what is the clinical presentation

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Clinical Presentation

Clinical considerations for care of children and adults with confirmed COVID-19

‹   View Table of Contents

• The clinical presentation of COVID-19 ranges from asymptomatic to critical illness.
• An infected person can transmit SARS-CoV-2, the virus that causes COVID-19, before the onset of symptoms. Symptoms can change over the course of illness and can progress in severity.
• Uncommon presentations of COVID-19 can occur, might vary by the age of the patient, and are a challenge to recognize.
• In adults, age is the strongest risk factor for severe COVID-19. The risk of severe COVID-19 increases with increasing age especially for persons over 65 years and with increasing number of certain underlying medical conditions .

Incubation Period

Data suggest that incubation periods may differ by SARS-CoV-2 variant. Meta-analyses of studies published in 2020 identified a pooled mean incubation period of 6.5 days from exposure to symptom onset. (1) A study conducted during high levels of Delta variant transmission reported an incubation period of 4.3 days, (2) and studies performed during high levels of Omicron variant transmission reported a median incubation period of 3–4 days. (3,4)

Presentation

People with COVID-19 may be asymptomatic or may commonly experience one or more of the following symptoms (not a comprehensive list) (5) :

• Fever or chills
• Shortness of breath or difficulty breathing
• Myalgia (Muscle or body aches)
• New loss of taste or smell
• Sore throat
• Congestion or runny nose
• Nausea or vomiting

The clinical presentation of COVID-19 ranges from asymptomatic to severe illness, and COVID-19 symptoms may change over the course of illness. COVID-19 symptoms can be difficult to differentiate from and can overlap with other viral respiratory illnesses such as influenza(flu) and respiratory syncytial virus (RSV) . Because symptoms may progress quickly, close follow-up is needed, especially for:

• older adults
• people with disabilities
• people with immunocompromising conditions, and
• people with medical conditions that place them at greater risk for severe illness or death.

The NIH COVID-19 Treatment Guidelines  group SARS-CoV-2 infection into five categories based on severity of illness:

• Asymptomatic or pre-symptomatic infection : people who test positive for SARS-CoV-2 using a virologic test (i.e., a nucleic acid amplification test [NAAT] or an antigen test) but who have no symptoms that are consistent with COVID-19.
• Mild illness : people who may have any of the various signs and symptoms of COVID-19 but who do not have shortness of breath, dyspnea, or abnormal chest imaging.
• Moderate illness : people who have evidence of lower respiratory disease during clinical assessment or imaging and who have an oxygen saturation (SpO 2 ) ≥94% on room air at sea level.
• Severe illness : people who have oxygen saturation <94% on room air at sea level, a ratio of arterial partial pressure of oxygen to fraction of inspired oxygen (PaO 2 /FiO 2 ) <300 mm Hg, a respiratory rate >30 breaths/min, or lung infiltrates >50%
• Critical illness : people who have respiratory failure, septic shock, or multiple organ dysfunction.

Asymptomatic and presymptomatic presentation

Studies have documented SARS-CoV-2 infection in people who never develop symptoms (asymptomatic presentation) and in people who are asymptomatic when tested but develop symptoms later (presymptomatic presentation). ( 6,7 ) It is unclear what percentage of people who initially appear asymptomatic progress to clinical disease.   Multiple publications have reported cases of people with abnormalities on chest imaging that are consistent with COVID-19 very early in the course of illness, even before the onset of symptoms or a positive COVID-19 test. (9)

Radiographic Considerations and Findings

Chest radiographs of patients with severe COVID-19 may demonstrate bilateral air-space consolidation. (23)  Chest computed tomography (CT) images from patients with COVID-19 may demonstrate bilateral, peripheral ground glass opacities and consolidation. (24,25)  Less common CT findings can include intra- or interlobular septal thickening with ground glass opacities (hazy opacity) or focal and rounded areas of ground glass opacity surrounded by a ring or arc of denser consolidation (reverse halo sign). (24)

Multiple studies suggest that abnormalities on CT or chest radiograph may be present in people who are asymptomatic, pre-symptomatic, or before RT-PCR detection of SARS-CoV-2 RNA in nasopharyngeal specimens. (25)

Common COVID-19 symptoms

Fever, cough, shortness of breath, fatigue, headache, and myalgia are among the most commonly reported symptoms in people with COVID-19. (5) Some people with COVID-19 have gastrointestinal symptoms such as nausea, vomiting, or diarrhea, sometimes prior to having fever or lower respiratory tract signs and symptoms. (10) Loss of smell and taste can occur, although these symptoms are reported to be less common since Omicron began circulating, as compared to earlier during the COVID-19 pandemic. (11,19-21) People can experience SARS-CoV-2 infection (asymptomatic or symptomatic), even if they are up to date with their COVID-19 vaccines or were previously infected. (8)

Several studies have reported ocular symptoms associated with SARS-CoV-2 infection, including redness, tearing, dry eye or foreign body sensation, discharge or increased secretions, and eye itching or pain. (13)

A wide range of dermatologic manifestations have been associated with COVID-19; timing of skin manifestations in relation to other COVID-19 symptoms and signs is variable. (14) Some skin manifestations may be associated with increased disease severity. (15) Images of cutaneous findings in COVID-19 are available from the American Academy of Dermatology .

Uncommon COVID-19 symptoms

Less common presentations of COVID-19 can occur. Older adults may present with different symptoms than children and younger adults. Some older adults can experience SARS-CoV-2 infection accompanied by delirium, falls, reduced mobility or generalized weakness, and glycemic changes. ( 12)

Transmission

People infected with SARS-CoV-2 can transmit the virus even if they are asymptomatic or presymptomatic. ( 16) Peak transmissibility appears to occur early during the infectious period (prior to symptom onset until a few days after), but infected persons can shed infectious virus up to 10 days following infection. (22 ) Both vaccinated and unvaccinated people can transmit SARS-CoV-2. ( 17,18) Clinicians should consider encouraging all people to take the following prevention actions to limit SARS-CoV-2 transmission:

• stay up to date with COVID-19 vaccines,
• test for COVID-19 when symptomatic or exposed to someone with COVID-19, as recommended by CDC,
• wear a high-quality mask  when recommended,
• avoiding contact with individuals who have suspected or confirmed COVID-19,
• improving ventilation when possible,
• and follow basic health and hand hygiene guidance .

Clinicians should also recommend that people who are infected with SARS-CoV-2, follow CDC guidelines  for isolation.

Table of Contents

• › Clinical Presentation
• Clinical Progression, Management, and Treatment
• Special Clinical Considerations
• Bhaskaran K, Bacon S, Evans SJ, et al. Factors associated with deaths due to COVID-19 versus other causes: population-based cohort analysis of UK primary care data and linked national death registrations within the OpenSAFELY platform. Lancet Reg Health Eur. Jul 2021;6:100109. doi:10.1016/j.lanepe.2021.100109
• Kim L, Garg S, O'Halloran A, et al. Risk Factors for Intensive Care Unit Admission and In-hospital Mortality among Hospitalized Adults Identified through the U.S. Coronavirus Disease 2019 (COVID-19)-Associated Hospitalization Surveillance Network (COVID-NET). Clin Infect Dis. Jul 16 2020;doi:10.1093/cid/ciaa1012
• Kompaniyets L, Pennington AF, Goodman AB, et al. Underlying Medical Conditions and Severe Illness Among 540,667 Adults Hospitalized With COVID-19, March 2020-March 2021. Preventing chronic disease. Jul 1 2021;18:E66. doi:10.5888/pcd18.210123
• Ko JY, Danielson ML, Town M, et al. Risk Factors for COVID-19-associated hospitalization: COVID-19-Associated Hospitalization Surveillance Network and Behavioral Risk Factor Surveillance System. Clin Infect Dis. Sep 18 2020;doi:10.1093/cid/ciaa1419
• Wortham JM, Lee JT, Althomsons S, et al. Characteristics of Persons Who Died with COVID-19 - United States, February 12-May 18, 2020. MMWR Morb Mortal Wkly Rep. Jul 17 2020;69(28):923-929. doi:10.15585/mmwr.mm6928e1
• Yang X, Zhang J, Chen S, et al. Demographic Disparities in Clinical Outcomes of COVID-19: Data From a Statewide Cohort in South Carolina. Open Forum Infect Dis. Sep 2021;8(9):ofab428. doi:10.1093/ofid/ofab428
• Rader B.; Gertz AL, D.; Gilmer, M.; Wronski, L.; Astley, C.; Sewalk, K.; Varrelman, T.; Cohen, J.; Parikh, R.; Reese, H.; Reed, C.; Brownstein J. Use of At-Home COVID-19 Tests — United States, August 23, 2021–March 12, 2022. MMWR Morb Mortal Wkly Rep. April 1, 2022;71(13):489–494. doi:http://dx.doi.org/10.15585/mmwr.mm7113e1
• Pingali C, Meghani M, Razzaghi H, et al. COVID-19 Vaccination Coverage Among Insured Persons Aged >/=16 Years, by Race/Ethnicity and Other Selected Characteristics - Eight Integrated Health Care Organizations, United States, December 14, 2020-May 15, 2021. MMWR Morb Mortal Wkly Rep. Jul 16 2021;70(28):985-990. doi:10.15585/mmwr.mm7028a1
• Wiltz JL, Feehan AK, Molinari NM, et al. Racial and Ethnic Disparities in Receipt of Medications for Treatment of COVID-19 - United States, March 2020-August 2021. MMWR Morb Mortal Wkly Rep. Jan 21 2022;71(3):96-102. doi:10.15585/mmwr.mm7103e1
• Murthy NC, Zell E, Fast HE, et al. Disparities in First Dose COVID-19 Vaccination Coverage among Children 5-11 Years of Age, United States. Emerg Infect Dis. May 2022;28(5):986-989. doi:10.3201/eid2805.220166
• Saelee R, Zell E, Murthy BP, et al. Disparities in COVID-19 Vaccination Coverage Between Urban and Rural Counties - United States, December 14, 2020-January 31, 2022. MMWR Morb Mortal Wkly Rep. Mar 4 2022;71(9):335-340. doi:10.15585/mmwr.mm7109a2
• Burki TK. The role of antiviral treatment in the COVID-19 pandemic. Lancet Respir Med. Feb 2022;10(2):e18. doi:10.1016/S2213-2600(22)00011-X
• Jayk Bernal A, Gomes da Silva MM, Musungaie DB, et al. Molnupiravir for Oral Treatment of Covid-19 in Nonhospitalized Patients. N Engl J Med. Feb 10 2022;386(6):509-520. doi:10.1056/NEJMoa2116044
• Bai Y, Du Z, Wang L, et al. Public Health Impact of Paxlovid as Treatment for COVID-19, United States. Emerg Infect Dis 2024;30(2) (In eng). DOI: 10.3201/eid3002.230835.
• Najjar-Debbiny R, Gronich N, Weber G, et al. Effectiveness of Paxlovid in Reducing Severe Coronavirus Disease 2019 and Mortality in High-Risk Patients. Clin Infect Dis 2023;76(3):e342-e349. (In eng). DOI: 10.1093/cid/ciac443.
• Shah MM, Joyce B, Plumb ID, et al. Paxlovid Associated with Decreased Hospitalization Rate Among Adults with COVID-19 - United States, April-September 2022. MMWR Morb Mortal Wkly Rep 2022;71(48):1531-1537. (In eng). DOI: 10.15585/mmwr.mm7148e2.
• Dryden-Peterson S, Kim A, Kim AY, et al. Nirmatrelvir Plus Ritonavir for Early COVID-19 in a Large U.S. Health System : A Population-Based Cohort Study. Ann Intern Med 2023;176(1):77-84. (In eng). DOI: 10.7326/m22-2141.
• Lewnard JA, McLaughlin JM, Malden D, et al. Effectiveness of nirmatrelvir-ritonavir in preventing hospital admissions and deaths in people with COVID-19: a cohort study in a large US health-care system. Lancet Infect Dis 2023;23(7):806-815. (In eng). DOI: 10.1016/s1473-3099(23)00118-4.
• Hammond J, Leister-Tebbe H, Gardner A, et al. Oral Nirmatrelvir for High-Risk, Nonhospitalized Adults with Covid-19. N Engl J Med 2022;386(15):1397-1408. (In eng). DOI: 10.1056/NEJMoa2118542.
• Arbel R, Wolff Sagy Y, Hoshen M, et al. Nirmatrelvir Use and Severe Covid-19 Outcomes during the Omicron Surge. N Engl J Med 2022;387(9):790-798. (In eng). DOI: 10.1056/NEJMoa2204919.
• Skarbinski J, Wood M, Chervo T, et al. Risk of severe clinical outcomes among persons with SARS-CoV-2 infection with differing levels of vaccination during widespread Omicron (B.1.1.529) and Delta (B.1.617.2) variant circulation in Northern California: A retrospective cohort study. Lancet Reg Health Am 2022;12:100297. https://dx.doi.org/10.1016/j.lan.
• Sjoding MW, Dickson RP, Iwashyna TJ, Gay SE, Valley TS. Racial Bias in Pulse Oximetry Measurement. N Engl J Med. Dec 17 2020;383(25):2477-2478. doi:10.1056/NEJMc2029240
• Jordan TB, Meyers CL, Schrading WA, Donnelly JP. The utility of iPhone oximetry apps: A comparison with standard pulse oximetry measurement in the emergency department. Am J Emerg Med. May 2020;38(5):925-928. doi:10.1016/j.ajem.2019.07.020
• Iuliano AD, Brunkard JM, Boehmer TK, et al. Trends in Disease Severity and Health Care Utilization During the Early Omicron Variant Period Compared with Previous SARS-CoV-2 High Transmission Periods - United States, December 2020-January 2022. MMWR Morb Mortal Wkly Rep. Jan 28 2022;71(4):146-152. doi:10.15585/mmwr.mm7104e4
• Taylor CA, Whitaker M, Anglin O, et al. COVID-19-Associated Hospitalizations Among Adults During SARS-CoV-2 Delta and Omicron Variant Predominance, by Race/Ethnicity and Vaccination Status - COVID-NET, 14 States, July 2021-January 2022. MMWR Morb Mortal Wkly Rep. Mar 25 2022;71(12):466-473. doi:10.15585/mmwr.mm7112e2
• Johnson AG, Amin AB, Ali AR, et al. COVID-19 Incidence and Death Rates Among Unvaccinated and Fully Vaccinated Adults with and Without Booster Doses During Periods of Delta and Omicron Variant Emergence - 25 U.S. Jurisdictions, April 4-December 25, 2021. MMWR Morb Mortal Wkly Rep. Jan 28 2022;71(4):132-138. doi:10.15585/mmwr.mm7104e2
• Danza P, Koo TH, Haddix M, et al. SARS-CoV-2 Infection and Hospitalization Among Adults Aged >/=18 Years, by Vaccination Status, Before and During SARS-CoV-2 B.1.1.529 (Omicron) Variant Predominance - Los Angeles County, California, November 7, 2021-January 8, 2022. MMWR Morb Mortal Wkly Rep. Feb 4 2022;71(5):177-181. doi:10.15585/mmwr.mm7105e1

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• How to present...

How to present clinical cases

• Related content
• Peer review
• Ademola Olaitan , medical student 1 ,
• Oluwakemi Okunade , final year medical student 1 ,
• Jonathan Corne , consultant physician 2
• 1 University of Nottingham
• 2 Nottingham University Hospitals

Presenting a patient is an essential skill that is rarely taught

Clinical presenting is the language that doctors use to communicate with each other every day of their working lives. Effective communication between doctors is crucial, considering the collaborative nature of medicine. As a medical student and later as a doctor you will be expected to present cases to peers and senior colleagues. This may be in the setting of handovers, referring a patient to another specialty, or requesting an opinion on a patient.

A well delivered case presentation will facilitate patient care, act a stimulus for timely intervention, and help identify individual and group learning needs. 1 Case presentations are also used as a tool for assessing clinical competencies at undergraduate and postgraduate level.

Medical students are taught how to take histories, examine, and communicate effectively with patients. However, we are expected to learn how to present effectively by observation, trial, and error.

Principles of presentation

Remember that the purpose of the case presentation is to convey your diagnostic reasoning to the listener. By the end of your presentation the examiner should have a clear view of the patient’s condition. Your presentation should include all the facts required to formulate a management plan.

There are no hard and fast rules for a perfect presentation, rather the content of each presentation should be determined by the case, the context, and the audience. For example, presenting a newly admitted patient with complex social issues on a medical ward round will be very different from presenting a patient with a perforated duodenal ulcer who is in need of an emergency laparotomy.

Whether you’re presenting on a busy ward round or during an objective structured clinical examination (OSCE), it is important that you are concise yet get across all the important points. Start by introducing patients with identifiers such as age, sex, and occupation, and move on to the complaint that they presented with or the reason that they are in hospital. The presenting complaint is an important signpost and should always be clearly stated at the start of the presentation.

Presenting a history

After you’ve introduced the patient and stated the presenting complaint, you can proceed in a chronological approach—for example, “Mr X came in yesterday with worsening shortness of breath, which he first noticed four days ago.” Alternatively you can discuss each of the problems, starting with the most pertinent and then going through each symptom in turn. This method is especially useful in patients who have several important comorbidities.

The rest of the history can then be presented in the standard format of presenting complaint, history of presenting complaint, medical history, drug history, family history, and social history. Strictly speaking there is no right or wrong place to insert any piece of information. However, in some instances it may be more appropriate to present some information as part of the history of presenting complaints rather than sticking rigidly to the standard format. For example, in a patient who presents with haemoptysis, a mention of relevant risk factors such as smoking or contacts with tuberculosis guides the listener down a specific diagnostic pathway.

Apart from deciding at what point to present particular pieces of information, it is also important to know what is relevant and should be included, and what is not. Although there is some variation in what your seniors might view as important features of the history, there are some aspects which are universally agreed to be essential. These include identifying the chief complaint, accurately describing the patient’s symptoms, a logical sequence of events, and an assessment of the most important problems. In addition, senior medical students will be expected to devise a management plan. 1

The detail in the family and social history should be adapted to the situation. So, having 12 cats is irrelevant in a patient who presents with acute appendicitis but can be relevant in a patient who presents with an acute asthma attack. Discerning the irrelevant from the relevant is not always easy, but it comes with experience. 2 In the meantime, learning about the diseases and their associated features can help to guide you in the things you need to ask about in your history. Indeed, it is impossible to present a good clinical history if you haven’t taken a good history from the patient.

Presenting examination findings

When presenting examination findings remember that the aim is to paint a clear picture of the patient’s clinical status. Help the listener to decide firstly whether the patient is acutely unwell by describing basics such as whether the patient is comfortable at rest, respiratory rate, pulse, and blood pressure. Is the patient pyrexial? Is the patient in pain? Is the patient alert and orientated? These descriptions allow the listener to quickly form a mental picture of the patient’s clinical status. After giving an overall picture of the patient you can move on to present specific findings about the systems in question. It is important to include particular negative findings because they can influence the patient’s management. For example, in a patient with heart failure it is helpful to state whether the patient has a raised jugular venous pressure, or if someone has a large thyroid swelling it is useful to comment on whether the trachea is displaced. Initially, students may find it difficult to know which details are relevant to the case presentation; however, this skill becomes honed with increasing knowledge and clinical experience.

Presenting in an exam

Although the same principles as presenting in other situations also apply in an exam setting, the exam situation differs in the sense that its purpose is for you to show your clinical competence to the examiner.

It’s all about making a good impression. Walk into the room confidently and with a smile. After taking the history or examining the patient, turn to the examiner and look at him or her before starting to present your findings. Avoid looking back at the patient while presenting. A good way to avoid appearing fiddly is to hold your stethoscope behind your back. You can then wring to your heart’s content without the examiner sensing your imminent nervous breakdown.

Start with an opening statement as you would in any other situation, before moving on to the main body of the presentation. When presenting the main body of your history or examination make sure that you show the examiner how your findings are linked to each other and how they come together to support your conclusion.

Finally, a good summary is just as important as a good introduction. Always end your presentation with two or three sentences that summarise the patient’s main problem. It can go something like this: “In summary, this is Mrs X, a lifelong smoker with a strong family history of cardiovascular disease, who has intermittent episodes of chest pain suggestive of stable angina.”

Improving your skills

The RIME model (reporter, interpreter, manager, and educator) gives the natural progression of the clinical skills of a medical student. 3 Early on in clinical practice students are simply reporters of information. As the student progresses and is able to link together symptoms, signs, and investigation results to come up with a differential diagnosis, he or she becomes an interpreter of information. With further development of clinical skills and increasing knowledge students are actively able to suggest management plans. Finally, managers progress to become educators. The development from reporter to manager is reflected in the student’s case presentations.

The key to improving presentation skills is to practise, practise, and then practise some more. So seize every opportunity to present to your colleagues and seniors, and reflect on the feedback you receive. 4 Additionally, by observing colleagues and doctors you can see how to and how not to present.

Remember the purpose of the presentation

Be flexible; the context should dictate the content of the presentation

Always include a presenting complaint

Present your findings in a way that shows understanding

Have a system

Use appropriate terminology

Additional tips for exams

Start with a clear introductory statement and close with a brief summary

After your summary suggest a working diagnosis and a management plan

Practise, practise, practise, and get feedback

Present with confidence, and don’t be put off by an examiner’s poker face

Be honest; do not make up signs to fit in with your diagnosis

Originally published as: Student BMJ 2010;18:c1539

Competing interests: None declared.

Provenance and peer review: Not commissioned; externally peer reviewed.

See “Medical ward rounds” ( Student BMJ 2009;17:98-9, http://archive.student.bmj.com/issues/09/03/life/98.php ).

• ↵ Green EH, Durning SJ, DeCherrie L, Fagan MJ, Sharpe B, Hershman W. Expectations for oral case presentations for clinical clerks: Opinions of internal medicine clerkship directors. J Gen Intern Med 2009 ; 24 : 370 -3. OpenUrl CrossRef PubMed Web of Science
• ↵ Lingard LA, Haber RJ. What do we mean by “relevance”? A clinical and rhetorical definition with implications for teaching and learning the case-presentation format. Acad Med 1999 ; 74 : S124 -7. OpenUrl CrossRef PubMed Web of Science
• ↵ Pangaro L. A new vocabulary and other innovations for improving descriptive in-training evaluations. Acad Med 1999 ; 74 : 1203 -7. OpenUrl CrossRef PubMed Web of Science
• ↵ Haber RJ, Lingard LA. Learning oral presentation skills: a rhetorical analysis with pedagogical and professional implications. J Gen Intern Med 2001 ; 16 : 308 -14. OpenUrl CrossRef PubMed Web of Science

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Tools for the Patient Presentation

The formal patient presentation.

• Posing the Clinical Question
• Searching the Medical Literature for EBM

Sources & Further Reading

First Aid for the Wards

Lingard L, Haber RJ.  Teaching and learning communications in medicine: a rhetorical approach .  Academic Medicine. 74(5):507-510 1999 May.

Lingard L, Haber RJ.  What do we mean by "relevance"? A clinical and rhetorical definition with implications for teaching and learning the case-presentation format . Academic Medicine. 74(10):S124-S127.

The Oral Presentation (A Practical Guide to Clinical Medicine, UCSD School of Medicine)  http://meded.ucsd.edu/clinicalmed/oral.htm

"Classically, the formal oral presentation is given in 7 minutes or less. Although it follows the same format as a written report, it is not simply regurgitation. A great presentation requires style as much as substance; your delivery must be succinct and smooth. No time should be wasted on superfluous information; one can read about such matters later in your admit note. Ideally, your presentation should be formulated so that your audience can anticipate your assessment and plan; that is, each piece of information should clue the listener into your thinking process and your most likely diagnosis."  [ Le, et al, p. 15 ]

Types of Patient Presentations

New Patient

New patients get the traditional H&P with assessment and plan.  Give the chief complaint and a brief and pertinent HPI.  Next give important PMH, PSH, etc.  The ROS is often left out, as anything important was in the HPI.  The PE is reviewed.  Only give pertinent positives and negatives.  The assessment and plan should include what you think is wrong and, briefly, why.  Then, state what you plan to do for the patient, including labs.  Be sure to know why things are being done: you will be asked.

The follow-up presentation differs from the presentation of a new patient.  It is an abridged presentation, perhaps referencing major patient issues that have been previously presented, but focusing on new information about these issues and/or what has changed. Give the patient’s name, age, date of admission, briefly review the present illness, physical examination and admitting diagnosis.  Then report any new finding, laboratory tests, diagnostic procedures and changes in medications.

The attending physician will ask the patient’s permission to have the medical student present their case.  After making the proper introductions the attending will let the patient know they may offer input or ask questions at any point.  When presenting at bedside the student should try to involve the patient.

Preparing for the Presentation

There are four things you must consider before you do your oral presentation

• Occasion (setting and circumstances)

Ask yourself what do you want the presentation to do

• Present a new patient to your preceptor : the amount of detail will be determined by your preceptor.  It is also likely to reflect your development and experience, with less detail being required as you progress.
• Present your patient at working or teaching rounds : the amount of detail will be determined by the customs of the group. The focus of the presentation will be influenced by the learning objectives of working responsibilities of the group.
• Request a consultant’s advice on a clinical problem : the presentation will be focused on the clinical question being posed to the consultant.
• Persuade others about a diagnosis and plan : a shorter presentation which highlights the pertinent positives and negatives that are germane to the diagnosis and/or plan being suggested.
• Enlist cooperation required for patient care : a short presentation focusing on the impact your audience can have in addressing the patient’s issues.

Preparation

• Patient evaluation : history, physical examination, review of tests, studies, procedures, and consultants’ recommendations.
• Selected reading : reference texts; to build a foundational understanding.
• Literature search : for further elucidation of any key references from selected reading, and to bring your understanding up to date, since reference text information is typically three to seven years old.
• Write-up : for oral presentation, just succinct notes to serve as a reminder or reference, since you’re not going to be reading your presentation.

Knowledge (Be prepared to answer questions about the following)

• Pathophysiology
• Complications
• Differential diagnosis
• Course of conditions
• Diagnostic tests
• Medications
• Essential Evidence Plus

Template for Oral Presentations

Chief Complaint (CC)

The opening statement should give an overview of the patient, age, sex, reason for visit and the duration of the complaint. Give marital status, race, or occupation if relevant.  If your patient has a history of a major medical problem that bears strongly on the understanding of the present illness, include it.  For ongoing care, give a one sentence recap of the history.

History of Present Illness (HPI)

This will be very similar to your written HPI. Present the most important problem first. If there is more than one problem, treat each separately. Present the information chronologically.  Cover one system before going onto the next. Characterize the chief complaint – quality, severity, location, duration, progression, and include pertinent negatives. Items from the ROS that are unrelated to the present problem may be mentioned in passing unless you are doing a very formal presentation. When you do your first patient presentation you may be expected to go into detail.  For ongoing care, present any new complaints.

Review of Systems (ROS)

Most of the ROS is incorporated at the end of the HPI. Items that are unrelated to the present problem may be briefly mentioned.  For ongoing care, present only if new complaints.  

Past Medical History (PMH)

Discuss other past medical history that bears directly on the current medical problem.  For ongoing care, have the information available to respond to questions.

Past Surgical History

Provide names of procedures, approximate dates, indications, any relevant findings or complications, and pathology reports, if applicable.  For ongoing care, have the information available to respond to questions.

Allergies/Medications

Present all current medications along with dosage, route and frequency. For the follow-up presentation just give any changes in medication.  For ongoing care, note any changes.

Smoking and Alcohol (and any other substance abuse)

Note frequency and duration. For ongoing care, have the information available to respond to questions.

Social/Work History

Home, environment, work status and sexual history.  For ongoing care, have the information available to respond to questions.

Family History Note particular family history of genetically based diseases.  For ongoing care, have the information available to respond to questions.

Physical Exam/Labs/Other Tests

Include all significant abnormal findings and any normal findings that contribute to the diagnosis. Give a brief, general description of the patient including physical appearance. Then describe vital signs touching on each major system. Try to find out in advance how thorough you need to be for your presentation. There are times when you will be expected to give more detail on each physical finding, labs and other test results.  For ongoing care, mention only further positive findings and relevant negative findings.

Assessment and Plan

Give a summary of the important aspects of the history, physical exam and formulate the differential diagnosis. Make sure to read up on the patient’s case by doing a search of the literature. 

• Include only the most essential facts; but be ready to answer ANY questions about all aspects of your patient.
• Keep your presentation lively.
• Do not read the presentation!
• Expect your listeners to ask questions.
• Follow the order of the written case report.
• Keep in mind the limitation of your listeners.
• Beware of jumping back and forth between descriptions of separate problems.
• Use the presentation to build your case.
• Your reasoning process should help the listener consider a differential diagnosis.
• Present the patient as well as the illness .
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Effectiveness of Clinical Presentation (CP) Curriculum in teaching clinical medicine to undergraduate medical students: A cross-sectional study.

Saroj adhikari yadav.

1 Patan Academy of Health Sciences, Kathmandu, 44600, Nepal

Sangeeta Poudel

Swotantra gautam.

2 B P Koirala Institute of Health Sciences, Dharan, Nepal

Sanjay Kumar Jaiswal

Samikchya baskota, aaradhana adhikari, binod duwadi, nischit baral, sanjay yadav.

3 Institute of Medicine, Kathmandu, 44600, Nepal

Associated Data

Underlying data.

Figshare: CP Curriculum Raw data updated in Excel and PDF. https://doi.org/10.6084/m9.figshare.18666410.v1 10

This project contains the following underlying data:

• - Analysis and Raw data.xlsx

Extended data

This project contains the following extended data:

• - CP Questionnaire for Faculties.pdf
• - CP Questionnaire for students.pdf
• - CP Surprise exam Questionnaire.pdf

Data are available under the terms of the Creative Commons Attribution 4.0 International license (CC-BY 4.0).

Peer Review Summary

Introduction:  The Clinical Presentation (CP) curriculum was first formulated in 1990 at the University of Calgary, Canada. Since then, it has been adopted at various medical schools, including Patan Academy of Health Sciences (PAHS), a state-funded medical school in a low-income country (LIC), Nepal. This study aims to evaluate the perceived effectiveness of the CP curriculum by students and faculty at PAHS, and test knowledge retention through a surprise non-routine exam administered to students. 

Method:  This is a cross-sectional study to evaluate the efficacy of the CP curriculum in teaching clinical medicine to the first batch of MBBS students of PAHS School of Medicine. Ethical approval was obtained from the Institutional Review Committee (IRC)-PAHS (Ref no std1505911069). Perceived effectiveness was evaluated using a set of questionnaires for faculty and students. A total of 33 students and 34 faculty filled the perception questionnaires. Subsequently, a questionnaire consisting of 50 Multiple Choice Questions (MCQs) from different clinical medicine disciplines was administered to test students’ knowledge retention. Out of 49 students, 38 participated in the surprise non-routine exam.  

Result:  A significantly higher number of faculty preferred the CP curriculum compared to the traditional system of teaching clinical medicine (16 vs 11, Kruskal Wallis: 0.023, ie. P-value < 0.05). A significantly higher number of the students liked and recommended CP curriculum in the clinical year of medical education (20 vs. 13 with p-value < 0.05). In the non-routine surprise exam, two thirds of the students scored 60% or above. 

Conclusion: Both faculty and students perceive that the CP curriculum system is an effective teaching and learning method in medical education, irrespective of their different demographic and positional characteristics. The students’ overall performance was good in surprise, non-routine exams taken without scheduling or reminders.

Introduction

Sir William Osler, considered the father of modern medicine, emphasized the teacher's role in helping students to observe and reason. He recommended abolishing the traditional lecture method of instruction. 1 Medical education is evolving in response to scientific advances and societal needs. 2 A well-organized comprehensive knowledge domain has practical implications in clinical problem solving, and appropriate teaching and learning methods play an important role in achieving the educational goals. 3

Clinical presentation (CP) is a relatively new and innovative approach to teaching medicine. CP engages medical students in their understanding of the disease process from clinical feature to diagnosis. Students begin studying abnormalities of complaints, examination, and laboratory findings; i.e., signs, symptoms, and laboratory investigations which a patient presents to the doctor with. Students then progress towards diagnosis. The underlying philosophy of the CP Curriculum is that: “The reaction of the human body to an infinite number of insults is always finite and stable over time”. 4 For example, if there is any attack on the respiratory system, whether infectious, inflammatory, immunological, traumatic, or iatrogenic; the respiratory system responds through coughing, cyanosis, chest pain, difficulty breathing, noisy breathing, or hemoptysis. 4 Thus, the CP Curriculum aims to help students understand the process of moving from “symptoms to diagnosis.”

The CP curriculum was first formulated in 1990 at the University of Calgary Faculty of Medicine in Canada. 5 The curriculum was adopted and redesigned based on local needs at various medical schools worldwide. Patan Academy of Health Sciences (PAHS), a state-funded medical school in Nepal, has adopted several new and innovative approaches in teaching and learning medicine. The CP Curriculum is one of the several approaches adopted by PAHS. 6

PAHS medical education team assumes that the CP curriculum is better than traditional lecture-based teaching. In this study we are testing the perceived effectiveness of students and faculty, and the level of knowledge among the students trained by the CP curriculum. The level of knowledge was assessed by marks scored by the students in a surprise non-routine exam without prior information. Perceived effectiveness was based on the thinking/perception of the students and faculty on the effectiveness of the CP curriculum. We assume the CP curriculum is at least not inferior to traditional lecture-based teaching.

Study design

This is a cross-sectional study that aims to evaluate the efficacy of the CP curriculum in teaching different disciplines of clinical medicine to undergraduate medical students of PAHS, which is currently the only medical school implementing the CP-curriculum in undergraduate medical education. A new Multiple-Choice Question (MCQ) based questionnaire was designed to evaluate the level of knowledge and two separate questionnaires were developed for faculty to evaluate perception about CP-curriculum.

Study population

All consenting medical students from 2016 of PAHS School of Medicine currently in clinical clerkship years and all clinical sciences faculty who had delivered at least one teaching-session with the CP curriculum to these students were included in the study. Consenting students were asked to fill the questionnaire together in class, whereas faculty were approached personally and asked to complete the questionnaires. Students and faculty who were part of the study team, those who didn’t provide consent, and those who participated in the pilot survey section of the questionnaire developed for this study were excluded. All 34 faculty completed the perception questionnaires, with zero non-response rate. Out of 49 students, 33 completed the perception questionnaires and 38 turned up to the surprise non-routine exam for assessment of knowledge retention.

Ethics and consent

This study was approved by the Institutional Review Committee (Ethical Committee) of Patan Academy of Health Sciences (PAHS), Kathmandu, Nepal (Ref No std1505911069). Written informed consent was obtained from all participants before completing the questionnaire. Students who gave verbal consent were asked to complete the questionnaire together in class. Faculty were approached personally and requested to complete the questionnaires. At the start of each questionnaire, a tick box was used for participants to indicate written consent. Participants were informed verbally and in writing that their names and identifiying information would be kept anonymous, and their data would only be used for research purposes.

Data collection

Three sets of questionnaires were used. The first set of questionnaires were designed to test the perceived effectiveness of the CP curriculum from the faculty perspective. It contained seven questions on background information (age, sex, job position, highest academic degree, etc) and 13 questions on perceived effectiveness.

Similarly, the second set of questionnaires for the students included 11 questions on background information and 15 questions on perceived effectiveness. The perception questionnaire had questions about effectiveness or satisfaction in regard to different aspects of the CP curriculum. Participants had to respond with a tick mark in a Likert scale ranging from one (strongly agree) to five (strongly disagree) for each question.

The third set of questionnaires tested the students' clinical knowledge and contained 50 MCQs from different clinical medicine disciplines. Based on curriculum of the university, there were seven MCQs each from surgery, medicine, pediatrics, obstetrics and gynecology, and two questions each from orthopedics, emergency medicine, general practice, otolaryngology, anesthesiology, dermatology, dentistry, psychiatry, radiology, ophthalmology, and forensic medicine. The questions were randomly selected from the question pool of the Examination section of university. The selected questions were randomly arranged, and a surprise non-routine written exam was conducted with this questionnaire. A maximum time of one hour was provided to solve these 50 questions.

These questionnaires were compiled and discussed in the research group and reviewed by the research advisors to establish content validity. Copies of all three questionnaires can be found under Extended data. 10 They were administered to randomly selected 15 students and 15 faculty in a pilot study to establish the face validity and feasibility. The students and faculty randomly selected for the pilot study were administered the questionnaires to complete. Then they were asked in detail about the questionnaire and any suggestions for revisions or editing needed. The pilot survey was not powered for statistical comparisons. Only a few grammatical corrections were made after review and feedback from the pilot study. Subsequently, the final study was conducted.

The faculty participants were also involved in the development of the CP curriculum at PAHS, hence, responder bias in favor of CP curriculum may be present in this study.

The data collected were digitalized using Epi-Info version 7 software. These raw data were exported to MS-Excel. The excel sheet is made available in the public domain for readers. 10 SPSS version 13.0 was used for statistical test and analysis. Shapiro-Wilk test was used first to test the normality. Non-parametric tests (Mann-Whitney and Kruskal Wallis) was used for normal distribution. Classical ANOVA for equal variance and Welch ANOVA for unequal variance were used after testing the homogeneity of variance, and post-hoc/tukey test was used for significant classical ANOVA results.

In this study, we calculated the total score via forced Likert scale, ranging from 1 (strongly agree) to 5 (strongly disagree) for each respondent determined as the dependent variable, and compared it with other variables i.e., background information. The total score of all the Likert scale questions was calculated, and the normality test was performed, keeping “total score” as the dependent variable. The full dataset can be found under Underlying data. 10

Response from faculty on perceived effectiveness of the CP curriculum

The data of the total score did not follow a normal distribution (Shapiro-Wilk Test, p < 0.05), so a non-parametric test was used to compare the dependent variable. We used Mann-Whitney and Kruskal Wallis tests for the variables containing two groups and more than two groups, respectively.

Among the 34 respondents from the faculty group, 24 (70.59%) were male, and 10 (29.41%) were female. 20 (58.82%) of the faculty respondents were lecturers, and the remaining 14 (41.18%) were senior professors, associate professors, and assistant professors. Out of the 34 respondents, 31 (91.18%) were involved in developing the CP curriculum at PAHS. However, 3 (8.82%) were involved in teaching the curriculum but not in developing the CP curriculum.

As many as 15 (44.12%) respondents favored the CP curriculum system over the traditional system, 11 (32.35%) preferred the traditional teaching system, and 8 (23.53%) preferred both. Overall, the faculty liked the CP curriculum more than the traditional system of teaching clinical medicine (Kruskal Wallis = 0.023, p-value < 0.05). The majority of faculty, 27 (79.41%), would suggest future students to join a medical school that implemented the CP curriculum system rather than the traditional system. Only 12 (35.29%) of them thought that the CP curriculum system should be the sole leading teaching and learning system in clinical medicine, meaning more faculty preferred a hybrid system of both the CP curriculum and the traditional system. However, these differences were not statistically significant (p-value > 0.05).

As shown in Table 1 , a significant number of faculty (p values > 0.05) perceive the CP curriculum to be more effective than the traditional system for teaching clinical medicine to undergraduate medical students. There is no significant difference in the perception of the effectiveness of the CP curriculum among faculty based on academic rank, gender, highest academic degree, or the institution of their residency training (p-value > 0.05). The median number of faculty who perceive the CP curriculum system to be more effective and suggest future students to study medicine in this system rather than the traditional system is higher. But, the difference was not statistically significant (p > 0.05). There was no significant difference in faculty foreseeing the CP curriculum as the leading method of teaching and learning medical education in the future (p > 0.05).

Response from students on perceived effectiveness of the CP curriculum

The normality test shows that the total score data follows a normal distribution (Shapiro-Wilk, p > 0.05) with a mean value of 50.57 with a standard deviation of 8.17. Therefore, we used a parametric test to compare the test variable with others. We subsequently tested for homogeneity of variance: we used classical ANOVA for equal variance, and Welch ANOVA for unequal variance. Finally, if significant classical ANOVA results were obtained, we used the post-hoc/tukey test.

There were 33 respondents, among which 23 (69.70%) were males, and 10 (30.30%) were females. The age group of respondents was between 20 to 30 years. A significantly higher number (20 i.e., 60.61%) of the respondents recommended studying in a medical school implementing CP curriculum (p < 0.05). No significant differences were seen between educational or geographical backgrounds and scholarship categories (p > 0.05) as shown in Table 2 .

Assessment for knowledge retention of the students

An hourly surprise non-routine written exam was conducted to test the knowledge of the students. A copy of this exam can be found under Extended data. 10 The exam included 50 MCQs from different disciplines of clinical medicine. The surprise test was conducted without prior reminders, and 38 out of 49 students participated. The findings, as outlined in Table 3 , show that 24 out of 38 (65.79%) of the students scored 60% or higher. The results demonstrate that approximately two-thirds of the students passed the surprise test, indicating good test performance.

The current study shows a higher preference for the CP curriculum by undergraduate medical students and faculty at PAHS for teaching and learning clinical medicine in medical school. These findings further substantiate previous reviews on the principles of teaching methods and the acceptability of the curriculum.

This curriculum was chosen in part because of confidence in the comprehensiveness of the knowledge it encompasses. Equally important was the organization of medical knowledge that this curriculum engenders: each clinical presentation is organized according to a variable number of causal diagnostic categories. Each of these categories is identified by a prototype. Exhaustive lists of diagnoses belonging to a given category are avoided. As students' clinical experiences increase and they encounter more diagnoses, the students can add them to the appropriate causal categories stored in their memories. How the diagnostic prototypes are presented allows students to identify the discriminating features within and between each. The process by which students can compare and contrast the distinctive features of each disease is facilitated. It is so because the CP curriculum is well organized and comprehensive. 3 , 7 Since the CP curriculum is simple to follow and to organize the learning content, students in the CP curriculum also reported less stress due to the volume and complexity of study materials and examinations. 7

Prior studies at the University of Calgary demonstrated a substantial effect size on students’ retention of basic science knowledge while participating in the CP curriculum. 8 Our study conducted on clinical clerkship year participants showed that two-thirds of students achieved 60% (passing scores) or more in the surprise non-routine exam, signifying a high retention of clinical discipline knowledge. Findings from the current study expand on the effectiveness of the curriculum across medical school years with respect to knowledge retention.

A study done among medical students utilizing the CP curriculum showed a favorable response to the use of schema in the CP curriculum. 9 In our study, we could not evaluate the use the schemas of CP to perform clinical assessment in order to reach the appropriate diagnosis. We recommend further studies in this respect. Additionally, long-term knowledge retention was not tested in our study, which could be another important area of investigation.

This study has several other limitations as well. The study was conducted at a single institution, thereby potentially reducing the overall generalizability of the findings. The faculty members recruited as participants for assessing the perceived effectiveness of the curriculum were also involved in the adaptation and development of curriculum at PAHS, hence, potentially increasing responder’s bias in the study by some degree. The cross-sectional nature of the study provides only a limited understanding of the effects of the curriculum over the long term.

Based on this study, we can conclude that both faculty and students perceive the CP curriculum system as an effective teaching and learning method in medicine, irrespective of their demographic and positional characteristics. The findings suggest higher knowledge retention in knowledge by implementing the CP curriculum during clinical clerkship years. Since the 1990s, CP Curriculum has been established as a multidimensional teaching-learning method in many medical school systems. In the evolving medical education world with rapid digitization, massive turnover of medical and education data, and increased use of remote learning methods, a deeper understanding of influencing variables will help effectively utilize this highly valued curriculum.

Data availability

Authors' contributions.

SAY, SKJ, AA, and BD conceptualized and designed the study. All 9 authors; SAY, SJ, SP, SG, SB, AA, BD, NB, and SY contributed to data analysis and interpretation. SAY and SP wrote the first draft of the article. All 9 authors, SAY, SP, SG, SJ, SB, AA, BD, NB, and SY critically revised the manuscript and approved the final version of manuscript for publication.

Acknowledgements

We thank Prof. Dr. Kedar Prasad Baral and Prof. (Associate) Shital Bhandary for their immense help during this research. We thank all respondent faculty and medical students of PAHS for participating in the study.

[version 1; peer review: 1 approved

Funding Statement

The author(s) declared that no grants were involved in supporting this work.

Reviewer response for version 1

1 Health Action and Research, Kathmandu, Kathmandu, Nepal

2 International Agency for Research on Cancer, Lyon, France

Dear author(s),

Thank you for your hard work on this research manuscript. Please find my comments/ queries below.

The research article deals with the effectiveness of Clinical Presentation (CP) curriculum in teaching clinical medicine to undergraduate medical students. CP curriculum is yet to be adopted in many low- and middle-income countries. The results show that the medical students and the faculty were satisfied with the CP curriculum and believed CP as a stand-alone method of teaching as well as in conjunction with traditional methods of teaching could benefit medical students.

Study design:

“This is a cross-sectional study that aims to evaluate the efficacy of the CP curriculum in teaching different disciplines of clinical medicine to undergraduate medical students of PAHS, which is currently the only medical school implementing the CP-curriculum in undergraduate medical education.”

• Is PAHS the only medical school implementing the CP-curriculum in Nepal or worldwide?

Ethics and consent:

“Students who gave verbal consent were asked to complete the questionnaire together in class.”

• Please elaborate on this sentence.
• Was any faculty member present in the class?
• Was the test compulsory or optional?
• Did the students have the right to refuse the test or leave the test in between?

Data collection:

• Was the questionnaire in English?
• How long did the questionnaire take to complete?
• How much time were the respondents given to complete the questionnaire?
• What were the minimum and maximum possible scores (total or based on questionnaire sets)?

I hope the comments are useful and would enable the author(s) to strengthen this study.

Is the work clearly and accurately presented and does it cite the current literature?

If applicable, is the statistical analysis and its interpretation appropriate?

Are all the source data underlying the results available to ensure full reproducibility?

Is the study design appropriate and is the work technically sound?

Are the conclusions drawn adequately supported by the results?

Are sufficient details of methods and analysis provided to allow replication by others?

Reviewer Expertise:

Global health, gerontology, cancer

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above.

Jayadevan Sreedharan

1 Department of Community Medicine, Gulf Medical University, Ajman, United Arab Emirates

Title: Effectiveness of Clinical Presentation (CP) Curriculum in teaching clinical medicine to undergraduate medical students: A cross-sectional study.

This study aimed to assess the perceived effectiveness of students and faculty and the level of knowledge among the students trained by the CP curriculum. The authors assume the CP curriculum is not inferior to traditional lecture-based teaching.

Are sufficient details of methods and analysis provided to allow replication by others?: 

It is not clear why the authors have given MCQ to the faculty (their score is given and statistical test done).

If applicable, is the statistical analysis and its interpretation appropriate?:

The authors mentioned in the article that "Classical ANOVA for equal variance and Welch ANOVA for unequal variance were used after testing the homogeneity of variance, and post-hoc/Tukey test was used for significant classical ANOVA results", where they have used this test is not clear in the manuscript.

The p-value is given in exact value; the importance of p-value is to check whether to accept the null or alternate hypothesis. In the methodology, they mentioned that p-value >0.05 is not significant. Then what more information do the readers get if they include the actual p-value? 

The sample size of this study is very small and the conclusion from this study can not be generalised to the entire population. 

The authors mentioned in the conclusion that "The findings suggest higher knowledge retention in knowledge by implementing the CP curriculum during clinical clerkship years" . How the authors reach this conclusion is unclear.

Epidemiology, Biostatistics, Medical education, Public health

Priyanka Panday

1 California Institute of Behavioral Neurosciences & Psychology, Fairfield, CA, USA

This article focuses on the importance of the clinical presentation (CP) curriculum in a particular institute (Patan Academy of Health Sciences (PAHS)) among medical students and faculty in terms of their preference and performance on a surprise non-routine exam. 

• Cross-sectional study is appropriate as a study design for this article.
• Relevant articles from 2020, 2019, and 2004 have been appropriately cited as references.
• The methods used for data collection, as well as the result of the study has been elaborated in detail to ensure accuracy.
• Results are presented in a tabular form and the conclusion derived coincides with the results indicating the effectiveness of the CP curriculum system as an effective teaching and learning method in medicine.
• As far as the statistical analysis is concerned, it is not my area of expertise. However, p< 0.05 for response of effective implementation of the CP curriculum and the response from faculty is statistically significant.

I cannot comment. A qualified statistician is required.

Endocrine disorders, Heart conditions, Medications, COVID-19, Obstetric conditions, Epilepsy, HIV, etc.

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard.

How to Give an Excellent Medical Presentation

• By Sulaiman Ahmad
• July 22, 2019
• Medical Student , Pre-med
• Self-improvement

In medicine, we are constantly learning from each other. Professors stand in front of lecture halls to teach the fundamental knowledge needed to pass board exams and to treat our patients. Outside of the classroom, medical students, researchers, and physicians attend conferences to communicate ideas and update their colleagues with oral and poster presentations. In the clinic, students and resident physicians relay pertinent patient information to the physician in charge. Eventually, you will find yourself in front of an audience listening to your talk or an attending grading your clinical presentation. First, I will discuss what it takes to make an excellent presentation.  I will then finish this topic by providing guidelines for perfecting different types of presentations.

Critical Elements of an Excellent Presentation

 do some research.

Your audience will consider you an expert on the information you deliver. It is your job to achieve the expected level of comprehension of the topic. After choosing a topic, gather enough background information from diverse but appropriate sources (e.g., journals articles, relevant chapters in textbooks, personal discussion with subject matter experts, online videos).  Your research should provide you with a thorough understanding of the topic and a list of the important facts supporting your take-home message . Any gaps in your knowledge will become evident during your presentation. The goal is to develop confidence in your understanding of the topic and ability to share what you know.

Know Your Audience

Before putting your presentation together, take a moment to assess the baseline understanding of your expected audience . Ultimately your audience should walk away having learned something new. Try to figure out their collective interest, reasons for attending, and prior experience with the topic. Knowing your audience will allow you to focus on information that will keep them engaged and interested. For example, premed students have a different understanding of medical topics than medical students.  A presentation on the same subject should be different for both groups. If your listeners have different levels of expertise, take a moment to explain the fundamental concept, then build up the language and complexity to allow everyone to benefit from the information shared. Your audience is the reason why you are presenting.

Tell a Story

The human brain is wired to remember stories , especially if presented logically. A presentation is about the information shared, but it should also include the presenters’ passion, excitement, and personal style. All topics can be formatted to include characters, a description of the setting, plot, conflict, and a resolution. The story should allow the audience to take a journey with you. The hardest part is identifying the start and endpoint of your story and which details are needed. Make every word count by checking if it adds value to your narrative. Consider using metaphors, real examples, and descriptions that give life to your words .

Practicing your presentation is a vital step in developing an excellent presentation. You can memorize a script. However, memorization can reduce your connection with the audience. But in certain situations, scripts are quick and effective means of communicating important facts. Another approach is drafting bullet points of the main ideas and practicing the natural flow of information . This method allows your personality to shine on stage. To become comfortable speaking, start by practicing on your own . You can also record yourself with a cellphone or tablet and review the recording to evaluate your performance. Next, find a small group to present in front of and ask for their honest assessment . Eventually, your presentation will feel natural, and your stage presence will aid in communicating your main idea.

Q&A Session

Usually, your presentation does not end until after a question and answer session. Most presentations should include approximately five minutes in the end for the audience to ask questions . This part of the presentation allows you to clarify or further explain any part of your presentation. A question can also lead to expanding your presentation beyond what you originally planned to discuss . It is important for you to understand what is being asked and address the specific question directly. And if you do not have an answer, it is okay to admit that you do not know . Questions will force you to be creative and truly test your knowledge of the topic.

Different Types of Presentations

Presentations have many different forms, each with different goals; thus, each form requires a unique approach. In medicine, professors and clinician often provide students with lecture objectives and PowerPoint presentations that guide the students in their hour-long lecture. Conferences are a researcher’s platform to share their lab’s progress and conclusions. The last presentation I will go into is the clinical presentation a student typically performs for the physician in charge.

The main purpose of the lecture is to educate the attendees. We all have had great professors captivate our attention and other experiences that were a complete waste of time. But what makes some lectures better than others? The lecturer’s knowledge on the topic becomes obvious, and their stage presence confirms how comfortable they are with the topic.  If you are tasked with lecturing on a topic or a series, ensure that you have a solid understanding and address your learning objectives in the time allotted . The main concepts should be repeated multiple times throughout the lecture, followed by examples . Your PowerPoint slides should be limited to only main points and images that support your talking points. After difficult concepts are covered, ask questions to gauge your audience’s understanding . It is better to reemphasize a concept before building up to more complex learning objectives.

Research Presentation

Attending a conference is exciting, especially if you are representing your lab with an oral presentation.  It is an opportunity to share your research story, from the point of identifying a question to the process of reaching a conclusion. Realize your audience will include Primary Investigators, post-docs, and Ph.D. students that are also experts in the field . Attempt to grab the audience’s attention from the beginning by providing them with a reason to care. Then continue to explain how your study relates to the published work . After building up the background, address how you arrived at your research question. The most exciting part of your presentation should be explaining your conclusions and the path you took to get there. Finish up strong by discussing the implications of your findings and how they will have an impact in the field . The natural flow of information will come with practice and a deep understanding of your research topic. Presenting as a student usually leads to networking with professors and clinicians that can help you progress in your career.

Patient Presentation

Medical students learn how to take a patient’s history and perform a physical exam, but it is more challenging to reason through your clinical findings and subsequently present to an attending . Your clinical presentation style will change depending on the environment, medical department, and supervising physician . Upon joining a medical team, discuss the expectations and preference with each physician . It may be a good idea to draft a script that can get you started on organizing your patient presentation. The success of your presentation is correlated to your knowledge of the basic sciences and ability to critically assess the patient’s history and physical exam; the more you learn and read, the easier decision making and producing a plan becomes. Another important element is practicing your presentation style until it comes out naturally . Take the time to listen to your peers and experienced colleagues; learn from their mistakes and strengths . After concluding your presentation, ask for feedback and practice implementing the suggestions. You will be the eyes and ears for the physicians in charge, perfecting your patient presentation will help get the care the patients need while making everyone’s job a little easier.

Final remarks

There are some basic steps to achieving an excellent presentation: know the topic well, understand who you’re presenting to, develop a memorable story, and practice until it comes out naturally. A career in medicine is very versatile; you can be at the forefront of the next generation of physicians sharing your experiences or updating the science community with your research conclusions. At the minimum, you will be presenting the patient in the clinic. Thus, presenting is a skill every physician must master.

Sulaiman Ahmad

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Clinical Words to Use in Progress Notes

Salwa Zeineddine

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Effective documentation is a cornerstone of quality patient care. Progress notes serve as a vital tool for clinicians to communicate and collaborate with colleagues, ensuring continuity and providing a comprehensive understanding of a patient's journey.

While progress notes are essential for legal and reimbursement purposes , they also play a crucial role in tracking treatment outcomes and facilitating evidence-based decision-making. To maximize the impact of your care, employing precise and clinically meaningful language is essential.

Using clinical words that accurately capture a patient's symptoms, emotions, and behaviors not only improves communication but also contributes to a more nuanced understanding of their condition.

Precise terminology allows for better collaboration among healthcare professionals, reducing the risk of miscommunication and ensuring appropriate treatment interventions.

As such, this blog post will explore a variety of clinical words to use in your progress notes while providing valuable insights on how to enhance your documentation skills.

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I will be honest, I must admit that I consistently encounter challenges when it comes to crafting my progress notes. I mean, you’ve been there. You know WHAT to write but HOW to write it?

Drawing upon my diverse background of working across various agencies, I humbly acknowledge that I do not possess absolute mastery. However, through diligent effort, I have managed to enhance my proficiency in composing comprehensive notes.

Each one of you probably has a distinct approach to documenting patients’ records, yet I have come to appreciate the following methods as my personal favorites. Hope this can be of help.

Counselor’s Thesaurus

The Counselor's Thesaurus represents a comprehensive compendium of lexicon and eloquent alternatives, meticulously curated to facilitate the discerning clinician in unearthing the precise verbiage, that is in “finding the right words”.

Clinical Words to Describe Affect (Mood or Disposition):

These are words that describe the patient’s underlying experience of emotion or mood, such as: PLACID, PEACEFUL, RESTFUL, TRANQUIL, PREOCCUPIED, ABSORBED, ENGROSSED, LOST IN THOUGHT, PERSONABLE, FRIENDLY, PLEASANT, AFFABLE, AGREEABLE, AMIABLE, PASSIVE, INACTIVE, INERT, UNRESISTANT, ENTHUSIASTIC, ENTHUSED, ARDENT, ZEALOUS, TEARFUL, WEEPY, TEARY, DEPRESSED, DEJECTED, DISPIRITED, DISHEARTENED, CONTROLLED, DETERMINED, REGIMENTED, DISCIPLINED, FLAT, SHALLOW, DULL, SPIRITLESS, BLUNTED, CURT, ABRUPT, BRUSQUE, DETACHED, INDIFFERENT, IMPERSONAL, EUPHORIC, BOUYANT, ELATED, JOYFUL, JOVIAL, MARRY, LIGHTHEARTED, CAREFREE, CHEERFUL, HEARTY, OPTIMISTIC, SMILING, PLACID, QUIET, SOBER, SEDATE, SERIOUS, HOPELESS, DESPERATE…

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Clinical words to describe behavior:.

RECKLESS, IRRESPONSIBLE, RASH, IMPRUDENT, IMPETUOUS, IMPULSIVE, EXCITABLE, ROUSING, HASTY, HURRIED, ABRUPT, UNEXPECTANT, RESTLESS, UNEASY, SPONTANEOUS, SELF-POSSESSED, OVER-CAUTIOUS, SLUGGISH, LETHARGIC, ORGANIZED…

Clinical Words to Describe Cognition (Thought Process):

These refer to both conscious and unconscious processes used to accumulate knowledge such as perceiving, recognizing, conceiving, and reasoning. Examples of words that can be included in your notes: JUDGEMENT, PROBLEM-SOLVING, DECISION MAKING, GOAL SETTING, COMPREHENSION, MEMORY…

Clinical Words to Describe Orientation:

Orientation refers to one’s awareness of the self, the time, the place, and the person one is talking to. Some clinical words that can be used to describe orientation are: FORGETFUL, CONFUSED, DISORIENTED, ORIENTED, DISTRACTIBLE, DETACHED, DISTANT…

Clinical Words to Describe Speech:

Speech can be characterized by an array of descriptors encompassing its multifaceted nature:

• Quantity of speech: This facet delves into the manner in which an individual engages in communication, encompassing traits such as being talkative, spontaneously expressive, expansively communicative, or experiencing paucity or poverty of speech, where minimal expression is observed.
• Rate of speech: This aspect pertains to the tempo at which speech is delivered, encompassing variations that range from rapid and hurried to leisurely and deliberate, or adhering to a normative cadence or experiencing a sense of pressure during speech.
• Volume (tone) of speech: This dimension relates to the auditory qualities of speech, encompassing a spectrum of attributes such as loudness, softness, monotonousness, weakness, or strength in vocal delivery.
• Fluency and rhythm of speech: This facet delves into the smoothness and rhythmic patterns present in speech, encompassing characteristics such as slurred speech, clarity, the presence of appropriately placed inflections, hesitancy, well-articulated delivery, or instances of aphasia.

More on Terminology… Applied to The SOAP Template

To enhance the precision and clarity of your progress notes , it is crucial to employ a variety of clinical words that capture the nuances of a patient's mental health condition. By incorporating effective clinical words, you can provide a comprehensive description of the patient's symptoms, emotions, cognitive functioning, etc. in each of the four sections of the most commonly used SOAP note template. Let's explore some examples of how this be achieved.

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Examples of clinical words to use in the subjective section:, a. symptom description:.

Agitation : Agitation refers to a state of restlessness, increased motor activity, and difficulty sitting still. It is often associated with conditions such as anxiety , mania, or substance withdrawal. Documenting such symptoms helps convey the patient's level of psychological distress and can inform treatment decisions, such as the need for medications to address underlying anxiety or manic symptoms.

Anhedonia : Anhedonia describes the inability to experience pleasure or a diminished interest in activities that were previously enjoyable. It is commonly observed in depression or certain psychotic disorders. By noting such conditions in progress notes using the proper terminology, clinicians can track the patient's response to treatment interventions and gauge the effectiveness of therapeutic strategies aimed at improving pleasure and engagement in daily activities.

Suicidal Ideation : Suicidal ideation involves thoughts or plans related to self-harm or suicide. Documenting suicidal ideation in progress notes and related signs and symptoms is of utmost importance, as it indicates a need for immediate attention and appropriate intervention to ensure patient safety. This information is vital for collaborative care and can guide treatment decisions, such as hospitalization or adjustments to medication regimens.

b. Emotion and Affect:

Euphoria : Euphoria signifies an exaggerated and elevated mood, often associated with manic episodes in bipolar disorder or substance-induced euphoria. Describing euphoria in progress notes provides insights into the patient's emotional state and can help assess the severity of manic symptoms. It aids in treatment planning, such as considering mood stabilizers or addressing substance misuse.

Dysphoria : Dysphoria represents a profound and persistent state of sadness, dissatisfaction, or unease. It is frequently observed in depression, anxiety disorders, or personality disorders. Properly referring to dysphoria in progress notes helps clinicians assess the severity and chronicity of negative emotions, guide treatment decisions, and monitor the effectiveness of interventions aimed at improving mood and emotional well-being.

Flat Affect : Flat affect denotes a reduced range or absence of emotional expression. It is commonly seen in schizophrenia or other psychotic disorders. Properly documenting flat affect in progress notes provides valuable information about the patient's emotional presentation, facilitating accurate diagnostic impressions and guiding treatment strategies , such as antipsychotic medications or psychosocial interventions.

c. Cognitive Functioning:

Disorganized Thinking : Disorganized thinking refers to difficulties in logical reasoning, coherence, or organization of thoughts. It is often observed in conditions such as schizophrenia or bipolar disorder with psychotic features. A proper description of disorganized thinking in progress notes helps clinicians assess the patient's cognitive impairment, guide diagnostic evaluations, and tailor treatment interventions that target cognitive deficits.

Impaired Insight : Impaired insight indicates a lack of awareness or understanding of one's own mental health condition. It can impede treatment adherence or decision-making abilities. Properly documenting impaired insight in progress notes helps track the patient's level of awareness regarding their illness and informs treatment strategies aimed at promoting insight and treatment engagement.

Poor Concentration: Poor concentration describes difficulties in focusing, sustaining attention, or completing tasks. It is seen in conditions such as attention deficit/hyperactivity disorder (ADHD) or depression. Appropriately noting poor concentration in progress notes helps clinicians assess the impact of cognitive symptoms on daily functioning and guides treatment decisions, such as prescribing stimulant medications or implementing cognitive-behavioral strategies to improve attention and concentration.

To note is that those are only a few examples rather than an extensive list of clinical words that can be used in your notes.

Examples of Clinical Words to Use in the Objective Section:

Vital signs:.

• Tachycardia : Rapid heart rate, often indicative of physiological stress or certain medical conditions.
• Hypotension : Low blood pressure, suggesting reduced perfusion and potential cardiovascular instability.
• Hyperthermia : Elevated body temperature, commonly associated with infection or systemic inflammation.

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Physical assessment:.

• Pallor : Abnormally pale skin tone, suggesting reduced blood flow.
• Edema : Excessive accumulation of fluid in tissues, typically presenting as swelling.
• Crepitus : Audible or palpable crackling sounds or sensations, indicating the presence of gas or air in soft tissues.

Neurological Findings:

a. Level of Consciousness :

• Alert and Oriented : Fully awake, aware, and able to respond appropriately to stimuli.
• Obtunded : Reduced alertness and responsiveness, often associated with central nervous system depression.
• Comatose : Profoundly decreased level of consciousness, with no meaningful response to stimuli.

b. Reflexes:

• Hyperreflexia : Exaggerated reflex responses, potentially indicating an upper motor neuron lesion.
• Hyporeflexia : Diminished reflex responses, suggestive of a lower motor neuron dysfunction.
• Clonus : Repetitive, rhythmic contractions and relaxations of a muscle, typically seen in certain neurological conditions.

c. Behavior and Speech:

• Psychomotor Agitation : Restlessness and excessive movement, often accompanied by rapid speech, seen in conditions such as anxiety or mania.
• Psychomotor Retardation : Slowed movement and reduced responsiveness, commonly observed in depression or certain neurological disorders.
• Pressured Speech : Rapid and non-stop speech, often difficult to interrupt, characteristic of manic or hypomanic episodes.

Diagnostic Findings (Laboratory Results):

• Leukocytosis : Elevated white blood cell count, indicating an inflammatory or infectious process.
• Hyponatremia : Low sodium levels in the blood, potentially pointing to fluid imbalances or certain medical conditions.
• Hyperglycemia : High blood sugar levels, frequently associated with diabetes or stress-related conditions.

Examples of Clinical Words to Use in the Assessment and Plan Sections:

• acknowledged the client’s need for improvement in…
• allowed the client to openly express…
• asked the client to be mindful of…
• clarified the expectations for…
• collaborated on/with…
• discussed the client’s current behavior, coping skills, triggers, and treatment plan.
• encouraged the client to express/use mindfulness/make alternative behavioral choices about…
• Educate: Provide information about the patient's diagnosis, treatment options, and self-care strategies.
• Teach: Offering guidance and skills training to enhance coping mechanisms or symptom management.
• Inform: Communicating relevant knowledge about the patient's condition, prognosis, or potential treatment outcomes.
• Cognitive Restructuring: Employing cognitive-behavioral techniques to identify and modify negative or distorted thought patterns.
• Interpersonal Therapy: Focusing on improving interpersonal relationships and resolving conflicts to alleviate symptoms.
• Mindfulness-Based Interventions: Incorporating mindfulness practices to enhance self-awareness and reduce emotional distress.
• Validated: Affirming and acknowledging the patient's experiences, emotions, and struggles.
• Empathized with: Demonstrating understanding and compassion towards the patient's challenges and concerns.
• Actively Listened: Providing undivided attention and receptiveness to the patient's thoughts, feelings, and concerns.
• Consult: Seeking advice or expertise from a specialist in a particular field related to the patient's condition.
• Refer: Directing the patient to another healthcare professional or specialty service for further evaluation or treatment.

Final Thoughts:

We, at Mentalyc , strive for excellence. So, here’s a piece of advice if your goals align with ours. Your progress notes should strike a balance between objective observations and subjective experiences. While objectivity provides measurable and observable information, subjectivity acknowledges the patient's individual experience and perspective. Combining both elements enhances the comprehensiveness of progress notes.

Consider the following strategies while crafting notes:

Objective Language:

• Use standardized rating scales or measurement tools to quantify symptom severity, such as the Hamilton Rating Scale for Depression or the Brief Psychiatric Rating Scale.
• Document observable behaviors, such as changes in sleep patterns, appetite, psychomotor activity, or social interaction.
• Incorporate relevant laboratory findings, imaging results, or diagnostic assessments to support clinical assessments and treatment decisions.

Subjective Language:

• Quote the patient's own words or descriptions of their experiences, providing insights into their subjective perspective.
• Use empathetic and validating language to acknowledge and reflect on the patient's emotional struggles.
• Employ descriptive language or metaphors to capture the patient's subjective experiences, facilitating a deeper understanding of their inner world.

Avoid Jargon and Stigma:

While clinical language is essential in psychiatric progress notes , it is crucial to strike a balance and avoid excessive jargon or stigmatizing terminology. Ensure that the language used is accessible and understandable to all healthcare professionals involved in the patient's care. Avoid stigmatizing or judgmental terms that may perpetuate stereotypes or hinder effective communication. Choose language that promotes empathy, respect, and dignity for the patient.

Ask for Help:

Mentalyc offers a sophisticated solution that empowers you to meticulously shape your progress notes by leveraging our extensive range of templates and assessment tools. Renowned as a frontrunner in the field of electronic health records (EHR) for behavioral health specialties, Mentalyc m delivers an intuitive and resilient charting platform designed to fulfill all your requirements while alleviating the weight of documentation. By embracing our innovative system, you can redirect your attention toward what truly holds significance. Embark on this transformative journey by scheduling a demo today or initiating a free trial to witness firsthand how our cutting-edge solutions can enrich your professional practice.

References:

• American Psychological Association. (2010) . Documentation in psychotherapy. American Psychologist, 65(7), 663–673.
• Ward, K. D. (2006) . Documentation: Charting and legal considerations for mental health professionals. Journal of Psychosocial Nursing and Mental Health Services, 44(11), 16–19.
• Green, B. E., & Tuerk, P. (2014) . A clinician's guide to clinical words. Journal of Mental Health Counseling, 36(3), 240-249.
• Sarmiento, I., Connell, M., & Kesten, K. (2016) . Enhancing the quality of mental health progress notes: A systematic review of the literature. Journal of Psychiatric and Mental Health Nursing, 23(1), 68-80.
• Gibson, K. J., & Rhynas, S. J. (2015) . The use of language in psychiatric nursing practice. Journal of Psychiatric and Mental Health Nursing, 22(2), 99-108.

About the author

Salwa Zeineddine is an expert in the mental health and medical field. She has extensive experience in the medical field, having worked as a medical researcher at the American University of Beirut. She is highly knowledgeable about therapist needs and insurance requirements. Salwa is passionate about helping people understand and manage their mental health, and she is committed to providing the best possible care for her patients. She is an advocate for mental health awareness and works to ensure that everyone has access to the resources they need.

Learn More About Salwa

All examples of mental health documentation are fictional and for informational purposes only.

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The National Kidney Foundation’s 2024 Spring Clinical Meetings Late-Breaking Presentation on New Therapy Shows Promising Results for IgAN Patients

(May 14, New York, NY)  – During a late-breaking abstract presentation at the annual 2024 NKF Spring Clinical Meetings (SCM) tomorrow Dr. Dana Rizk, from the University of Alabama at Birmingham (UAB) Medical Center, will present data on the impact and safety of Fabhalta (iptacopan) in the treatment of patients with IgA nephropathy (IgAN) also known as Berger disease. Iptacopan was approved by the FDA in 2023 for the treatment of another disease entity, paroxysmal nocturnal hemoglobinuria. IgAN is an incurable glomerular disease that can cause chronic kidney disease (CKD) and is a leading cause of end-stage renal disease (ESRD). The presentation entitled, Efficacy and Safety of Iptacopan in Patients with IgAN: Interim Analysis (IA) of the Phase 3 APPLAUSE-IgAN Study will be held at the Long Beach Convention Center, 300 East Ocean Blvd, on Wednesday, May 15 from 2:30 to 4:30 p.m. (PT).

          In the analysis, patients treated with iptacopan in addition to standard supportive care, achieved a 38.3% (p<0.0001) proteinuria reduction (as measured by 24-hour urine protein to creatinine ratio [UPCR]) at 9 months when compared to placebo 1 .) Proteinuria reduction is an increasingly recognized surrogate marker correlating with progression to kidney failure and has been used in IgAN clinical trials to support accelerated approvals 7 . The study also showed that iptacopan was well tolerated by IgAN patients with a favorable safety profile consistent with previously reported data 1,8 .

Quote from Researcher

          “In IgAN, part of the immune system called the alternative complement pathway can become overly activated in the kidneys, which causes an inflammatory response, leading to progressive kidney damage and gradual loss of kidney function. The loss of kidney function, together with potential side effects of IgAN treatments available until recently, significantly impact patients’ lives,” said Professor Dana Rizk, Investigator, APPLAUSE-IgAN Steering Committee Member, and Professor in the UAB Division of Nephrology. “Fabhalta is the first potential treatment for IgAN that specifically targets the alternative complement pathway.”

Highlights of the Study

          APPLAUSE-IgAN is the first Phase III multicenter, randomized, placebo-controlled study to demonstrate significant proteinuria reduction by targeting the complement system in patients with IgAN. This pre-specified interim analysis included 250 patients for the efficacy analysis and 443 for the safety analysis 1 . The APPLAUSE-IgAN study continues in a double-blind fashion until the final analysis of the primary endpoint related to iptacopan's ability to slow IgAN progression by measuring the annualized total estimated glomerular filtration rate (eGFR) slope over 24 months. Those results are expected at study completion in 2025 9,10 .

          The two primary endpoints of the study for the interim and final analysis, respectively, are proteinuria reduction at 9 months as measured by UPCR, and the annualized total eGFR slope over 24 months 9,10 . At the time of final analysis, the following secondary endpoints will also be assessed: the proportion of participants reaching UPCR <1 g/g without receiving corticosteroids/immunosuppressants or other newly approved drugs or initiating new background therapy for treatment of IgAN or initiating kidney replacement therapy (KRT), time from randomization to first occurrence of composite kidney failure endpoint event (reaching either sustained ≥30% decline in eGFR relative to baseline or sustained eGFR <15 mL/min/1.73 m 2  or maintenance dialysis or receipt of kidney transplant or death from kidney failure), change from baseline to 9 months in the fatigue scale measured by the Functional Assessment Of Chronic Illness Therapy-Fatigue questionnaire 9,10 .   

          The main study population enrolled patients with an eGFR ≥30 mL/min/1.73 m 2  and UPCR ≥1 g/g based on a 24 hr urine collection at baseline 9,10 . In addition, a smaller cohort of patients with severe renal impairment (eGFR 20–30 mL/min/1.73 m 2  at baseline) was also enrolled to provide additional information but will not contribute to the main efficacy analyses 9,10 .

          “There is a need for effective, targeted therapies for IgAN patients and the detailed Applause-IgAN study gives valuable, promising insights to healthcare providers and patients living with IgAN,” said NKF President Dr. Sylvia Rosas. “The alternative complement pathway has been implicated in the pathogenesis of IgAN, so it gives patients hope that a novel therapeutic intervention may lead to slowing progression of chronic kidney disease and avoiding kidney failure.” 

          The annual 2024 NKF Spring Clinical Meetings (SCM) will be held in Long Beach, CA from May 14 – 18.

NKF Spring Clinical Meetings

For the past 32 years, nephrology healthcare professionals from across the country have come to NKF’s  Spring Clinical Meetings  to learn about the newest developments related to all aspects of nephrology practice; network with colleagues; and present their research findings. The NKF Spring Clinical Meetings is designed for meaningful change in the multidisciplinary healthcare teams’ skills, performance, and patient health outcomes. It is the only conference of its kind that focuses on translating science into practice for the entire healthcare team. 

About Kidney Disease

In the United States, more than 37 million adults are estimated to have kidney disease, also known as chronic kidney disease (CKD) - and approximately 90 percent don't know they have it. About 1 in 3 adults in the U.S. are at risk for kidney disease. Risk factors for kidney disease include:  diabetes ,  high blood pressure ,  heart disease ,  obesity , and  family history . People of Black or African American, Hispanic or Latino, American Indian or Alaska Native, Asian American, or Native Hawaiian or Other Pacific Islander descent are at increased risk for developing the disease. Black or African American people are about four times as likely as White people to have kidney failure. Hispanics experience kidney failure at about double the rate of White people.

NKF Professional Membership

Healthcare professionals can join NKF to receive access to tools and resources for both patients and professionals, discounts on professional education, and access to a network of thousands of individuals who treat patients with kidney disease. 

• Perkovic V, Kollins D, Renfurm R, et al. Efficacy and Safety of Iptacopan in Patients with IgA Nephropathy: Interim Results from the Phase 3 APPLAUSE-IgAN Study. Presented at the World Congress of Nephrology (WCN); April 15, 2024; Buenos Aires, Argentina.
• Kidney Disease: Improving Global Outcomes (KDIGO) 2021 Clinical Practice Guideline for the Management of Glomerular Diseases.  Kidney Int . 2021;100(4):S1-S276. doi:10.1016/j.kint.2021.05.021
• Rizk DV, Maillard N, Julian BA, et al. The Emerging Role of Complement Proteins as a Target for Therapy of IgA Nephropathy.  Front Immunol . 2019;10:504. doi:10.3389/fimmu.2019.00504
• Medjeral-Thomas NR, O'Shaughnessy MM. Complement in IgA Nephropathy: The Role of Complement in the Pathogenesis, Diagnosis, and Future Management of IgA Nephropathy.  Adv Chronic Kidney Dis . 2020;27(2):111-119. doi:10.1053/j.ackd.2019.12.004
• Boyd JK, Cheung CK, Molyneux K, Feehally J, Barratt J. An Update on the Pathogenesis and Treatment of IgA Nephropathy.  Kidney Int . 2012;81(9):833-843. doi:10.1038/ki.2011.501
• Reich HN, Troyanov SAA, Scholey JW, Cattran DC. Remission of Proteinuria Improves Prognosis in IgA Nephropathy.  J Am Soc Nephrol . 2007;18(12):3177-3183. doi:10.1681/ASN.2007050526
• Thompson A, Carroll K, Inker LA, et al. Proteinuria Reduction as a Surrogate End Point in Trials of IgA Nephropathy.  Clin J Am Soc Nephrol . 2019;14(3):469-481. doi:10.2215/CJN.08600718
• Zhang H, Rizk DV, Perkovic V, et al. Results of a Randomized Double-Blind Placebo-Controlled Phase 2 Study Propose Iptacopan as an Alternative Complement Pathway Inhibitor for IgA Nephropathy.  Kidney Int . 2024;105(1):189-199. doi:10.1016/j.kint.2023.09.027
• Rizk DV, Rovin BH, Zhang H, et al. Targeting the Alternative Complement Pathway with Iptacopan to Treat IgA Nephropathy: Design and Rationale of the APPLAUSE-IgAN Study.  Kidney Int Rep . 2023;8(5):968-979. doi:10.1016/j.ekir.2023.01.041
• ClinicalTrials.gov. NCT04578834. A Multi-Center, Randomized, Double-Blind, Placebo-Controlled, Parallel Group, Phase III Study to Evaluate the Efficacy and Safety of LNP023 in Primary IgA Nephropathy Patients. Available from:  https://clinicaltrials.gov/ct2/show/NCT04578834 . Accessed April 2024.
• Novartis. Novartis receives FDA approval for Fabhalta® (iptacopan), offering superior hemoglobin improvement in the absence of transfusions as the first oral monotherapy for adults with PNH. Available from:  https://www.novartis.com/news/media-releases/novartis-receives-fda-approval-fabhalta-iptacopan-offering-superior-hemoglobin-improvement-absence-transfusions-first-oral-monotherapy-adults-pnh . Accessed April 2024.
• Novartis. Novartis Fabhalta® (iptacopan) receives positive CHMP opinion as first oral monotherapy for adult patients with paroxysmal nocturnal hemoglobinuria (PNH). Available from:  https://www.novartis.com/news/media-releases/novartis-fabhalta-iptacopan-receives-positive-chmp-opinion-first-oral-monotherapy-adult-patients-paroxysmal-nocturnal-hemoglobinuria-pnh . Accessed April 2024.
• McGrogan A, Franssen CF, de Vries CS. The Incidence of Primary Glomerulonephritis Worldwide: A Systematic Review of the Literature.  Nephrol Dial Transplant . 2011;26(2):414-430. doi:10.1093/ndt/gfq665
• Xie J, Kiryluk K, Wang W, et al. Predicting Progression of IgA Nephropathy: New Clinical Progression Risk Score.  PLoS ONE.  2012;7(6):e38904. doi:10.1371/journal.pone.0038904
• Novartis. Novartis completes acquisition of Chinook Therapeutics. Available from:  https://www.novartis.com/news/media-releases/novartis-completes-acquisition-chinook-therapeutics . Accessed April 2024.

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Maia biotechnology abstract accepted for poster presentation at american society of clinical oncology (asco) 2024 annual meeting.

Poster to present new efficacy data from Phase 2 THIO-101 trial in non-small cell lung cancer (NSCLC)

CHICAGO, May 16, 2024 --( BUSINESS WIRE )--MAIA Biotechnology, Inc., (NYSE American: MAIA) ("MAIA", the "Company"), a clinical-stage biopharmaceutical company developing targeted immunotherapies for cancer, today announced that an abstract about its Phase 2 THIO-101 clinical trial named " A phase 2, multicenter, open-label, dose-optimization study evaluating telomere-targeting agent THIO sequenced with cemiplimab in patients with advanced NSCLC: Updated results " was accepted for poster presentation at the American Society of Clinical Oncology (ASCO) 2024 Annual Meeting, to take place May 31-June 4, 2024, in Chicago, Illinois. The poster is scheduled for presentation on June 3, 2024, from 1:30pm to 4:30pm CST.

"We are proud to accept ASCO’s invitation to present at its 2024 Annual Meeting, the most significant gathering of oncology professionals worldwide," said Vlad Vitoc, M.D., MAIA’s Chairman and Chief Executive Officer. "We look forward to revealing the newest efficacy results from THIO-101 and discussing our pioneering telomere targeting science underlying THIO, the first and only cancer treatment of its kind in clinical development."

MAIA’s abstract will be available online at the ASCO Annual Meeting 2024 website during the week prior to the conference start date, and the poster will be published on maiabiotech.com on the day of the presentation, June 3, 2024.

The 2024 ASCO Annual Meeting will feature more than 200 sessions and 5,000 posters complementing the theme, "The Art and Science of Cancer Care: From Comfort to Cure."

Founded in 1964, the American Society of Clinical Oncology is the world's leading professional organization for physicians and oncology professionals caring for people with cancer. Its mission is to conquer cancer through research, education, and promotion of the highest quality, equitable patient care. ASCO’s vision is a world where cancer is prevented or cured, and every survivor is healthy. asco.org

About MAIA Biotechnology, Inc.

MAIA is a targeted therapy, immuno-oncology company focused on the development and commercialization of potential first-in-class drugs with novel mechanisms of action that are intended to meaningfully improve and extend the lives of people with cancer. Our lead program is THIO, a potential first-in-class cancer telomere targeting agent in clinical development for the treatment of NSCLC patients with telomerase-positive cancer cells. For more information, please visit www.maiabiotech.com .

Forward Looking Statements

MAIA cautions that all statements, other than statements of historical facts contained in this press release, are forward-looking statements. Forward-looking statements are subject to known and unknown risks, uncertainties, and other factors that may cause our or our industry’s actual results, levels or activity, performance or achievements to be materially different from those anticipated by such statements. The use of words such as "may," "might," "will," "should," "could," "expect," "plan," "anticipate," "believe," "estimate," "project," "intend," "future," "potential," or "continue," and other similar expressions are intended to identify forward looking statements. However, the absence of these words does not mean that statements are not forward-looking. For example, all statements we make regarding (i) the initiation, timing, cost, progress and results of our preclinical and clinical studies and our research and development programs, (ii) our ability to advance product candidates into, and successfully complete, clinical studies, (iii) the timing or likelihood of regulatory filings and approvals, (iv) our ability to develop, manufacture and commercialize our product candidates and to improve the manufacturing process, (v) the rate and degree of market acceptance of our product candidates, (vi) the size and growth potential of the markets for our product candidates and our ability to serve those markets, and (vii) our expectations regarding our ability to obtain and maintain intellectual property protection for our product candidates, are forward looking. All forward-looking statements are based on current estimates, assumptions and expectations by our management that, although we believe to be reasonable, are inherently uncertain. Any forward-looking statement expressing an expectation or belief as to future events is expressed in good faith and believed to be reasonable at the time such forward-looking statement is made. However, these statements are not guarantees of future events and are subject to risks and uncertainties and other factors beyond our control that may cause actual results to differ materially from those expressed in any forward-looking statement. Any forward-looking statement speaks only as of the date on which it was made. We undertake no obligation to publicly update or revise any forward-looking statement, whether as a result of new information, future events or otherwise, except as required by law. In this release, unless the context requires otherwise, "MAIA," "Company," "we," "our," and "us" refers to MAIA Biotechnology, Inc. and its subsidiaries.

View source version on businesswire.com: https://www.businesswire.com/news/home/20240516196926/en/

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