Monday, March 28, 2016

Assessment of the patient-information-communicator’s Online-learning portfolio for Arun Chaudhary, March 2016

Experience:

Patients are interviewed by the learner and s/he also creates their HIPAA de-identified online-health-records that may contain their history and clinical images other than their investigations
Cases
(Prepared by Jyoti Tripathi)
Case 2: Blog not made but history shared on non-shareable-online forum

Reflection-

Here the learner is concerned with how things happen by attempting to see them from different perspectives and relying on one’s thoughts, feelings and judgement. (Reference 1)

Arun Chaudhary Matformin ....chal ri h sir ....but raat ko 10 baje k aas pas ...460 mg/dl ...ho gya tha to inko ...6 unit regular insulin ..stat ..me diya
Rakesh Biswas To unhen hum regularly 6 units khane se pehle de diy6a karen aur raat ko saath mein units mixtard bhi diya ja sakta hai Prakhar.
Like · Reply · 1 · March 23 at 8:39am
Arun Chaudhary Yes sir. ..vahi dena chahiye ...
Rakesh Biswas Regularly 6 units ka mera yeh bhi matlab tha ki Regular inuslin Actrapid 6 unit before meals Arun
Like · Reply · 1 · March 23 at 8:42am
Arun Chaudhary Yes sir ....de denge ...but vo pehle tablet pr the ...abhi parso raat se unko ..regular insulin ...lgna start hua h
Rakesh Biswas Sugar ki bimaari kab se hai?
Arun Chaudhary Sir ...ni pta ...mujhe ..bcozz mene history ni le paya inki ...aaj bta dunga sir ...

Conceptualization-

 Arun C: N ..sir ...plzzz tell me something about the ..tablet of .insulin ...that ..what is the 

dose of insulin contain ...a tablet ...how much unit ..n dose ...n ..mg ?

Bcozz sir ...ab mujhe hi usko tablet pe ..Lana pdega ...aaj night me main vahi krta hu ...n sir ..
tell me the ...effective ..salt of ..insulin tablet ...

Insulin tablet jo avishkaar karenge unhen Nobel prize milega. smile emoticon


Thanxxx sir

To fir ..sir ..ye ..matformin ..n glimpride ...kese control krti h ..sugar ko ..


RB: Glimeperide sulphonylurea hai. Sulphonyl urea ka mechanism of action padh ke batao


Arun C: Okkkk sir ...thanxxx

Sulfonylureas stimulate insulin secretion from pancreatic β-cells and are widely used to treat 

type 2 diabetes. Their principal target is the ATP-sensitive potassium (KATP) channel, 

which 

plays a major role in controlling the β-cell membrane potential.

Smajh gya sir ...main ab ..thank you so much sir ......but sir ...ek doubt h ....uski insulin ki 

dose kaafi increase h ...means ...damage of ..beta cells ..of pancreas ...so kya ye tablet 

..uske beta cells ..se insulin secret krva payegi ...


Ye test main aaj krke dekhta hu ...

Action-

The learner attempts to influence people and change situations as necessary. (Reference 1)
 

Cognitive/Intellectual Action

Taking patient histories (in patient’s voice) and taking clinical images and recording them in blogs
 Not done
 Using structured templates to record patient findings such as Mini-mental scores, depression scores, quality of life scores etc
 

Case-1: Arun Chaudhary  Result of MMSE ..

1. Morning , evening or night = morning ...

2. Which day of week today = No 

3. What is date = No ..

4. Which month of year = No

5 . Which climate runs = No 

6. Which post office of your residence = No ..

7. Which district u live = yes ..

8 . which village/residence = yes ..

9. City's block or pin code = No 

10 . Where u present this time = No ..pt tell other place ..1250 place

11. Delhi calculation ..= No 

12. Week days = No remember 

13 , 15 . which thing bring from Delhi = No ..

16 . Pt. Recognize - watch , pen,bottle ..
But not mobile ..

17. Watch = yes

18. Pen = recognize ..touch pen ..

19 . Revise = no if or no but ..= No .

20 . Look at my face and close your eyes and look my facial expressions = No ..

21 . Fold paper n give to patient ..for give him shape = No .

22. Tell me something different about your home = No

23. Draw the shapes of = square , rectangle, cube, or triangle ..= No 

How many children = don't know 

Date of marriage / year of marriage = No remember .

Note: Pt. Remember his son name and the day of his job holiday .

RB:  Thanks Arun can you total the score for the above (can you help in the 

scoring Kuldeep)?
Arun Chaudhary Sir ...scoring to mene ni ki ...but ..sir ...aisa lgta h us patient ko dekhke k vo ..depression ..me h ..

RB: Depression wala scoring ke liye chart alag hai. Yeh aapne MMSE ka kiya hai. Aap 




fir se padh kar (document ke bilkul neeche Kuldeep nei likha hai) dekh sakte hain kaise 

score karna hai



Making an optimal assessment and plan for the patient


Arun Chaudhary S- ARF with HTN with Severe anemia 
Improvement - no any fresh complain
Total intake - 2.5 ltr
Output- 4 times - 150*4 = 600 ml

O- GC- stable 
Pulse- 72/min
BP- 140/90 mg/hg
CNS- conscious
RR- 20/min

A- AFT with HTN with severe anemia with right ovarion cyst

P- inj- emiset 4 mg
Tab. Pantop 40 
Tab. Amlodipine 5 mg
Tab. IFA 
Tab. Lasix ..
Adv- BP monitoring ..I/O monitoring 
Plan adv- urea ..creatinin
Hemogram ....repeat 
Present urea 24-02. - 134
Creatinine - 8.7
Haemoglobin - 23-02- ...5.8 gm

Today HD is done ..HD notes ..
UF- 800 ml
HD duration - 4 hrs
Prev. BP - 130/90 mm/hg
Post BP - 130/90 mm/hg
Prev. Wt- 38.3 kg
Post wt- 37.7 kg
IM - Dex - 50 % - 1
Rakesh Biswas Well done Arun. Hope you will be able to do all the other 29 patients currently in both MMW and FMW in a similar manner so that the day residents (Jyoti, Madhavi, Deepshikha, Arti, Arjun) will also be able to do it in this manner for every patient.

Writing an order for pharmacological therapy (only for those with a licence)


Physical/Motor Action:

Assisting in data collection not only directly from the patient’s bedside but also from the patient’s radiology, labs and procedures and documenting it with images
Arun inka fever charting kal aapke ward se jaane ke baad aur kisi ne nahin kiya.
Like · Reply · 15 hrs
Arun Chaudhary Sorry sir ...aaj hoga inka fever charting ..
Unlike · Reply · 1 · 15 hrs

Arun Chaudhary's photo.

Performing physiotherapy (only for those with a licence)

Learning points-

These can be either based on the case or the number of learning points gained by the learner during the entire week.

Diabetes Insulin and Oral Hypoglycemics
Cognitive assessment
Approach to fever
Writing SOAP notes


Reference:

1)    Kohonen,V. 2009 Learning to learn through reflection – an experiential learning perspective. Full text downloaded on March 28th 2016 from http://archive.ecml.at/mtp2/Elp_tt/Results/DM_layout/00_10/05/Supplementary%20text%20E.pdf


Further reading:


Methodological differences that our 'constructivist' program has with traditional programs here in this link:http://images.slideplayer.com/10/2754034/slides/slide_20.jpg


Portfolios: Learning and Assessment in Medical Education Catherine Moltzan MD FRCPC: downloaded on March 28th 2016 from https://umanitoba.ca/faculties/health_sciences/medicine/education/pgme/media/Portfolio_Presentation_copy.pdf


Images of Portfolio Based learning: 





Check-list for patient-safety near miss reporting (toward quality improvement): 


Assessment of the patient-information-communicator’s Online-learning portfolio for Dr Jyoti Tripathi, March 2016

Experience:

Patients are interviewed by the learner and s/he also creates their HIPAA de-identified online-health-records that may contain their history and clinical images other than their investigations

Past patient experiences by Dr Jyoti Tripathi recorded online here: https://plus.google.com/109363683741842663030/posts

Reflection-

Here the learner is concerned with how things happen by attempting to see them from different perspectives and relying on one’s thoughts, feelings and judgement. (Reference 1)



Jyoti Tripathi Sir before meal sugar normal rh tha...bt after meal sugar 200 ke uper aati h .. aisa kyo ho rh h...
Like · Reply · 1 · March 15 at 8:27pm
Rakesh Biswas Meal khane ke baad sabhi ki sugar badhti hai. Isliye kaide s ehar meal se pehle extra insulin ki zaroorat padhti hai jisePrakhar ne add bhi karwaya tha. Kya aajkal patient ko woh mill nahi raha?
Like · Reply · 1 · March 15 at 9:04pm
Arun Chaudhary Sir ...per day me ..3 times milta h ...8 unit ..before brkfst .....8 unit before lunch .....and sir ..8 unit ..before dinner ....sir
Like · Reply · 1 · March 15 at 9:44pm
Prakhar Gupta Sir before short meals bhi hai and they give it to him. But problem ye hai ki wo randomly snacks kar leta hai

Jyoti Tripathi Hb_5.8gm %
Jyoti Tripathi
Jyoti Tripathi Sir Hb kam h...blood tranfusion krna h kya...
Rakesh Biswas
Rakesh Biswas Prakhar will decide while on the rounds
Jyoti Tripathi
Jyoti Tripathi Sir patient...feel better...bt ab kya krenge....
Rakesh Biswas Step 1--Pehle unki vartaman sthiti ka mulyankan kijiye: Kyon hua hai yeh kidney problem? Aur kya janchon se yeh pata chal sakta hai. Kaun si chapter mein yeh padha ja sakta hai? Patient had features of glomerulonephritis in the urine RM with nephrotic range proteinuria and active sediment in the form of RBCs. So i guess you can begin finding the answer to step 1 by googling each of these individually and then share with us what you learn about it here before we can move on to step 2. Please others (Arun, Madhavi, Arjun, Arti, Niranjan attendance will be given only if you participate here daily.
Jyoti Tripathi Sir...why increased creatinine after dailysis....
Rakesh Biswas Google it and let us know. Prakhar already mentioned the answer once in the rounds 3 days back
Rakesh Biswas Hint: Any relation between total body water, dialysis and creatinine?

Conceptualization-

Here learning is achieved by rigorous thinking (reflecting), using a systematic approach to structure and frame the phenomena being experienced. Emphasis is placed on the definition and classification of abstract ideas and concepts, aiming at precise conceptual categories. (Reference 1)

Mechanisms of Blood sugar control

Approach to a patient of renal failure



Action-
The learner attempts to influence people and change situations as necessary. (Reference 1)

Cognitive/Intellectual Action

Taking patient histories (in patient’s voice) and taking clinical images and recording them in blogs

Using structured templates to record patient findings such as Mini-mental scores, depression scores, quality of life scores etc

Making an optimal assessment and plan for the patient


Jyoti Tripathi Pt complaining chest pain since night
Like · Reply · 7 hrs
Jyoti Tripathi
Jyoti Tripathi N fever....bt abhi fever nh h.....
Like · Reply · 7 hrs
Rakesh Biswas Unka ECG hua hai? Idhar please share kijiye aur saath mein unka fever chart bhi. Objective data matlab yeh hain (aur unki cpmplaints subjective hain). Sahi interpretation ke liye dono ka hona zaroori hai.
Like · Reply · 7 hrs
Jyoti Tripathi Hmm sir ECG ho gyi h
Like · Reply · 7 hrs
Jyoti Tripathi's photo.

Like · Reply · 7 hrs
Jyoti Tripathi's photo.

Like · Reply · 7 hrs
Rakesh Biswas Jyoti inke pehle ka bhi ECG chahiye hoga compare kar ke dekhne ke liye.
Like · Reply · 6 hrs
Jyoti Tripathi Kl day me 500ml ke somthing urine huaa h...
Like · Reply · 6 hrs
Jyoti Tripathi Pt med n water refus kr rh h....See Translation
Like · Reply · 6 hrs
Jyoti Tripathi Portclor syrup nh le rh h pt
Like · Reply · 6 hrs
Rakesh Biswas
Rakesh Biswas Pot klor syrup se bhi zaroori hai unka khana lena. Unse kahiye agar woh muh se nahi le rahe hain to RT daalna hoga.
Like · Reply · 6 hrs
Jyoti Tripathi Sir samjha to rh h..bt pt nh man rh h
Like · Reply · 6 hrs
Jyoti Tripathi Prakhar sir ne bhi pt dekha h....or pani n khane ka bola h...bt 1spoon pani lene ke bad mna kr diya

Writing an order for pharmacological therapy (only for those with a licence in that particular medical stream in which the prescription is being provided)


Physical/Motor Action:

Assisting in data collection not only directly from the patient’s bedside but also from the patient’s radiology, labs and procedures and documenting it with images
Prakhar Gupta Jyoti unki dressing ho gayi?
Like · Reply · 2 · March 7 at 2:50pm
Jyoti Tripathi Hnji sir....kr diya dressing
Like · Reply · 1 · March 7 at 3:11pm

Performing physiotherapy (only for those with a licence)

Learning points-

These can be either based on the case or the number of learning points gained by the learner during the entire week.

Renal failure approach
Dressings
Insulin therapy mechanisms and dose adjustment


Reference:

1)    Kohonen,V. 2009 Learning to learn through reflection – an experiential learning perspective. Full text downloaded on March 28th 2016 from http://archive.ecml.at/mtp2/Elp_tt/Results/DM_layout/00_10/05/Supplementary%20text%20E.pdf

Further reading:

Methodological differences that our 'constructivist' program has with traditional programs here in this link:http://images.slideplayer.com/10/2754034/slides/slide_20.jpg


Portfolios: Learning and Assessment in Medical Education Catherine Moltzan MD FRCPC: downloaded on March 28th 2016 from https://umanitoba.ca/faculties/health_sciences/medicine/education/pgme/media/Portfolio_Presentation_copy.pdf




Sample ‘patient-information-communicator’ weekly-learning-portfolios recorded here:



Check-list for patient-safety near miss reporting (toward quality improvement):