Medicine Department : September 2023

Thursday, September 28, 2023

The Healthy plate diet in Bengali, Telegu

The copyright belongs to Harvard institution and this translation has been done by our patient advocates purely to help spread the message available in their publicly available (but not globally translated) webpage here : https://www.hsph.harvard.edu/nutritionsource/healthy-eating-plate/

Bengali :

আমাদের খাদ্য তালিকা এমন হওয়া উচিৎ যাতে আমাদের শরীরের ওজন না বৃদ্ধি পায় এবং আমাদের পেটের দৈর্ঘ ৮০ সেন্টিমিটারের নীচে থাকে ।

কী খাবেন না?

চিনি আর ময়দা জাতীয় খাদ্য পুরোপুরি বন্ধ। বিস্কুট আর পাউরুটি ময়দা দিয়ে তৈরি করা হয়, তাই বিস্কুট ও পাউরুটি খাওয়া বন্ধ রাখুন। তেল মাসে ৫০০ গ্রামের বেশি খাওয়া উচিৎ নয়।

কী খাবেন?

খাবারের থালার ৪০ ভাগ বিভিন্ন শাক সব্জি এবং ১০ ভাগ বিভিন্ন রঙের ফল থাকবে। বাকী অর্ধেকের অর্ধেক শ্বেতসার দানা শস্য যেমন চাল, গম ইত্যাদি ও কন্দ (আলু) জাতীয় খাদ্য থাকবে। বাকী অর্ধেক প্রটিন জাতীয় খাদ্য যেমন ভিভিন্ন মাছ, মাংস, বিভিন্ন বিন্স ও ডাল থাকবে।

আপনার প্রতিটি খাবার প্লেট, প্রাতরাশ, মধ্যাহ্ন ভোজন, টিফিন বা নৈশ ভোজন সব ক্ষেত্রেই ওপরের অনুপাতে হওয়া উচিৎ। এইটি সাধারন খাদ্য তালিকা, বাড়ির প্রতিটি সদস্য সঠিক ভাবে তা গ্রহণ করছেন তা লক্ষ্য রাখুন।

Telegu :

మన శరీర బరువు పెరగకుండా మరియు మన పొట్ట పొడవు 80 సెం.మీ కంటే తక్కువగా ఉండేలా మన ఆహారం ఉండాలి. ఏమి తినకూడదు? చక్కెర మరియు పిండితో కూడిన ఆహారం పూర్తిగా నిలిపివేయబడింది. బిస్కెట్లు మరియు బ్రెడ్ పిండితో తయారు చేస్తారు, కాబట్టి బిస్కెట్లు మరియు బ్రెడ్ తినడం మానేయండి. నెలకు 500 గ్రాముల కంటే ఎక్కువ నూనె వినియోగించరాదు. ఏమి తినాలి ఫుడ్ ప్లేట్‌లో 40% వివిధ ఆకుపచ్చ కూరగాయలు మరియు 10% వివిధ రంగుల పండ్లు. మిగిలిన సగంలో బియ్యం, గోధుమలు మొదలైన తెల్లటి గింజలు మరియు దుంపలు (బంగాళదుంపలు) ఉంటాయి.

Mana śarīra baruvu peragakuṇḍā mariyu mana poṭṭa poḍavu 80 seṁ.Mī kaṇṭē takkuvagā uṇḍēlā mana āhāraṁ uṇḍāli. Ēmi tinakūḍadu? Cakkera mariyu piṇḍitō kūḍina āhāraṁ pūrtigā nilipivēyabaḍindi. Biskeṭlu mariyu breḍ piṇḍitō tayāru cēstāru, kābaṭṭi biskeṭlu mariyu breḍ tinaḍaṁ mānēyaṇḍi. Nelaku 500 grāmula kaṇṭē ekkuva nūne viniyōgin̄carādu. Ēmi tināli phuḍ plēṭ‌lō 40% vividha ākupacca kūragāyalu mariyu 10% vividha raṅgula paṇḍlu. Migilina saganlō biyyaṁ, gōdhumalu modalaina tellaṭi gin̄jalu mariyu dumpalu (baṅgāḷadumpalu) uṇṭāyi.

Submitted internship competence assessment online portfolio links toward 360 degree peer feedback and assessment

Summary: Shared below is an evolving model of patient centered, evidence based, user driven submissions of online portfolio links on learning themes for 360 degree peer feedback and assessment.

Background : Scroll down to the bottom of this write up. For other developed ways toward 360 degree assessments : https://www.omicsonline.org/open-access/assessing-competences-in-medical-students-with-a-newly-designed-360degree-examination-of-a-simulated-first-day-of-residency-a-feas-2161-0711-1000550.php?aid=92767

Submissions :System 2 shared logging under four themes toward peer review and critical appraisal feedback

FMG from Phillipines :

1) Self reflective writing on their medical student career

https://mahithaakireddyfmg07.blogspot.com/2023/09/self-reflective-writing-on-their.html

2) Evidence based date wise workflow logs collated by the intern with clickable and verifiable links

https://mahithaakireddyfmg07.blogspot.com/2023/09/evidence-based-date-wise-workflow-logs_19.html

3) Anecdotal self reflections on their internship learning with some video evidence of procedures performed

https://mahithaakireddyfmg07.blogspot.com/2023/09/evidence-based-date-wise-workflow-logs.html

4) Case based OSCE along with Bloom's learning levels acheived

https://mahithaakireddyfmg07.blogspot.com/2023/09/osce-on-30-yf-with-headache.html

Submitted by IMG Telangana 2018 entry

A) Self reflective writing on their medical student career

https://nikhilsaikarnatirollno69.blogspot.com/2023/09/1-self-reflective-writing-on-their.html

LLM driven assessment promoted by collectively gathered UDLCO

"Let's evaluate the provided writing of the intern both in terms of Bloom's taxonomy and the specified rubric questions:

**1. Bloom's Taxonomy Evaluation:**

- **Knowledge (Remembering):** The intern successfully gathers basic patient information such as history, presenting complaints, personal and family history, and examination findings. This demonstrates knowledge application at the remembering level.

- **Comprehension (Understanding):** The intern understands the patient's condition by correlating the symptoms, physical findings, and laboratory results. This level of comprehension is evident in the diagnosis section.

- **Application (Applying):** The intern applies medical knowledge by ordering relevant investigations like serology, RBS, B.urea, S.Cr, and ECG, and interprets these results to make a diagnosis. They also prescribe medications and treatment, which reflects the application of medical interventions.

- **Analysis (Analyzing):** The report lacks in-depth analysis of the patient's condition. While a diagnosis is provided, there is limited discussion of the underlying pathophysiology or potential differential diagnoses. An in-depth analysis would involve considering various possibilities and critically evaluating them.

- **Synthesis (Creating):** The intern does not demonstrate synthesis in the report. They do not connect the patient's condition to broader medical concepts or research. Synthesis would involve exploring how this case fits into the larger context of COPD, acute cor pulmonale, and other related conditions.

- **Evaluation (Evaluating):** The report does not include an evaluation of the effectiveness of the treatment plan, the potential complications, or the overall management strategy. This is an important aspect that could improve the report's quality.

**2. Rubric Evaluation:**

- **General Knowledge Learning Points:** The report provides basic information about the patient's condition, such as symptoms, examination findings, and lab results. However, it lacks insights into the broader implications or epidemiology of COPD or acute cor pulmonale. It also doesn't reference external sources or guidelines for further context.

- **Discovery-Driven Learning Questions:** The report mentions the patient's history and symptoms but does not delve into specific questions related to the internal or external medicine aspects of the case. It could benefit from exploring questions like the cause of the acute exacerbation, the role of smoking cessation, or the relationship between COPD and heart failure.

- **Clinical Complexity:** The report briefly touches on the patient's clinical complexity, mentioning comorbidities like diabetes and hypertension. However, a deeper analysis of the biological, psychological, and social aspects of the patient's condition is lacking.

- **Thematic Analysis:** The report does not conduct a thematic analysis of the patient's case or identify overarching themes that could provide insights or guidance for future management.

- **Impact on Patient Outcomes:** The report does not discuss the potential positive or negative impacts of the diagnosis and treatment on the patient's short-term and long-term outcomes.

- **Competence of the Intern:**

- (i) **Competence in Data Capture:** The intern successfully captures the patient's data, including history, examination findings, and lab results.

- (ii) **Competence in Asking Questions:** The report lacks in-depth questioning and exploration of the case. It does not effectively sort themes for thematic analysis.

- (iii) **Competence in Finding Answers:** The intern makes a diagnosis and prescribes treatment but does not engage in in-depth analysis or exploration of new knowledge.

- (iv) **Competence in Communication:** The report could improve in communicating the case's learning points effectively, particularly in relation to how the findings could influence patient outcomes and future research.

In summary, while the medical report demonstrates competence at the knowledge and comprehension levels of Bloom's taxonomy, it falls short in terms of analysis, synthesis, and evaluation. Additionally, it lacks depth in addressing the rubric's questions related to clinical complexity, thematic analysis, and the impact on patient outcomes. Enhancing critical thinking and providing more comprehensive insights would improve the report's quality."

B) Evidence based date wise workflow logs collated by the intern with clickable and verifiable links

https://nikhilsaikarnatirollno69.blogspot.com/2023/09/2-evidence-based-date-wise-workflow.html

C) Anecdotal self reflections on their internship learning with some video evidence of procedures performed

https://nikhilsaikarnatirollno69.blogspot.com/2023/09/3-anecdotal-self-reflections-on-their.html

D) Case based OSCE along with Bloom's learning levels acheived

https://nikhilsaikarnatirollno69.blogspot.com/2023/09/4-case-based-osce-along-with-blooms.html

2) IMG Telangana 2018 entry

1) Self reflective writing on their medical student career

https://kattaphanikeerthanarollno72.blogspot.com/2023/09/self-reflective-writing-on-their.html

2) Evidence based date wise workflow logs collated by the intern with clickable and verifiable links

https://kattaphanikeerthanarollno72.blogspot.com/2023/09/2-evidence-based-date-wise-workflow.html

3) Anecdotal self reflections on their internship learning with some video evidence of procedures performed

https://kattaphanikeerthanarollno72.blogspot.com/2023/09/internship-learning-and-procedures.html

4) Case based OSCE along with

Bloom's learning levels achieved

https://kattaphanikeerthanarollno72.blogspot.com/2023/09/71-year-old-male-with-co-decreased.html

A) Self reflective writing on their medical student career

https://kandrucherishrollno68.blogspot.com/2023/05/my-bounty-is-as-boundless-as-sea-my.html

B) Evidence based date wise workflow logs collated by the intern with clickable and verifiable links

https://kandrucherishrollno68.blogspot.com/2023/09/traces-of-my-work-during-my-internship.html

C) Anecdotal self reflections on their internship learning with some video evidence of procedures performed

https://kandrucherishrollno68.blogspot.com/2023/09/3-anecdotal-self-reflections-on-their.html

D) Case based OSCE along with Bloom's learning levels acheived

https://kandrucherishrollno68.blogspot.com/2023/09/35-year-old-female-presented-with-co.html

To all interns (past, present and future):

In our 360 degree learning completion assessment, leaves don't matter as much.

What you learned during your internship matters most along with evidence of your learning experiences in your online learning portfolio.

Check out the 4 online portfolios by Nikhil Sai and 3 others posted in this ward group and start providing your peer review feedback on each of them as already demonstrated above by @⁨Rahul healthcare 2.0⁩ as a start and continuation of your osce.

Osce will never be completed till the end of their internship. It can only be started. The earlier the start more the advantage to the learning ecosystem.

We shall only declare the results around who did well (and may get to present in the optimizing clinical complexity 2024 CPD) and who got 30 days extension all with user driven evidence for this current group of 30 by 30th September.

Each Intern will get 4 chances to complete their 30 day extensions well and after 4th attempt may again have to give UG NEET (worst case scenario)!

Let me also red flag the one's started as well as at risk : 👇

1) @⁨~Nikhileshwar K⁩

2) @⁨~Madugula Vineeth⁩

3) @⁨~Santhoshini Madupu⁩

4) @⁨~Bhargavi⁩

5) @⁨~Hemanth Mandava⁩

6) @⁨~Bhavya Popuri⁩

7) @mahitha

8) @⁨~Tejaswini Kandhada⁩

9) @⁨~ASHRAF⁩

10) @⁨~Prasanna⁩

11) @⁨~Keerthana⁩

12) @⁨Metapsyched Intern (not Metapsychist)⁩

13) @⁨~Lasya Reddy⁩

14) @⁨Sampath Kasarabadha Kims 2018 UG⁩

15) @⁨~Cherish Kandru⁩

16) @⁨Nikhilsai Karnati 2018 Kims UG⁩

17) @⁨~Bindu⁩

18) @⁨~Khushi Tulsyan⁩

19) @⁨~Nischal cyril⁩

20) @⁨~Aarthi Priyanka⁩

Extended 30 days:

21) @⁨~Yamini⁩

21a)@⁨~Bhargavi⁩

Extended 45 days

22) @Pardhu

Background : [9/18, 9:20 PM] PG Medicine Haripriya KIMS 2021: @⁨~Keerthana⁩ @⁨~Madugula Vineeth⁩

@mahitha

@⁨Nikhilsai Karnati 2018 Kims UG⁩

Get ready with your opd and ward cases tomorrow morning at 10:00am for your assessment..

[9/18, 9:36 PM] Rakesh Biswas: Please be ready with as many opd and IPD cases as you can.

The osce doesn't end tomorrow. It continues with your continued sharing on those and other new cases over the subsequent days

[9/18, 10:30 PM] Rakesh Biswas: The following sample links are what needs to be seen in every intern's online learning portfolio before making them eligible for the internship completion:

1) Self reflective writing on their medical student career

https://medicinedepartment.blogspot.com/2023/06/?m=0

2) Evidence based date wise workflow logs collated by the intern with clickable and verifiable links

https://kandrucherishrollno68.blogspot.com/2023/09/traces-of-my-work-during-my-internship.html

3) Anecdotal self reflections on their internship learning with some video evidence of procedures performed

https://ailanibyogita.blogspot.com/2022/10/internship-assessment-roll-no-1-8.html

4) Case based OSCE along with Bloom's learning levels acheived

https://vaishnavimaguluri.blogspot.com/2023/07/general-medicine-case-report-osce.html

Sunday, September 24, 2023

Ongoing UDLCO general medical knowledge project: Contribution of Anatomy dissection and autopsies to growth of Medical knowledge and Organ transplantation

Summary:

Ontology development (level 6 in blooms taxonomy) over existing ones in the area of anatomy dissection and autopsies and further post humanist experimentation toward growth of Medical knowledge and organ transplantation

Conversational transcripts :

[9/24, 8:31 AM] Thanga Prabhu: https://www.indiatoday.in/india/story/funerals-of-organ-donors-to-be-conducted-with-state-honours-in-tamil-nadu-2439480-2023-09-23

[9/24, 8:36 AM] Thanga Prabhu: Pledged my organs and body so that after I am done with my business on this earth, my body can be used to improve atleast 7 lives!

It can't get easier than this.

It's free and also painless.

https://pledge.mygov.in/organ-donation/

DM me if you need to know more. Also check out https://notto.mohfw.gov.in/

[9/24, 8:39 AM] Thanga Prabhu: My mbbs mate died after suffering stroke. Liver and kidneys were donated, hence 3 people live today. Very noble gesture. I have also pledged to donate. Key is for family and friends to know ones decision. They are the ones who refuse, causing hindrance.

[9/24, 10:26 AM] Rakesh Biswas: https://www.statnews.com/2023/09/22/pig-heart-transplant-university-of-maryland/

A few minutes of silence for past thwarted 'Make in India' initiative in this direction?:

Quote:

Dhaniram Baruah is an Assamese heart surgeon known for his work in the field of xenotransplantation.

He is popularly known as India's Pig Heart Doctor.[1]

On 1 January 1997, he became the first heart surgeon in the world to transplant a pig's heart in a human body.[2]

Although the recipient died subsequently, it was a precursor to the first successful pig-to-human heart transplant performed 25 years later by Bartley P. Griffith in January 2022.[3]

While Griffith used a genetically modified pig's heart, Barua had transplanted a normal pig heart.[4]

Barua is also the founder of Dr Dhaniram Baruah Heart Institute & Research Centre.[5] He can only communicate through hand gestures after a brain stroke left him unable to speak.[6]

Unquote

https://en.m.wikipedia.org/wiki/Dhaniram_Baruah#:~:text=Dhaniram%20Baruah%20is%20an%20Assamese,heart%20in%20a%20human%20body.

[9/24, 10:50 AM] Thanga Prabhu: Discussing with my lung transplant surgeon colleague learnt today literally whole body is usable post death. Organs harvestable: eyes, heart, lungs, liver, intestines, kidneys, skin - is the largest organ, arms below elbow, pancreas, bones. Rest is donated for medical students to dissect and learn anatomy. After academic year is over, human remains are blessed, prayers offered to God and buried with reverence. We as 1st year med students were taught: Cadaver - your greatest teacher. Ever indebted to all those unknown souls who we got to learn about human body on. Today when we suture or operate...it is their magnanimity to start with.

[9/24, 10:51 AM] SM : 🙏🏽 To Dhaniram Baruah! As a society we failed to support him. He was right in principle and many live may have been saved or even given temporary reprieve if India was with him.

[9/24, 10:59 AM] Rakesh Biswas: I've been able to leverage this certificate even before my death by getting good access to the anatomy labs where we could launch a udhc health education project to make public comfortable with human anatomy as a subsequent stepping stone to gathering healthcare knowledge through contextual 'real time point of care anatomy' learning where we would take the patient to the dead body and point out to them their organ involved and it's anatomical ramifications! Meeting the cadaver for the first time too had it's own advantages that we elucidated further here👇

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4587042/

In subsequent projects and workplaces I wasn't able to leverage a medical college, government recognized for organ transplantation toward cadaveric transplants (the same that you all just signed up for) only because of very low levels of awareness that refused us any kind of breakthrough in the last 6 years!

However in their anatomy dissecting lab, I find one of the past faculty now exhibited as a cadaver from which students learn and realize that one day most of us would be that even after our organs live in different next gen humans!

[9/24, 10:59 AM] Thanga Prabhu: In Canada and UK driving license has this info on the card. Very smart. Trick is to keep it on oneself and clearly declare intention to close relatives. Especially next of kin.

[9/24, 11:02 AM] Rakesh Biswas: They are also very smart when it comes to learning from their dead with very high rates of pathological autopsies in most of their medical colleges, while in India it's a trickle in comparison even in some of it's elite but globally average medical colleges such as PGI Chandigarh etc

[9/24, 11:07 AM] Thanga Prabhu: True. Our Death Audit meetings revealed a lot of gaps in the care process. It used to be run as a scientific activity with 0 blame game and a fact finding mission. Dean ensured it didn't deteriorate into a thoo-thoo mei-mei.

[9/24, 11:08 AM] Rakesh Biswas: In India it's only verbal autopsy that rules!

[9/24, 11:19 AM] SM : This has to be the norm. Our culture of reconciliation and bettering lives has been annihilated. We have to rebuild the culture.

[9/24, 11:42 AM] Avinash Gupta: I am going to release our book in print (worldwide delivery) on November 1.

_Requesting for feedback here or in dm on the book from whoever gave it a quick read or forward._

Disclaimer - I promise to not use any of these feedback/review for any promotional purpose.

Read - https://archive.org/details/building-inner-strength or https://narmeenshah.github.io

[9/24, 11:43 AM] Avinash Gupta: 2nd edition with upgrades.

Image under creative commons from :

https://commons.m.wikimedia.org/wiki/File:The_Ayurvedic_Man.,_c.18th_century_Wellcome_L0017592.jpg#mw-jump-to-license

Ongoing project : Knee ligament tear Patient centred UDLCO (User driven learning community ontology) development through conversational learning transcripts

First information Case report by medical intern: http://hiteshvutlapally191.blogspot.com/2023/08/48-yr-old-male-with-problem-in-left.html

PaJR UDLCO conversational learning transcripts :

[8/20, 8:40 PM] Rakesh Biswas: To quote from your case report 👇

"He used to go to his work daily since he meet with this accident he is going once in 2-3 days"

Please share how his hourly routine that you described has been hourly disrupted after his injury. When he goes once in 3 days to his office, what is that day like in comparison to how it was before the accident?

[8/20, 8:43 PM] Rakesh Biswas: @⁨~Hitesh⁩ Can you add the patient advocate to the group and ask him to not reveal the patient's identity to preserve his confidentiality and ask him to keep logging the patient's daily hourly activities (energy expenditure) along with sharing his food plate images (energy inputs)?

[8/20, 8:48 PM] +intern : Ok sir

[8/20, 9:42 PM] +intern : Sir patient said specifically he has no pain in the knee joint he just mentioned difficulty in walking

[8/20, 9:43 PM] +intern : Changes in daily routine

He wakes at same time 6:30

He has difficulty in going to washroom (western toilet)

He will walk downstairs or to market near his home at very slow pace and if it's at more distance he will go by bike (self driving)

He will walk slightly after lunch and dinner and there are no changes in lunch ,dinner and sleeping pattern

Previously he used to walk to railway station to go to his work now he is using bike(self drive)

[8/21, 6:45 AM] Rakesh Biswas: So please tell us specifically what makes it difficult for him to walk if not pain!

And if it's pain then where exactly is the pain anatomically located?

[8/21, 9:37 AM] intern : Usually he doesn't have any pain but on walking for 5-10 min or standing he developes mild pain in knee, burning type,gradually progressive, radiating to ankle which is relieved on rest

[8/21, 9:40 AM] Rakesh Biswas: How long after rest is this mild pain relieved?

Was the pain as mild as now when he got his MRI done that revealed a cruciate ligament tear?

[8/21, 9:42 AM] Rakesh Biswas: How does he reach his office if he's unable to walk for more than 5 minutes due to the pain? Does he drive his own car to office?

What kind of work does he do in his office?

[8/21, 9:45 AM] intern : It releives on 5 min of rest

MRI report :partial Tear in the anterior cruciate ligament associated near tibial attachment involving posterior lateral fibers

[8/21, 9:52 AM] Rakesh Biswas: The mri report wasn't my question

The question was :

Was the pain similar then as now? Has it reduced or increased?

Added question :

When was the mri done?

[8/21, 9:55 AM] +intern : He walks to bustop which is 3 min away and goes by bus

Before the incident he used to walk to railway station then go by train to his working place

[8/21, 9:57 AM] +intern : Yes sir MRI is done

Pain relieved gradually after MRI

[8/21, 9:58 AM] Rakesh Biswas: How far is the Railway station?

[8/21, 9:58 AM] Rakesh Biswas: Therapeutic mri?

[8/21, 9:59 AM] Rakesh Biswas: How many days since mri now

If pain was 10 during mri how much is it now?

[8/21, 11:31 AM] +intern : 1 min away from his home but he has to stand while travelling so he prefers bus as he can travel by sitting which is 3 min away from his place

[8/25, 10:48 PM] Patient Advocate 48M Knee Ligament Tear WB: I am not getting any update in the case of ligament tear.what's the imigiate steps to be taken for that's purpose? I have wants to be a doctor's prescribed format,which shows in my work place for taking maximum rest of my left leg

[8/25, 10:57 PM] Patient Advocate 48M Knee Ligament Tear WB: Not me it's patient working place..

[8/26, 6:21 AM] Rakesh Biswas: We need to know exactly how much is his current knee pain and how much disability is it causing.

From the discussion above with the other patient advocate @⁨~Hitesh⁩ we realize that the patient has mild pain but he's still able to manage his walk to the bus stand and then for the entire day he has to sit in his workplace which would automatically put the knee at rest?

@⁨~Hitesh⁩ We will need both the knee images taken together for comparison

[8/26, 7:35 AM] intern : Ok sir

[8/28, 10:17 AM] Rakesh Biswas: The left knee does appear more swollen than the right. Well taken image

[8/30, 10:03 PM] Patient Advocate 48M Knee Ligament Tear WB: Patient wants to know the precaution measure in daily Life,& any remedies in prescribed format ..

[8/30, 10:04 PM] Rakesh Biswas: Avoid riding the bike as that was the cause of this injury

[8/30, 10:21 PM] Patient Advocate 48M Knee Ligament Tear WB: Okay ok...but how to walk when attend office? Bcos don't know the precaution of this injury in walking concern

[8/30, 10:23 PM] Rakesh Biswas: Walking won't cause injury

[8/30, 10:24 PM] Patient Advocate 48M Knee Ligament Tear WB: Okay ok..I can walk as like as before

[9/24, 12:40 PM] Rakesh Biswas: How is your patient now? Hope he's walking well and didn't need surgery?

[9/24, 12:56 PM] Patient Advocate 48M Knee Ligament Tear WB: Patient Walking well but after walking about 15 minutes..then feel some mild pen...one thing is that cramps happened in midnight or in morning on left leg..it's for walking more?or some other problems?

[9/24, 12:57 PM] Rakesh Biswas: How many times has the patient experienced cramps? How many days previously since the injury?

[9/24, 1:02 PM] Patient Advocate 48M Knee Ligament Tear WB: Patient very much experience this cramps in two legs also since 8to 10 year's when walking more & more than normaly daily walking

[9/24, 1:04 PM] Patient Advocate 48M Knee Ligament Tear WB: Now in left leg cramp more in this period

[9/24, 1:09 PM] Rakesh Biswas: Okay so this is a separate problem of muscle cramps and unrelated to his knee pains 👍

It's thought to be because of a malfunctioning molecular pump that makes the calcium accumulate in the muscles. One can take Paracetamol 650 mg or any other NSAID to relieve this problem but as it's thought to be a faulty pump due to a genetic coding error there's no current permanent solution to this problem as you may have learned over last 8-10.years

Saturday, September 23, 2023

Ongoing project : UDLCO-Ontology development (level 6 in blooms taxonomy) over existing ones in the area of subclinical hypothyroidism, leucorrhea, overdiagnosis, overtreatment, pure impure placebos and study design to adjudge pure placebo efficacies over impure expensive placebos (real but non evidence based medicines)

Ongoing project: Patient centred user driven learning community ontology development through conversational learning transcripts--Ontology development (level 6 in blooms taxonomy) over existing ones in the area of subclinical hypothyroidism, leucorrhea, overdiagnosis, overtreatment, pure impure placebos and study design to adjudge pure placebo efficacies over impure expensive placebos (real but non evidence based medicines)

Summary : A woman comes with leucorrhea and wants a thyroid test as her friend adviced her to get it done as treating her presumably subclinical hypothyroidism made her leucorrhea disappear! Ontology development (level 6 in blooms taxonomy) over existing ones in the area of subclinical hypothyroidism, leucorrhea, overdiagnosis, overtreatment, pure impure placebos and study design to adjudge pure placebo efficacies over impure expensive placebos (real but non evidence based medicines)! Medical cognition also needs to focus on patient cognition other than health professional cognition.

Conversational transcripts :

PaJR link (broken for patient confidentiality) : https://chat.whatsapp.com/I9qoZEoXoZi8cuogkc (More about PaJR : https://userdrivenhealthcare.blogspot.com/2022/09/current-pajr-workflow-and-how-to-make.html?m=0)

[9/23, 9:07 PM] Rakesh Biswas: Please share your questions around this patient to trigger the discussion that may help everyone to learn how to provide better care to this patient

[9/23, 9:29 PM] Medicine 2021 UG : good evng sir

sir, do there is any relation between hyperthyroidism with happening of white discharge

[9/23, 10:36 PM] Rakesh Biswas: Can you share the first and last thyroid function test values of the patient?

[9/24, 6:50 AM] Medicine 2021 UG : sir actually the patient told that she came for thyroid test because there is similar history for her neighbour and she told she did thyroid test and there are variations in it and used tablets for thyroid and white discharge stopped so she came for thyroid test on basis of that

[9/24, 7:41 AM] Rakesh Biswas: Good potential bloom level 6 insights 👏

Looks like she may have had a placebo response to low dose thyroxine tablets some one may have given her unnecessarily and the patient herself wanted to pursue this placebo effect (unknowingly off course) in the hope that it may eventually cure her leucorrhea!

I guess any causal relationship between thyroxine deficiency and leucorrhea is perhaps currently not well known and one may always pursue a search engine to see if anyone has tried to look earlier in this direction!

However what were the variations in her thyroid test and what was the dose of thyroxine she used earlier? Please call her up and clarify this with the images of the earlier reports and earlier doses adviced.

[9/24, 7:53 AM] 2021 Medical UG: sir actually the patient came for the first time for thyroid test on advice of her neighbour because her neighbour used thyroid tablets due to variations in her thyroid levels and cured leucorrhea after taking those tablets

[9/24, 7:54 AM] 2021 Medical UG: patient is thinking that variation in thyroid levels also may cause leucorrhea

[9/24, 7:55 AM] Rakesh Biswas: We need to also trace the neighbor by phone and find out the vital information around what were her thyroid function tests trends since she began taking thyroxine tablets and what were her thyroxine doses

[9/24, 7:56 AM] 2021 Medical UG: ok sir

[9/24, 7:57 AM] Rakesh Biswas: This could be a breakthrough lead in our focus area of medical cognition where we largely focus on health professional cognition but also need to focus on patient cognition! 👏

[9/24, 8:00 AM] Rakesh Biswas: There's this interesting study I just saw that actually experimented with using real cheaper placebos.

Most of our current many patient's healthcare options consists of using non evidence based expensive placebos given by their non evidence based bloom level 1-2 practitioners. That could change with more studies such as these👇

https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-023-03074-4

Friday, September 22, 2023

Bloom level 3 Online learning portfolio driven 2019 batch medicine 2nd internal summative exam theory questions to assess Bloom 1-2 level of medical student learning

Our theory curriculum delivery in general medicine follows from constructivist learning principles where knowledge is co constructed by the secondary (medical student) and primary beneficiaries of medical education (patients). The links below each question represents the real work (bloom level 3) done by each student to generate the (bloom level 1-2) theory question paper below. This illustrates that the syllabus in medicine lies in what this batch of students have constructed themselves over the last few years of their practical postings. Please don't erase these links. We have purposefully chosen the average or below average student learning portfolios that can make medical educators introspect on better ways to strengthen our students practical training foundation. NMC already seems to be introspecting in it's recent strategy to change the theory practical equation to 40:60 instead of the current 50:50. If we look at the existing hidden curriculum it will be 80:20 theory practical and 20 here is represents the practical free pass while NMC could be wanting to change the current game to 50:50 by disrupting the hidden curriculum with their 40:60 directive?

DEPARTMENT OF GENERAL MEDICINE

8h SEMESTER I - INTERNAL ASSESSMENT EXAMINATION September – 2023

Date: 20.9.2023

Time: 10 am to 1 pm

Note: Answer all questions Max Marks: 100

PART A

WRITE AN ESSAY ON THE FOLLOWING 1*15 - 15 Marks

1)Definition,Types, Etiology, patho physiology,clinical features and management of heart failure

https://38nandinigandla.blogspot.com/2022/07/hi-this-is-g.html

WRITE SHORT NOTE ON THE FOLLOWING

4*5= 20 Marks

2)Leptospirosis