Problem statement :
"Fever is a common complaint in healthcare settings with various possible aetiologies including infection, connective tissue disorders, malignancies, and a number of miscellaneous conditions. The cause of fever may not be immediately obvious because of non-specific clinical manifestations and a lack of specificity in initial laboratory findings. The condition is referred to as undifferentiated fever and there is a broad differential diagnosis, usually influenced by the geographical location. Further laboratory investigations are usually undertaken to determine the cause of fever. Sometimes, despite iinvestigation, undifferentiated fevers remain undiagnosed, and whilst some undiagnosed undifferentiated fevers (UUDFs) resolve spontaneously, others may be associated with considerable morbidity and even mortality."
Quoted from :
Susilawati TN, McBride WJ. Undiagnosed undifferentiated fever in Far North Queensland, Australia: a retrospective study. Int J Infect Dis. 2014;27:59–64. Epub 2014/09/01. doi: 10.1016/j.ijid.2014.05.
"Acute undifferentiated fever defined as any febrile illness for ≤ 14 days without evidence of localized infection."
"Current clinical guidelines provide guidance on how to manage severe illness, common localizing infections like pneumonia and urinary tract infections, as well as malaria. How to manage other cases of acute febrile illness is less clear and is the focus of this review. Without an etiologic diagnosis, clinicians frequently prescribe empiric antibiotics that may be unnecessary or inadequate."
In the past, to help community practitioners resolve their diagnostic questions and reduce the unnecessary use of antibiotics for viral fevers, thus helping to contain antibiotic resistance, we have suggested fever-charting and monitoring fever patterns for two days.
Biswas R, Dineshan V, Narasimhamurthy NS, Kasthuri AS. Integrating hospital-acquired lessons into community health practice: optimizing antimicrobial use in Bangalore. J Contin Educ Health Prof. 2007 Spring;27(2):105-10
AIM:
To reduce diagnostic and therapeutic uncertainity while managing patients with acute febrile illness
OBJECTIVES:
1. To identify various uncertainities during organ system localisation in patients with unexplained fever during various points in the course of illness beginning with their presentation to the hospital.
2. To identify the role of fever diagnostic uncertainties in precipitation of antibiotic overuse due to therapeutic uncertainty
3) To identify possible correctable factors to resolve diagnostic and therapeutic uncertainty in patients with fever and thus promote antibiotic stewardship
PATIENTS AND METHODS:
PLACE OF STUDY: GENERAL MEDICINE DEPARTMENT
STUDY PERIOD: November 2022- October 2024
STUDY DESIGN: Prospective, Observational, qualitative study
STUDY PERIOD – over 2 years
SAMPLE SIZE - 100 patients
SAMPLE POPULATION -Patients of age 18-50 yrs attending Medicine Department in kamineni institute of medical sciences
INCLUSION CRITERIA:
1. Written informed consent from each patient or legal guardian prior to enrollment.
Patients Age 18 and above
2. Recent-onset fever (within one to five days)
3. Poorly localizable symptoms to organ systems such as myalgia, arthralgia, generalised body pains, frontal headache, cold associated with chills and rigor etc
•The study will be submitted for approval by the ethics committee
•All patient satisfying the inclusion criteria will be enrolled in the
study.
•A written informed consent will be taken from the patients prior to
the start of the study
EXCLUSION CRITERIA:
1. Patient below 18 years of age(minors)
2. Patients not capable of giving consent (mentally ill patients)
3. Patients not willing to give consent for study
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
Data from clinical general and systemic examination
Pallor
Lymphadenpathy
Nails
Organomegaly
Skin
Muscle mass
Mid arm circumference
Visceral fat
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 daily physical activities)
Daily diet in the form of meal images captured before consumption
Daily intake output
Sample thesis case report links:
https://drkulkarnimd.blogspot.
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. (2) 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-LOG
Link To Master Chart:
https://drive.google.com/file/
PATIENT INFORMATION SHEET
English:
https://drive.google.com/file/
Telugu:
https://drive.google.com/file/
Template of this "patient information sheet" is borrowed from this website:
https://www.ncbi.nlm.nih.gov/
And modified accordingly to my thesis topic.
REFERENCES:
1) Biswas R, Dineshan V, Narasimhamurthy NS, Kasthuri AS. Integrating hospital-acquired lessons into community health practice: optimizing antimicrobial use in Bangalore. J Contin Educ Health Prof. 2007 Spring;27(2):105-10
2) Susilawati TN, McBride WJ. Undiagnosed undifferentiated fever in Far North Queensland, Australia: a retrospective study. Int J Infect Dis. 2014;27:59–64
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