Summary:
This morning report illustrates how we regularly utilise a user driven participatory medical cognition (aka integrating medical educators and practice since brick and mortar times) to generate insights from the current heat between Web 2.0-3.0.
Glossary:
ProJR: project journey record
cm: CBBLE moderator
More here about CBBLE and other abbreviations:
Previous ProJR session from yesterday:
Today's:
EMR summary: 2.0
[08/05, 07:48] PI Portal Hypertension Project 2022:
Case 12
Admission-19/8/23
Discharge 19/4/23
Follow up- expired
Diagnosis
CHRONIC LIVER DISEASE WITH SPONTANEOUS BACTERIAL PERITONITIS( RESOLVING)
WITH LOWER LIMB CELLULITIS WITH PRE RENAL AKI (RESOLVING) WITH H/O ESOPHAGEAL
BANDING 1YR BACK. (RESOLVING) WITH K/C/O T2DM SINCE 8YRS WITH 3FFP TRANSFUSION
ON 20/08/2023 WITH 1 PRBC TRANSFUSION ON 22/08/2023.
Case History and Clinical Findings
C/O SOB SINCE 1 WEEK
HOPI- PATIENT WAS APPARENTLY ASYMPTOMATIC 1WEEK, THEN DEVELOPED SOB, GRADE
III-IV, INSIDIOUS IN ONSET AND GRADUALLY PROGRESSIVE, NO AGGRAVATING AND
RELIEVING FACTORS.
H/O ABDOMINAL DISTENSION SINCE 1ODAYS, INSIDIOUS, PROGRESSIVE, NO
AGGRAVATING/ RELIEVING FACTORS.
NO C/O CHEST PAIN, PALPITATIONS, ORTHOPNEA, PND
NO C/O FEVER, DECREASED URINE OUTPUT, BURNING MICTURITION, VOMITING, LOOSE
STOOLS.
C/O PAIN AND SWELLING OVER THE LEFT LIMB SINCE 10DAYS. INSIDIOUS AND GRADUALLY
PROGRESSIVE, FOLOOWED BY UNKOWN? INSECT BITE.
K/C/O CLD AND ESOPHAGEAL BANDING DONE TWICE (1YR BACK)
K/C/O T2DM SINCE 2016 AND IS ON UNKNOWN MEDICATION.
NOT A K/C/O HTN, THYROID DISORDERS, EPILEPSY.
H/O 3 BLOOD TRANFUSION 4DAYS BACK.
COURSE IN HOSPITAL:
PATEINT CAME WITHC/O SOB SINCE 1 WEEK
SOB, GRADE III-IV, INSIDIOUS IN ONSET AND GRADUALLY PROGRESSIVE, NO
AGGRAVATING AND RELIEVING FACTORS.
C/O ABDOMINAL DISTENSION SINCE 1ODAYS,
ON ADMISSION VITALS
TEMP- AFEBRILE
BP- 110/70MMHG
PR- 95BPM
RR- 21CPM
CVS- S1S2+, NO MURMURS
RS- BAE+, NVBS
NO ORGANOMEGALY
GRBS- 148MG/DL
ON FURTHER INVESTIGATIONS-
PATIENT WAS FOUND TO HAVE PANCYTOPENIA FOR WHICH 3FFP TRANSFUSIONS WERE
DONE ON 20/08/2023 AND 1 PRBC TRANSFUSION WAS DONE ON 22/8/2023. AND WAS
UNEVENTFULL
GASTROENTEROLOGIST OPINION WAS TAKEN IVO CLD AND H/O ESOPHAGEAL BANDING -
ADVISED TO CONTINUE SAME MEDICATION AS BY TREATING PHYSICIAN.
DIAGNOSTIC AND THERAPEUTIC TAP WAS DONE:ASCITIC TAP WAS DONE ON 20/08/2023
(1LITRE OF FLUID)
ASCITIC FLUID ANALYSIS REVEALED HIGH SAAG LOW PROTEIN 2 TO CLD.
AND ASCITIC TAP WAS DONE ON THE DAY DISCHARGE I.E ON 24/08/2023
AND AFTER TAP VITALS
BP- 110/60MMHG
PR- 86BPM
RR- 19CPM
TEMP- 98.4F
PATIENT WAS MANAGED CONSERVATIVELY AND BEING DISCHARGED IN
HEMODYNAMICALLY STABLE CONDITION.
Investigation
SERUM ELECTROLYTES (Na, K, C l) AND SERUM IONIZED CALCIUM 19-08-2023 04:14:PM
SODIUM139 mEq/L
145-136 mEq/L
POTASSIUM4.5 mEq/L
5.1-3.5 mEq/L
CHLORIDE102 mEq/L
98-107 mEq/L
CALCIUM IONIZED1.05 mmol/Lmmol/L
LIVER FUNCTION TEST (LFT) 19-08-2023 04:14:PM Total Bilurubin2.58 mg/dl
1-0 mg/dl
Direct Bilurubin0.81 mg/dl
0.2-0.0 mg/dl
SGOT(AST)18 IU/L
35-0 IU/L
SGPT(ALT)11 IU/L
45-0 IU/L
ALKALINE PHOSPHATE253 IU/L
128-53 IU/L
TOTAL PROTEINS6.1 gm/dl
8.3-6.4 gm/dl
ALBUMIN2.10 gm/dl
5.2-3.5 gm/dl
A/G RATIO0.53
COMPLETE URINE EXAMINATION (CUE) 19-08-2023 04:14:PM COLOURPale
yellowAPPEARANCEClearREACTIONA
1.010
ALBUMIN
++
SUGAR
NIL
BILE SALTS
Nil
BILE PIGMENTS
Nil
PUS CELLS
2-4
EPITHELIAL CELLS
2-3
RED BLOOD CELLS
Nil
CRYSTALS
Nil
CASTS
Nil
AMORPHOUS DEPOSITS
Absent
OTHERSNil
LIVER FUNCTION TEST (LFT) 22-08-2023 03:52:AM Total Bilurubin1.57 mg/dl
1-0 mg/dl
Direct Bilurubin0.26 mg/dl
0.2-0.0 mg/dl
SGOT(AST)17 IU/L
35-0 IU/L
SGPT(ALT)9 IU/L
45-0 IU/L
ALKALINE PHOSPHATE241 IU/L
128-53 IU/L
TOTAL PROTEINS6.5 gm/dl
8.3-6.4 gm/dl
ALBUMIN2.2 gm/dl
5.2-3.5 gm/dl
A/G RATIO0.53
ASCITIC FLUID ANALYSIS:
NO ACID FAST BACILLI, FEW DISINTEGRATED PUS CELLS, NO ORGANISMS. NO GROWTH
AFTER 48 HRS OF AEROBIC INCUBATION.
2D ECHO:
MILD TR +, WITH PAH, TRIVIL AR, NO MR
NO RWMA, NO ASLMS, SCLEROTIC AV, GOOD LV SYSTLOC DYSFUNCTION, NO DIASTOLIC
DYSFUNCTION, NO LV CLOT
Treatment Given(Enter only Generic Name)
1. FLUID RESTRICTION <1.5 L/DAY
2. SALT RESTRICTION <2G/DAY
3. INJ LINEZOLID 600MG IV/BD
4. INJ PIPTAZ 3.375GM IV/TID
5. TAB SPIRONOLACTONE 25MG PO/OD
6.TAB RIFAGUT 500MG PO/BD
7. TAB LASIX 40MG PO/OD
8. SYP LACTULOSE 15ML PO/BD
9. SYP HEPAMERZ 15ML PO/TID
10. INJ HAI S/C TID PREMEAL
11. TAB UDILIN 300MG PO/OD
12. DRESSING OF LOWER LIMB AND LIMB ELEVATION
13. PROTEIN POWDER 2TBSP IN 1 GLASS OF WATER PO/TID
Advice at Discharge
1. FLUID RESTRICTION <1.5 L/DAY
2. SALT RESTRICTION <2G/DAY
3. TAB LINEZOLID 600MG PO/BD
4. TAB UDILIN 300MG PO/OD
5. TAB SPIRONOLACTONE 25MG PO/OD
6.TAB RIFAGUT 500MG PO/BD
7. TAB LASIX 40MG PO/OD
8. SYP LACTULOSE 15ML PO/BD
9. SYP HEPAMERZ 15ML PO/TID
10. INJ HAI S/C TID PREMEAL
11. TAB AUGMENTIN 625MG PO/TID
12. DRESSING OF LOWER LIMB AND LIMB ELEVATION
13. PROTEIN POWDER 2TBSP IN 1 GLASS OF WATER PO/TID
Follow Up
REVIEW TO MEDICINE OP 78 AFTER 1WEEK OR SOS
@AI please convert this into structured case report with a summary and discuss about spontaneous bacteria peritonitis and esophageal banding new learning points
3.0 with human in the loop in action:
[08/05, 07:48] AI: *Case Report:*
*Title:* Chronic Liver Disease with Spontaneous Bacterial Peritonitis and Lower Limb Cellulitis: A Case Report
*Summary:* A patient with chronic liver disease and a history of esophageal banding presented with shortness of breath, abdominal distension, and lower limb cellulitis. The patient was diagnosed with spontaneous bacterial peritonitis (SBP) and managed conservatively with antibiotics and supportive care. This case highlights the importance of prompt diagnosis and treatment of SBP in patients with chronic liver disease.
*Case Presentation:*
A patient with chronic liver disease and a history of esophageal banding presented with shortness of breath, abdominal distension, and lower limb cellulitis. Laboratory tests revealed pancytopenia, and the patient received blood transfusions. Ascitic fluid analysis confirmed SBP, and the patient was managed with antibiotics and supportive care.
*Investigations:*
- *Serum electrolytes*: Sodium 139 mEq/L, Potassium 4.5 mEq/L, Chloride 102 mEq/L
- *Liver function tests*: Total bilirubin 2.58 mg/dl, Direct bilirubin 0.81 mg/dl, SGOT 18 IU/L, SGPT 11 IU/L
- *Ascitic fluid analysis*: High SAAG, low protein
- *2D Echo*: Mild tricuspid regurgitation, pulmonary arterial hypertension
*Treatment and Outcome:*
The patient was managed conservatively with antibiotics (linezolid and pip-taz), diuretics (spironolactone and lasix), and supportive care. The patient showed significant improvement and was discharged with follow-up appointments.
*Discussion:*
Spontaneous bacterial peritonitis (SBP) is a serious complication of chronic liver disease, characterized by bacterial infection of the ascitic fluid without any apparent source of infection. SBP is diagnosed by ascitic fluid analysis, which typically shows a high white blood cell count (>250 cells/μL) and positive bacterial culture. Prompt treatment with antibiotics is essential to prevent complications and improve patient outcomes.
Esophageal banding is a procedure used to manage esophageal varices in patients with chronic liver disease. While effective in reducing the risk of variceal bleeding, esophageal banding may not prevent SBP.
*New Learning Points:*
- *Importance of prompt diagnosis and treatment*: SBP requires prompt diagnosis and treatment to prevent complications and improve patient outcomes.
- *Role of ascitic fluid analysis*: Ascitic fluid analysis is crucial in diagnosing SBP and guiding treatment.
- *Use of antibiotics*: Antibiotics are essential in managing SBP, and the choice of antibiotic should be guided by the patient's clinical condition and local antimicrobial resistance patterns.
- *Multidisciplinary care*: Patients with chronic liver disease and SBP require multidisciplinary care, including hepatology, gastroenterology, and infectious disease expertise.
By understanding the diagnosis, treatment, and management of SBP in patients with chronic liver disease, healthcare providers can improve patient outcomes and reduce complications.
Web 2.0 to Web 3.0 in action:
[08/05, 07:52]Web 2.0 cm: @Meta AI what was the most important diagnostic test here to identify spontaneous bacterial peritonitis? Why couldn't we culture the bacteria? What were the other diagnostic and therapeutic uncertainties in this patient and as a result what were the over-testing and overtreatment outcomes in this patient?
[08/05, 07:52] Meta AI: The most important diagnostic test for identifying spontaneous bacterial peritonitis (SBP) is ascitic fluid analysis, specifically the polymorphonuclear neutrophil (PMN) count. A PMN count greater than 250 cells/μL is diagnostic of SBP. In some cases, the PMN count may need to be corrected for blood contamination if there are more than 100,000 red blood cells (RBCs) per μL, subtracting 1 PMN for every 250 RBCs.
*Challenges in culturing bacteria:*
- Ascitic fluid cultures can be negative in up to 60% of patients with SBP, despite the presence of infection. This may be due to¹:
- *Low bacterial load*: The number of bacteria in the ascitic fluid may be too low to detect by culture.
- *Prior antibiotic use*: Patients may have received antibiotics before the culture was taken, reducing the likelihood of a positive result.
- *Culture technique*: Cultures should be inoculated at the bedside to increase sensitivity.
*Other diagnostic uncertainties:*
- *Differentiating SBP from secondary bacterial peritonitis*: Secondary bacterial peritonitis is a more severe condition often requiring surgical intervention. Red flags for secondary peritonitis include:
- *Frank peritoneal signs* on exam or localizing abdominal pain
- *Complex, loculated fluid* on ultrasonography
- *Multiple organisms* on gram stain or culture
- *Failure to respond to medical management*
- *Evaluating for secondary peritonitis*: A CT scan of the abdomen/pelvis may be necessary to exclude any focus of infection requiring source control.
*Over-testing and overtreatment outcomes:*
- *Unnecessary antibiotics*: Broad-spectrum antibiotics may be started empirically, potentially leading to overuse and antibiotic resistance.
- *Additional testing*: Repeated diagnostic paracentesis, imaging studies, or other tests may be performed, increasing healthcare costs and resource utilization.
- *Prolonged hospital stay*: Patients may require longer hospital stays due to the complexity of their condition, increasing the risk of hospital-acquired infections and other complications.²
[08/05, 07:54] Rakesh Biswas: @Meta AI is there any diagnostic evidence of spontaneous bacterial peritonitis presented in the EMR content below? 👇
Case 12
Admission-19/8/23
Discharge 19/4/23
Follow up- expired
Diagnosis
CHRONIC LIVER DISEASE WITH SPONTANEOUS BACTERIAL PERITONITIS( RESOLVING)
WITH LOWER LIMB CELLULITIS WITH PRE RENAL AKI (RESOLVING) WITH H/O ESOPHAGEAL
BANDING 1YR BACK. (RESOLVING) WITH K/C/O T2DM SINCE 8YRS WITH 3FFP TRANSFUSION
ON 20/08/2023 WITH 1 PRBC TRANSFUSION ON 22/08/2023.
Case History and Clinical Findings
C/O SOB SINCE 1 WEEK
HOPI- PATIENT WAS APPARENTLY ASYMPTOMATIC 1WEEK, THEN DEVELOPED SOB, GRADE
III-IV, INSIDIOUS IN ONSET AND GRADUALLY PROGRESSIVE, NO AGGRAVATING AND
RELIEVING FACTORS.
H/O ABDOMINAL DISTENSION SINCE 1ODAYS, INSIDIOUS, PROGRESSIVE, NO
AGGRAVATING/ RELIEVING FACTORS.
NO C/O CHEST PAIN, PALPITATIONS, ORTHOPNEA, PND
NO C/O FEVER, DECREASED URINE OUTPUT, BURNING MICTURITION, VOMITING, LOOSE
STOOLS.
C/O PAIN AND SWELLING OVER THE LEFT LIMB SINCE 10DAYS. INSIDIOUS AND GRADUALLY
PROGRESSIVE, FOLOOWED BY UNKOWN? INSECT BITE.
K/C/O CLD AND ESOPHAGEAL BANDING DONE TWICE (1YR BACK)
K/C/O T2DM SINCE 2016 AND IS ON UNKNOWN MEDICATION.
NOT A K/C/O HTN, THYROID DISORDERS, EPILEPSY.
H/O 3 BLOOD TRANFUSION 4DAYS BACK.
COURSE IN HOSPITAL:
PATEINT CAME WITHC/O SOB SINCE 1 WEEK
SOB, GRADE III-IV, INSIDIOUS IN ONSET AND GRADUALLY PROGRESSIVE, NO
AGGRAVATING AND RELIEVING FACTORS.
C/O ABDOMINAL DISTENSION SINCE 1ODAYS,
ON ADMISSION VITALS
TEMP- AFEBRILE
BP- 110/70MMHG
PR- 95BPM
RR- 21CPM
CVS- S1S2+, NO MURMURS
RS- BAE+, NVBS
NO ORGANOMEGALY
GRBS- 148MG/DL
ON FURTHER INVESTIGATIONS-
PATIENT WAS FOUND TO HAVE PANCYTOPENIA FOR WHICH 3FFP TRANSFUSIONS WERE
DONE ON 20/08/2023 AND 1 PRBC TRANSFUSION WAS DONE ON 22/8/2023. AND WAS
UNEVENTFULL
GASTROENTEROLOGIST OPINION WAS TAKEN IVO CLD AND H/O ESOPHAGEAL BANDING -
ADVISED TO CONTINUE SAME MEDICATION AS BY TREATING PHYSICIAN.
DIAGNOSTIC AND THERAPEUTIC TAP WAS DONE:ASCITIC TAP WAS DONE ON 20/08/2023
(1LITRE OF FLUID)
ASCITIC FLUID ANALYSIS REVEALED HIGH SAAG LOW PROTEIN 2 TO CLD.
AND ASCITIC TAP WAS DONE ON THE DAY DISCHARGE I.E ON 24/08/2023
AND AFTER TAP VITALS
BP- 110/60MMHG
PR- 86BPM
RR- 19CPM
TEMP- 98.4F
PATIENT WAS MANAGED CONSERVATIVELY AND BEING DISCHARGED IN
HEMODYNAMICALLY STABLE CONDITION.
Investigation
SERUM ELECTROLYTES (Na, K, C l) AND SERUM IONIZED CALCIUM 19-08-2023 04:14:PM
SODIUM139 mEq/L
145-136 mEq/L
POTASSIUM4.5 mEq/L
5.1-3.5 mEq/L
CHLORIDE102 mEq/L
98-107 mEq/L
CALCIUM IONIZED1.05 mmol/Lmmol/L
LIVER FUNCTION TEST (LFT) 19-08-2023 04:14:PM Total Bilurubin2.58 mg/dl
1-0 mg/dl
Direct Bilurubin0.81 mg/dl
0.2-0.0 mg/dl
SGOT(AST)18 IU/L
35-0 IU/L
SGPT(ALT)11 IU/L
45-0 IU/L
ALKALINE PHOSPHATE253 IU/L
128-53 IU/L
TOTAL PROTEINS6.1 gm/dl
8.3-6.4 gm/dl
ALBUMIN2.10 gm/dl
5.2-3.5 gm/dl
A/G RATIO0.53
COMPLETE URINE EXAMINATION (CUE) 19-08-2023 04:14:PM COLOURPale
yellowAPPEARANCEClearREACTIONA
1.010
ALBUMIN
++
SUGAR
NIL
BILE SALTS
Nil
BILE PIGMENTS
Nil
PUS CELLS
2-4
EPITHELIAL CELLS
2-3
RED BLOOD CELLS
Nil
CRYSTALS
Nil
CASTS
Nil
AMORPHOUS DEPOSITS
Absent
OTHERSNil
LIVER FUNCTION TEST (LFT) 22-08-2023 03:52:AM Total Bilurubin1.57 mg/dl
1-0 mg/dl
Direct Bilurubin0.26 mg/dl
0.2-0.0 mg/dl
SGOT(AST)17 IU/L
35-0 IU/L
SGPT(ALT)9 IU/L
45-0 IU/L
ALKALINE PHOSPHATE241 IU/L
128-53 IU/L
TOTAL PROTEINS6.5 gm/dl
8.3-6.4 gm/dl
ALBUMIN2.2 gm/dl
5.2-3.5 gm/dl
A/G RATIO0.53
ASCITIC FLUID ANALYSIS:
NO ACID FAST BACILLI, FEW DISINTEGRATED PUS CELLS, NO ORGANISMS. NO GROWTH
AFTER 48HRS OF AEROBIC INCUBATION.
2D ECHO:
MILD TR +, WITH PAH, TRIVIL AR, NO MR
NO RWMA, NO ASLMS, SCLEROTIC AV, GOOD LV SYSTLOC DYSFUNCTION, NO DIASTOLIC
DYSFUNCTION, NO LV CLOT
Treatment Given(Enter only Generic Name)
1. FLUID RESTRICTION <1.5 L/DAY
2. SALT RESTRICTION <2G/DAY
3. INJ LINEZOLID 600MG IV/BD
4. INJ PIPTAZ 3.375GM IV/TID
5. TAB SPIRONOLACTONE 25MG PO/OD
6.TAB RIFAGUT 500MG PO/BD
7. TAB LASIX 40MG PO/OD
8. SYP LACTULOSE 15ML PO/BD
9. SYP HEPAMERZ 15ML PO/TID
10. INJ HAI S/C TID PREMEAL
11. TAB UDILIN 300MG PO/OD
12. DRESSING OF LOWER LIMB AND LIMB ELEVATION
13. PROTEIN POWDER 2TBSP IN 1 GLASS OF WATER PO/TID
Advice at Discharge
1. FLUID RESTRICTION <1.5 L/DAY
2. SALT RESTRICTION <2G/DAY
3. TAB LINEZOLID 600MG PO/BD
4. TAB UDILIN 300MG PO/OD
5. TAB SPIRONOLACTONE 25MG PO/OD
6.TAB RIFAGUT 500MG PO/BD
7. TAB LASIX 40MG PO/OD
8. SYP LACTULOSE 15ML PO/BD
9. SYP HEPAMERZ 15ML PO/TID
10. INJ HAI S/C TID PREMEAL
11. TAB AUGMENTIN 625MG PO/TID
12. DRESSING OF LOWER LIMB AND LIMB ELEVATION
13. PROTEIN POWDER 2TBSP IN 1 GLASS OF WATER PO/TID
Follow Up
REVIEW TO MEDICINE OP 78 AFTER 1WEEK OR SOS
Web 3.0 summary:
[08/05, 07:54] Meta AI: The diagnostic evidence for spontaneous bacterial peritonitis (SBP) in this case is limited. The ascitic fluid analysis revealed:
- *High SAAG (Serum-Ascites Albumin Gradient)*: consistent with cirrhosis and portal hypertension
- *Low protein*: consistent with cirrhosis
- *Few disintegrated pus cells*: suggestive of possible infection or inflammation
- *No organisms*: no bacteria were seen on Gram stain
- *No growth after 48 hours of aerobic incubation*: negative culture result
However, the diagnosis of SBP is typically based on an absolute polymorphonuclear neutrophil (PMN) count ≥ 250 cells/μL in the ascitic fluid. Unfortunately, this information is not provided in the case report.
Given the clinical presentation and laboratory findings, it's possible that the patient was treated empirically for SBP based on clinical suspicion, despite the lack of definitive diagnostic evidence. The patient's symptoms, such as abdominal distension, and laboratory findings, such as low protein in the ascitic fluid, may have raised suspicion for SBP.
The treatment with antibiotics, such as linezolid and pip-taz, would be consistent with empirical treatment for SBP. However, without further information on the PMN count or other diagnostic criteria, it's difficult to confirm the diagnosis of SBP with certainty.
Web 2.0 to Web 3.0
[08/05, 07:56]cm: @Meta AI what are the over treatment issues here with respect to overuse of antibiotics escalation and usage of non evidence based hepamerz also known as L ornithine L aspartate LOLA?
[08/05, 07:56] Meta AI: *Over-treatment issues:*
1. *Overuse of antibiotics:* The patient was prescribed multiple antibiotics, including linezolid, pip-taz, and augmentin. This may contribute to antibiotic resistance, adverse effects, and increased healthcare costs.
2. *Escalation of antibiotics:* The patient was started on IV antibiotics, which may not be necessary for all cases of suspected SBP. Escalation to broader-spectrum antibiotics may be justified in severe cases or those with specific risk factors.
3. *Usage of non-evidence-based L-Ornithine L-Aspartate (LOLA):* LOLA, also known as Hepamerz, is not recommended for routine use in patients with liver disease or hepatic encephalopathy. The evidence for its effectiveness is limited, and its use may not be justified in this case.
*Concerns with LOLA:*
1. *Lack of strong evidence:* There is limited high-quality evidence supporting the use of LOLA in patients with liver disease or hepatic encephalopathy.
2. *Unclear benefits:* The benefits of LOLA in reducing ammonia levels or improving outcomes in patients with liver disease are not well established.
3. *Potential adverse effects:* LOLA may cause gastrointestinal side effects, such as nausea and vomiting.
*Implications:*
1. *Antibiotic stewardship:* The overuse and escalation of antibiotics should be carefully considered, and alternative approaches should be explored when possible.
2. *Evidence-based practice:* The use of LOLA should be evaluated based on current evidence and guidelines, and alternative treatments with stronger evidence should be considered.
3. *Risk-benefit analysis:* The potential benefits and harms of each treatment should be carefully weighed, and treatment plans should be individualized based on patient-specific factors.
Web 2.0 to 3.0
[08/05, 07:58]cm: @Meta AI what is the learning point from this patient in terms of optimizing clinical complexity navigating diagnostic and therapeutic uncertainty to minimise over-testing and overtreatment?
Web 3.0 summary learning points:
[08/05, 07:58] Meta AI: *Learning points:*
1. *Careful consideration of diagnostic uncertainty:* In complex cases, clinicians should carefully weigh the potential benefits and limitations of diagnostic tests, considering factors like test sensitivity, specificity, and potential harms.
2. *Evidence-based treatment decisions:* Clinicians should prioritize evidence-based treatments and avoid non-evidence-based interventions, like LOLA in this case, to minimize overtreatment and potential harm.
3. *Antibiotic stewardship:* Clinicians should carefully consider the use of antibiotics, taking into account the potential risks of resistance, adverse effects, and interactions.
4. *Individualized care:* Treatment plans should be tailored to the individual patient's needs, taking into account their unique circumstances, comorbidities, and preferences.
5. *Multidisciplinary collaboration:* Complex cases may benefit from multidisciplinary collaboration, including input from specialists like gastroenterologists, to ensure comprehensive care.
6. *Regular review and adjustment:* Treatment plans should be regularly reviewed and adjusted based on the patient's response, new information, or changes in their condition.
*Optimizing clinical complexity:*
1. *Streamlined diagnostic approaches:* Clinicians should aim to use the most efficient and effective diagnostic approaches, minimizing unnecessary tests and procedures.
2. *Risk-benefit analysis:* Clinicians should carefully weigh the potential benefits and harms of each treatment or intervention, considering the patient's individual circumstances.
3. *Patient-centered care:* Clinicians should prioritize patient-centered care, taking into account the patient's values, preferences, and goals.
By applying these principles, clinicians can navigate diagnostic and therapeutic uncertainty, minimize over-testing and overtreatment, and provide high-quality, patient-centered care.
Glossary:
cm: CBBLE moderator
More about CBBLE in the glossary:
ProJR: project journey record, more ProJRs in the links below:
For example if our currently encountered patient was one of the patients out of these 50 patients of anemia that we have archived from our EMR summaries, then one could extract the themes from each patient: Ref 40: https://
and check which of those matched our current patient.
Similarly for altered sensorium here: Ref 41 https://medicinedepartment.
And cardio renal failure here: Ref 42 https://medicinedepartment.
And even for something as common place for trunkal obesity here: Ref 43 https://medicinedepartment.
However it's still a work in progress with a lot of non peer reviewed data building up through primary https://pajr.in/ EMR data which for the first time can be well analysed by LLMs once we figure out a way to further automate this process seamlessly between our primary patient Ux and the data processing Ux.
Images generated by Canva prompts
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