Successive Encounters Research Articles

Telemedical Direction to Optimize Resource Utilization in a Rural Emergency Medical Services System.

Telemedicine remains an underused tool in rural emergency medical servces (EMS) systems. Rural emergency medical technicians (EMT) and paramedics cite concerns that telemedicine could increase Advanced Life Support (ALS) transports, extend on-scene times, and face challenges related to connectivity as barriers to implementation. Our aim in this project was to implement a telemedicine system in a rural EMS setting and assess the impact of telemedicine on EMS management of patients with chest pain while evaluating some of the perceived barriers. This study was a mixed-methods, retrospective review of quality assurance data collected prior to and after implementation of a telemedicine program targeting patients with chest pain. We compared quantitative data from the 12-month pre-implementation phase to data from 15 months post-implementation. Patients were included if they had a chief complaint of chest pain or a 12-lead electrocardiogram had been obtained. The primary outcome was the rate of ALS transport before and after program implementation. Secondary outcomes included EMS call response times and EMS agency performance on quality improvement benchmarks. Qualitative data were also collected after each telemedicine encounter to evaluate paramedic/EMT and EMS physician perception of call quality. The telemedicine pilot project was implemented in September 2020. Overall, there were 58 successful encounters. For this analysis, we included 38 patients in both the pre-implementation period (September 9, 2019-September 10, 2020) and the post-implementation period (September 11, 2020-December 5, 2021). Among this population, the ALS transport rate was 42% before and 45% after implementation (odds ratio 1.11; 95% confidence interval 0.45-2.76). The EMS median out-of-service times were 47 minutes before, and 33 minutes after (P = 0.07). Overall, 64% of paramedics/EMTs and 89% of EMS physicians rated the telemedicine call quality as "good." In this rural EMS system, a telehealth platform was successfully used to connect paramedics/EMTs to board-certified EMS physicians over a 15-month period. Telemedicine use did not alter rates of ALS transports and did not increase on-scene time. The majority of paramedics/EMTs and EMS physicians rated the quality of the telemedicine connection as "good."

Disruption of dark matter minihalos by successive stellar encounters

Disruption of dark matter minihalos by successive stellar encounters

Evolution of the Disk in the Be Binary δ Scorpii Probed during Three Periastron Passages

We examine the evolution of the disk surrounding the Be star in the highly eccentric 10.8 yr binary system δ Scorpii over its three most recent periastron passages. V-band and B − V photometry, along with Hα spectroscopy, are combined with a new set of extensive multiband polarimetry data to produce a detailed comparison of the disk's physical conditions during the time periods surrounding each closest approach of the secondary star. We use the three-dimensional Monte Carlo radiative transfer code HDUST and a smoothed particle hydrodynamics code to support our observations with models of disk evolution, discussing the behavior of the Hα and He i 6678 Å lines, V-band magnitude, and polarization degree. We compare the characteristics of the disk immediately before each periastron passage to create a baseline for the unperturbed disk. We find that the extent of the Hα emitting region increased between each periastron passage, and that transient asymmetries in the disk become more pronounced with each successive encounter. Asymmetries of the Hα and He i 6678 Å lines in 2011 indicate that perturbations propagate inward through the disk near periastron. When the disk’s direction of orbit is opposite to that of the secondary, the parameters used in our models do not produce spiral density enhancements in the Hα emitting region because the tidal interaction time is short due to the relative velocities of the disk particles with the secondary. The effects of the secondary star on the disk are short-lived and the disk shows independent evolution between each periastron event.

Surprising Pedagogy through Japanese Anime

<p>At the intersection of embodiment, education, and anime, this essay describes how transcultural classroom encounters with anime can pollinate changes in ecological self-conceptions and thus embodiment. Using examples from teaching with anime in Russia and the United States, I describe how interpretive encounters shifted students’ ecological self-sense and conceptualization of embodiment. In the classroom, anime acted as an interpretive device for teaching contemporary thought about ecology, technology, microbes, animal-human figures, interconnection, and interdependence. I present evidence of oddly successful encounters between local Japanese cultural/embodied contexts of anime and its partial connections to globally shared human ecological and technological situations. In these transcultural encounters, the Japanese anime pollinate and germinate material and conceptual possibilities that are incipient for the students but not easily possibly with outside pollination.</p>

Integrating Telemedicine Training into the Graduate Medical Education Curriculum

Objectives The primary objective of this study was to examine current emergency medicine resident knowledge of telemedicine, expose residents to standardized telemedicine patients virtually, and analyze the effectiveness of telemedicine training on completing a successful encounter. Methods emergency medicine residents first underwent a virtual standardized telemedicine encounter using the ZoomTM telecommunications application without prior training in telemedicine. Standardized patients were then queried on resident success during this untrained encounter using a survey with aspects of a successful telemedicine encounter. The following session involved a lecture by a telemedicine physician. After this intervention, the residents underwent a repeat virtual encounter, with standardized patients responding to the same questions on the fundamental aspects of a successful interview. Residents also underwent a post-survey on their experiences with the training. Results Statistically significant differences were noted on aspects of the encounter related to obtaining informed consent (0% vs. 61%, p = 0.00012), asking about privacy in the patient’s environment (6% vs. 87%, p <0.00001), verifying name and/or date of birth (29% vs. 94%, p =0.00014), explaining the telehealth process and expectations to the patient (0% vs. 94%, p <0.00001). No statistical significance was seen with: resident introducing themselves (94% vs. 100%, p =.31732), asking focused questions about medical condition (100% vs. 100% p = 1), closing the encounter by explaining care plan (94% vs. 94%, p = 1). Conclusions Overall, emergency medicine residents had significant improvement on aspects of an encounter with a standardized patient that were unique to telemedicine after undergoing training from an expert in the field. Similar training could easily be utilized across the country in emergency medicine residencies. This training could prove to be essential in the future because of the global health crisis of the COVID-19 pandemic, but also for rural emergency patient care and remote educational programs.

Non-verbal communication in the workplace: Perceptions of hospitality management Filipino student interns in the service encounters

Effective communication plays a crucial role in the hospitality industry's successful service encounter. Although verbal communication is significant for this role, non-verbal communication is just as significant. However, there's a relatively limited body of knowledge about non-verbal communication in the hospitality and tourism literature. Therefore, the study's objectives are to elucidate the perception of Filipino hospitality management student interns of the roles of non-verbal communication and how its dimensions assist in the service encounters. By achieving the abovementioned objectives, the findings have provided valuable insights to the inadequate knowledge. Using a qualitative approach, specifically interpretative phenomenological analysis (IPA), target students from Bachelor of Science in Hospitality Management (BSHM) taking an internship in Tacloban City. Applying purposive convenience sampling, 18 selected participants who conformed to the criteria were interviewed (semi-structured). The data collected were analyzed using Braun and Clarke's (2021) thematic analysis, followed by Saldaña's (2015) manual coding for the emergence of themes imperative for final conclusions. Findings show that non-verbal communication is an important part of service encounters, promoting effective connections, improving customer satisfaction, and optimizing customer interaction. While the non-verbal dimensions including facial expressions, kinesics, paralinguistics, and proxemics greatly aids by creating exceptional customer experiences and enhancing overall service quality. While the student interns met the customer's demands and forged stronger bonds by effectively utilizing and understanding these non-verbal cues. Therefore, it concludes that non-verbal communication intervention and the assistance provided by its dimensions contribute to successful service encounters and create favorable experiences for both student interns and customers.

Yellow Perils: Pandemic imaginaries and the contest for global power

The precise origins of COVID-19 may never be established, but the weight of available evidence confirms that, together with the pandemics of 1890 and 1918 and the two most recent coronavirus viruses, SARS and MERS, it has followed a zoonotic path of transmission—from animals to humans. In which case the problem lies with the accelerating clearances of forests and woodlands for cattle ranching and palm oil and soya plantations to service a global food system increasingly organised around meat intensive fast and convenience foods. McDonald’s and KFC may have originated in America, but their brightly lit outlets are now a familiar sight in Chinese cities servicing a shared urban lifestyle that supports the unsustainable consumption that is driving the present climate and environmental emergencies. If this analysis is correct, responsibility for COVID-19 and the likelihood of future coronavirus pandemics lies primarily with the corporations promoting the intensified industrialisation of global agriculture. These companies form a complex agribusiness network connecting US and Chinese enterprises and driving deforestation and habitat destruction across the world. By escalating contacts between displaced species and humans these interventions significantly increase the likelihood of zoonotic transmission. Addressing this threat requires transformative changes to prevailing priorities for global production and consumption. Confronting the embedded cultures of distrust and antagonism generated by successive abrasive encounters between China and the West is an essential step towards recognising that the major perils now facing humanity are universal and in urgent need of a common and collaborative response.

Four scenarios in which shadow competition should be prominent and factors affecting its strength

Shadow competition is the interception of moving prey by a predator closer to its arrival source, preventing its availability to predators downstream. Shadow competition is likely common in nature, and unlike some other competition types, has a strong spatial component (with the exception of competition for space, which clearly also has a spatial component). We used an individual‐based spatially‐explicit simulation model to examine whether shadow competition takes place and which factors affect it in four scenarios considering ambush predators and active prey. First, when prey capture is uncertain (‘the ricochet effect'). Here, the strength of shadow competition increases when it is harder to capture prey after the first unsuccessful capture attempt, whereas shadow competition is moderated if capture success is higher in successive attempts. Second, shadow competition becomes stronger when predators can capture prey arriving only from certain directions. Third, when prey tend to move along a barrier after encountering it. Here, predators located along this barrier may be more successful than those at random positions, but shadow competition in this scenario drastically decreases the capture success of predators in central positions along a barrier (i.e. having more than a single neighbor). Finally, in three‐level systems of plants in clusters, herbivores searching for plants, and predators ambushing herbivores inside plant patches, predators with ambush locations in the periphery of plant patches are more successful than those at the patch center, especially at high predator densities. Our simulation indicates that shadow competition is plausibly relevant in various scenarios of ambush predators and prey, and that it varies based on the habitat structure and capture probability of prey by predators as well as the change in capture probability with successive encounters.

Visions of Esmeralda Lock: Epistemic Injustice, ‘The Gypsy Woman’, and Gypsilorism

Using a combination of Jodie Matthews’ concepts of “The Gypsy Woman” as a product of successive trans-historical encounters (actual, literary, or visual) between Gypsy subject and non-Gypsy audience, formal Archival sources in the Scott MacFie Gypsy Collection at the University of Liverpool, Foucaultian archives of subjugated knowledges, and Miranda Fricker’s approaches to epistemic injustices, this article examines the life-narrative of a Romani woman, Esmeralda Lock, and her changing relationship with her Gypsilorist interlocutors over 70 years of her life. Following the example of Laura Ann Stoler, “factual stories” in Esmeralda’s life that re-affirm Gypsilorist fictions are also examined. Esmeralda was unique in that she was literate, and hence able to leave a small but important trail of correspondence spanning 62 years (including a hitherto unknown sketch and commentary) enabling a challenge to Gypsilorist (mis)representations of her life. Her correspondence also allows her changing epistemic value of Gypsilorists to be traced. Further analyses of epistemic injustices may offer new dimensions to understanding and explaining not just the construction of subordinating discourses, but also the mechanisms of Romani epistemic suppression.

Influence of Planetary Encounters on the Magnitude of the Yarkovsky Effect in Asteroid Dynamics

The influence of the solar radiation pressure and the Yarkovsky effect on the long-term orbital dynamics is estimated for a number of asteroids experiencing successive planetary encounters. The variation in the asteroid’s proper rotation period due to its approach to the planet and its effect on the asteroid’s further orbital dynamics through the Yarkovsky effect is considered. It is shown that close planetary encounters of small asteroids (tens of meters in diameter) with short rotation period (less than 10 h), which change the asteroid’s rotation period by several hours, significantly affect the magnitude of the Yarkovsky effect.

The feasibility, acceptability, and usability of telehealth visits.

Telemedicine is now common practice for many fields of medicine, but questions remain as to whether telemedicine will continue as an important patient care modality once COVID-19 becomes endemic. We explored provider and patients' perspectives on telemedicine implementation. Physicians from three specialties within the Department of Medicine of a single institution were electronically surveyed regarding their perceptions of satisfaction, benefits, and challenges of video visits, as well as the quality of interactions with patients. Patients were surveyed via telephone by the Survey Research Group at Cornell about participation in video visits, challenges encountered, perceived benefits, preferences for care, and overall satisfaction. Providers reported an overwhelmingly positive experience with video visits, with the vast majority agreeing that they were comfortable with the modality (98%) and that it was easy to interact with patients (92%). Most providers (72%) wanted to have more telemedicine encounters in the future. Key factors interfering with successful telemedicine encounters were technical challenges and insufficient technical support. Overall, patients also perceived video visits very positively regarding ease of communication and care received and had few privacy concerns. Some (10%-15%) patients expressed interest in receiving more technical support and training. There was a gradient of satisfaction with telemedicine across specialties with patients receiving weight management reporting more favorable responses while patients with lymphoma expressed more mixed responses. Both providers and patients found telemedicine to be an acceptable and useful modality to provide or receive medical care. The principal barrier to successful encounters was technical challenges.

Investigating The Effect of Attitudes on Learners’ Intercultural Awareness Development

This article aims at investigating intercultural awareness development among Moroccan high school learners. It focuses on the central role of the ‘attitudes’ component in helping learners get involved in successful intercultural encounters. The study adopts Byram’s (1997) intercultural communicative competence (ICC) as an influential model that has brought intercultural education to the forefront of the teaching-learning process. Research reveals that the concept of the native speaker as an ideal is no more valid. Instead, targeting intercultural speakers who can interact with the other with no communicative breakdowns should receive a primary goal. Developing the learners’ intercultural awareness has become essential to the success of intercultural encounters among interlocutors belonging to different cultures. This study employed a mixed-method design. Both qualitative and quantitative research methods, in the form of a questionnaire and program evaluation, were used to gather information. Descriptive and inferential statistics were employed to analyze the data quantitively. The overall findings of attitudes showed unfavourable statistical scores. Universal values and cultural issues activities that are responsible for promoting positive attitudes have been proven to be decontextualised in the textbook high school students use in Morocco. Students are, therefore, unaware of target cultures as almost all teaching activities are language oriented. The results clearly demonstrated that learners have not developed the intercultural component as the teaching approach in Morocco does not target ICC as a primary goal.

The Ubiquitin-Proteasome System Participates in Sperm Surface Subproteome Remodeling during Boar Sperm Capacitation.

Sperm capacitation is a complex process endowing biological and biochemical changes to a spermatozoon for a successful encounter with an oocyte. The present study focused on the role of the ubiquitin-proteasome system (UPS) in the remodeling of the sperm surface subproteome. The sperm surface subproteome from non-capacitated and in vitro capacitated (IVC) porcine spermatozoa, with and without proteasomal inhibition, was selectively isolated. The purified sperm surface subproteome was analyzed using high-resolution, quantitative liquid chromatography-mass spectrometry (LC-MS) in four replicates. We identified 1680 HUGO annotated proteins, out of which we found 91 to be at least 1.5× less abundant (p < 0.05) and 141 to be at least 1.5× more abundant (p < 0.05) on the surface of IVC spermatozoa. These proteins were associated with sperm capacitation, hyperactivation, metabolism, acrosomal exocytosis, and fertilization. Abundances of 14 proteins were found to be significantly different (p < 0.05), exceeding a 1.5-fold abundance between the proteasomally inhibited (100 µM MG132) and vehicle control (0.2% ethanol) groups. The proteins NIF3L1, CSE1L, NDUFB7, PGLS, PPP4C, STK39, and TPRG1L were found to be more abundant; while BPHL, GSN, GSPT1, PFDN4, STYXL1, TIMM10, and UBXN4 were found to be less abundant in proteasomally inhibited IVC spermatozoa. Despite the UPS having a narrow range of targets, it modulated sperm metabolism and binding by regulating susceptible surface proteins. Changes in CSE1L, PFDN4, and STK39 during in vitro capacitation were confirmed using immunocytochemistry, image-based flow cytometry, and Western blotting. The results confirmed the active participation of the UPS in the extensive sperm surface proteome remodeling that occurs during boar sperm capacitation. This work will help us to identify new pharmacological mechanisms to positively or negatively modulate sperm fertilizing ability in food animals and humans.

The bus synchronization timetabling problem with dwelling times

We study the bus synchronization timetabling problem (BST) including bus dwelling times, motivated by the night shift of the transit system operating in Santiago-Chile. The operation at night under a frequency-setting modality could become inefficient, as at night the frequencies must be low under this type of policy, which may result in long waiting times and poor service quality for passengers. To address these inefficiencies, the authorities have required that all of their night services will operate according to fixed timetables considering the possibility of providing coordinated transfers between certain lines to reduce waiting times in night transfers. For this purpose, we propose a mixed integer programming model to define the specific timetables and the duration of the vehicle dwelling periods, taking the line frequencies as given. The model includes all the specifications and operation details of the real system, with a special focus on the synchronization of transfers at stops, pursuing the maximization of successful encounters through the inclusion of dwelling times as optimization variables together with the departure times of each line. The model was strengthened by adding different sets of valid inequalities. The performance is analysed in a real case study of 94 lines comprising 48 services and 14 transfer zones, showing an increase of around 73% in the number of encounters of the most flexible model with respect to the base case operation.

Keck and Gemini spectral characterization of Lucy mission fly-by target (152830) Dinkinesh

Recently, the inner main belt asteroid (152830) Dinkinesh was identified as an additional fly- by target for the Lucy mission. The heliocentric orbit and approximate absolute magnitude of Dinkinesh are known, but little additional information was available prior to its selection as a target. In particular, the lack of color spectrophotometry or spectra made it impossible to assign a spectral type to Dinkinesh from which its albedo could be estimated. We set out to remedy this knowledge gap by obtaining visible wavelength spectra with the Keck telescope on 2022 November 23 and with Gemini-South on 2022 December 27. The spectra measured with the Keck I/Low Resolution Imaging Spectrometer (LRIS) and the Gemini South/Gemini Multi-Object Spectrograph South (GMOS-S) are most similar to the average spectrum of S- and Sq-type asteroids. The most diagnostic feature is the ≈15 ± 1% silicate absorption feature at ≈0.9–1.0 μm. Small S- and Sq-type asteroids have moderately high albedos ranging from 0.17 to 0.35. Using this albedo range for Dinkinesh in combination with measured absolute magnitude, it is possible to derive an effective diameter and surface brightness for this body. The albedo, size and surface brightness are important inputs required for planning a successful encounter by the Lucy spacecraft.

Put PEP into Telehealth: An Etiquette Framework for Successful Encounters

Increased utilization of videoconferencing platforms to conduct meetings and patient encounters has illuminated the need to focus on video etiquette. Though telehealth has been utilized since the 1950s, the SARS-COV-2 (COVID-19) pandemic propelled virtual care into the forefront of healthcare to protect both patients and providers. Historically, few academic programs have incorporated telehealth into the curriculum, and the rapid transition to telehealth typically left providers to learn the art of virtual care without education. The experience of many nurse providers is often limited to virtual platforms typically used for casual interactions versus a successful patient encounter. A quality telehealth encounter that enhances patient-provider communication and strengthens the provider-patient relationship must include telehealth etiquette and webside manner. This article describes the PEP framework for telehealth encounters to provide a detailed description of the elements of performance, environment, and privacy/security as best practices to underpin successful virtual health visits.

Implementation fidelity to a behavioral diabetes prevention intervention in two New York City safety net primary care practices

BackgroundIt is critical to assess implementation fidelity of evidence-based interventions and factors moderating fidelity, to understand the reasons for their success or failure. However, fidelity and fidelity moderators are seldom systematically reported. The study objective was to conduct a concurrent implementation fidelity evaluation and examine fidelity moderators of CHORD (Community Health Outreach to Reduce Diabetes), a pragmatic, cluster-randomized, controlled trial to test the impact of a Community Health Workers (CHW)-led health coaching intervention to prevent incident type 2 Diabetes Mellitus in New York (NY).MethodsWe applied the Conceptual Framework for Implementation Fidelity to assess implementation fidelity and factors moderating it across the four core intervention components: patient goal setting, education topic coaching, primary care (PC) visits, and referrals to address social determinants of health (SDH), using descriptive statistics and regression models. PC patients with prediabetes receiving care from safety-net patient-centered medical homes (PCMHs) at either, VA NY Harbor or at Bellevue Hospital (BH) were eligible to be randomized into the CHW-led CHORD intervention or usual care. Among 559 patients randomized and enrolled in the intervention group, 79.4% completed the intake survey and were included in the analytic sample for fidelity assessment. Fidelity was measured as coverage, content adherence and frequency of each core component, and the moderators assessed were implementation site and patient activation measure.ResultsContent adherence was high for three components with nearly 80.0% of patients setting ≥ 1 goal, having ≥ 1 PC visit and receiving ≥ 1 education session. Only 45.0% patients received ≥ 1 SDH referral. After adjusting for patient gender, language, race, ethnicity, and age, the implementation site moderated adherence to goal setting (77.4% BH vs. 87.7% VA), educational coaching (78.9% BH vs. 88.3% VA), number of successful CHW-patient encounters (6 BH vs 4 VA) and percent of patients receiving all four components (41.1% BH vs. 25.7% VA).ConclusionsThe fidelity to the four CHORD intervention components differed between the two implementation sites, demonstrating the challenges in implementing complex evidence-based interventions in different settings. Our findings underscore the importance of measuring implementation fidelity in contextualizing the outcomes of randomized trials of complex multi-site behavioral interventions.Trial registrationThe trial was registered with ClinicalTrials.gov on 30/12/2016 and the registration number is NCT03006666.

Can clinical characteristics differentiate patients with unexplained chronic cough from patients with asthma and COPD?

Background: Chronic cough is reported in up to 20% of the adult population and often persists despite medical treatment with currently available therapies. Many clinical conditions, including asthma and chronic obstructive pulmonary disease (COPD), must be excluded before making a Unexplained chronic cough diagnosis. Methods: The primary objective was to use a large hospital dataset to compare clinical features of patients with a primary diagnosis of UCC with those with asthma or COPD without a primary diagnosis of UCC to help clinicians differentiate between these conditions more readily. Data were collected for all hospitalization and outpatient medical encounters for each patient between November 2013 and December 2018. Information included demographics, encounter dates, medications prescribed at every encounter for chronic cough, lung function testing, and hematologic parameters. Asthma and COPD were combined into one group to ensure there was no overlap with UCC and due to limitations of International Classification of Diseases coding to confirm an asthma(A)/COPD diagnosis. Results: Female gender represented 70% of encounters for UCC versus 61.8% for asthma/COPD (p < 0.0001); the mean age was 56.9 years for UCC versus 50.1 years for A/COPD (p < 0.0001). The number of patients on cough medications and the cough medication frequency were significantly higher in the UCC versus A/COPD group (p < 0.0001). UCC versus A/COPD patients had a total of eight versus three cough-related encounters over the study duration (i.e., 5 years) (<0.0001). The average interval between successive encounters was less for UCC (114 days) versus the A/COPD (288 days) group. Gender-adjusted Forced expiratory volume in the first second of exhalation/Forced vital capacity (FEV1/FVC) ratios, residual volume%, and Diffusion capacity for carbon monoxide (DLCO%) were significantly higher in UCC versus A/COPD, whereas the response to bronchodilators of FEV1, FVC and residual volumes were significantly greater in A/COPD patients. Conclusions: Clinical characteristics differentiating UCC from A/COPD could accelerate recognition of UCC diagnosis especially in the subspecialty setting where patients with these disorders are referred.

Service quality in health care: empathy as a double-edged sword in the physician–patient relationship

PurposeAs one of the five major dimensions of service quality, empathy has been and continues to be regarded as a requirement for a successful service encounter. This paper focuses on the highly customer-centric service industry of health care. The purpose of this paper is to shed light on the potential negative effects of empathy on both the physician and the patient.Design/methodology/approachBuilding on an in-depth review of literature and well-established service quality models, the authors propose a new model for understanding the complex role of physician empathy in the physician–patient encounter. The trait, emotional intelligence (EI), is presented as a moderator for physician empathy levels.FindingsThe Health Care Optimal Physician Empathy (HOPE) model enables further characterization and analysis of the tradeoffs between patient satisfaction and physician burnout and determining when empathy optimally works to the benefit of both the physician and the patient to maximize service quality. The HOPE model provides a systematic way to understand and determine the appropriate level of physician empathy that results in optimal outcomes for both physicians and their patients by demonstrating the tradeoffs between physician burnout and patient satisfaction.Originality/valueThe authors highlight the potential detrimental effects on physicians themselves, and, in turn, on service quality. The theoretical and practical implications in this paper provide insights into the development and implementation of empathy-focused interventions and best practices to optimize service quality in the physician–patient interaction. The HOPE model is the first of its kind in shedding light on the manifestation of physician empathy.

How to successfully handle the initial encounter with a delusional infestation patient.

Managing a delusional patient is one of the most challenging situations experienced by dermatologists. This is exacerbated by the scarcity of psychodermatology training offered in residency and similar training programs. A few practical management tips can be easily employed in the initial visit to avoid an unsuccessful encounter. We highlight the most important management and communication techniques needed for a successful first encounter with this traditionally tricky patient population. Topics such as diagnosing primary versus secondary delusional infestation, how to prepare before entering the exam room, how to write the initial patient note, and when is the ideal time to introduce pharmacotherapy are discussed. Tips on preventing clinician burnout and creating a stress-free therapeutic relationship are reviewed.