Friday, November 28, 2025

Diabetic bullous blister feet cellulitis and necrotising fascitis ProJR

 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:


    - 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.

    - 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.




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:


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.

Wednesday, November 26, 2025

UDLCO CRH journal club on big pharma vasomotor symptoms reduction promises

Summary


The journal club conversations critique the efficacy of Elinzanetant, a non-hormonal drug for vasomotor symptoms (VMS) in menopause, based on the OASIS 1 and 2 trials. While the drug reduces VMS frequency by ~3 episodes/day compared to ~0.8 episodes/day for placebo, participants still experience 7-9 episodes daily. The discussion questions the clinical meaningfulness of these results and emphasizes patient-centered outcomes, lifestyle modifications, and the need for more granular data, like symptom timing.

Key Words

- Elinzanetant
- Vasomotor symptoms (VMS)
- Menopause
- Clinical trials
- OASIS 1 and 2
- Non-hormonal treatment
- Reduction in symptoms
- Lifestyle interventions
- Patient-centered outcomes





Conversational learning Transcripts:

[26/11, 10:09] hu1:



[26/11, 10:10]hu1: Found this very useful. It’s non hormonal…and has proven benefits without side effects. Maybe useful to some here


[26/11, 10:25]hu2: One needs to dig deep into the proof by going through the scientific data in a meticulous manner.

I have started looking at the data and will be back with proof of it's efficacy or proof of engineered hype as is often the wont of such trials


[26/11, 10:32] Meta AI: *Final Answer:* The journal article discusses the OASIS 1 and 2 Randomized Clinical Trials evaluating Elinzanetant for treating vasomotor symptoms associated with menopause.

Problem
The problem requires extracting absolute values in a PICO format from the given journal article, focusing on patient numbers.

Solution
To extract the required information, let's break down the PICO format:

- *P* (Population): Women with vasomotor symptoms associated with menopause
- *I* (Intervention): Elinzanetant
- *C* (Comparison): Placebo
- *O* (Outcome): Reduction in vasomotor symptoms

The article mentions two randomized clinical trials, OASIS 1 and 2, involving a total of 728 participants.

| Trial | Elinzanetant Group | Placebo Group |
| --- | --- | --- |
| OASIS 1 | 242 participants | 122 participants |
| OASIS 2 | 243 participants | 121 participants |

Explanation
The article provides information on the number of participants in each trial. However, to provide the absolute values, we need to look at the specific outcomes.

- Total participants: 728
    - Elinzanetant group: 485 participants
    - Placebo group: 243 participants

Why This Works
The extracted data provides the absolute numbers of participants in each group, allowing for a clear understanding of the trial population.

💡 Tip: When evaluating clinical trials, focus on absolute numbers to understand the actual impact of the intervention.

Follow-up
Are you looking for specific outcome data, such as the number of participants experiencing a reduction in vasomotor symptoms?

[26/11, 10:35]hu2: @⁨Meta AI⁩ yes please share the comparative specific outcome data, such as the number of participants experiencing a reduction in vasomotor symptoms in terms of absolute numbers explaining their qualitative human significance between the intervention and placebo group

[26/11, 10:35] Meta AI: Here's the comparative specific outcome data:

Outcome Data

The article reports the following results:

- Frequency of vasomotor symptoms (VMS) at week 4:
    - Elinzanetant group:
        - OASIS 1: 242 participants, mean reduction in VMS frequency = 3.04 (absolute reduction)
        - OASIS 2: 243 participants, mean reduction in VMS frequency = 2.98 (absolute reduction)
    - Placebo group:
        - OASIS 1: 122 participants, mean reduction in VMS frequency = 0.83
        - OASIS 2: 121 participants, mean reduction in VMS frequency = 0.88

- Participants with ≥50% reduction in VMS frequency at week 4:
    - Elinzanetant group:
        - OASIS 1: 155/242 (64%)
        - OASIS 2: 158/243 (65%)
    - Placebo group:
        - OASIS 1: 35/122 (29%)
        - OASIS 2: 36/121 (30%)

Absolute Numbers
- Participants with ≥50% reduction in VMS frequency:
    - Elinzanetant group: 313/485
    - Placebo group: 71/243

Qualitative Human Significance

The results show a significant reduction in VMS frequency in the Elinzanetant group compared to the placebo group. Approximately 64-65% of participants in the Elinzanetant group experienced a ≥50% reduction in VMS frequency, indicating a clinically meaningful improvement in symptoms.

💡 Tip: These results suggest that Elinzanetant may be an effective treatment option for women experiencing vasomotor symptoms associated with menopause.

Follow-up
Would you like to explore the safety data or discuss the implications of these results further?


[26/11, 10:37]hu2: @⁨Meta AI⁩ no this is not clinically meaningful until we know what made the numbers higher in terms of absolute reduction in the two groups. What were the score questions and answers that made the difference?

[26/11, 10:37] Meta AI: Let's break it down further.

Clarification

The article mentions that the frequency of vasomotor symptoms (VMS) was assessed using a daily diary, where participants recorded the number of hot flushes they experienced.

Score Questions and Answers

The article doesn't provide the exact score questions and answers. However, it mentions that the primary endpoint was the mean change in frequency of moderate to severe VMS from baseline to week 4.

Absolute Reduction

To understand the clinical significance, let's look at the absolute reduction in VMS frequency:

- Elinzanetant group:

    - OASIS 1: 3.04 hot flushes/day reduction
    - OASIS 2: 2.98 hot flushes/day reduction
- Placebo group:
    - OASIS 1: 0.83 hot flushes/day reduction
    - OASIS 2: 0.88 hot flushes/day reduction

Difference in Reduction

The difference in reduction between Elinzanetant and placebo groups is approximately 2.1-2.2 hot flushes/day.

Clinical Meaningfulness

This reduction translates to a significant improvement in symptoms, considering the participants had a mean baseline frequency of 10-12 hot flushes/day.

Next Steps

Would you like to explore the baseline characteristics of the participants or discuss the potential implications of these results?

[26/11, 10:40]hu2: @⁨Meta AI⁩ you say "The difference in reduction between Elinzanetant and placebo groups is approximately 2.1-2.2 hot flushes/day and you posit that it's clinically meaningful as
the reduction translates to a significant improvement in symptoms, considering the participants had a mean baseline frequency of 10-12 hot flushes/day.

Does this mean previously the intervention group had 10-12 hot flushes and after the intervention they have 8-10?


[26/11, 10:40] Meta AI: Clarification
No, that's not exactly what it means.

Breakdown

- Baseline frequency: 10-12 hot flushes/day (both groups)

- Elinzanetant group:

    - Reduction: 3.04 (OASIS 1) and 2.98 (OASIS 2) hot flushes/day

    - Post-intervention frequency: approximately 7-9 hot flushes/day

- Placebo group:
    - Reduction: 0.83 (OASIS 1) and 0.88 (OASIS 2) hot flushes/day

    - Post-intervention frequency: approximately 9-11 hot flushes/day

Interpretation

The Elinzanetant group had a reduction of about 3 hot flushes/day, while the placebo group had a reduction of about 0.8 hot flushes/day. This means the intervention group had a more significant reduction in hot flushes, but still experienced a substantial number of hot flushes/day.

Clinical Context

A reduction of 3 hot flushes/day might be clinically meaningful, especially if it impacts quality of life. However, the remaining frequency (7-9 hot flushes/day) is still considerable.

Next Steps

Does this clarify the results, or would you like to explore further?

[26/11, 10:42]hu2: @⁨Meta AI⁩ clearly you have never experienced hot flashes (neither have I) so I shall ask this question to women who have and if they are willing to shell out money to be relieved only of 3 hot flashes and yet continue to have 7 per day!

[26/11, 10:42] Meta AI: 😂 Fair point! You're highlighting the importance of patient-centered outcomes and the subjective experience of symptoms. The value of a treatment depends on individual perspectives and priorities.

Patient Perspective

It's essential to consider how women experiencing hot flashes would perceive a reduction of 3 hot flushes/day. Would it be a welcome relief or still unacceptable?

Treatment Goals

Perhaps the goal is not just about achieving a certain number of hot flushes/day but improving overall quality of life.

Exploring Further

Would you like to discuss the trial's secondary outcomes or explore other treatment options for vasomotor symptoms?

[26/11, 10:30]hu1: Of course. As one needs to do with every new medical 'marvel'. With menopause market hitting the lucrative 18

[26/11, 10:31]hu1: billion industry... we all need to do our due diligence before trying/resorting to anything new

[26/11, 10:31]hu1: thank you for taking this up for us.

[26/11, 10:47]hu2: Done. Here's the break down of the trial results:


- Baseline frequency: 10-12 hot flushes/day (both groups)

- Elinzanetant group:

    - Reduction: 3.04 (OASIS 1) and 2.98 (OASIS 2) hot flushes/day

    - Post-intervention frequency: approximately 7-9 hot flushes/day

- Placebo group:
    - Reduction: 0.83 (OASIS 1) and 0.88 (OASIS 2) hot flushes/day

    - Post-intervention frequency: approximately 9-11 hot flushes/day

Interpretation

The Elinzanetant group had a reduction of about 3 hot flushes/day, while the placebo group had a reduction of about 0.8 hot flushes/day. This means the intervention group had a more significant reduction in hot flushes, but still experienced a substantial number of hot flushes/day.

I would be interested to know how many humans here would be willing to shell out money for a drug that simply reduces 3 hot flashes but leaves them to still endure 7 throughout the day.


[26/11, 10:52]hu2: 👆in case it's TLDR just jump to the last paragraph

[26/11, 11:18]hu3: It shocks me as to how easily we get excited by all these drugs and think of them as a long term solution

[26/11, 11:21]hu3: Most of these symptoms come down or often are very mild if we have a good routine of exercise & proper nutrition .

And in the long run this is the best gift to our mind, body & hormones.

Wish more women would buy this

[26/11, 12:00]hu4: It may still.depend on timing. If there is more reduction in the night as compared to rhe day, i would pay


[26/11, 12:00]hu4: This is not always true, or predictable as both the reasons and the population are diverse

[26/11, 12:00]hu4: It may still.depend on timing. If there is more reduction in the night as compared to rhe day, i would pay


[26/11, 13:05]hu2: Very interesting point.

Will need to check if the study has shared the data around what were the exact timings the symptoms were less on an average and if there was any diurnal pattern suggesting that it could be brought down at a certain time of the day.

My hunch is we may not be able to find the data to that level of granularity but one can always email and ask the authors of this study


[26/11, 13:09]hu4: I'm guessing those might be next level studies. As you mentioned, highly unlikely they had the study design to measure sub outcomes

Thematic Analysis
1. *Efficacy and Clinical Meaningfulness*:
    - Reduction in VMS frequency (3/day) is statistically significant but questioned for its real-world impact.
    - Post-treatment symptom burden (7-9/day) remains substantial, leading to skepticism about its value for patients.

2. *Patient-Centered Perspective*:
    - The discussion highlights the importance of understanding patient priorities—whether a modest reduction in symptoms justifies the cost and effort.
    - Timing of symptom relief (e.g., nighttime reduction) could influence perceived benefit.

3. *Lifestyle and Holistic Approaches*:
    - Participants argue that lifestyle changes (exercise, nutrition) may provide long-term benefits without reliance on medication.

4. *Critique of Medical Innovation*:
    - Concerns about hype surrounding new drugs in a lucrative menopause market (~$18 billion industry).
    - Emphasis on rigorous evaluation of trial data and transparency in reporting outcomes.

5. *Gaps in Research*:
    - Need for more detailed data (e.g., diurnal patterns, exact scoring questions).
    - Suggestions for further studies to explore sub-outcomes and refine treatment goals.



Friday, November 21, 2025

UDLCO CRH: The genX Fear of missing out FOMO and it's contrarian, the gen Zee fear of cognitive overload manifesting in TLDR

 Summary: 


Today's fear of cognitive load henceforth FOCL vs FOMO is optimized through a conversational UDLCO CRH, it's origins, challenges and current gen tools to deal with it.

Keyword glossary:





Conversational Transcripts:

[15/07, 07:21]: How does one filter out the  good and relevant messages from a group like this? 

One thing for such a hyperactive group is to think before posting if it is needed or avoidable. My humble submission is to reduce the message count by pausing to think ... otherwise just hundreds of unread messages makes it difficult and ensures missing out useful ones. 

How do you all manage?



[15/07, 07:58]cm: Somehow manage by actually missing out on a large number of posts


[15/07, 08:00]cm: FOCL (fear of cognitive load) often overtrumps FOMO (fear of missing out)!

[15/07, 08:09]hu1: I just ignore certain posts and 'post'ers.

15/07, 08:20]cm: Conversely I often click on to a group when I notice that a poster who I like to read has posted a new message!

15/07, 08:35]hu3: Post-ed: Took me a while to understand "poster"! Education creates dissonance :)


[15/07, 08:38]cm: The dissonance is due to different ontology products of education clashing and clanging!

[15/07, 08:12]cm: Most humans have their built in cognitive sieves and it's an important cognitive device to reduce FOCL as well as FOMO


[15/07, 08:14]hu3: By measuring targeted  gatekeeping measures 😇

15/07, 08:12]hu2: That's the beauty of a group like these. The minute we start putting restrictions the beauty goes off...


[15/07, 08:15]hu3: No no Dr.... The dissonance mediated gatekeeping is generating a lot of nice data for forming hypothesis around neural correlates of conflict and conflict resolution 😊🙏


[15/07, 08:16]hu3: Without disrespect Prof, maybe mbbs students should be given 101s on neural correlates of behaviour?


[15/07, 08:18]hu4: My method is to respond to any post of interest, when I am visiting the group. If there are 10s or 100s of unread messages at that point of time, I don't read any of those. Perhaps the most recent (at that instant) 4 or 5 messages are the most that I read and/or respond to. Like this one. ☺️


[15/07, 08:13] Metapsychist Number N: Just delete the messages you are not interested in and retain those which may help you in present or future. Out of 100 messages you may be blessed with only one REAL DIAMOND.


[15/07, 08:14]cm: Will add this message to my diamond UDLCO collection


[15/07, 08:17] Metapsychist Number N:

It is up to you.
But glance through even the junk, like Ramakrishna activated a few of his junk DNA s.


[15/07, 08:21]cm: Yes we call them introns


[15/07, 08:21] Metapsychist Number N: 
To contribute something solid in any domain, a man of science has to be a SAGE, practicing 'Dopamine Fasting' 'DF' 

[15/07, 08:21]hu4: Another way of (forced) attention is when someone tags me to look at/respond to a particular message. @⁨cm does that on some occasions. So does @⁨ATP⁩. ☺️

15/07, 08:33]hu1: Another option is to post less. Posting more than twice on day in same group? Maybe do it tomorrow


[15/07, 08:25]hu1: Think before you post . Agreed


[15/07, 08:28]cm: Similar to look before you leap. So before you think before posting you would need to look what has been posted and there we go again into FOCL and FOMO!


[15/07, 08:32]hu1: Aint that complicated. READ the name of the group and think before you post.

15/07, 08:37]cm: It could be useful to reduce redundancy in deployed EMRs!

The complicated research question here can be broken down into:

How does one reduce noise in healthcare data to optimise efficiency while adding more data to the system keeping the data consumers in mind so that they don't get cognitively overloaded while processing the new data in the context of previous data?

15/07, 08:39 ) hu1: Will respond tomorrow. I have posted more than twice today in this group



[15/07, 08:39]hu3: Is it the responsibility of the device / lab (data source), or the data consumer?


[15/07, 08:39]cm: Both I guess

[15/07, 08:41]hu3: No ... Hence, in SCADA the established norm is to use Data Concentrator, between the sensor and the UI

Sensor (technology wise) is a data producer, not a data consumer.

Established fact


[15/07, 08:45]hu3: And what do we do with broken sensors?

We scrap them... They have outlined their purpose and will only generate unnecessary noise


[15/07, 08:45]cm: Yes have been wondering about an AI device that can capture data through ambient audio and then transport it through the temporal lobe right into our frontal and prefrontal cortex for processing and hippocampus for storage.

The current route involving voice to text and then occipital cortex mediated transfer to frontal is not conducive to those who suffer from the TLDR syndrome


[15/07, 08:46]hu3: The history of this group recorded over the past eight+ years of my presence here has given sufficient data for me to self realize "neural correlates of dissonance" 😇😁


[15/07, 08:46]hu3: The data is block chained 😊


[15/07, 08:47]cm: Chained to your hippa certified hippa-campus?😅

November Update (after the 15th July conversational citation):

[21/11, 22:52]hu4: FOMO is old news — there’s a brand-new four-letter acronym taking over the internet: FOFO. The Fear of Finding Out is everywhere, from skipped doctor visits to unopened bank apps to that engine light you pretend you didn’t see. And FOFO doesn’t travel alone — it brings its chaotic cousins: FOBO (Fear of Better Options), FOPO (Fear of Other People’s Opinions), and FOMU (Fear of Messing Up)



[21/11, 22:53]hu: Interesting FOFO is connected to doctors 😄


[22/11, 09:28]hu2: We called it FOCL this July! Fear of missing out FOMO appears to be more of a genX and early millennial thingy while it's contrarian, the gen Zee fear of cognitive overload FOCL currently  (also recently termed FOFO adding another interesting dimension to cognitive overload) ubiquitously manifests in TLDR!



Sunday, November 16, 2025

UDLCO CRH: Kena upanishad Shloka and Shukrat

 Summary:


The conversation revolves around the nature of wisdom, knowledge, and the limits of human understanding. The quote "The only true wisdom is in knowing you know nothing" attributed to Socrates sparks a discussion about the importance of humility in learning and the dangers of claiming absolute knowledge.

Key Words: Socrates, Kena Upanishad, wisdom, knowledge, questioning, philosophy, spirituality, humility





Conversational learning Transcripts:

Hu1: 

"The only true wisdom is in knowing you know nothing."

Attributed to Socrates, a classical Greek philosopher.

[28/09, 13:12] hu3 : Not sure whether he said this himself but people around him certainly realised that. From a man who created a watershed moment in Philosophical understanding of this World into pre-Socratic and Post-Socratic world!

As you all know apparently there is no question he hasn’t asked about our existence and understanding our human condition. We are still grappling with answers to those questions.  

No wonder West has done well following his and his disciples writings. We will do well as a country if we can decipher the man behind the questions. The questions themselves would not trouble a GCSC student, but the answers will whatever our age!


[28/09, 13:31]hu4: You must be a scholar in both eastern and western philosophies to be able to decipher the differences...

In Indian philosophy, the proponents never claimed any fame or name for themselves.

They realised how insignificant they are as compared to the infinite vastness of God's creation.


[28/09, 13:58]hu3: That’s the point actually. I am not an expert on anything. 

Thinking that our philosophy has deciphered everything and answered every problem has catapulted us into darkness, from which, we are trying to crawl back most times unsuccessfully. Internet is changing things a bit with spread of knowledge. Hope the momentum continues with some good results.


[28/09, 14:31]hu4: That is because we got caught in the destruction of our culture through the idea of the superiority of one philosophy over the other (read - religion), gave in to accepting all things eastern as inferior (matter vs mind), and struck a truce through so-called secularism.


[29/09, 20:25]hu2: Socrates got it from the kena upanishad?

"It is not known by those who know It; It is known by those who do not know It."

यस्यामतं तस्य मतं मतं यस्य न वेद सः ।
अविज्ञातं विजानतां विज्ञातमविजानताम् ॥ ३॥

yasyāmataṃ tasya mataṃ mataṃ yasya na veda saḥ .
avijñātaṃ vijānatāṃ vijñātamavijānatām .. 3..


Hu5: Counterpoint: One of the best ways that religion has used to establish authority over human mind is to make itself indecipherable, and as a consequence, unquestionable. Science doesn’t tell the humans, you can never understand quantum physics, space, human body, physical phenomena, etc. If it can’t explain, it strives to. If it offers an incorrect explanation, and someone offers a better one, it accepts it. That is often shown as a weakness (esp by charlatans like B M Hegde and likes), but it is its biggest strengths.

Religion, existence of God, His nature, all these have been kept out of questioning. You cannot know this through questioning and logic, says every scripture in the world. Only if you surrender yourself (basically meaning, only if you stop questioning), and give your intellect to a Guru, you will be able to ‘know’. 

As Kenopanishad says, more you question, less you understand, and vice versa. 

यस्यामतं तस्य मतं मतं यस्य न वेद सः ।
अविज्ञातं विजानतां विज्ञातमविजानताम् ॥ ३ ॥

‘Those who think they can understand God with their intellects have no understanding of God. Only those who think that He is beyond the scope of their comprehension truly understand Him.’

Game, set, and match. Discussion over. Ghar jaao.

Thematic analysis:

- *Humility in Learning:* Recognizing the limits of one's knowledge is a sign of true wisdom. This theme is echoed in the Kena Upanishad's verse, "It is not known by those who know It; It is known by those who do not know It."

- *The Limits of Intellect:* The conversation highlights the limitations of human intellect in understanding the divine or ultimate reality. The Kena Upanishad's verse suggests that those who think they can understand God through intellect have no understanding of God.

- *The Importance of Questioning:* The discussion also touches on the importance of questioning in learning and the pursuit of knowledge. While science encourages questioning and seeking answers, religion often discourages questioning and emphasizes surrender and faith.

- *The Dangers of Dogmatism:* The conversation warns against dogmatic thinking and the dangers of claiming absolute knowledge. It highlights the importance of recognizing the complexity and mystery of existence.

- *Cultural and Philosophical Exchange:* The discussion also touches on the importance of exploring and learning from different philosophical traditions, both Eastern and Western.

*Insights:*

- The conversation highlights the importance of approaching knowledge with humility and recognizing the limits of human understanding.

- It emphasizes the need for ongoing questioning and inquiry in the pursuit of knowledge and wisdom.

- The discussion also suggests that spirituality and philosophy can be complementary, rather than mutually exclusive, and that exploring different traditions can lead to a deeper understanding of existence.


Copilot:

Here's a structured summary and thematic analysis of the conversation:

---

*🔑 Key Words*
- Socrates, Wisdom, Ignorance
- Kenopanishad, Brahman, Eastern Philosophy
- Western Philosophy, Secularism, Religion
- Questioning, Knowledge, Guru
- Science vs Religion, Authority, Comprehension
- Cultural Decline, Internet, Intellectual Humility

---

*🧭 Thematic Analysis*

*1. Wisdom Through Ignorance*
- Socrates' quote and the Kenopanishad shloka both emphasize the paradoxical nature of wisdom: true understanding begins with acknowledging one's ignorance.
- This theme bridges Eastern and Western thought, suggesting a universal philosophical insight.

*2. East vs West: Philosophical Traditions*
- Western philosophy is portrayed as question-driven and analytical, with Socrates as a pivotal figure.
- Indian philosophy is described as humble, anonymous, and spiritually vast, focusing on surrender rather than intellectual conquest.
- The contrast highlights differing epistemologies: logic and inquiry vs. transcendence and intuition.

*3. Cultural Self-Perception and Decline*
- There's a critique of India's philosophical complacency and cultural erosion due to colonial and religious influences.
- The conversation laments the loss of intellectual rigor and the misinterpretation of secularism as philosophical surrender.

*4. Science vs Religion: Epistemic Authority*
- Science is praised for its openness to questioning and revision.
- Religion is critiqued for discouraging inquiry and establishing authority through mystery and surrender.
- The Kenopanishad is used both to support and challenge this view, depending on interpretation.

*5. Role of the Internet and Modern Knowledge Sharing*
- The internet is seen as a tool for democratizing knowledge and potentially reversing cultural stagnation.
- There's hope that increased access to information can reignite philosophical curiosity and critical thinking.

---

*📚 Learning Points*

- *Intellectual humility* is foundational to both philosophical and spiritual growth.
- *Cross-cultural dialogue* enriches understanding and reveals shared human concerns.
- *Critical inquiry* is essential for progress, whether in science or philosophy.
- *Cultural introspection* is necessary to reclaim lost intellectual traditions.
- *Scriptural interpretation* can be both a source of insight and a tool of control—context and openness matter.

---


Saturday, November 15, 2025

UDLCO CRH: AI healthcare leadership through a PaJR data driven transparent and accountable workflow

Summary:


The conversation revolves around a proposed Healthcare Leadership Platform that utilizes real-world healthcare data to create realistic scenarios for leadership training. One conversationist aims to develop strategic and ethical leaders capable of governing AI adoption and driving digital transformation in clinical and administrative settings through a PaJR, participatory refined, data driven  platform. The discussion also touches on the Digital Personal Data Protection Rules, 2025, and its implications for healthcare data management.

*Key Words:*

- Healthcare Leadership Platform
- Artificial Intelligence (AI)
- Data-driven healthcare
- Digital Personal Data Protection Rules, 2025
- Patient Journey Record (PaJR)
- Data Protection Impact Assessment (DPIA)
- Significant Data Fiduciary (SDF)


Conversational learning Transcripts aka CDSS Conversational decision support and more recently participatory refinement (as in full text here: https://academic.oup.com/rssdat/article/1/1/udaf002/8317136)

[13/11, 13:15]hu1: Do they need faculty for this?😊

[13/11, 15:21]hu3: What is the definition of "expert"?

[13/11, 15:23]hu4: This may be ok for Lead with AI in operation. Definitely NOT for Lead with AI in science or technology. 😊

[13/11, 15:33]hu5: 

all in all alaguraja. 

Tamilians will understand 😀

all rounder in 1 subject

[13/11, 15:40]hu1: May be, an idea brewing for an AI healthcare edtech.


[13/11, 15:51]hu5: bolo


[13/11, 16:49]hu1: Here's a thesis for the esteemed members of the group to review and comment👇

Healthcare Leadership Simulator Platform (The
"MediLead" Platform)

This startup focuses on developing strategic and ethical leaders capable of governing AI adoption, managing complex data streams, and driving digital transformation in clinical and
administrative settings.

Core Concept

A sophisticated, cloud-based simulation platform that utilizes real-world (anonymized and
synthetic) healthcare data to create hyper-realistic scenarios for leadership training.

Target Audience
● 
Mid-to-senior level healthcare managers (Hospital VPs, Department Heads, Clinical Directors).

● Future healthcare executives (MBA/MHA students).

● AI/Data Science professionals transitioning into healthcare leadership.

Key Features and EdTech Value

● Dynamic, Data-Backed Scenarios: Leaders tackle challenges like managing a sudden surge in patient volume due to a pandemic (simulating real-time resource allocation), implementing a new diagnostic AI tool while navigating regulatory and ethical concerns,
or managing a system-wide cyber attack on patient data.

● "Digital Twin" Hospital: Participants manage a simulated hospital/clinic "twin" where their decisions (e.g., staffing, technology investment, process changes) have measurable, downstream effects on key performance indicators (KPIs) like patient outcomes, operational efficiency, and staff burnout rates.

● Ethical AI Governance Module: Specific training on establishing AI governance
frameworks, addressing bias in clinical algorithms, ensuring data privacy (HIPAA, GDPR compliance), and communicating AI decisions to clinical staff and patients.

● Personalized Feedback Loop: AI-powered grading and feedback that evaluates not just the outcome of a decision (did the KPI improve?) but the process (was the ethical concern addressed? was communication effective? was the data analysis sound?).

Why this is a good fit?

This moves beyond case studies to experiential learning. It develops the critical decision-making under pressure required for leaders to integrate AI safely and effectively, which is the single biggest technological challenge in healthcare today


[13/11, 16:49]hu1: My AI assistant made it for me😃😃


[13/11, 16:53]hu5: nice disclaimer


[14/11, 13:04]hu1: No takers, no investors?

[14/11, 13:10]hu2: Would love to take it up as hands on experiential learning electives in our campus. More about it here: 


Can we get a few potential healthcare leadership trainees to go through this publicly available data generated by our hospital and provide their inputs on how they may have averted this?👇




[14/11, 12:00]hu6: Digital Personal Data Protection Act & Rules published today: https://egazette.gov.in/(S(ht1vstbmp0ar3cpam2kdjj2q))/ViewPDF.aspx

[14/11, 13:12]hu7: Is this a new release sir?

[14/11, 13:13]hu7: Yes - today.

[14/11, 13:14]hu2ai: The **Digital Personal Data Protection Rules, 2025** (DPDP Rules) provide the crucial procedural and operational backbone to the **Digital Personal Data Protection Act, 2023** (DPDPA).

Here is a detailed analysis of the key rules and their direct implications for a **PaJR (Patient Journey Record) workflow**, along with actionable suggestions for compliance.

### Executive Summary

The DPDP Rules significantly formalize and add granularity to the obligations under the DPDPA. For a PaJR system, which handles highly sensitive personal data (health information), the rules around **consent, security, data breach notification, and data retention** are particularly critical. Your workflow must evolve from simply collecting data to actively managing it with demonstrable accountability and robust security.

---

### Key Rule Analysis & Impact on PaJR Workflow

#### 1. Rule 3: Notice by Data Fiduciary (PaJR Provider) to Data Principal (Patient)

*   **What it says:** The notice of consent must be clear, standalone, in simple language, and include an itemized description of the personal data and the specific purpose of processing. It must also provide easy means for the patient to withdraw consent, exercise rights, and file complaints.
*   **Impact on PaJR:** The generic consent forms you might use now will be insufficient.
*   **Suggestions:**
    *   **Redesign Consent UI:** Create a dedicated, pop-up or page for consent that is not buried within Terms of Service.
    *   **Granularity:** Instead of "I agree to share my data," specify: "I consent to the processing of my [medical history, medication logs, symptom descriptions] for the purpose of [personalized health tracking, clinician review, generating health insights]."
    *   **Easy Access:** Provide prominent, easy-to-find buttons/links labeled "Manage Your Consent" or "Withdraw Consent" within the PaJR app/portal.

#### 2. Rule 4: Consent Manager

*   **What it says:** Establishes a framework for registered "Consent Managers" – third-party platforms (like account aggregators in finance) that allow users to manage consent across multiple data fiduciaries from a single dashboard.
*   **Impact on PaJR:** In the future, patients might use a central health Consent Manager to control access to their PaJR data by hospitals, insurers, or researchers. You may need to integrate with such platforms.
*   **Suggestions:**
    *   **Monitor Ecosystem:** Keep an eye on the development of the Consent Manager ecosystem in India, especially for healthcare.
    *   **API Strategy:** Plan for a technical architecture that can securely interact with Consent Manager APIs to receive and act on patient consent instructions.

#### 3. Rule 6: Reasonable Security Safeguards

*   **What it says:** Mandates specific security measures, including:
    *   **Encryption, Masking, Tokenization** of personal data.
    *   Access controls and logging/monitoring of data access.
    *   Data backup and business continuity plans.
    *   Retention of logs and personal data for **a minimum of one year**.
    *   Contractual security obligations on Data Processors (e.g., cloud providers).
*   **Impact on PaJR:** This is a direct and non-negotiable requirement. A PaJR system is a high-value target.
*   **Suggestions:**
    *   **Technical Audit:** Conduct a security audit against these specific points. Ensure data is encrypted *at rest* and *in transit*.
    *   **Access Logs:** Implement detailed logging of *who* accessed *which* patient's record and *when*. This is crucial for breach investigation (Rule 7).
    *   **Review Contracts:** Ensure your contracts with cloud hosting providers (AWS, Azure, etc.) explicitly assign security responsibilities as required by this rule.

#### 4. Rule 7: Intimation of Personal Data Breach

*   **What it says:** In case of a breach, the Data Fiduciary (you) must:
    *   **Notify each affected patient** without delay, detailing the breach's nature, consequences, and mitigation measures.
    *   **Notify the Data Protection Board (DPB)** within **72 hours** with a detailed report.
*   **Impact on PaJR:** A data breach of health data is a catastrophic event. This rule mandates a swift and transparent response.
*   **Suggestions:**
    *   **Create an Incident Response Plan (IRP):** Have a clear, documented plan that designates a response team, defines communication templates for patients and the Board, and outlines technical containment steps.
    *   **Practice Drills:** Conduct table-top exercises to test your IRP.

#### 5. Rule 8 & Third Schedule: Data Erasure & Retention

*   **What it says:** Specifies that for certain entities (e-commerce, online gaming, social media), data must be erased if the user is inactive for 3 years, unless required by law. More importantly, it mandates that **all data fiduciaries must retain processing logs for at least one year**.

*   **Impact on PaJR:** While the 3-year rule may not directly apply to you, the one-year log retention is critical. Furthermore, you must have a clear data retention and deletion policy.

*   **Suggestions:**

    *   **Define a Retention Policy:** Establish a policy stating how long you retain a patient's core health data after account deactivation. This must balance the rule's principle of deletion with other laws (e.g., clinical record-keeping laws that may require longer retention).

    *   **Automate Deletion:** Build workflows to automatically flag data for anonymization or deletion as per your policy.

    *   **Log Management:** Implement a system to securely store access and processing logs for at least one year.

#### 6. Rule 10: Verifiable Consent for Children

*   **What it says:** Requires obtaining verifiable consent from a parent/guardian before processing a child's data. It specifies methods for verifying the parent's identity and adulthood (e.g., through reliable records or Digital Locker).

*   **Impact on PaJR:** If your PaJR is used for pediatric care, you need a robust age-gating and parental consent mechanism.

*   **Suggestions:**

    *   **Age Verification:** Implement an age-collection field during sign-up.

    *   **Parental Consent Flow:** For users identified as children, create a separate flow that pauses data processing until verifiable parental consent is obtained, using one of the methods outlined (e.g., integration with DigiLocker for verification).

#### 7. Rule 13: Additional Obligations of Significant Data Fiduciary (SDF)

*   **What it says:** SDFs have extra duties, including conducting a **Data Protection Impact Assessment (DPIA)** and annual audit, appointing a Data Protection Officer (DPO), and adhering to potential data localization requirements.

*   **Impact on PaJR:** Given the sensitive nature of health data, it is highly likely that a PaJR platform will be classified as an SDF.

*   **Suggestions:**

    *   **Proactive Compliance:** Act as if you are an SDF from day one.

    *   **Conduct a DPIA:** Proactively perform a DPIA for your PaJR system. Identify risks in your data processing and mitigate them.

    *   **Appoint a DPO:** Designate a Data Protection Officer (even if initially a senior team member) to be the point of contact and oversee compliance.

    *   **Prepare for Localization:** Be technically prepared to store and process a copy of critical personal data within India if the government mandates it for health data SDFs.

#### 8. Rule 14: Rights of Data Principals

*   **What it says:** Data Fiduciaries must publish the means for Data Principals to exercise their rights (access, correction, erasure, grievance redressal) and respond to grievances within a defined timeframe.

*   **Impact on PaJR:** Patients will have the right to ask for their data, correct it, or delete their account. You must have a system to handle these requests efficiently.

*   **Suggestions:**

    *   **Create a Rights Portal:** Build a dedicated section in the app/website where patients can easily submit requests to access, correct, or delete their data.

    *   **Grievance Redressal Mechanism:** Establish a clear process with a defined timeline (the rule suggests a "reasonable period not exceeding ninety days," but best practice is much faster) for responding to all user complaints and rights requests. Publish the contact details of your Grievance Officer.

### Overall Recommendations for Your PaJR Workflow

1.  **Gap Analysis:** Map your current data flows, consent mechanisms, security practices, and policies against each rule.

2.  **Document Everything:** The mantra of data protection is "Show, don't tell." Document your processes, risk assessments, and decision-making.

3.  **Privacy by Design:** Integrate these compliance requirements into the design of new features, rather than bolting them on later.

4.  **Team Training:** Ensure your technical, product, and support teams are trained on these rules and their importance.

5.  **Seek Legal Counsel:** This analysis is a starting point. Engage with a legal professional specializing in Indian data protection law to review your specific PaJR implementation and ensure full compliance.

By proactively adapting to these rules, you can not only achieve compliance but also build a more trustworthy and resilient PaJR platform, strengthening your relationship with patients and partners.


[15/11, 05:18]hu8: Dear hu2
Interested to see two separate links and a query on how _healthcare leadership trainees_ could help avert the latter.
By itself that term seems to be an oxymoron and also wondering if you want to avert the particular incident which caused a CPA ruling or the adverse ruling. Regrettably the latter has been an unfortunate and sad decision. The death has been caused by a mixture of bad Anaesthesia decision coupled with an emergency. Giving GA to a hypothyroid is fraught with risk. It is not clear but probably Spinal Anaesthesia failed and they had to give GA- The term double Anaesthesia is however a legal invention and making it the basis of the adverse award would means it would be thrown out as a clear evidence of not being commonsensical.
However how your PAJR would have helped prevent this is also not fathomable to me as the adverse circumstances and their interpretation is unlikely to be clear to a lay person and even less so to the so called legal brains.


[15/11, 05:20]hu8: Maybe metaAI could have answered??

[15/11, 08:19]hu2: Thanks for the interesting feedback 
🙂🙏

I'll also get the PaJR team to ask AI but for the time being for whatever it's worth here's my human input:

The PaJR workflow is largely about "data driven healthcare." 

Patient event outcomes data, drive patient interventions which becomes data to cyclically again influence patient event outcomes data toward creating a positive change in the health of the patient.


The newspaper article where the patient's case report has been shared well enough with some narrative data (not sure if they had a DPDP approved signed informed consent from the patient like PaJR does @⁨hu6 Cnmc⁩ or is further debate appropriate around how patient privacy appears to be a convenient trade-off especially when it works positively for either stakeholders in healthcare litigation, more about the misunderstandings around the word litigation forthcoming in another paper) but what a PaJR case report may have offered over and above the newspaper documented data is an hour by hour account of what actually happened during the hours from when this particular patient first felt the symptoms till her death with optimal transparency and accountability.

We have multiple examples that regularly get updated on our home page that could be currently far from the ideal we are striving towards in our daily quest toward using data driven healthcare to improve accountability and avert these misunderstandings because to a physician who has seen many peripartum cardiomyopathies and pulmonary embolisms and has patients regularly dying under his her care this is essentially a pure misunderstanding between those with professional expertise in the subject and between those who have been subjected to that professional expertise.

It's clearly a misunderstanding between those who can see the uncertainty in clinical complexity and those who are sold to the hype of healthcare market forces!

Further reading:


PaJR home page:



[15/11, 08:25]hu6: Privacy in ... is mostly selective.

[15/11, 08:28]hu2: I guess "selective privacy" is a global phenomenon as in"jiski lathi uski privacy!"


[15/11, 09:42]hu8: Agreed, but I quantify further - laws are made and enforced only to benefit the law makers- and here specifically are two examples -PCPNDT and Traffic rules 
- though some of the latter do help enforce traffic discipline but PCPNDT has only worsened healthcare
Regarding PAJR and the specific case- I don’t think any non professional saw the Pateint between being wheeled to OR and her death (she was not conscious when she came out)

[15/11, 10:02]hu2: Yes in this specific case all standard professional expertise was delivered and hence the PaJR pitch for making such data available in real time to multiple stakeholders at the point of care even as events unfold before it becomes too late and simply remains newspaper fodder with momentary shock value.

Question is will experts be able to handle a positive Orwellian (non dystopian) data driven healthcare system?

Or will they drown in cognitive overload?

Can @⁨hu1's AI healthcare leadership program make a difference in the current landscape?

As an aside from another parallel discussion around  recently viral AIIMS AI usage implications, there's this interesting debate in the comments section of Sumer's post linked here: 


Insightful comments from the founder of qure.ai overseeing this AIIMS Radiology triage:

"As a radiologist and a product manager at Qure (full disclosure, the above report appears to be generated by qXR algorithm developed by Qure.ai), my observation has been that sites that are truly successful in capturing the value of implementing AI in their clinical workflow have the following characteristics: 

1. They have a clear understanding of why they need automation and AI (Clear need) 

2. They have defined expectations from the AI algorithm which match their needs (Defined Expectations) 

3. They have clear understanding of the limitations and constraints of AI (Clear Boundaries)

 4. Good understanding where AI shines and where Radiologists shine (Collaborative vs Competitive Mindset)

An AI tool is only as successful as the clinical and radiological team that is behind it’s implementation and operation"

Thematic Analysis:*

- *Data-driven Healthcare:* The conversation highlights the importance of leveraging data to improve healthcare outcomes and create a more accountable and transparent healthcare system.

- *AI Governance:* The discussion emphasizes the need for strategic and ethical leadership in governing AI adoption in healthcare, ensuring that AI systems are designed and implemented with accountability, transparency, and patient privacy in mind.

- *Data Protection:* The Digital Personal Data Protection Rules, 2025, are discussed, highlighting the importance of protecting patient data and ensuring compliance with regulatory requirements.

- *Healthcare Leadership:* The conversation touches on the need for effective healthcare leadership, emphasizing the importance of developing leaders who can navigate the complexities of AI-driven healthcare and make informed decisions.

Some key points from the conversation include:

- The importance of creating a culture of transparency and accountability in healthcare, leveraging data to improve patient outcomes and reduce errors.
- The need for healthcare leaders to develop a deep understanding of AI and its applications in healthcare, ensuring that AI systems are designed and implemented to support patient-centered care.
- The importance of protecting patient data and ensuring compliance with regulatory requirements, such as the Digital Personal Data Protection Rules, 2025.
- The potential for AI to improve healthcare outcomes, but also the need for careful consideration of the limitations and constraints of AI in healthcare.