Project Summary
The project revolves around the management and learning of diabetic bullous blister lesions, cellulitis, and necrotizing fasciitis in diabetic patients through *ProJR (Project journey record )* and *PaJR (Patient journey record)* conversational learning platforms. The cases highlight the challenges of early identification, appropriate management, and collaborative problem-solving among healthcare professionals, with the active involvement of patients and caregivers. The project emphasizes the importance of capturing qualitative data (e.g., patient-reported symptoms, visual documentation) and integrating it with evidence-based clinical practices to improve outcomes.
Project Qualitative Data Capture and Analysis Design
Data Capture:
1. *Patient-Reported Inputs*:
- Symptoms (pain, presence of fluid in blisters, etc.)
- Visual documentation (photos of lesions captured by caregivers via mobile phones).
2. *Provider Communication*:
- Collaborative discussions between healthcare providers on diagnosis, treatment strategies, and learning from prior cases.
- Integration of global expert inputs from platforms like PaJR.
3. *Clinical Observations*:
- Progression of lesions (from blisters to cellulitis and necrotizing fasciitis).
- Response to treatment (e.g., insulin adjustments, wound care).
4. *Evidence Integration*:
- Reference to academic resources (e.g., PubMed articles, case reports) and ProJR case compilations for comparative insights.
Analysis Design:
- *Thematic Analysis*:
- Coding patient and provider inputs into themes (e.g., early diagnosis, treatment challenges, outcomes).
- Identifying patterns in lesion progression, response to treatment, and outcomes.
- Evaluating gaps in management strategies and knowledge.
- *Outcome Analysis*:
- Comparing clinical outcomes based on different treatment approaches (e.g., standard cellulitis management vs. bullous lesion-specific care).
- Assessing the impact of patient involvement (e.g., early reporting through mobile photos).
- *Feedback Loop*:
- Using insights from cases to refine protocols for future management.
- Sharing learnings through academic platforms and training sessions.
PaJR conversational learning Transcripts:
November 2025 from PaJR linked here:
8.11 am, 27/11/2025] PA: Fasting sugar 128mg/dl
[8:11 am, 27/11/2025] PA: సార్ మా అమ్మా కి ఇలా కాలు బొగ్గాలు వస్తున్నాయి
[4:22 pm, 27/11/2025] PPM 14: నీరు ఉందా? నొప్పి ఏమైనా ఉందా?
[4:22 pm, 27/11/2025] PPM 14: @PPM1 Sir patient is developing these on foot sir. foot ulcers?
[5:15 pm, 27/11/2025] PPM 12: Could these be diabetic bullae, sir?
[5:34 pm, 27/11/2025] PPM 1: Yes we seem to see these more commonly here in our hospital but most of the time it's just obtained on history but thanks to PaJR we are able to actually see a picture in the early phases.
@CR there must be a ProJR for this that needs to be collated from this case as well as previous ones such as here (recently submitted for a conference by @PPM12)👇
[6:15 pm, 27/11/2025] PPM 1: This is the first patient where we got to see the bullous lesions after the patient was brought to us only because the son had captured and stored them in his mobile phone 👇
[6:26 pm, 27/11/2025] PA: సార్ నీరు ఉంది నొప్పి ఉంది
[2:45 am, 28/11/2025] PPM 14: what would be the plan of action in this case sir? @PPM1 Sir
[4:44 am, 28/11/2025] PA: Today come hospital sir
[8:55 am, 28/11/2025] PPM 1: Yes we can evaluate her in OPD and admit her if necessary
[9:15 am, 28/11/2025] PPM 1: In an academic institution:
July 2025:
From PaJR here: https://
30-07-2025 15:55] PPM 1: @Meta AI @PPM3 what approach would you recommend to sort out our current management strategies for these cutaneous diabetic bullous lesions?
Context 👇
68F with lower limb blister like lesions progressing to cellulitis and sepsis affecting kidneys with AKI
We see these diabetic patients with bullous blisters quite often in Narketpally and somehow other departments treat them in a blanket way as cellulitis and necrotising fascitis with general debridement without exploring and factoring the bullous blister like mechanisms in their outcomes.
[30-07-2025 15:55] Meta AI: To manage cutaneous diabetic bullous lesions effectively, consider the following approach:
## Assessment and Diagnosis
- Identify the condition as bullosis diabeticorum, a rare skin condition seen in individuals with diabetes.
- Rule out other possible causes of blistering skin conditions, such as autoimmune bullous diseases or infections.
- Assess the patient's diabetes control and adjust treatment plans accordingly.
## Treatment Strategies
- Leave blisters intact: Whenever possible, leave the blister intact to serve as a sterile dressing and prevent secondary infection.
- Aspiration: Aspirate fluid from bullous lesions with sterile technique using a small-bore needle to prevent accidental rupture.
- Immobilization: Immobilize the affected area to prevent damage to the blister.
- Monitor for secondary infection: Closely monitor patients for signs of secondary infection, such as increased redness, swelling, or pus, and initiate antibiotic therapy promptly if necessary.
- Debridement and wound care: Perform debridement only if necessary, and prioritize aggressive wound healing interventions to promote healing.
September 2025:
The OPLL, metabolic syndrome and cellulitis connection:
Thematic Analysis
- *Key Findings*:
- Visual documentation (e.g., mobile photos) by caregivers plays a critical role in early identification of diabetic bullous lesions.
- PaJR enables timely reporting of symptoms, often before the patient presents to the hospital.
- *Implication*:
- Encouraging caregivers to document and share symptoms can prevent delays in treatment.
- *Key Findings*:
- ProJR facilitates learning from past cases and academic resources, improving diagnostic accuracy.
- Discussions among providers (e.g., debridement necessity, aspiration techniques) highlight the value of collaborative decision-making.
- *Implication*:
- Platforms like PaJR can enhance interdisciplinary collaboration, leading to evidence-based, patient-centered care.
- *Key Findings*:
- Mismanagement of diabetic bullous lesions as generalized cellulitis or necrotizing fasciitis can lead to suboptimal outcomes.
- Lack of awareness about specific interventions (e.g., leaving blisters intact, sterile aspiration) among some providers.
- *Implication*:
- Need for targeted training on managing bullous diabetic lesions and their complications.
- *Key Findings*:
- Patients and caregivers actively participating in reporting symptoms and sharing feedback improve care quality.
- Challenges like caregiver availability and affordability of advanced tools (e.g., CGM devices) influence outcomes.
- *Implication*:
- Addressing socioeconomic barriers is critical for effective management.
- *Key Findings*:
- Integration of academic resources (e.g., case reports, clinical studies) informs better treatment strategies.
- Use of ProJR for documenting and analyzing prior cases provides valuable insights for similar future cases.
- *Implication*:
- Combining real-world data with evidence-based guidelines can optimize treatment.
Conclusion
This project demonstrates the power of conversational learning platforms (PaJR and ProJR) in improving the management of diabetic bullous lesions. Key strategies include early reporting through visual documentation, collaborative decision-making, and evidence-based interventions. However, addressing systemic challenges like caregiver availability and socioeconomic constraints remains essential.
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