Simplified textual schematic for a quick TLDR workaround to understanding the workflow components:
1) Patient experiences symptoms events at home
2) Comes to hospital for a routine OPD or Casualty emergency clinical encounter depending on the symptoms and finally gets admitted in the in patient wards or returns home from OPD
3) Engages with a community outreach service of the same hospital who provides care either at home or hospital
Workflow illustration below , archived from a currently functioning , open access, real-patient centred , blended learning, home hospital integrative workflow since few decades with superficial alterations over time due to evolving technology
1) Home symptoms event:
50-year-old female from a rural village in Telangana presented to a local medical center on Day 0, approximately 40 minutes after being bitten on her right big toe by a small, approximately 10 cm long, snake identified as a juvenile Russell's viper (Daboia russelii). She presented with local swelling and fang marks.
Full text below:
For richer image based data can click into the patient diary at the above link
2) Comes to hospital Casualty
Day 0: Acute Presentation and Anaphylaxis Upon arrival, her initial vital signs included a heart rate of 110 bpm, unrecordable blood pressure, and SpO2 of 81% on 10L O2, with a "silent chest." A 20-minute whole blood clotting time (WBCT) test was performed, which was initially recorded as negative but later corrected to positive (incoagulable blood), confirming severe systemic envenomation with venom-induced consumptive coagulopathy (VICC). Initial management included wound cleaning, Betadine application, tetanus toxoid, intramuscular promethazine (Avil) 45.5mg, and intravenous hydrocortisone 100mg. Following protocol, an initial dose of 5 vials of polyvalent ASV in 500ml normal saline was initiated.
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Full text below:
For richer image based data can click into the patient diary at the above link
3) Inpatient wards:
Day 1: Persistent Coagulopathy and Stabilization On Day 1, the patient exhibited extensive subcutaneous ecchymosis, indicating active bleeding into the skin. Laboratory results confirmed coagulopathy with a prolonged Prothrombin Time (PT) of 20.6 seconds (control 13.5 seconds) and an International Normalized Ratio (INR) of 1.5. A subsequent PT/INR showed further prolongation to 22.5 seconds and INR 1.7, while Activated Partial Thromboplastin Time (APTT) was within normal limits (31.5 seconds). Despite the systemic coagulopathy, renal function tests (RBS 91 mg/dL, Urea 31 mg/dL, Creatinine 1.1 mg/dL) remained within normal limits.
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Full text below:
For richer image based data can click into the patient diary at the above link
Discharge:
Day 3: Discharge and Follow-up Challenges The patient was discharged on Day 3 against medical advice (LAMA) as she did not wish to wait for continuous observation. She was reported to have reduced systemic envenomation and no other features suggestive of progressive envenomation. However, the provided patient advocate's contact number was incorrect, hindering post-discharge follow-up.
Community outreach:
Day 6: Remote Follow-up Through an international phone call to the patient's husband, it was confirmed that the patient was doing well with no ongoing symptoms or health concerns.
More:
Full text below:
For richer image based data can click into the patient diary at the above link
Further learning and publications from the above real patient data:
The project team is addressing a fundamental flaw in how frontier Large Language Models (LLMs) are currently evaluated.
Static case reports are easily "cracked" by LLMs through training memorization. Conversely, dynamic, un-indexed PaJR pathways challenge models to exhibit genuine clinical cognition.
Quantum analogies in clinical decision making
Added to our snake bite project:
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