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  <head>
    <title>046-01 Foundations</title>
    <ownerName>Integrated Medical Foundations</ownerName>
  </head>
  <body>
    <outline text="Integrated ward presentation, handover, and longitudinal care">
      <outline text="Orientation and first contact">
        <outline text="Converting incomplete information into safe action">
          <outline text="Threats, representation, ranking, tests, treatment, revision"/>
        </outline>
        <outline text="Ward care coordinates people, shifts, settings"/>
        <outline text="Handover preserves reasoning and future tasks"/>
        <outline text="Treat physiological threats before full history">
          <outline text="Normal pressure does not exclude shock"/>
        </outline>
        <outline text="Confirm identity, allergies, pregnancy, decision support"/>
        <outline text="Record pre-intervention state">
          <outline text="Treatment response distinguishes mechanisms"/>
        </outline>
      </outline>
      <outline text="Problem representation and problem list">
        <outline text="One sentence: context, tempo, syndrome, severity"/>
        <outline text="Qualifiers: acute, focal, inflammatory, progressive"/>
        <outline text="Negatives only if reliable and discriminating"/>
        <outline text="Avoid premature labels, update with new data"/>
        <outline text="Separate syndromes, diagnoses, complications, barriers"/>
        <outline text="Merge duplicates, preserve causal relationships"/>
        <outline text="Rank by threat, reversibility, time, patient priority"/>
      </outline>
      <outline text="Differential diagnosis">
        <outline text="Built from anatomy, mechanism, tempo"/>
        <outline text="Likely, dangerous, and patient-specific causes">
          <outline text="Long unranked list is not safer"/>
        </outline>
        <outline text="Evidence for and against leading possibilities"/>
        <outline text="Stable patient: diagnostic time can be therapeutic"/>
        <outline text="Irreversible risk: immediate empirical action"/>
        <outline text="Treatment failure: revisit alternatives"/>
      </outline>
      <outline text="Investigation strategy">
        <outline text="Each test has a defined purpose"/>
        <outline text="Predict how each result changes action">
          <outline text="No change in action: reconsider testing"/>
        </outline>
        <outline text="Good specimens before treatment when safe"/>
        <outline text="Verify unexpected results"/>
        <outline text="Critical findings by closed loop">
          <outline text="Recipient, meaning, action, escalation"/>
        </outline>
      </outline>
      <outline text="Treatment plan and therapeutic trial">
        <outline text="Written around goals and mechanisms"/>
        <outline text="Drug, dose, route, interval, review, stop conditions">
          <outline text="Another clinician can continue safely"/>
        </outline>
        <outline text="Trial needs target, time frame, alternative">
          <outline text="No response: wrong diagnosis, delivery, disease, time"/>
        </outline>
        <outline text="Balance benefits over different horizons">
          <outline text="Avoid hypoglycaemia over intensive control"/>
          <outline text="Held preventive drugs need restart review"/>
        </outline>
      </outline>
      <outline text="Medication reconciliation">
        <outline text="Pre-admission use vs current and discharge orders"/>
        <outline text="Multiple sources: patient, pharmacy, primary care"/>
        <outline text="Differences intentional or unintentional">
          <outline text="Omission, duplication, wrong concentration"/>
          <outline text="Kidney adjustment failure, harmful restart"/>
        </outline>
        <outline text="High-risk: anticoagulants, insulin, opioids"/>
        <outline text="Held medicines: reason and restart criteria">
          <outline text="Unexplained list transfers ambiguity"/>
        </outline>
        <outline text="Confirm access, affordability, dexterity, cognition"/>
      </outline>
      <outline text="Ward review, escalation, and uncertainty">
        <outline text="Review trends, intake, devices, results, response"/>
        <outline text="Per problem: status, action, monitoring, escalation"/>
        <outline text="Concern overrides a reassuring score"/>
        <outline text="Escalate when physiology worsens or setting fails">
          <outline text="Urgency first, then context and specific request"/>
          <outline text="Persist through hierarchy if unsafe"/>
        </outline>
        <outline text="Grade uncertainty: known, likely, dangerous">
          <outline text="Safety-net: observation, thresholds, follow-up"/>
        </outline>
        <outline text="Diagnostic error: anchoring, premature closure">
          <outline text="Pause: what else, what does not fit"/>
        </outline>
      </outline>
      <outline text="Handover and documentation">
        <outline text="Lead with action-critical information"/>
        <outline text="Task: what, why, when, owner, expected, abnormal"/>
        <outline text="Closed-loop questions and restatement"/>
        <outline text="Unresolved danger communicated directly"/>
        <outline text="Notes timely, factual, attributable, useful"/>
        <outline text="Separate observation, reports, inference"/>
        <outline text="Describe behaviour without judgement"/>
      </outline>
      <outline text="Discharge and longitudinal care">
        <outline text="Planning begins at admission"/>
        <outline text="Stability: safe outside current monitoring"/>
        <outline text="Pending tests with owners, warning symptoms"/>
        <outline text="Teach-back and accessible written information"/>
        <outline text="Address cause and predisposing conditions"/>
        <outline text="Multimorbidity: benefit, burden, goals">
          <outline text="Coordinate specialists across organs"/>
        </outline>
        <outline text="Rehabilitation and social support are treatment"/>
      </outline>
      <outline text="Shared decisions, goals, and safety learning">
        <outline text="Options, outcomes, uncertainty, burdens, values"/>
        <outline text="Resuscitation decision covers arrest only"/>
        <outline text="Palliative care alongside disease treatment">
          <outline text="Intensify comfort, not abandonment"/>
        </outline>
        <outline text="After harm: stabilise, disclose, preserve evidence"/>
        <outline text="Standardisation and design beat education"/>
        <outline text="Just culture: error, shortcuts, recklessness"/>
      </outline>
    </outline>
  </body>
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