Meeting information needs: The role of clinical case reports

This was my response to queries posted on this topic in the forum HIFA2015.

"Would such a database be useful as a reference or learning tool to support the delivery of health care in low-resource settings?"

It would be the most useful database ever utilized in medical practice be it the developing or the developed world.

To quote Dr Smith's editorial in the same journal, 'GPs might, and will, use their experience - as they have done for centuries. Their experience might be supplemented with evidence from high quality databases that follow every one of a cohort of patients. But they might also search our journal and database to find a patient just like theirs and see how the patient was treated and what happened to him or her (follow up will be very important).'

"Who might use it - health professionals, researchers, policymakers? How might it be used?"

It would be utilized by multiple stakeholders in the patient's journey though his/her illness. These would include among others the patients, their relatives, their immediate primary care as well as their referral physicians.

"How might it be used?"

One way to better the usage would be to create portfolios of contributors be it patients contributing their own disease perspectives or health professionals reflecting on their day to day activity and then link these with web 2.0 tools commonly available in social networking sites such as Facebook. In this way patients and health professionals can remain in touch just by following their status updates (thus maintaining informational continuity or follow up which as Dr Smith pointed out is vital to positive health outcomes).

"What features would such a database require to provide maximum benefit for end-users in developing countries?"

Free to publish (I am sure it will be for those in HINARI countries but that leaves a lot of poor Indian academics in the lurch due to Indian's newfound non HINARI exalted status).

How would an Indian villager access it to share his stories? Well a villager could go to the nearest internet kiosk and his story could be uploaded by the kiosk operator (that would also create an employment opportunity).

Finally do we have a quicker and easier way of doing this instead of having to go through a lengthy peer review process (which could be better performed in the post publication rapid responses from those who happen to discover the story as it matches theirs)?

We have tried to create a similar model where we have health professionals and patients as group members with their individual portfolios and these health professionals and patients stay in touch with each other by just following each others status updates.

Many of the patients have chosen user names (one such is "English Patient" that you will find on the site) to protect their identity.

Feel free to join the group, add the patients or health professionals to your contacts and start following their status updates. I am sure you will find that just sharing your concern with these patients (with or even without sharing your expertise) may make this a different experience.
http://www.facebook.com/group.php?gid=77835023213

You could begin with by adding "English Patient" to your contacts, read her notes, (which are categorized into an unstructured one she created and the structured summary that her physician did) and finally do go through her status updates and the comments of the health professionals who responded to them.
We have another similar group for our medical students as well:
http://www.facebook.com/group.php?gid=102177045567

warm regards,
rakesh
http://peoplesgroup.academia.edu/RakeshBiswas

Experiences on Medical Education networking

To share experiences on medical education networking I guess I won't have to go back further than when I was an undergrad medical student.

I always thought the best way to crack the assessments would be to know what our examiners knew. A bit of networking with them would have allowed me to know what was on their minds but then getting to get to know them was a major challenge in our college where even the internal examiners were actually from a different college (although from the same university).

So we had to restrict ourselves to knowing what was general knowledge ( I believe the MCI calls them "must know").

However a bit of networking with our hostel seniors did allow us a sneak peak into the previous assessment scenarios with interesting tit bits on the examiners as well.

Hostel life that way was a great place for networking.

I soon grew out of the assessment networking fever after having completed UG although I could never grow up from being a medical student: http://student.bmj.com/issues/03/02/reviews/41.php

In my clinical practice I realize that networking is essential to success and each and every new workplace offers its own challenges in setting up networks from scratch ( I have changed a good many places from Kolkata, Chandigarh, Nepal, Bangalore, Malaysia and finally Bhopal).

However online networking gives me an opportunity to maintain older networks with ease. My facebook contacts ( 250 and growing) are mostly people who I met on my previous institutions, many of them students sharing their life pictures ranging from holidaying in US or Borneo to getting married or having children etc etc.

Wish I could have kept in touch with my patients in the same manner.

Facebook gives me a hope that some day in the distant/near future we shall be able to network more meaningfully with our students and patients.

Open health information management and user driven health care

What if we have user driven health records generated in the community by patients, relatives IT professionals (call them PHR, EMR whatever) and this was stored in an openly accessible platform (without patient identifying data) and this in turn was utilized effectively to upgrade stage 6 and 7 of Hospital records? (HIMSS says there are 7 stages of hospitals, most US hospitals on stage 3 and none on stage 7.The seven stages are : Stage1 Lab, Radiology and Pharmacy all networked, Stage 2 Clinical Data repository, Controlled medical Vocabulary, Clinical Data Support System, may have Document Imaging, Stage 3 Clinical Flow Sheets, CDSS, PACS, Stage 4 CPOE,CDSS , Stage 5 Closed Loop, Stage 6 Physician documentation complete, Stage 7 Medical record fully electronic)
.

http://www.igi-global.com/reference/details.asp?ID=33436&v=tableOfContents (chapter XVIII)

I know it sounds whacky but I feel this is actually what is happening today on paper (minus a lot of valuable data that goes unrecorded due to time and resource constraints thus making our present paper records useless...barring exceptions).

What is happening today is that the same PHR exists in an individual patient's and his/her relatives mind and a fracton of it is handed out to the busy clinician who records an even lesser fraction of it in his paper record. Thus a valuable opportunity to share patient and health professional driven experiential insights is lost.

openEHR platforms are changing for the better daily and the coming years will remain exciting for the clinical informatics community.

Van Couvering Is Not a Verb: User-driven health care

Van Couvering Is Not a Verb: User-driven health care

user driven health care for plants

I guess the following discussion that I generated on a list serv may serve as an example:
We have noticed these leaf changes in our queen's crepe myrtle from a potted sapling since Jan 2008 (image apr 18 2008) as they persist even today although the plant continues to thrive. (Image Jan 25 2009).

Would be grateful for comments, suggestions regarding these peculiar changes and remedies.

rakesh

Response 1

I notice a couple of leaves having a sort of crumpled appearance. Itcould be the larvae of some insect on the rear side of the leaves.Sometimes, the moths lay their eggs on the rear portion of the leavesand the larvae build some kind of cocoon around themselves. If that isthe case, removing the cocoon should help.regards

Yazdy Palia.

Response 2

Rakesh-- Occasionally I've had an occasional deformed leaf, usually caused by either minor insect damage or drought stress as leaves are starting to expand. Again, I wouldn't worry about it at all. Enjoy the color of the new growth!

Regards--
Ken Greby,
Broward County,
Florida USA

Response 3

My own:

Thanks Ken.

Yes I guess this is a minor problem after all as long as they aren't failing to thrive.

rakesh

Thanks Yazdy.

I shall keep that in mind.

Meanwhile the discussion contiues to evolve:

Hi Yazdy,

Whenever u see the leaves are being eaten/crumpled in a potted plant, u tend to use the pesticides to remove the infection.

However, many a times it is a food plant of caterpillars of butterflies or moths. Although all the leaves are eaten and the the entire plant becomes leafless, dont worry. It is the natural process which u should not interfere into. After some days, these caterpillars will form a pupa/ cocoon and imrge into a butterfly or a moth. Eventually, the plant will grow new leaves again.

i have reared many butterflies and moths so far sucessfully.

please remember when u remove a cocoon from a leaf, u kill a butterfly or a moth before it is born.

cheers,

shubhada

Hope it continues...

Cheers to pluralism.
rakesh