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
http://kg83797.blogspot.in/2016/03/a-60-years-old-man-with-seizure-since.html (Prepared by Kuldeep Gupta)
(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?
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 .
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
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
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
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:
Sample ‘patient-information-communicator’
weekly-learning-portfolios recorded here:
http://userdrivenhealthcare.blogspot.in/2016/03/assessment-of-patient-information_28.html
http://userdrivenhealthcare.blogspot.in/2016/03/experience-patients-are-interviewed-by.html
http://userdrivenhealthcare.blogspot.in/2016/03/assessment-of-patient-information.html
http://userdrivenhealthcare.blogspot.in/2016/03/assessment-of-patient-information_87.html
http://userdrivenhealthcare.blogspot.in/2016/03/assessment-of-patient-information_28.html
http://userdrivenhealthcare.blogspot.in/2016/03/experience-patients-are-interviewed-by.html
http://userdrivenhealthcare.blogspot.in/2016/03/assessment-of-patient-information.html
http://userdrivenhealthcare.blogspot.in/2016/03/assessment-of-patient-information_87.html
Sample UDHC Case-study: http://userdrivenhealthcare.blogspot.in/2016/03/udhc-case-study-from-online-patient.html
Check-list for patient-safety near miss reporting (toward
quality improvement):
