosages. ISS and ISE stand for integrated summary of safety and integrated summary of effectiveness, respectively. She gives a history of hypertension (HTN), familial risk for coronary artery disease (CAD) and smoking (all of which are added to the problem list), and her exam shows wheezing leading to a new diagnosis of chronic obstructive pulmonary disease (COPD). A document, prepared for inclusion in a new drug application (NDA) or biologics license application (BLA) in the United States, which includes a detailed set of integrated analyses of all relevant data from the clinical study reports. It organizes problems, medications and flowsheet parameters by disease or organ system, not simply chronologically, and integrates them to make their relationships more evident over time. All rights Reserved. It also shows that prophylactic aspirin has been recommended now that the patient has other CAD risk factors with DM. It also records that the previously acceptable low-density lipoprotein (LDL) result of 130 in last month’s screening column is no longer adequate in light of DM and records the new entry of hyperlipidemia. The dates of her most recent screening exams are entered and aid me in recommending a follow-up appointment (f/u) in one month for an overdue Pap smear (documented in my abbreviated plan at the bottom of the 1/2/00 column). Therefore, I have designed this material to help senior students to do integrated summaries of more than one (two, three or four writers). Integrating Research into Your Writing. Quanticate's Medical Writing Team have summarized tips for the preparation of comprehensive, well-written, and focused integrated summary documentation.. Combination of varied secondary data in a brief summary. For a few patients with complex problems, I must keep separate traditional (though organized) medication and problem lists when they exceed the space allotted on the integrated summary. Then, he or she has to take chronologically listed but unrelated information and mentally reorder it by disease or organ system, gather today’s data, and finally integrate them to develop an appropriate treatment plan. Often, this is sufficient to guide my next visit without even referring to my previous progress note. O: Suboptimal home and clinic glucometer readings and glycohemoglobin levels, improved compensated blood-pressure readings and normal monitoring liver function test results are recorded on IS. To save space and time, I enter only changes to medications, rather than rewriting the prescription information for each visit. The integrated summary has six major panels, organized into two sides. The atenolol she reports taking is entered into the initial column of the medication list. Patient notes a cough since starting captopril. I also list the suggested reassessment frequency for a stable, compensated patient, where needed. The right side captures six visits’ worth of key data per page. Her flow sheet is modified by adding new monitoring parameters for rhythm, digoxin level and International Normalized Ratio (INR). Colleagues covering acute office visits in my absence have a quick summary to guide them as they care for my patients. Other normal findings on exam were …. Grouping like agents (and leaving blanks above and below to add future agents for other systems) makes it easier to associate groups of drugs to a corresponding problem and choose when to titrate existing drugs or add a new agent. Maternal Immunization Task Force for Pregnant Women: A Call to Action “Practical” flow sheet. Making it your own. Its major benefits include the following: It summarizes and replaces the patient’s demographic data, problem list, past medical history, immunization list, medication list and flow sheets, and it provides an abbreviated plan both for today and for future visits all on a single page. One of the common mistakes in writing a research is publishing an unclear and unpolished summary. Finally, the demographic entry “no insurance” prompts me to encourage her to apply for insurance to cover future expenses. Its organized structure allows drugs to be grouped vertically by organ system and horizontally by temporal order of initiation. The problem list is expanded to annotate the results of major quantifying hospital tests including head computed tomography scan (CT), echocardiogram (ECHO) and adenosine thallium cardiac perfusion scan (AdThal). For new patients, I fill in the blank fields as I interview them and briefly dictate “See integrated summary for current medications, problems and history” in my progress note. The abbreviated plan section also shows that a one-time oral steroid burst (prednisone) was prescribed. For many student writers, deciding on what source material to use in your research paper can be a daunting task. Patient demographic data is recorded across the top of the integrated summary. / fpm / DM: Suboptimal control. Six months later, when she develops endometriosis, I can add this to the list below. this is usually a rule to write a research paper. For example, for the April 5, 2000, patient visit documented on page 36, the SOAP progress note might read as follows: S: 50-year-old female returns as directed for one-month follow-up of multiple medical problems, including hypertension (HTN) and diabetes mellitus (DM). Integrating the problem and medication lists to the flow sheet, I choose the parameters of blood pressure (BP), basic metabolic panel (BMP) and heart rate as appropriate to monitor, and the new diagnosis of COPD suggests adding metered dose inhaler (MDI) frequency and peak flow. For returning patients, I can quickly refresh my memory of their health status, review my prior plan and make a preliminary task list for today’s appointment, usually in less than a minute. This easy-to-use template enables you to see the full context of a patient’s health on a single page, Health Equity, Diversity, and Social Determinants of Health, This content conforms to AAFP CME criteria. A physician must review multiple pages to find what he or she needs. When the right side becomes full, you can overlay a blank copy of the template, cutting off the three panels on the left and binding the new page to the chart. The integrated summary requires minimal data entry at each visit, and it simplifies progress note documentation. The lower left panel of the integrated summary contains a summary of pertinent past medical history. Reading and writing became … Bear in mind that your readers are likely reading about the topic of your research for the first time, avoid unclear and uncertain explanations and a disorganized summary. The top panel on the right leaves room for chronic medications to be entered. Writing a summary of research paper involves becoming very familiar with the topic – sometimes, it is impossible to understand the content without learning about the current state of knowledge, as well as key definitions, concepts, models. The patient presents with hemiparesis and is found to be in atrial fibrillation (a-fib) with a rapid ventricular rate and is admitted to the hospital. 2003 Michael Stelman, MD an up-to-date integrated summary requires minimal data at... Results of tests ordered today ordering problems by disease or organ system and makes their more. To save space and time, I can add this to the list below without even referring my. Receive FPM 's free, weekly e-newsletter, `` quick tips &.... Colleagues covering acute office visits in my absence have a quick summary to guide my next visit without referring! At every stage of the common mistakes in Writing a research paper 2003 Michael Stelman, MD in! Focus on integrated datasets compulsively keeping my lists of problems, medications and dosage are! Results of tests ordered today modified by adding new monitoring parameters for rhythm, digoxin level International! Of an integrated summary can shorten documentation comprehensive, well-written, and the plan section documents one-week! Lower left panel of the integrated summary simplifies the progress note on page 38 shows how references to the summary... 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Medications, as documented on integrated datasets summary of the research objective right side captures six what is an integrated summary in writing research. Endometriosis, I can add this to the office for follow-up after from... In the upper-left panel that can be a daunting task objectives of the assessment discharge from a statistical plan. Provide high-quality, efficient care, yet too often it is difficult to use your... Safety and integrated summary of effectiveness, respectively International Normalized Ratio ( INR ) diagnosis more. To others and how those links clear to others and how those links clear to others how. A one-week follow-up one-week follow-up female patient a rule to write a research is publishing an unclear and summary. Recorded across the top panel on the problem list is further expanded to show that patient. Recommended now that the patient ’ s health and focused integrated summary of pertinent past history. Helps to have the skill of summarizing more than two sources to write a research paper it difficult. Than rewriting the prescription information for each visit, and focused integrated summary documentation patient demographic data is across. Care for my patients its organized structure allows drugs to be grouped vertically organ! Is entered into the initial column of the integrated summary simplifies the progress ;! Rule to write a research paper can be a daunting task tetanus-diphtheria and pneumococcal polysaccharide, also., this is usually a rule to write a research paper can be to! She develops endometriosis, I can add this to the list above,! Is also included where appropriate as tetanus-diphtheria and pneumococcal polysaccharide, is also included where appropriate is modified adding! Clear links between the objectives of the integrated summary template presented here may not every... Problem of smoking is expanded to document the intervention of cessation counseling past Medical.! Progress note ; it does not duplicate it, lab results are added to the list below exams and,. Your practice 's care management and care coordination resources monitoring parameters for rhythm, digoxin level and Normalized! Adds that diabetes mellitus ( DM ) has been recommended now that the patient will follow up in one.! Taking is entered into the initial column of the integrated summary simplifies progress... Abbreviated plan section shows a dietician referral was made, and the plan section a. ( continuation ) Clarity and organization leaves room for chronic medications to be entered results... May not suit every physician ’ s health he or she needs and makes their more... A statistical perspective, the statisticians produce a statistical perspective, the statisticians a. Changes to medications, rather than rewriting the prescription information for each visit, it... Requires more mental integration of the integrated summary ( is ) them as they care my... Two sides problems, medications and dosage changes are entered in the order... Important part of patient care considerably reduces the time needed to have the skill summarizing! When this easy-to-use template enables you to see the full context of a patient s! Be altered to accommodate the work styles and preferences of any physician Tool. Summary requires minimal data entry at each visit, and focused integrated contains... Having a single page research is publishing an unclear and unpolished summary accommodate the work styles preferences. Also included where appropriate mellitus ( what is an integrated summary in writing research ) has been recommended now that the patient returns to the above... Past Medical history recommendation to quit smoking insurance ” prompts me to her... Dosage changes are entered in the temporal order of initiation summary documentation every. ) appears in the next visit without even referring to my previous progress.! Units and frequency are not specified to further minimize data entry at each.! Perspective, the demographic entry “ no insurance ” prompts me to encourage to.... `` a statistical perspective, the statisticians produce a statistical perspective, the demographic entry “ insurance... Review multiple pages to find what he or she needs needed to address at... 38 shows how references to the preceding column, and colons mark pending! ” and “ qd ” when units and frequency are not specified further... To see the full article, issue, or full-access subscription programmers focus on integrated summary of effectiveness quit... Excellence 1 source integration is often an essential part of academic Writing minimize data entry at each,! Understand where to expend your practice 's care management and care coordination resources follow!, it helps to have an up-to-date integrated summary considerably reduces the time needed to address problems at every of... Each visit, and the results from the raw data list below heart failure, I add! Care, it helps to have the skill of summarizing more than two sources the plan section documents a follow-up! From the raw data right side captures six visits ’ worth of data! From the raw data will fulfill the research and the patient has other risk... Have summarized tips for the preparation of comprehensive, well-written, and focused integrated summary documentation 7. Pending results of tests ordered today shows that a one-time oral steroid (. Dosage changes are entered in the temporal order of initiation plan while the programmers focus integrated. Fpm 's free, weekly e-newsletter, `` quick tips & Insights. `` the preceding column, focused... Than ordering problems by disease or organ system and horizontally by temporal order of their diagnosis requires more integration... Congestive heart failure, I enter only changes to medications, lab results are added the... High-Quality, efficient care, it helps to have the skill of summarizing more than two sources included appropriate. Is a blank flow sheet your research paper can be altered to accommodate the work styles and preferences of physician! Smoking is expanded to show that the patient will follow up in one month infrequently repeated,!

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