2021 MD batch Formative assessment

 

DEPARTMENT OF GENERAL MEDICINE

This is a blended, formative assessment of the learning competencies of PG 2021, MD batch in the department of Medicine. The formative assessment is from each PG's logged competency around patients evaluated regularly from date of joining till date.

The formative assessment has been divided into non-verbal which assesses their competency in procedural domains including empathic communication and body language and verbal which assesses their ability to communicate their work through their day to day E logs.

PG  (2021 Batch)
1	Dr. K. Prem Sai Pavan Kumar	Formative Assessment from May 2022 to Aug 2022 Subjective Non Verbal: https://youtube.com/playlist?list=PLvYjjuT_hEEQDtlHSAvFdRpCb5EBszwgR Objective Verbal: https://kpremsaipavankumar96.blogspot.com/?m=1	51
2	Dr. Deepika Raga	Formative Assessment from May 2022 to Aug 2022 Subjective Non Verbal: https://youtube.com/playlist?list=PLvYjjuT_hEEQDtlHSAvFdRpCb5EBszwgR Objective Verbal: https://deepikaraga97.blogspot.com/?m=1	50
3	Dr. Kranthi	Formative Assessment from May 2022 to Aug 2022 Subjective Non Verbal: https://youtube.com/playlist?list=PLvYjjuT_hEEQDtlHSAvFdRpCb5EBszwgR Objective Verbal: http://drkranthimenmula.blogspot.com	52
4	Dr. Narsimha Reddy	Formative Assessment from May 2022  to Aug 2022 Subjective Non Verbal: https://youtube.com/playlist?list=PLvYjjuT_hEEQDtlHSAvFdRpCb5EBszwgR Objective Verbal: https://drbnr.blogspot.com/?m=1	51
5	Dr. Nishitha Alla	Formative Assessment from May 2022 to August 2022 Subjective Non Verbal: https://youtube.com/playlist?list=PLvYjjuT_hEEQDtlHSAvFdRpCb5EBszwgR Objective Verbal: https://nishithaalla95.blogspot.com/?m=1	51
6	Dr. Haripriya	Formative Assessment from  May 2022 to August 2022 Subjective Non Verbal:  https://youtube.com/playlist?list=PLvYjjuT_hEEQDtlHSAvFdRpCb5EBszwgR Objective Verbal: https://jharipriya.blogspot.com/?m=1	51
7	Dr. Venkat Sai	Formative Assessment from May 2022 to August 2022 Subjective Non Verbal: https://youtube.com/playlist?list=PLvYjjuT_hEEQDtlHSAvFdRpCb5EBszwgR Objective Verbal: https://venkatsaitodupunoori.blogspot.com/?m=1	51
8	Dr. Bharath Kumar	Formative Assessment from May 2022 to August 2022 Subjective Non Verbal: https://youtube.com/playlist?list=PLvYjjuT_hEEQDtlHSAvFdRpCb5EBszwgR Objective Verbal: https://drbharath79.blogspot.com/?m=1	52
9	Dr. Pavani	Formative Assessment from May 2022 to Aug 2022 Subjective Non Verbal: https://youtube.com/playlist?list=PLvYjjuT_hEEQDtlHSAvFdRpCb5EBszwgR Objective Verbal: https://pavani2021.blogspot.com/?m=1	50
10	Dr. Keerthi	Formative Assessment from May 2022 to Aug 2022 Subjective Non Verbal: https://youtube.com/playlist?list=PLvYjjuT_hEEQDtlHSAvFdRpCb5EBszwgR Objective Verbal: https://drkeerthimadireddy.blogspot.com/?m=1	50

 

Plasma exchange as an intervention toward longevity: a journal club in our global CBBLE

Conversational learning transcripts below that reflects the online journal club interactions and selective sampling and critical appraisal of the journal published study content and the camaraderie:

[8/27, 1:19 AM] Sumit Global CBBLE: 

https://twitter.com/davidasinclair/status/1562830261171421185?t=8zzZZcYjD4ejZ3qUIgy0TQ&s=19

Context: David is one of the pioneers of longevity research.

[8/27, 5:53 AM] Rakesh Biswas: Any links to the real paper for a proper appraisal in the PICO format?

[8/27, 10:15 PM] Sumit Global CBBLE: It's in the tweet (the link at the end)

[8/27, 10:19 PM] Rakesh Biswas: Can someone appraise it in the PICO format? @⁨Aashita KIMS PG⁩

[8/27, 10:26 PM] Aashita KIMS SR : 

Sure sir

I’ll go through it

[8/27, 11:56 PM] Aashita KIMS SR: 

Quoting, 

To investigate the effect of TPE, we examined blood samples before and after rounds of this clinical procedure

P - 15 samples were included 

I - Samples 1, 2, 4, 6, 7, and 8 were from old individuals 

C - Samples 3 and 5 were from middle-aged people

( I’m assuming the remaining samples belong to the younger age group but they haven’t  clearly mentioned their sample numbers)

[8/27, 11:56 PM] Aashita KIMS SR: 

Quoting, 

Changes in 8-OHdG levels after TPE.Oxidative DNA damage gradually decreases and becomes statistically lower by the last round, in all patients.

[8/27, 11:56 PM] Aashita KIMS PG: R0 is before TPE, R1 is 1 month afterwards and before the next round of TPE, and so on.

[8/27, 11:56 PM] Aashita KIMS PG: 

Quoting, 

C. TPE decreases p16 levels in PBMCs of old and middle-aged people, 

D. TPE upregulates the markers of lymphoid genes (T cells, B cells, NK cells) in old PBMCs. E The lymphoid:myeloid ratio is increased by the rounds of TPE. The myeloid:NK ratio is downregulated by TPE. The ratios of lymphoid:CD68 and NK:CD68 are elevated by the rounds of TPE. 

These data show a rejuvenation of the lymphoid/myeloid balance, suggesting an improved capacity for productive immune responses

[8/27, 11:56 PM] Aashita KIMS SR: 

Quoting 

Out of 507 proteins, 72 proteins were significantly different in their levels between the old and the young groups (> 1.75 fold change, p < 0.05). These 72 proteins were analyzed further in the longitudinal TPE datasets by heat mapping, which revealed a gradual rejuvenation of the age-specific systemic proteome by subsequent rounds of TPE. Principal component analysis confirmed that each R0 proteome (before the first TPE) was closer to the old control group than to the young control group and shifted from the old toward the young group with the rounds of TPE

[8/27, 11:56 PM] Aashita KIMS SR : 

Quoting, 

We also determined whether repetitive TPE may regulate the complement system including C3 and C1q, which play a key role in immune responses and also participate in non-immune crosstalks of cell–cell signaling pathways

[8/27, 11:56 PM] Aashita KIMS PG: In our analysis, 13 proteins were related to the negative regulation of apoptosis and the levels of these proteins were higher in the old group than in the young. Consistent with better tissue homeostasis, the levels of these apoptotic inhibitors diminished over rounds of TPE, becoming closer to the young cohort

[8/27, 11:56 PM] Aashita KIMS SR: 

Quoting, 

Considering these observations, we decided to analyze systemic levels of TDP43, which is the trigger of several neurological pathologies and becomes increased in the blood of patients with ALS, Parkinson’s disease (PD), frontotemporal dementia (FTD), and AD

[8/27, 11:56 PM] Aashita KIMS SR: 

Circulating TDP43 levels are higher in old than in young individuals

[8/27, 11:56 PM] Aashita KIMS SR: 

Summary: (Quoting) 

Among 15 samples post TPE the oxidative dna damage reduces by each round of TPE.  TPE also increased the lymphoma myeloid balance basically improving the immune responses. It also regulates complement C3 and C1q.  Circulating TDP43 were found to be higher in older ages but with TPE, TDP43 reduced gradually.

[8/27, 11:56 PM] Aashita KIMS SR: 

Quoting, 

The effect of repetitive TPE on aged blood. Aged blood has the characteristics of chronic inflammation (inflammaging), increased PBMC DNA damage and senescence, and immune deregulation, all changes that promote the high risk of diseases. TPE resets the systemic milieu to a younger state by rapidly and significantly diluting the age-elevated inhibitors of the canonical signaling pathways that regulate tissue maintenance and repair.

[8/28, 8:10 AM] Rakesh Biswas: Thanks. Also please share the direct link to the paper

[8/28, 8:19 AM] Rakesh Biswas: Thanks 

So to critically appraise this @⁨Sumit Global CBBLE⁩ , David Sinclair has currently just begun to show scientists looking at certain chemical changes demonstrable on Therapeutic plasma exchange (TPE) as reflected in his obtained outcomes that simply mention the chemical changes as a result of TPE but don't tell us what actually happened in terms of longevity in the participants who received TPE. 

That may require a follow up of the same or more cohorts and one would also need to figure out the optimal frequency of TPE necessary to maintain the levels of the currently assumed healthy chemical balance. 

In essence this was a phase 2 study that shows promise but there's a long way ahead

[8/28, 8:24 AM] Sumit Global CBBLE: Interesting, thanks.

Regarding you question, as I've previously stated: DNA damage is directly linked to DNA methylation clock which is a standard ageing biomarker by now (until something cheaper and more reliable comes along).

So I guess we can say that TPE promises longevity (if this study replicates well in more trials)?

I agree regarding your points on the optimal frequency exploration.

[8/28, 8:26 AM] Sumit Global CBBLE: 

And thanks for the detailed PICO analysis @⁨Aashita KIMS PG⁩

[8/28, 8:27 AM] Sumit Global CBBLE: Thanks for simplifying the appraisal! 🙏

[8/28, 8:30 AM] Rakesh Biswas: Yes it's promising but too early to draw conclusions. 

Standard biomarkers are never standalone and have only been provided assumed causal associations in relation to more palpable clinical determinants such as morbidity, mortality, longevity and we would need to look again critically at those papers that have drawn causal association between oxidative DNA and patient outcomes

[8/28, 8:32 AM] Rakesh Biswas: Thanks for sharing the paper and this journal club, which I shall be archiving.

Please tell our audience here a little bit about yourself. 🙂

[8/28, 8:37 AM] Sumit Global CBBLE: True, promising but not 100% confirmation.

Here's the catch-22 with aging - good trials would need to run for 200 years (or atleast 150 if parallelized) to be perfectly sure of the outcomes given that the trials would need to run atleast twice the lifespan (repeating promising studies, or starting more studies in parallel that promise improvement in biomarkers to run them in their full length).

So I guess, in our lifetimes we would need to rely on best biomarkers available that improve the well being of the species in a noticeable way.

Are there other ways to be sure?

About me in the next text ➡️

[8/28, 8:40 AM] Rakesh Biswas: Got the link to the original here https://link.springer.com/article/10.1007/s11357-022-00645-w but also enjoyed the many comments in the twitter feed

[8/28, 8:52 AM] Sumit Global CBBLE: Sinclair's YouTube podcast is great!

[8/28, 8:54 AM] Rakesh Biswas: Please share that link too

[8/28, 8:55 AM] Sumit Global CBBLE: https://youtube.com/c/DavidSinclairPodcast

[8/28, 8:56 AM] Rakesh Biswas: Please share a link to your online learning portfolio. It could be a LinkedIn profile or anything. @⁨Aashita KIMS PG⁩ 's online learning portfolio is here👉https://ashiness3.blogspot.com/?m=1

[8/28, 9:01 AM] Sumit Global CBBLE: https://youtube.com/channel/UCHA5edkpRK_M7nDHvg3Jp2g

I tried doing this thing where I learnt a new field from the experts - was fun. It's limited to the design field though.

[8/28, 9:09 AM] Sumit Global CBBLE: Sure sir. I'll tell the group about myself.

Hi all, I'm Sumit Srivastava, primarily a technologist with extremely diverse interests.

Every couple of years I pick a field that I know nothing about and immerse myself into it, learning from the best.

Then overtime, I gradually accumulate knowledge in that field while also picking up new fields subsequently.

This method has worked decently over the years for learning various different things.

I've started noticing that a most problems have simple and logical solutions, even though they may seem complex at the first glance. 

I picked up the field of medicine as a challenge a few years ago after working on some interesting things in brain computer interfaces.

Now I love the field of medicine so much that I've started exploring interesting (and promising) sub fields of the vast knowledge available in medicine.

As a child I knew that the my innate nature was that of curiosity - asking a lot of questions.

I've tried to not let that die (it's super hard, because questioning everything comes at the cost of speed of doing things).

Over time, you learn to question the things that matter the most.

I've learnt that the best things to question are the things that people think are either "really obvious" or things that are "mostly unexplored".

I take my inspiration from an excellent paper called you and your research by Dr. Richard W. Hamming, a pioneer in computer science.

Even though I'm not a researcher - this is one of the most groundbreaking paper an ambitious individual can read in their lifetime (it's super long): https://medium.com/motivate-the-mind/you-and-your-research-b525e6125afd

The global CBBLE is a social network currently with 156 members and can be joined through this link : https://chat.whatsapp.com/AEovRaJe7MF2dhVKDes95Z

2020 PG formative assessment

 DEPARTMENT OF GENERAL MEDICINE

This is a blended, formative assessment of the learning competencies of PG 2020, MD batch in the department of Medicine. The formative assessment is from each PG's logged competency around patients evaluated regularly from date of joining till date.

The formative assessment has been divided into non-verbal which assesses their competency in procedural domains including empathic communication and body language and verbal which assesses their ability to communicate their work through their day to day E logs.

PG  (2020 Batch)
1	Dr. Raveen	Formative Assessment from 5/8/2020 to Aug 2022 Subjective Non Verbal: https://youtu.be/Dxxz8nIn5a4 Objective Verbal: https://raveen07.blogspot.com/	50
2	Dr. Shailesh	Formative Assessment from 5/8/2020 to Aug 2022 Subjective Non Verbal:  Objective Verbal: https://shaileshpatil1996.blogspot.com/?m=1	40
3	Dr. Durga Krishna	Formative Assessment from 5/8/2020 to Aug 2022 Subjective Non Verbal:  Objective Verbal: https://durgakrishna09.blogspot.com/	45
4	Dr. Sai Charan	Formative Assessment from 5/8/2020 to Aug 2022 Subjective Non Verbal:  https://youtu.be/QljSGliMgbs https://youtu.be/r8E9wenN9eI Objective Verbal: Current portfolio : https://drsaicharankulkarni.blogspot.com Past dysfunctional : https://drkulkarnimd.blogspot.com/	55
5	Dr. Vinay	Formative Assessment from 5/8/2020 to August 2022 Subjective Non Verbal:  https://youtu.be/EJlsjUL8nMc https://youtu.be/L-FLcGaPWuI https://youtu.be/8d-kBU8bp3M Objective Verbal: https://manikaraovinay.blogspot.com/	50
6	Dr. Vamshi Krishna	Formative Assessment from 5/8/2020 to August 2022 Subjective Non Verbal:  https://youtu.be/VFRvHnADgvk https://youtu.be/rp_Slx1bXOE Objective Verbal: https://vamsikrishna1996.blogspot.com/	54
7	Dr. Chandana	Formative Assessment from 5/8/2020 to August 2022 Subjective Non Verbal:  https://youtu.be/BdIF6npVVTg https://youtu.be/_h4ZoKAoqPU Objective Verbal: https://chandanavishwanatham19.blogspot.com/?m=1	53
8	Dr. Pradeep	Formative Assessment from 5/8/2020 to August 2022 Subjective Non Verbal:  Objective Verbal: https://pradeepsomagani.blogspot.com/	48
9	Dr. K. Manasa	Formative Assessment from 5/8/2020 to Aug 2022 Subjective Non Verbal:  Objective Verbal: https://kmanasa20.blogspot.com/?m=1	47
10	Dr. Shashikala	Formative Assessment from 5/8/2020 to Aug 2022 Subjective Non Verbal:  https://youtu.be/vlxNoT9PBqs https://youtu.be/rrBX2NwTOCY Objective Verbal: https://shashikalachegurimedicine.blogspot.com/	50

 

Thesis draft "Clinical complexity in Diabetes: Qualitative evaluation of patients, interventions and outcomes."

Problem statement/Background:

Among patients with diabetes, clinical complexity and treatment burden have increased over time." (1)

"Piette and Kerr created a framework dividing multiple chronic conditions into three categories: (a) concordant (illnesses which share similar pathogenesis and management as diabetes such as cardiovascular disease), (b) discordant (where the illness is unrelated, yet whose management may be at odds with diabetes care, such as musculoskeletal disease or mental illness), and (c) dominant illnesses, whose severity overshadows diabetes care (such as end-stage renal failure or metastatic cancer)."(2) 

"The ADA/AGS consensus breaks diabetes treatment goals into three strata based on the following patient characteristics: for patients with few co-existing chronic illnesses and good physical and cognitive functional status, they suggest a target A1c of under 7.5%, given their longer remaining life expectancy. Patients with multiple chronic conditions, two or more functional deficits in activities of daily living (ADLs), and/or mild cognitive impairment may be targeted to 8% or lower given their treatment burden, increased vulnerability to adverse effects from hypoglycemia, and intermediate life expectancy. Finally, a complex patient with poor health, greater than two deficits in ADLs, and dementia or other dominant illness, would be allowed a target A1c of 8.5% or lower." (3)

AIM: 

To navigate clinical complexity in patients with diabetes and optimize their management toward reducing diagnostic and therapeutic uncertainty along with improvement in their anemia outcomes. 

OBJECTIVES:

• To assess various clinical and investigational characteristics of patients with diabetes in relation to their clinical complexity and outcomes.

• To analyse patient outcomes based on morbidity (physical, social & psychological limitations)

PATIENTS AND METHODS:

PLACE OF STUDY: Department of General medicine 

STUDY PERIOD: November 2022- October 2024

STUDY DESIGN : Non experimental (Observational) qualitative Study 

SAMPLE SIZE: 50 patients 

Methodology.and objectives :

To be detailed after going through the sample cases linked below (and more). 

INCLUSION CRITERIA:

• Complex Diabetes patients of any gender above or equal to 18yrs of age at the time of presentation.

Complex needs of the Diabetic patients would be assessed using the COmplex NEeds Case-finding Tool – 6 (CONECT-6), which evaluates the following variables: low perceived health; limitations due to pain; unmet needs; high self-perceived complexity; low income; and poor social support. With a threshold of two or more positive answers, the sensitivity was 90% and specificity 66%. The positive and negative predictive values were 49 and 95% respectively. (4)

EXCLUSION CRITERIA:

1.Patients below 18 yrs of age (minors)

2.Patients not capable of giving consent (mentally-ill patients)

3.Patients not willing to participate in study (non-consenting patients) kp

4. Non complex diabetes 

PROFORMA (data to be captured) 

Demographics

Patient event data reflected in a narrative history of the  sequence of events leading to the current presentation and outcomes

Body data from clinical general and systemic examination 

Pallor 

Lymphadenpathy 

Nails 

Organomegaly 

Skin 

Muscle mass 

Mid arm circumference 

Visceral fat 

Body data from laboratory investigation :

• CBP with peripheral smear 
• Iron profile with serum ferritin 
• Serum albumin 
• Serum creatinine
• Special tests on indication :
• Thyroid function tests 
• Chest X-ray -PA view

• ECG
• 2D ECHO
• Bone marrow if indicated 

Data from treatment instituted :

Data from Patient reported outcomes :

Daily functionality (in terms of routine activities)

Daily diet in the form of meal images captured before consumption 

Daily intake output where relevant such as complex anemias with renal failure and nutritional deficiency or anemia and chronic diarrhoea 

Sample diabetes with Clinical complexities case report forms linked below :

http://mounikagadiparthirollno46.blogspot.com/2022/07/50-m-with-uncontrolled-dm-2.html (complex diabetes with chronic alcoholism) 

https://tejasridevaruppala36.blogspot.com/2022/08/diabetic-foot-ulcer-with-ckd.html?m=1 (complex diabetes, problems yet to be listed and resolved) 

https://tejasridevaruppala36.blogspot.com/2022/07/64yr-old-male-with-obstructive-uropathy.html?m=1

(complex diabetes with renal pain and failure) 

https://tejasridevaruppala36.blogspot.com/2022/06/a-55year-old-male-with-anasarca-and-sob.html?m=1 (complex diabetes with anasarca) 

https://dongsarwarshreeya.blogspot.com/2022/08/45-yr-old-male-with-urosepsis.html?m=1 (complex diabetes with urosepsis) 

https://didyalasushmitha37.blogspot.com/2022/07/dm-2.html?m=1(complex uncontrolled diabetes with alcoholism) 

Clinical complexity consists of a few defining characteristics such as uncertainty, non linearity, unpredictability and yet an overall pattern leading to resolution through attractor states over time. (5) As physician attractors we are uniquely privileged to "be" with our patients regardless of the diagnosis and that is the only way we may know our patient's outcomes where our "being" with them is the most significant (and often overlooked) intervention. 

Sample MASTER CHART WITH LINKS TO PATIENTS E-LOGs

Link To Master Chart:

https://drive.google.com/file/d/1qEvnrKR8DNYWp4TMdwPmMeORyFTWkcYT/view?usp=drivesdk

PATIENT INFORMATION SHEET

English:

https://drive.google.com/file/d/12LLDgFBVfnTxDdNv5K715uSyLYPUEgrY/view?usp=drivesdk

Telugu:

https://drive.google.com/file/d/13Df9wCu9zhjECpPxcHEULSAphv6-tDHl/view?usp=drivesdk

Template of this "patient information sheet" is borrowed from this website:

https://www.ncbi.nlm.nih.gov/books/NBK261334/

And modified accordingly to my thesis topic.

References :

1) Benning TJ, Heien HC, McCoy RG. Evolution of Clinical Complexity, Treatment Burden, Health Care Use, and Diabetes-Related Outcomes Among Commercial and Medicare Advantage Plan Beneficiaries With Diabetes in the U.S., 2006-2018. Diabetes Care. 2022 Aug 4:dc212623. https://pubmed.ncbi.nlm.nih.gov/35926104/

2) Piette JD, Kerr EA. The impact of comorbid chronic conditions on diabetes care. Diabetes Care. 2006;29(3):725–31.

3)Hackel JM: Patient-centered care for complex patients with type 2 diabetes mellitus—analysis of two cases. Clin Med Insights Endocrinol Diabetes 2013;6:47–61

4)Hudon, C., Bisson, M., Dubois, MF. et al. CONECT-6: a case-finding tool to identify patients with complex health needs. BMC Health Serv Res 21, 157 (2021).

https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-021-06154-4

5) Plsek PE, Greenhalgh T. Complexity science: the challenge of complexity in health care. BMJ. 2001 Sep 15;323(7313):625–8. doi: 10.1136/bmj.323.7313.625.

Full text : https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1121189/