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

 http://kg83797.blogspot.in/2016/03/a-60-years-old-man-with-seizure-since.html (Prepared by Kuldeep Gupta)

http://swaudhc13.blogspot.in/2016/03/45yr-old-man-with-dm-since-10yr.html?m=1

(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

Like · Reply · March 23 at 8:26am

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 ...

Like · Reply · March 23 at 8:41am

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

Like · Reply · March 23 at 8:44am

Rakesh Biswas Sugar ki bimaari kab se hai?

Like · Reply · March 23 at 9:41am

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)?

Like · Reply · March 25 at 9:01am

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

Like · Reply · March 25 at 9:30am

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

yahan https://1.bp.blogspot.com/-SGoqJZHK2tk/VvOxK-

oC8kI/AAAAAAAADsc/3Q53jolqCpQ0dkEF_Axp5mKZa4rnZ5sKA/s1600/hindi%2Bmini%2B

mental%2Bscoring%2Btest.jpg 

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

Case 3: http://globaludhc07.blogspot.in/2016/02/a-18-years-old-girl-with-lower.html

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

Unlike · Reply · 1 · February 25 at 10:40pm

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

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 28^th 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 28^th 2016 from https://umanitoba.ca/faculties/health_sciences/medicine/education/pgme/media/Portfolio_Presentation_copy.pdf

Images of Portfolio Based learning: 

http://image.slidesharecdn.com/dublin2016-balancing-160323110905/95/dublin2016-balancing-2-638.jpg?cb=1458731715,

http://image.slidesharecdn.com/dublin2016-balancing-160323110905/95/dublin2016-balancing-24-638.jpg?cb=1458731715

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

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): 

http://www.jabfm.org/content/28/4/452/F1.large.jpg

http://www.jabfm.org/content/28/4/452.full