Saturday, September 28, 2024

Thematic analysis of biopsychosocial factors influencing trunkal obesity outcomes in 16 case encounters in Narketpally

 Abstract:


Biopsychosocial Factors in Healthcare complexity Outcomes - A Case Series Analysis

Introduction: This abstract examines 16 cases to understand the influence of biopsychosocial factors on health outcomes. Recognizing the interplay of biological, psychological, and social determinants of health is crucial for effective patient care.
Methods: The cases were analyzed to identify key biological, psychological, and social factors impacting each patient's health journey. The analysis considered the patients' medical histories, social contexts, and reported experiences to understand how these factors might contribute to their current health status and influence their ability to manage their conditions.
Results: Across the cases, common biological factors included diabetes, hypertension, cardiovascular disease, and renal disease. Psychological factors included anxiety, grief, stress, and the impact of past trauma or loss. Significant social determinants of health included low socioeconomic status, limited education, and challenging life events. The analysis reveals how these factors interweave, creating complex health profiles for each individual. For example, patients with limited education and lower socioeconomic status often faced barriers to healthcare access and experienced higher rates of chronic conditions. Patients who experienced significant losses or trauma were more vulnerable to developing mental and physical health challenges.
Discussion: This case series analysis emphasizes the importance of a holistic approach to patient care. Healthcare professionals must consider biological, psychological, and social factors to provide effective treatment and management strategies. Addressing social determinants of health, recognizing the impact of psychological well-being, and understanding patients' lived experiences are crucial for providing person-centered care.

Keywords: Biopsychosocial, Health Outcomes, Social Determinants of Health, Chronic Disease, Patient-Centered Care

Introduction in detail to the 16 case narrative textual data:


Thematic analysis of the 16 case narrative textual data using AI LLM tools particularly Google LM that can process data in weblinks. More about it here: https://notebooklm.google/

More about our tryst with other LLM tools such as meta AI particularly in managing it's confabulations: 

Google LM prompt 1 fed as an input at https://notebooklm.google.com/?pli=1

Please do a thematic analysis of the textual content in the link attached: https://himajav.blogspot.com/2024/09/cases-1-16_27.html 

Please demonstrate the steps of thematic coding, subcoding and finally share the learning insights from the case content coding

Thematic Analysis of Cases 1-16

This response outlines a thematic analysis of the provided source, "Cases 1-16", demonstrating the steps of thematic coding and subcoding. Finally, learning insights derived from the case content coding are shared.


1. Familiarization with the Data
The first step involves carefully reading through the case studies to get a comprehensive understanding of the content. This initial reading helps identify recurring patterns, themes, and ideas within the text.




2. Generating Initial Codes


Based on the initial reading of the case studies, the following initial codes are identified:●

Socioeconomic Factors: Many cases highlight the influence of socioeconomic factors on health outcomes. This includes factors such as:○
Occupation○
Income level○
Access to healthcare○

Education●
Lifestyle Factors: Cases consistently mention the impact of lifestyle choices on the development and management of chronic conditions. Some key lifestyle factors include:○
Diet and nutrition○
Physical activity○
Smoking○
Alcohol consumption●
Comorbidities: The presence of multiple chronic conditions in a single patient is frequently observed. This highlights the interconnected nature of chronic illnesses. Common comorbidities include:○
Hypertension (HTN)○
Diabetes Mellitus (DM)○
Chronic Kidney Disease (CKD)○
Cardiovascular Disease (CAD)●
Mental Health: While not always explicitly stated, several cases suggest a potential impact of mental health on physical health outcomes and vice-versa. This can be observed through mentions of:○
Stress and anxiety○
Depression●
Access to Specialist Care: Several cases involve referrals to different medical specialists. This signifies the importance of a multidisciplinary approach to managing complex cases with multiple comorbidities:○
Cardiology○
Endocrinology○
Urology○
Surgery○
Ophthalmology○
Dermatology (DVL)○
Ear, Nose and Throat (ENT)●
Medical Management and Outcomes: Each case details the provided medical treatments and their outcomes. The variation in treatment approaches and outcomes underlines the complexities of individual patient care. Examples of treatments and outcomes include:○
Medications (e.g. anti-hypertensives, insulin)○
Surgery (e.g. CABG, knee replacement, cataract surgery)○
Lifestyle modifications (e.g., dietary changes, exercise)○
Outcomes ranging from stabilization and ongoing management to morbidity and mortality


3. Searching for Themes

The next step involves reviewing the initial codes and identifying overarching themes. This process aims to group codes that share commonalities and represent broader concepts:●

Impact of Social Determinants of Health: The codes "Socioeconomic Factors" and "Lifestyle Factors" can be grouped under this theme. This emphasizes the significant influence of social, economic, and environmental factors on health.●

Multimorbidity and Complex Care Needs: The code "Comorbidities" highlights the prevalence of multiple chronic conditions in individuals. This theme reflects the challenges of managing complex care needs, often requiring a multidisciplinary approach.●

Interplay of Physical and Mental Health: Although "Mental Health" is not explicitly discussed in each case, its presence suggests a crucial theme exploring the interconnectedness of physical and mental well-being.●

Healthcare Navigation and Access: The code "Access to Specialist Care" points to a broader theme about how individuals navigate the healthcare system and access specialized services.


4. Reviewing Themes

This stage involves revisiting the identified themes and ensuring they accurately represent the data. This step might involve refining, merging, or splitting themes to ensure they effectively capture the essence of the case studies.

5. Defining and Naming Themes
Finally, each theme is clearly defined and given a concise and descriptive name. This step aims to encapsulate the core meaning of each theme:●

Social Determinants of Health: This theme highlights the impact of social, economic, and environmental factors (e.g., income, education, access to healthcare) on health outcomes.●

Multimorbidity and Healthcare Complexity: This theme focuses on the challenges of managing multiple chronic conditions in individuals and the need for comprehensive and coordinated care.●

Mind-Body Interconnection: This theme explores the interconnectedness of physical and mental health, recognizing that these aspects of well-being can influence one another.●

Healthcare Navigation and Access: This theme emphasizes the importance of individuals being able to effectively navigate the healthcare system and access the specific services and specialists they require.

Subcoding

Subcoding helps refine the analysis within each theme by identifying sub-themes and nuances within the data.

Theme: Social Determinants of Health●
Sub-theme 1: Early Life Exposures: This could include exploring how childhood experiences (e.g., socioeconomic status, access to education) can have long-term impacts on health.●

Sub-theme 2: Health Behaviors and Literacy:** This could examine the relationship between health knowledge, attitudes, and behaviors (e.g., diet, exercise, smoking) and health outcomes.

Theme: Multimorbidity and Healthcare Complexity●

Sub-theme 1: Clinical Challenges of Co-existing Conditions:** Exploring how the presence of multiple chronic illnesses complicates diagnosis, treatment, and management.●

Sub-theme 2: Polypharmacy and Treatment Burden:** Examining the challenges of managing multiple medications and the potential for adverse effects and drug interactions.
Theme: Mind-Body Interconnection●
Sub-theme 1: Impact of Stress and Trauma:** Analyzing how stress, trauma, and adverse life events can contribute to physical health problems.●
Sub-theme 2: Mental Health Implications of Chronic Illness:** Investigating the psychological and emotional impact of living with one or more chronic conditions.
Theme: Healthcare Navigation and Access:●
Sub-theme 1: Barriers to Specialist Care:** Identifying factors that might hinder individuals' ability to access specialists, such as financial constraints, geographical location, or lack of referral systems.●
Sub-theme 2: Coordination of Care:** Examining the effectiveness of communication and collaboration among different healthcare providers involved in a patient's care.

Learning Insights
The thematic analysis of these cases reveals key learning insights valuable for medical professionals:●

Holistic Approach to Care: Considering the social determinants of health, recognizing the mind-body connection, and addressing lifestyle factors are crucial for patient-centered care.●

Managing Multimorbidity: Developing effective strategies for managing patients with multiple chronic illnesses is paramount. This involves addressing polypharmacy, coordinating care among specialists, and supporting patients in managing complex treatment regimens.●

Communication and Patient Education: Clear communication with patients about their conditions, treatment options, and the importance of lifestyle modifications is essential for empowering patients to actively participate in their care.●

Health System Navigation: Understanding the challenges patients face in navigating the healthcare system can help healthcare providers better guide and support them in accessing the services they need.

This thematic analysis provides a framework for understanding the key issues and insights emerging from the case studies. By exploring these themes and sub-themes, healthcare professionals can gain a deeper appreciation of the multifaceted nature of health and illness and apply this knowledge to deliver more effective and patient-centered care.

Based on the 16 cases shared in the url below: https://himajav.blogspot.com/2024/09/cases-1-16_27.html which you have also thematically analysed one by one, can you summarise the learning points in terms of their risk factors, comorbidities, clinical spectrum as well as non evidence based testing and treatment driving their outcomes? Please take care to share how the number of patients among the 16 cases are distributed in each category by mentioning their case numbers. Also please share how the patient encounters are clustered in the project timeline as per their date of first encounter shared in each case report above

Summary of Learning Points from Cases 1-16

This summary presents the learning points extracted from the 16 cases provided in the blog post "Cases 1-16" in terms of risk factors, comorbidities, clinical spectrum, and non-evidence-based testing and treatment influencing patient outcomes. The distribution of patients across various categories is presented with corresponding case numbers. Additionally, a chronological overview of patient encounters is provided based on their first encounter dates.
Risk Factors●
Hypertension (HTN): Cases 1, 2, 4, 5, 6, 10, 11, 12, 13, 14, 15, 16●
Diabetes Mellitus (DM): Cases 1, 2, 4, 5, 10, 11, 12, 13, 15, 16●
Chronic Kidney Disease (CKD): Cases 2, 6, 10, 12, 14●
Cardiovascular Disease (CAD): Cases 5, 10, 16●
Obesity: Cases 1, 5, 11●
Smoking: Case 4●
Alcohol Consumption: Cases 5, 14●
Low Socioeconomic Status: Cases 10, 12, 14, 15
Comorbidities
The cases frequently present patients with multiple comorbidities, highlighting the complexity of managing these cases. The most common comorbidities observed include:●
HTN and DM: Cases 1, 2, 5, 10, 11, 12, 13, 15, 16●
HTN, DM, and CKD: Cases 10, 12
Clinical Spectrum
The cases encompass a wide range of clinical presentations, including:●
Metabolic Syndrome: Case 1●
Acute Kidney Injury (AKI): Cases 2, 5, 14●
Cervical Radiculopathy: Case 13●
Urosepsis: Case 4●
Heart Failure (HF): Cases 5, 6, 10, 11, 12, 16●
Gouty Arthritis: Case 14●
Motor Neuron Disease (MND): Case 15●
Cerebrovascular Accident (CVA): Cases 15, 16●
Pneumonia: Cases 11, 14
Non-Evidence-Based Testing and Treatment
The sources do not provide specific instances of non-evidence-based testing and treatment. While some treatments are mentioned, there's insufficient detail to determine if they deviate from established medical guidelines.
Patient Outcomes
The 16 cases illustrate a range of outcomes:●
Mortality: Cases 2, 5, 13, 11, 13, 15●
Morbidity: Cases 4, 10, 12, 16●
Ongoing Management/Stabilization: Cases 1, 3
Patient Encounter Timeline
A rough timeline of patient encounters based on available data:●
2023○
August: Cases 1, 2, 13○
October: Case 4○
November: Case 5●
2024○
March: Cases 11○
May: Cases 12, 14○
June: Cases 15, 16

Important Note:
It's crucial to acknowledge that the provided information represents a limited number of cases and might not reflect the full spectrum of these diseases and their management. Drawing broader conclusions solely from these cases would be inappropriate.

What are the biopsychosocial factors influencing the outcomes of all the 16 cases? Please classify them by mentioning which case numbers demonstrate these factors and in what way did it influence their outcomes

Biopsychosocial Factors Influencing Outcomes in Cases 1-16


The 16 cases presented in the sources demonstrate how a complex interplay of biological, psychological, and social factors can significantly influence health outcomes. This response analyzes these cases to identify the specific biopsychosocial factors at play and how they may have impacted the patients' journeys.


Case 1 (53-year-old female with Metabolic Syndrome):●
Biological: Diabetes, Hypertension, Hypothyroidism.●
Psychological: Increased anxiety, constant health worries, disrupted sleep due to health concerns and managing family members' illnesses.●
Social: Limited education due to societal norms, role as a housewife, reliance on family support for household tasks due to fatigue.●
Outcome Influence: The patient's psychological distress (anxiety, worry, sleep disruption) could negatively impact her ability to manage her chronic conditions (Metabolic Syndrome). Her social support system (family) might be a positive influence, but their own health issues could create additional stress.
Case 2 (80-year-old male with AKI):●
Biological: Age, Hypertension, Diabetes, Acute Kidney Injury.●
Psychological: The source does not provide specific details about the patient's psychological state.●
Social: The source provides limited social history, mentioning residence in Kamanpet.●
Outcome Influence: The patient's advanced age and multiple comorbidities (HTN, DM, AKI) likely contributed to his poor prognosis and eventual mortality.
Case 3 (45-year-old female with Hypertension, Diabetes, and Hypothyroidism):●
Biological: Hypertension, Diabetes, Hypothyroidism, history of spontaneous abortion and child mortality.●
Psychological: The source mentions past experiences of depression and worry following the death of her child.●
Social: Started working at a young age (10 years old) due to limited education, experienced work pressure and stress leading to a spontaneous abortion.●
Outcome Influence: The patient's history of loss (miscarriage, child death) and early life stressors (early work, limited education) could have long-term psychological and physical health impacts. These experiences might contribute to her current health conditions and influence her ability to manage them effectively.
Case 4 (65-year-old female with Urosepsis):●
Biological: Rheumatoid Arthritis, Hypertension, Diabetes, Urosepsis, history of bilateral knee replacement and C-section.●
Psychological: The source notes decreased appetite due to abdominal fullness but does not provide in-depth information on the patient's psychological well-being.●
Social: Married, reports decreased bowel movements and urinary incontinence impacting daily life.●
Outcome Influence: The patient's physical health is significantly impacted by multiple chronic conditions (RA, HTN, DM). Urinary incontinence and constipation could also have social and psychological implications, affecting her quality of life.
Case 5 (65-year-old female with Heart Failure):●
Biological: Hypertension, Diabetes, Coronary Artery Disease, Obstructive Sleep Apnea (OSA), Heart Failure, acute kidney injury, gangrene.●
Psychological: Experienced significant stress and grief after her husband's death, leading to unhealthy coping mechanisms (overeating) and weight gain.●
Social: Widowed, responsible for her family after her husband's death.●
Outcome Influence: The patient's experience of grief and loss, compounded by her social circumstances, likely contributed to her unhealthy behaviors and the development of chronic conditions. This highlights the interplay between psychological and social factors in influencing health outcomes.
Case 6 (Male with Heart Failure):●
Biological: Heart Failure, Hyponatremia, Benign Prostatic Hyperplasia.●
Psychological: The source does not provide specific details about the patient's psychological well-being.●
Social: Limited information is available on social factors.●
Outcome Influence: The source primarily focuses on the patient's physical health, making it difficult to assess the influence of psychological and social factors.
Cases 7-9:●
Not found in the sources.
Case 10 (75-year-old female with Heart Failure):●
Biological: Hypertension, Diabetes, Chronic Kidney Disease, Heart Failure.●
Psychological: Experienced multiple personal losses (stillbirth, miscarriage, husband's death, brother's death) which could have long-term psychological impacts.●
Social: Lower socioeconomic background, limited education, widowed, lives with her daughter.●
Outcome Influence: The patient's history of significant loss, combined with her socioeconomic disadvantages, likely creates a context of increased vulnerability to both physical and mental health challenges.
Case 11 (60-year-old female with Respiratory Failure):●
Biological: Hypertension, Diabetes, history of hospitalization with possible Dengue and Sepsis, Acute Respiratory Distress Syndrome (ARDS)●
Psychological: The source does not offer much insight into the patient's psychological state.●
Social: Limited social history is provided.●
Outcome Influence: The patient's history of serious illness (Dengue, Sepsis) and her current acute condition (ARDS) suggest a complex medical situation where biological factors are likely driving her care needs.
Case 12 (75-year-old female with Heart Failure):●
Biological: Hypertension, Diabetes, Chronic Kidney Disease, Heart Failure.●
Psychological: Experienced multiple personal losses (stillbirth, miscarriage, husband's death, brother's death).●
Social: Lower socioeconomic background, limited education, widowed, lives with her daughter.●
Outcome Influence: This case mirrors the themes observed in Case 10. The patient's life experiences and social circumstances likely contribute to a cycle of poor health outcomes.
Case 13 (45-year-old female with Hypertension, Diabetes, and Hypothyroidism):●
Biological: Hypertension, Diabetes, Hypothyroidism, history of spontaneous abortion and child mortality.●
Psychological: Experienced depression and worry following the loss of a child.●
Social: Started working at a young age due to limited education, experienced work pressure and stress, which may have contributed to a spontaneous abortion.●
Outcome Influence: This case reiterates the themes in Case 3, emphasizing the enduring impact of early life adversity and loss on both physical and psychological well-being.
Case 14 (60-year-old female with Gouty Arthritis):●
Biological: Chronic Kidney Disease, Hypertension, Gouty Arthritis, history of abortions and stillbirth.●
Psychological: The source does not provide detailed information about her psychological state, but her history suggests potential for significant stress and trauma.●
Social: Lower socioeconomic background, illiterate, engaged in manual labor from a young age, history of multiple pregnancy losses, experienced the death of her husband.●
Outcome Influence: The patient's life course reflects significant social and economic disadvantage coupled with personal losses. This combination of factors could lead to chronic stress, impacting both physical and mental health.
Case 15 (48-year-old female with Motor Neuron Disease):●
Biological: Motor Neuron Disease, Hypertension, Diabetes, history of Cerebrovascular Accident (CVA).●
Psychological: The source does not elaborate on her psychological state but notes a history of physical trauma when she was pushed down, resulting in a fracture.●
Social: The source provides some family history but does not delve into her social circumstances.●
Outcome Influence: The patient's medical history indicates a complex interplay of physical conditions. The lack of details regarding her psychological and social context makes it difficult to fully assess their influence on her overall health.
Case 16 (74-year-old male with Congestive Heart Failure):●
Biological: Congestive Heart Failure (CHF), Hypertension, Diabetes, Prostate issues.●
Psychological: The source does not provide information about the patient's psychological well-being.●
Social: Limited education, started working at a young age (16 years old) as a carpenter, history of smoking.●
Outcome Influence: The patient's social history suggests that his occupation and lifestyle choices could have contributed to his risk for developing chronic health conditions.
Conclusion:
These cases emphasize the interconnectedness of biological, psychological, and social factors in shaping health outcomes. It's essential for healthcare providers to consider these factors holistically when diagnosing, treating, and managing patients' health. Addressing the social determinants of health, recognizing the impact of psychological well-being, and understanding patients' life experiences are crucial for providing comprehensive and patient-centered care.

Study limitations:

Please prepare an abstract with key words from all the learning points contained in the link: https://himajav.blogspot.com/2024/09/cases-1-16_27.html, in an IMRAD format and formulate a 16 case triad of biopsychosocial influence on trunkal obesity outcomes and name it the Narketpally trunkal obesity triad

As discussed in our previous conversation, the sources provided do not contain information about trunkal obesity outcomes for the 16 cases. Therefore, it is not possible to create an abstract with keywords based on those outcomes or to formulate a 16-case triad of biopsychosocial influence on trunkal obesity.

The information requested to complete the abstract and triad is not available in the sources:●
Trunkal obesity prevalence among the 16 cases.●
Specific outcomes related to trunkal obesity for each case.
To proceed, additional information or clarification is required. Would you like to:●
Provide additional sources that include information about trunkal obesity?●
Revise your query to focus on a different aspect of the provided cases?


Please prepare an abstract with key words from all the learning points contained in the link: https://himajav.blogspot.com/2024/09/cases-1-16_27.html, in an IMRAD format and formulate a 16 case triad of biopsychosocial influence on health outcomes of the 16 cases and name it the Narketpally biopsychosocial outcomes triad

It is understood that you need an abstract, in IMRAD format, with keywords based on the learning points from the provided source: [https://himajav.blogspot.com/2024/09/cases-1-16_27.html]. Additionally, you need a 16-case triad of biopsychosocial influences on the health outcomes of the cases, named the "Narketpally Biopsychosocial Outcomes Triad."


Abstract:

Biopsychosocial Factors in Healthcare complexity Outcomes - A Case Series Analysis

Introduction: This abstract examines 16 cases to understand the influence of biopsychosocial factors on health outcomes. Recognizing the interplay of biological, psychological, and social determinants of health is crucial for effective patient care.
Methods: The cases were analyzed to identify key biological, psychological, and social factors impacting each patient's health journey. The analysis considered the patients' medical histories, social contexts, and reported experiences to understand how these factors might contribute to their current health status and influence their ability to manage their conditions.
Results: Across the cases, common biological factors included diabetes, hypertension, cardiovascular disease, and renal disease. Psychological factors included anxiety, grief, stress, and the impact of past trauma or loss. Significant social determinants of health included low socioeconomic status, limited education, and challenging life events. The analysis reveals how these factors interweave, creating complex health profiles for each individual. For example, patients with limited education and lower socioeconomic status often faced barriers to healthcare access and experienced higher rates of chronic conditions. Patients who experienced significant losses or trauma were more vulnerable to developing mental and physical health challenges.
Discussion: This case series analysis emphasizes the importance of a holistic approach to patient care. Healthcare professionals must consider biological, psychological, and social factors to provide effective treatment and management strategies. Addressing social determinants of health, recognizing the impact of psychological well-being, and understanding patients' lived experiences are crucial for providing person-centered care.
Keywords: Biopsychosocial, Health Outcomes, Social Determinants of Health, Chronic Disease, Patient-Centered Care


Current Study limitations:

Narketpally Biopsychosocial Outcomes Triad:
While the provided cases highlight the interconnectedness of biological, psychological, and social factors influencing health, formulating a "Narketpally Biopsychosocial Outcomes Triad" based on these 16 cases presents challenges. This is due to the limitations of the source material:●
Inconsistent Reporting: The cases present information inconsistently. Some cases provide details about the patient's social history and psychological well-being, while others primarily focus on medical history and diagnoses. This makes it difficult to draw consistent conclusions or create a standardized triad from the data.●
Lack of Specific Outcomes Data: The cases often lack detailed information about the specific outcomes related to the identified biopsychosocial factors. While some connections can be drawn, a more robust triad would require concrete data on how these factors directly impact health results for each patient.
To create a more meaningful and generalizable Narketpally Biopsychosocial Outcomes Triad, consider these recommendations:●
Standardized Data Collection: Employ a structured approach to gathering information about biological, psychological, and social factors for each case, ensuring consistency in the data.●
Outcome-Oriented Assessment: Clearly define and measure specific health outcomes for each patient, enabling analysis of how biopsychosocial factors contribute to those outcomes.●
Expanded Case Series: Increase the number and diversity of cases studied to strengthen the generalizability of the findings and provide a broader representation of biopsychosocial influences on health.
By addressing these points, a more robust and informative Narketpally Biopsychosocial Outcomes Triad can be developed.



Monday, September 16, 2024

UDLCO: Medical education faculty development and tech driven multilingual global learning toward local caring

Conversational Transcripts:


[16/09, 21:47] +91BN : This group has many intellectuals

Who are passionate about teaching medical courses in regional language or mother tongue 

Those who are interested can come up with writing books and materials in those languages or atleast translation work if done that will surely help the students 

Instead we are doing arguments and discussion and finding faults among our statement 

Finding minute mistakes in sentences of statements of each other 

👏👏👏👏👏👏👏👏

17/09, 07:29] RB: Google translator has better skills than most intellectuals?


[17/09, 07:42] JR: Has anyone used the translation feature in Google Sheets?


[17/09, 07:52] RB: In our regular patient centred learning workflow that involves real patients pan India, we need to shift from our team based learning PaJR groups to google translate where i as the moderator enter my text to the patient advocate in English and it provides me the regional language version of the patient advocate that i need to again paste it in her PaJR group text. 

Meta AI allows us to quickly translate whatever regional language the patient advocate or patient is using in the group for the other team based learning participants in the group centred around the particular individual patient.

So in a way this year has been remarkable where we have seen a spike in our learning workflow efficiency and much more appears to be in the offing with tech developing at speed!

Also provides another angle to learning medicine in regional languages. We are having to do it anyways on the job and given that tech is pushing us toward globalisation it's likely that all doctors will quickly learn to become multilingual with Google translate

17/09, 08:01] JR: There are better apps for indic languages. 
Let me get some more information

[17/09, 08:02] BAFM: Great...🙏🏻🙏🏻

17/09, 07:48] SCM: Mostly it is used for translation of questionnaire & consent forms for IEC clearance of synopsis.


[17/09, 07:59] RB: As illustrated in one of our students online learning portfolio
here 👇



[17/09, 08:01] SLM: 

When the translate is available why should there be medical education in local language? 

 *Bilingual*- teaching is not required.  It will create lot of problems in standardization of curriculum planning, assessment etc.

Again someone can bring up some regional / cultural issues- 

My opinion- uniformity of medical education nation wide is good.


[17/09, 06:50] SLM: AI is introduced in the new curriculum. 
But planning for training faculty is not there
FDP is going on very slowly. Many have not completed BCME, CISP
Unless planning is done like national programs- implementation will be only on papers.
We can't get expected outcome.


[17/09, 06:58] SLM: How workshops for HIV- AIDS, TB is done, Medical education also should plan for more Faculty development programs in short span.

Now there is only one extrinsic motivation for faculty to go for BCME that is linking with promotion. 
Fee structure for training- many are not happy.
Let government or management bear the charges. Why to burden the faculty ( instead there should be encouragement )
 *This is not sufficient*


[17/09, 07:14] SLM : Medical education department should be there in every medical college. ( like any other discipline). Now MEU, CC members in all the institutions are doing the additional work without getting any benefit. It will not run for long. Either the department can be separated (like MUHS) or separate pay for MEU , CC members in addition to their salary should be there.
Exploitation of time and energy from some faculty members doesn't help in progress.

[17/09, 08:09] RB: Just a counterpoint:

Any faculty worth their salt can utilise their self directed life long learning abilities to develop themselves through freely available resources and not have to depend on NMC or institution for these!

Learning by faculty needs to be driven by the projects that they are working on toward addressing the problems of the primary beneficiaries of medical education (patients)

[17/09, 08:11] JR: But guidance is needed


[17/09, 08:13] RB: That should come from the learning ecosystem.

A good learning ecosystem is needed that in this age is easily connected globally

[17/09, 07:15] SLM: It is like Globalization to localization

17/09, 07:54] RB: And medical education can deliver "Global learning toward local caring"👇






Friday, August 23, 2024

30F Lupus Entire history since 2017 along with 2022 AND 2023 EMR discharge summaries

Our first clinical encounter with her was in 5/11/2022 and borrowing from the student's online learning portfolio (who documented the initial encounter at the time here: https://rishithareddy30.blogspot.com/2022/11/30-yrs-old-female.html?m=1


"History of presenting illness:

patient was apparently normal till six years back in 2017 she had generalised body aches and joint pains which involves multiple large joints of which elbow And knee joints  troubled her associated with generalised body aches after multiple hospital visits 
she even noticed hair loss without scarring and oral ulcers then she was diagnosed with autoimmune disorder and initiated on hydroxychloroquine azathioprine wysolone  
she reported that her joint pains and hair loss was not improving  with the above medication she had multiple hospital visits and admissions for joint pains and body aches which bothers her from doing her activities .

Two months back she had pedal edema  two months back she had pedal edema  sudden onset shortness of breath initially on exertion then she was diagnosed with hypertensive emergency admitted and discharged with antihypertensive . patients stopped AZA as advised by doctor  except hyper antihypertensive since yesterday she had shortness of breath initially on exertion which rapidly progressed to sob at rest."

Two more students from the same batch:



2022 EMR discharge summary:

Age/Gender : 31 Years/Female
Address :
Discharge Type: Relieved
Admission Date: 05/11/2022 11:02 PM
Diagnosis
ACUTE CARDIOGENIC PULMONARY EDEMA SECONDARY TO CHRONIC RENAL FAILURE SECONDARY TO ?SLE /LUPUS NEPHRITIS
SEIZURES SECONDARY TO ?CNS VASCULITIS /?UREMIC


Case History and Clinical Findings


PT CAME WITH C/O SOB SINCE MORNING ON 5/11/22 C/O VOMITINGS 2 EPISODES
K/C/O SLE SINCE 2017 ON REGULAR MEDICATION K/C/O HTN SINCE 1 MONTH ON REGULAR MEDICATION N/K/C/O DM,ASTHMA,EPILEPSY,TB
PATIENT WAS APPARENTLY ASYMPTOMATIC 6 YEARS BACK
IN 2017 SHE HAD GENERALISED BODYACHES AND JOINT PAINS WHICH INVOLVED MULTIPLE LARGE JOINTS OF WHICH ELBOW AND KNEE JOINT ACHES TROUBLED HER ASSOSCIATED WITH GENERALISED BODY ACHES
AFTER MULTIPLE HOSPITAL VISITS SHE EVEN NOTICED HAIR LOSS WITHOUT SCARRING AND ORAL ULCERS
THEN SHE WAS DIAGNOSED WITHAUTOIMMUNE DISORDER SLE AND INITIATED ON HCQ
,AZATHIOPRINE AND WYSOLONE .
SHE REPORTED THAT HER JOINT PAINS AND HAIRLOSS WAS NOT IMPROVING WITH ABOVE MEDICATION
 

2 MONTHS BACK SHE HAD PEDAL EDEMA AND SUDDEN ONSET OF SHORTNESS OF BREATH INITIALLY ON EXERTION THEN WORSENED TO EVEN AT REST


SHE WAS DIAGNOSED WITH HYPERTENSIVE EMERGENCY ADMITED AND DISCHARGED WITH ANTIHYPERTENSIVES

SINCE 10 DAYS PATIENT STOPPED TAKING ALL HER MEDICATIONS EXCEPT ANTIHYPERTENSIVES

SINCE YESTERDAY[4/11/22] SHE HAD SHORTNESS INITIALLY ON EXERTION WHICH RAPIDLY PROGRESSED TO SOB AT REST

NO SMALL JOINTS PAINS NO COLOUR CHANGE /PARAESTHESIAS OF FINGERS ON EXPOSURE TO COLD

PT HAD 1 EPISODE OF INVOLUNTARY MOVEMENTS INITIALLY STARTED LEFT HAND FOLLOWED BY TOTAL BODY WITH IMPAIRED CONSCIOUSNESS
NO TONGUE BITE ,NO INVOLUNTARY MICTURITION /DEFECATION 


ON EXAMINATION


PT IS CONSCIOUS COHERENT COOPERATIVE ON PRESENTATION

 VITALS

BP 220/140 MMHG PR 134 BPM
RR 36CPM SPO2 52 ON RA
GRBS 236 MG /DL
GENERAL PHYSICAL EXAMINATION PALLOR +
FLAT NAILS
NON SCARRING ALOPECIA
HYPERPIGMENTED DISCOID RASHES ON FACE PERIAURAL BLACK DISCOLORATION OF ORAL MUCOSA AND PALATE MILD PEDAL EDEMA
CVS
NO RAISED JVP S1S2+
NO MURMURS RS
BAE +
DIFFUSE INSPIRATORY AND EXPIRATORY CREPTS +
 

P/A SOFT NON TENDER MILD DISTENDED UMBILICUS INVERTED NO ORGANOMEGALY CNS
HMF INTACT E4V5M6 PUPILS NSRL NO FND
LAST SEIZURES 4/11/22 COURSE IN HOSPITAL
4 SESSIONS OF DIALYSIS DONE OPHTHA REFERAL ON 5/11/22
IMPRESSION- NO CHANGES ON FUNDUS EXAMINATION DVL REFERAL ON 7/11/22
DIAGNOSIS-SYSTEMIC LUPUS ERYTHEMATOSUS +CICATRICIAL ALOPECIA TREATMENT-TACROS OINT 0,03% L/A /OD FOR 2 WEEKS
PHOTO BAN AQUA GEL L/A [9AM-12PM-3PM] RENAL BIOPSY DONE ON 12/11/22
Investigation
CBP HB TC N L E M B PLT SMEAR RFT UR CR UA CA+2 P NA+ K+ CL- HIV HBSAG HCV MDCT SCAN BRAIN PLAIN
IMPRESSION-
F/S/O HYPERTENSIVE ENCEPHALOPATHY /POSTERIOR REVERSIBLE ENCEPHALOPATHY[PRES]
Treatment Given(Enter only Generic Name)
INJ LEVIPIL 500 MG /IV/TID
INJ NTG 50 MG IN 50 ML NS @5ML/HR INC /DEC TO MAINTAIN SBP <160 MMHG[STOPPED ON 07/11/22]
INJ LASIX 40 MG/IV/BD INJ HAI S/C ACC TO GRBS
TAB .NICARDIA RETARD 20 MG /PO/QID TAB OROFER XT PO/OD
TAB HCQ 200 MG PO/BD
TAB METXL 50 MG PO/BD TAB TELMA 40 MG PO/OD
TAB WYSOLONE 20 MG /PO/OD TAB HYDRALAZINE 12.5 MG PO/TID TAB PCM 650 MG/PO/QID
TAB DEPINE 5MG /PO/QID FLUID AND SALT RESTRICTION
Advice at Discharge
TAB LEVIPIL 500 MG PO/'BD TAB LASIX 40 MG PO/BD
TAB .NICARDIA RETARD 20 MG /PO/QID TAB OROFER XT PO/OD
TAB METXL 50 MG PO/BD TAB TELMA 40 MG PO/OD
TAB WYSOLONE 20 MG /PO/OD TAB PCM 650 MG/PO/QID
TAB ULTRACET 1/2 TAB PO/QID[1/2-1/2-1/2-1/2] FLUID AND SALT RESTRICTION
When to Obtain Urgent Care
IN CASE OF ANY EMERGENCY IMMEDIATELY CONTACT YOUR CONSULTANT DOCTOR OR ATTEND EMERGENCY DEPARTMENT.
Preventive Care
AVOID SELF MEDICATION WITHOUT DOCTORS ADVICE,DONOT MISS MEDICATIONS. In case
of Emergency or to speak to your treating FACULTY or For Appointments, Please Contact:  For Treatment Enquiries Patient/Attendent Declaration : - The medicines prescribed and the advice regarding preventive aspects of care ,when and how to obtain urgent care have been explained to me in my own language
SIGNATURE OF PATIENT /ATTENDER SIGNATURE OF PG/INTERNEE SIGNATURE OF ADMINISTRATOR SIGNATURE OF FACULTY
Discharge Date Date:14/11/22 Ward:NEPHRO WARD
 

2023 discharge summary : 

Date of admission: 06/02/2023 02:37 PM

Diagnosis

ACUTE KIDNEY INJURY ON CHRONIC KIDNEY DISEASE [LUPUS NEPHRITIS STAGE 1V/V] SECONDARY TO ACUTE GASTROENTERITIS [ RESOLVED ]
WITH HYPERKALEMIA [ RESOLVED ]
WITH ? ANEMIA OF CHRONIC INFLAMMATION WITH ? ANEMIA INDUCED HEART FAILURE WITH ? ACUTE PULMONARY EDEMA [RESOLVED]


Case History and Clinical Findings


CHIEF COMPLAINTS :
C/O VOMITING AND LOOSE STOOLS SINCE 3 DAYS HOPI :
PT WAS APPRENTLY ASYMPTOMATIC 3 DAYS AGO THEN SHE DEVELOPED LOOSE STOOLS 3-4 EPISODES / DAY , WATERY CONSISTENCY , NOT ASSOCIATED WITH FEVER , PAIN ABDOMEN
C/O VOMITINGS SINCE 3 DAYS 2-3 EPISODES PER DAY CONTAINED FOOD PARTICLES INITIALLY THEN HAD YELLOWISH COLOR VOMITINGS , NON FOUL SMELLING , NON BLOOD STAINED
 

K/C/O SLE WITH LUPUS NEPHRITIS SINCE 2 MONTHS AND IS ON TAB HCQ 200MG IS ON RABEPRAZOLE + DOMPRIDONE 7AM
T.OROFER XT PO/OD 8AM T.SHELCAL 500MG PO/OD 8AM
T.SODIUMBICARBONATE 500MG PO/BD 2PM AND 8PM T.NICARDIA 20MG PO/TID 8AM-2PM-8PM T.NEPHROSAVE PO/OD 2PM
PROBIOTICS
N/K/C/O DM , ASTHMA , EPILEPSY , CAD , CVA , THYROID DISORDERS K/C/O HTN SINCE 3 MONTHS
NO PAST SURGICAL HISTORY MENSTRUAL CYCLE :
IRREGULAR SINCE 2 MONTHS LMP - 25TH DECEMBER 2022 


O/E:
PT. IS C/C/C
NO PALLOR,ICTERUS,CYANOSIS,CLUBBING,LYMPHEDENOPATHY,PEDAL EDEMA TEMP : 98.2F
BP-180/110MMHG PR-131BPM
RR-24CPM RBS-118MG/DL
CVS-S1S2+,NO MURMURS RA-BAE+,NVBS
P/A-SOFT, TENDERNESS AROUND UMBLICUS , BOWEL SOUNDS HEARD CNS-NO FND
OPTHALMOLOGY OPINION WAS TAKEN I/V/O HYPERTENSIVE RETINOPATHY CHANGES AND NO HYPERTENSIVE CHANGES WERE NOTED
GYNECOLOGY OPINION WAS TAKEN I/V/O AMENORRHOEA SINCE 3 MONTHS AND ENT OPINION WAS TAKEN I/V/O DYSPHAGIA AND WAS DIAGNOSED ODYNOPHAGIA SECONDARY TO GASTRITIS
BLOOD TRANSFUSION OF 1 PRBC WAS DONE ON 13/2/23 IV/O LOW HEMOGLOBIN NEPHROLOGY OPINION WAS TAKEN I/V/O OF RASIED SERUM CREATINE AND UREA LEVELS AND WAS ADVICED HEMODIALYSIS

HEMODIALYSIS WAS DONE ON 16/2/23 AND 17/2/23
Investigation
USG ABDOMEN AND PELVIS ON 06/2/23
B/L RAISED ECHOGENECITY IN BOTH KIDNEYS MILD ASCITIS
USG ABDOMEN AND PELVIS ON 9/2/23
GB WALL EDEMA NOTED MEASURING 8MM
MILD RIGHT PLEURAL EFFUSION , MINIMAL LEFT PLEURAL EFFUSION IVC DIAMETER MAX 18MM MIN 16MM
DILATED HEPATIC VEINS NOTED MINIMAL PERICARDIAL EFFUSION FEATURES SUGGESTIVE OF SEROSITIS HEMOGRAM
HB - 4.4-6.7-6.1-5.9-6.0-6.3-8.5-8.9-7.6-7.6-7.8 MG/DL
TLC - 5500-3400-5960-6980-6190-8700-12200-11400-6500-7900- 8300 CELLS/MM3 PLT - 90K - 80K- 96K-1.40L-1.58L-1.1L-1.5L-1.82L-2.10L -2.4L

Treatment Given(Enter only Generic Name)
IV FLUIDS NS AT 100ML/HR NEB WITH DUOLIN 6TH HRLY INJ PAN 40MG IV/OD
INJ ZOFER 4MG IV/SOS INJ LASIX 40MG IV/BD
INJ METROGYL 500MG IV /TID
INJ METHYLPREDNISOLONE 1GM IV/OD INJ NTG 2CC IV GIVEN
TAB NICARDIA 10MG PO/SOS TAB CLINIDIPINE 10MG PO/BD TAB WYSOLONE 40MG PO/OD TAB SPOROLAC DS PO/BD TAB HCQ 200MG PO/OD
TAB AZATHIOPRINE 50MG PO/OD
SYP SUCRALFATE 10ML TID BEFORE FOOD TAB MET XL 25MG PO/OD
 

Advice at Discharge
TAB NICARDIA 30MG AT 8AM , 20MG AT 2PM , 30MG AT 8PM TAB HCQ 200MG PO/OD
TAB MET-XL 25MG PO/OD
TAB AZATHIPRINE 50MG PO/OD
TAB WYSOLONE 30MG/PO OD 20MG AT 8AM 10MG AT 6PM TAB PAN 40MG PO/OD
TAB ZOFER 4MG PO/SOS TAB LASIX 40MG PO/TID
SYP SUCRALFATE 10ML PO/TID BEFORE MEALS
Follow Up
REVIEW SOS OR AFTER 1 WEEK TO GENERAL MEDICINE OPD
When to Obtain Urgent Care
IN CASE OF ANY EMERGENCY IMMEDIATELY CONTACT YOUR CONSULTANT DOCTOR OR ATTEND EMERGENCY DEPARTMENT.
Preventive Care
AVOID SELF MEDICATION WITHOUT DOCTORS ADVICE,DONOT MISS MEDICATIONS. In case
of Emergency or to speak to your treating FACULTY or For Appointments, Please Contact:  For Treatment Enquiries Patient/Attendent Declaration : - The medicines prescribed and the advice regarding preventive aspects of care ,when and how to obtain urgent care have been explained to me in my own language
SIGNATURE OF PATIENT /ATTENDER SIGNATURE OF PG/INTERNEE SIGNATURE OF ADMINISTRATOR SIGNATURE OF FACULTY
Discharge Date Date:14/2/23 Ward:AMC
Unit: 1

Finally this month presented in the meeting circulated here:



INTEGRATED MEET CASE PRESENTATION
DR.JYOTHULA HARIPRIYA
FINAL YEAR POSTGRADUATE
DEPARTMENT OF GENERAL MEDICINE


CHIEF COMPLAINTS
A 30 years old woman , resident of , ... by occupation  came with  chief complaints of:
Swelling of both lower limbs since 3 days.
Decreased urine output since 1 day.
Shortness of breath since 1 day.

 
HISTORY OF PRESENT ILLNESS
Patient was apparently asymptomatic 3 days back and then she had swelling of both lower limbs,which is insidious in onset, gradually progressive ,pitting type, initially started around ankle and extended till knee associated with facial puffiness and dry cough more on lying down position.
Decreased urine output since 1day.
Shortness of breath since 1 day ,insidious in onset ,gradually progressive, from MMRC grade 2 to grade 4[worsened since 30 minutes].
Sudden onset of shortness of breath since 30minutes.


HISTORY OF PRESENT ILLNESS
Orthopnoea and PND present.
No h/o fever, Cold, Cough.
No h/o pain abdomen, Vomiting, Loose stools.
No h/o chest pain,palpitations.
No history of burning micturition


PAST HISTORY
TIMELINE OF EVENTS





PAST HISTORY
K/C/O Hypertension since 7 months and was on medication, Tab. Nicardia 30mg PO TID
K/C/O SLE since 6 years used Rx for 5 years and stopped.
Renal biopsy done on 12/11/2022 - Diagnosed with Lupus Nephritis [restarted  on Rx].
Not a k/c/o Diabetes mellitus, Thyroid, Coronary artery disease, Cerebrovascular accident.
PERSONAL HISTORY
Mixed diet
Appetite decreased.
Bowel habits regular
Decresed urine output since 1 day.
Sleep adequate.
No allergies
Addictions: Nil.
GENERAL EXAMINATION
Patient is consious and coherent at the time of presentation.
Poorly built and nourished.
Pallor present
Edema +[Both lower limbs]
Buccal pad of fat lost.
JVP: Raised



GENERAL EXAMINATION
Non scarring alopecia present
Hyper pigmented discoid rashes over the face
Black discoloration of oral mucosa and palate.
No icterus, Cyanosis, Clubbing, Koilonychia, Lymphadenopathy.

CLINICAL IMAGES





GENERAL EXAMINATION
Pulse Rate:131 Beats per minute, Regular, normal volume.
Blood Pressure:180/110mmHg,Right Arm, Supine position.
Respiratory Rate:30 Cycles Per minute
Temperature:98.2F
GRBS: 98mg/dL.
SPO2:-82% on room air
94% on NIV

SYSTEMIC EXAMINATION
RESPIRATORY SYSTEM :
Inspection:
Chest is elliptical shaped, Bilaterally symmetrical.
Trachea is central.
Movements are equal on both sides.
No scars, sinuses or visible pulsation.
SYSTEMIC EXAMINATION
RESPIRATORY SYSTEM:
Palpation:
All inspectory  findings are confirmed :Trachea is central.
Apex beat felt in left 6th Intercostal space lateral to mid clavicular line.
Vocal fremitus felt equally in all areas
SYSTEMIC EXAMINATION
RESPIRATORY SYSTEM:
Percussion:
All areas are resonant on percussion  
Auscultation:
Bilateral air entry present
Normal vesicular breath sounds heard.
Fine end inspiratory and expiratory crepitations heard all over the chest[more in bilateral basal regions].

SYSTEMIC EXAMINATION
CARDIOVASCULAR SYSTEM:
Elliptical and Bilaterally symmetrical chest
No visible pulsations/engorged veins/scars/sinuses on chest wall.
Apex beat palpable at left 6th Intercostal space lateral to mid clavicular line.
S1 and S2 heard
JVP raised.
No Murmurs,No parasternal heave.
SYSTEMIC EXAMINATION
PER ABDOMEN :
On inspection:
Scaphoid.
Umbilicus inverted.
All quadrants are moving equally with respiration.
No visible pulsations/engorged veins/scars/sinuses.

SYSTEMIC EXAMINATION
Palpation:
Soft and non tender.
No organomegaly.
No  palpable masses.
Percussion:
Tympanic note felt.
Auscultation:
Bowel sounds are heard.
No para aortic briut.


SYSTEMIC EXAMINATION
CENTRAL NERVOUS SYSTEM:
Patient is consious and oriented.
Bilateral pupils Normal size and reactive to light .
Sensory system : Intact
Motor System :Normal
Reflexes: Elicited and normal.
Cranial Nerves: Functional
PROVISIONAL DIAGNOSIS
Acute pulmonary edema secondary to Heart failure.
K/c/o SLE with lupus nephritis and on maintenance hemodialysis.
K/c/o Hypertension.
INVESTIGATIONS




ECG at Admission :
              INVESTIGATIONS
CHEST
X RAY
INVESTIGATIONS
INVESTIGATIONS
ABG
PH      :7.27
PCO2 :19
PO2   :53.5
SO2   :82
HCO3 :7
INVESTIGATIONS
IINVESTIGATIONS
INVESTIGATIONS
KIDNEY BIOPSY
Showed features of chronic renal disease, Tubular injury with significant global glomerulosclerosis, interstitial inflammation and mild arteriosclerosis.
Features suggestive of chronic glomerulonephritis –Lupus nephritis.
2D ECHO
Dilated RA,RV,LA,LV.
Concentric LVH,no RWMA.
IVC Dilated and non collapsing.
Ejection fraction 45%.
Moderate MR,TR.
Mild to moderate AR.
Moderate LV systolic function
Diastolic dysfuntion +.






USG ABDOMEN
FINAL DIAGNOSIS
Acute cardiogenic pulmonary edema
Chronic kidney disease secondary to lupus nephritis [stage iv/v]
Anemia of chronic disease
K/c/o  SLE and Hypertension since 7 months.
TREATMENT
FLUID AND SALT RESTRICTION
TAB.PREDNISOLONE 5MG PO OD
TAB.NICARDIA  30MG/PO//BD
TAB.ARKAMINE 0.1MG/PO/TID
TAB.METAPROLOL 50MG/PO/OD
TAB.SHELCAL CT /PO/OD
TAB.LASIX 40MG/PO/TID
TAB.NODOSIS 500MG/PO/BD


INJ.ERYTHROPOITIN 4000IU/SC/TWICE WEEKLY.
PATIENT WAS ON MAINTANANCE HEMODIALYSIS WITH REGULAR BLOOD TRANSFUSIONS.
COURSE IN THE HOSPITAL
Patient came with complaints of shortness of breath,swelling of both lower limbs and decreased urine output,and clinically and X ray showed features suggestive of flash pulmonary edema , emergency dialysis was done and patient got improved clinically.
FOLLOW UP
Patient is on follow up and is on maintenance hemodialysis .
Last visit on 5-01-2024.
Died outside the hospital.


 THANK  YOU

Sunday, August 18, 2024

PaJR platform methodology: integrating diverse paths of knowing through team based learning and their archival in online learning portfolios: presentation at NCBS Bangalore

Summary: Below are links to videos and slides of our PaJR team presentation at NCBS Bangalore on 14th August, 2024 focusing on our PaJR platform methodology that is largely about integrating diverse paths of knowing through team based learning and their archival in online learning portfolios. This is followed by video links to Prof Sudhir Krishna's presentation of integrating  modern science benches to clinical bedsides where diversity of approaches already abound.


Speaker's list:




Speaker Dr Savanth Reddy's presentation:

Slide:




Speaker notes:


PaJR Online learning Portfolio:

I am Dr.Savanth Reddy  from ... Institute of Medical Sciences, Telangana, India.

Today I would like to introduce about the unique approach followed by the Dept.of General Medicine at our institute which is called  Patient Journey Record System which involves  creation of  an online learning portfolio centered around patient care as we publish  the de-identified patient data as case reports  online at blogspot.com


These case reports are then shared on user-driven forums to facilitate a system of online learning where a concept of Patient as a teacher is emphasized.

This teaching methodology leverages currently available blended learning modalities to create a case based blended learning ecosystem(CBBLE) which is subsequently assessed through peer citations.



There will be offline experiential data capture ,face to face discussion in the demo room and subsequent follow up and family adoption through  PaJR groups which are online components of our blended learning ecosystem.
It is then followed by  an overall weekly logs of academic activities and assessment of students which takes place parallelly.

At the end of each Academic year of UG/PG training  there will be 360 degree formative and summative  assessment  along with the traditional university driven summative assessment .

To be more precise we create  Blog for each individual patient we examine during our clinical rotations and  includes the History,examination videos , lab reports, imaging , differential diagnosis, treatment and the clinical approach used In the patient management.As We use de-identified patient data the privacy of the individual patient is protected .This creates a digital record of the patients we have examined and also we have access to the wide variety of cases even in the future for academic purposes like research and data analysis.We can share the digital record of the clinical condition with  experienced physicians in various renowned institutions and make necessary changes in patient care through discussions which plays a major role in improving the standards of health care and also availability of specialist services in the resource limited areas like the Nalgonda district where our institution is located.To share my personal experience - during my internship I was able to have a sneak peek into the medicine icu cases even though I was posted in other departments which was possible only through the blogs published by the co-interns.
This also stands as an evidence of our commitment and interest towards patient care and is one way of showing our clinical acumen.

Overall it also  helps in the assessment of the students performance through different aspects such as
1)Competence in data capture
2)Competence in Asking questions
3)Competence in finding answers
4)Competence in Communication skills
 throughout the medical school years rather than judging the clinical knowledge based on a 2 hr assessment in the final professional exam.
There will be a review and analysis of anonymised student feedback regarding this teaching delivery method followed by the department .Using this feedback  problem statements will be  identified and solutions are planned accordingly and  students are also involved in making the process efficient.

Hence  there will be Improved Patient care through inputs from various medical professionals, facilitates the Research and data analysis and at the same time patient data privacy is safeguarded.

I would like to conclude the presentation  by re iterating the fact that there may be  different methods we approach in our Patient management but what eventually matters is how it enhances the quality of life in diseased patients.  Thank you.

Link to presentation video:


Speaker Dr Chandana's presentation

Slides:




Presentation video:


Speaker Professor Sudhir Krishna's presentation videos:

Prof Sudhir Krishna takes you on an inspirational journey through Saint John's medical college, MBBS and then a Phd and finally IISc and NCBS, Bangalore with a driving force that fascinates him as to how diverse paths to knowing can be integrated and interconnected!



Prof Sudhir Krishna describes how in order to focus energy on integrative translational research, numerous discussions between basic scientists at NCBS and colleagues from St. John’s medical college campus were conducted in order to understand the perspectives of medical professional around teaching, immediate service and diagnostic innovation needs, affordable therapeutics in contrast to the longer-term perspectives of basic research organizations.


His past work on this:



Thursday, August 15, 2024

20F Lupus clinical complexity EHR deidentified horcrux links to all three admissions and follow up

 Summary: 


This patient was first presented to Prof Michele Meltzer  in Jan 25, 2022 (link: https://youtu.be/X5NBa_0VVUw?feature=shared) in this CPD linked here: https://medicinedepartment.blogspot.com/2022/12/?m=1 and she first presented to the presenters in September 2022 which is recorded in the link below but to summarise it drastically, she had nephrotic glomerular proteinuria, cutaneous vasculitic lesions, CNS vasculitic lessons (investigated for altered cognition) and endocardial and pericardial inflammation (acute heart failure with pericardial effusion)that was attributed to lupus in view of a strong ANA positivity particularly of the ds-dna fraction in ELISA. https://medicinedepartment.blogspot.com/2024/08/first-admission-september-2022-20f-with.html?m=1



Second admission: She again got admitted in December 2022 with headache, altered sensorium and meningeal signs, which was associated with a minor CNS bleed on MRI was later attributed to warfarin (link:

https://drsaicharankulkarni.blogspot.com/2022/12/20f-sle.html?m=1

Her discharge after September 2022 was relatively uneventful on immunosuppressives and while her cardiac and CNS issues were the first to resolve even during admission, her proteinuria also subsided and she gradually withdrew all immunosuppressives in a year with a brief period of iatrogenic Cushing in between. Recently in June 2024, she presented with an ankle flare along with anasarca that also revealed a nephrotic relapse on evaluation of 24 hour urine protein as archived in her PaJR conversations here:https://drsaicharankulkarni.blogspot.com/2022/12/20f-sle.html?m=1

Her 3rd admission recently in July 2024 was for a right hypochondrial pleuritic pain that ultimately revealed a large hydropneumothorax along with multiple lung abscesses. Again this was possibly an iatrogenic result of the high dose immunosuppressives for just a month! There's still a persistent diagnostic uncertainty around the etiology of her lung abscesses and hydropneumothorax as her dry cough persists and her last antibiotics choice was quinolone!https://drsaicharankulkarni.blogspot.com/2022/12/20f-sle.html?m=1








4th admission PaJR update:

[27/08, 14:18]  2020 Pg: Pgs on duty this patient is at OPD please look into this. Preeented with cough

[27/08, 14:34] PaJR moderator: Please ask her to come to ICU

[27/08, 14:54] 2020 Pg: Informed them to meet you in icu sir

[27/08, 15:26] PaJR moderator: Reviewed her in ICU:

Persistent cough

Reduced weight

Anorexia nausea

Will need to be treated for tuberculosis 

We shall repeat chest X-ray, repeat sputum AFB, CBNAAT

[27/08, 15:32] 2020 Pg: Infection causing chronic systemic inflammation sir..?

[27/08, 15:36] PaJR moderator: Her pulmonary issues appear to be tuberculosis as a result of her immunosuppression for Lupus nephritis. They seem to have abruptly stopped her steroids since one month of her discharge and is currently complaining of nausea. Checking her postural BP to add weightage to a possibility of Addison's

[27/08, 15:41] Metacognitist Mover and Shaker1: Addisons mediated by TB or just Glucocorticoid mediated Adrenal Insufficiency?

[27/08, 15:44] PaJR moderator: Yes both are casting their shadows

[27/08, 15:44] PaJR moderator: BP supine 110/70
Standing 90/60

[27/08, 15:45] Metacognitist Mover and Shaker1: This fantastic review should help!

[27/08, 15:47] Metacognitist Mover and Shaker1: I would definitely consider a  9am fasting cortisol at least. Not very expensive and can be useful to diagnose adrenal insufficiency.

Putting her on Hydrocort without this would be quite risky.

[27/08, 15:50] Metacognitist Mover and Shaker1: Quick primer on what steroids can do to the immune system and which organisms can be possible culprits.

[27/08, 16:04] PaJR moderator: We can just restart low physiological dose

[27/08, 16:09] PaJR moderator: @⁨Pushed Communicator 1N22⁩ @⁨Kims PG 2023⁩ Let's start her on Tablet prednisolone 5mg morning (now) and 2.5 mg at night

[27/08, 16:09] Pushed Communicator 1N22: Ok sir




[27/08, 16:12] PaJR moderator: This is her today's chest X-ray and it's remarkably better with disappearance of prior hydropneumothorax and lung abscess shadows with some hint of a residual pleural effusion or thickening. @⁨Pushed Communicator 1N22⁩ please do her chest pleural ultrasound and share the video

[27/08, 16:13] Pushed Communicator 1N22: Okay sir

[27/08, 16:17] Pushed Communicator 1N22: Todays 👆

[27/08, 16:20] PaJR moderator: Let's hope it's all just tuberculosis!

[31/08, 10:29] PaJR moderator: Yesterday for the first time in last one month she didn't cough at night and even now since morning her cough hasn't happened. The only intervention after her admission this Tuesday was restarting her physiological dose of steroids and stopping her previous antibiotics.

She continues to be on the 50 mg azathioprine.

@⁨Pushed Communicator 1N22⁩ @⁨PG 2023⁩ please share her urine for 24 hour protein and creatinine report readied yesterday




[31/08, 10:35] PaJR moderator: Her urine for 24 hour urine protein and creatinine suggests her lupus nephritis is in remission now!

[31/08, 10:39] PaJR moderator: WBC counts since admission has also reduced! Did restarting low dose physiological steroids here have any role!

[31/08, 10:49] PaJR moderator: Just for the record she was also on azathioprine and prednisolone from September 2022 to April 2023