PaJR group Conversational learning transcripts :
[2/26, 1:40 PM] 29f Htn DM Patient Advocate 2: Yesterday - 25/02/23- *Saturday*
*8am-* Bp-162/126.(Tab Nicardia 20mg )
*10am-* 126/74
*11:15am -* 124/75
*1pm*- 139/92- tab Telma 40mg
*3PM-* 146/100.
*5PM-* 163/108- Tab Nicardia 20mg .
*6:30pm -* 130/84
*7:30pm* -113/69
**10pm* -*134/86- Tab Amlodipine 5mg.
[2/26, 1:54 PM] Rakesh Biswas: Will be looking forward to seeing the BP charting today to see the effect of yesterday's Amlodipine
[2/26, 4:14 PM] 29F Htn DM Patient Adv 1: 4:10 pm bp is 141 by 99 sir
[2/26, 6:42 PM] 29F Htn DM Patient Adv 1: 6:40 pm bp is 172 by 110 sir...
[2/26, 6:42 PM] 29F Htn DM Patient Adv 1: Nicardia 20 veskunna sir
[2/26, 8:30 PM] Rakesh Biswas: Should have taken it at 4:10 PM
@29f Htn DM Patient Advocate 2 @Asma Kim's 2021 Pharm PG Theoretically based on past reports when can we expect tablet Amlodipine to start working?
[2/26, 9:33 PM] Rakesh Biswas: 👆She's taking what you wrote here. By now all our team members following this may have realized that either telmisartan takes more than 48 hours to act or is not acting in her at all. @Asma Kim's 2021 Pharm PG Does it depend on her plasma renin activity? If so then what can be done further to assess that?
@29f Htn DM Patient Advocate 2 If when we are convinced that ARB is not helping her shall we substitute it with the only drug that appears to be helping her till now that is nifedipine? Let's see if when Amlodipine starts working for her. @Salma Kims 2017 @Dr Meera SR Pharma Kims Have you ever experienced such a ringside view of pharmacological action of drugs before?
[2/26, 9:49 PM] 29f Htn DM Patient Advocate 2: Today morning,she didn't check her BP...
Sir, i think Removing tablet Telma and starting nicardia 20mg at 2pm and if morning BP is ok..shall we .continue tab amlong 5mg in the night ??
[2/26, 9:50 PM] Rakesh Biswas: Let her check her BP the whole day tomorrow then before we make any changes to what you have already listed above for yesterday
[2/26, 10:01 PM] Asma Kim's 2021 Pharm PG: In a study comparing telmisartan 40–120 mg with the long-acting calcium channel blocker amlopidine 5–10 mg, both treatments produced comparable reductions in clinical blood pressure after 12 weeks in patients with mild-tomoderate hypertension (Lacourcière et al 1998). Clinic measurements revealed that both telmisartan and amlodipine reduced trough blood pressure, with no significant difference between the two treatments.
[2/26, 10:01 PM] Asma Kim's 2021 Pharm PG:
[2/26, 10:05 PM] Rakesh Biswas: What was the mean time of onset of action for both these drugs ?
What was the time range for their onset of action?
[2/26, 10:24 PM] Asma Kim's 2021 Pharm PG: Telmisartan onset of action is 3 hrs sir.
Amlodipine peak plasma conc is 6-8hrs
[2/27, 8:06 AM] Rakesh Biswas: @29f Htn DM Patient Advocate 2 Did she take the Amlodipine?
[2/27, 8:09 AM] Rakesh Biswas: Looks like both these drugs haven't worked at all for her till now although we may not be having properly captured data to infer that perhaps but @Asma Kim's 2021 Pharm PG what do you think would be the reason someone may not respond to either of these drugs? In your review of literature how many patients could you find who didn't respond to these drugs at all and what were the hypothesis postulated for these non responses?
[2/27, 8:10 AM] Rakesh Biswas: @29f Htn DM Patient Advocate 2 Ask her to monitor her BP hourly for these few days while we are trying to adjust the optimal combination for her
[2/27, 8:23 AM] 29f Htn DM Patient Advocate 2: @29F Htn DM Patient Adv 1 ..ninna night amlodipine vesukunnara??
Oka 2-3 days , konchem hourly bp chudara.
[2/27, 8:29 AM] Asma Kim's 2021 Pharm PG: Can u please post yesterday's Bp Monitoring with time and medicines taken.
[2/27, 8:29 AM] 29F Htn DM Patient Adv 1: Ninna nyt Amlodipine veskoledu sir
[2/27, 8:30 AM] 29f Htn DM Patient Advocate 2: Ninna morning and evening oka nicardia theskunnaru
[2/27, 8:30 AM] 29f Htn DM Patient Advocate 2: Tarvatha madyanam oka telam anthena
[2/27, 8:30 AM] 29f Htn DM Patient Advocate 2: ??
[2/27, 8:30 AM] 29F Htn DM Patient Adv 1: Today 8:10 am bp is 157 by 111 sir
Nicardia veskunna sir
[3/1, 9:25 AM] 29f Htn DM Patient Advocate 2: *Yesterday: 28/02/22: Tuesday.*
7:15am- 144/94
8:05am: 144/95-tab *Nicardia 20mg*
10:30am- 100/57
11:30am- 110/66
1pm- 125/76 *- Telma 80mg.*
3:40pm- 135/87
5pm-146/97
6:15pm- 161/102- Tab *Nicardia 20mg*
8pm- 149/101
10pm- 109/64- *Tab Amlodipine 5mg*
[3/2, 6:20 AM] 29f Htn DM Patient Advocate 2: *Yesterday - 1/03/22- Wednesday*
8am- 148/102- **tab Nicardia 20mg* .
10am- 103/59
11am- 109/58
12pm- 114/68
1pm-126/82- *Tab Telma 80mg*
2:45- 129/81
4:15- 136/88
5:30- 149/94 *-tab .Nicardia 20mg*
8:10pm- 126/78
100pm- 118/72- *Tab Amlong 5mg.*
[3/3, 8:19 AM] 29f Htn DM Patient Advocate 2: *Yesterday: Thursday: 2/03/23*
8AM- 167/106.- *Tab Nicardia 20mg*
10:30AM- 105/58
12PM- 114/67
1PM- 128/80- *Tab Telma 80mg*
3PM- 133/82
4:30PM- 146/95- *Tab Nicardia 20mg*
6:30PM- 146/97
10PM- 111/65.- *Tab Amlong 5mg*
[3/8, 5:56 AM] 29f Htn DM Patient Advocate 2: *Yesterday - 7/03/23- Tuesday*
8:20am- 141/91- *Tab Nicardia 20mg*
10:30 am- 95 /51
11:30 am -109/ 62
1pm- 126/73- *Tab Telma 80mg*
3:00 pm-124/ 76
4:00 pm-128 /80.
5:40 pm- 136/ 86.
6:30 pm- 148/ 93.
*Tablet Nicardia 20mg.*
10pm- 108/62- *Tab Amlodipine 10mg*
2:20am( 8/03/23)- 132/82.
[3/16, 10:31 AM] 29f Htn DM Patient Advocate 2: *Yesterday - 15/03/23- Wednesday.*
8am- 139/94- *Tab Nicardia 20mg*
10:30 am- 96 /56
1:00 pm - 122/ 75.
*Tab Telma 80 mg*
4:00 pm -134/ 88
5:30 pm- 139 /89.
6:20 pm-139/92
*Tab.Nicardia 20 mg*
8:00 pm- 100 /62.
10:00 pm- 121/ 74
*Tab Amlodipine 10mg*
[3/25, 9:13 AM] 29f Htn DM Patient Advocate 2: *Yesterday -24/03/23- Friday*
8:00 am - 137 /93.
*Tab Nicardia 20mg*
10:30 am- 99 /54
11:40 am - 111 / 64
12:40 pm - 113/ 69
*Tab Telma 80mg*
2:30 pm - 129 / 81
3:30 pm -123/ 82
5:30 pm - 148/ 100. *Tab Nicardia 20mg*
8:00 pm -145 / 94
10 :00 pm-101/ 60
*Tab Amlodipine 10mg*
[4/7, 8:21 PM] 29F Htn DM Patient Adv 1: Today
8:00 am bp is 135 by 87.... Nicardia 20
10:30 am bp is 96 by 57..
1:00 pm bp is 122 by 79.. telma 80
4:30 pm bp is 132 by 85...
5:30 pm bp is 135 by 89.... nicardia 20
8:00 pm bp is 107 by 66...
More about PaJR, CBBLE and user driven health care:
Glossary of terms :
user driven healthcare UDHC : Subset of "Medical Cognition' globally where multiple users, all healthcare stakeholders including patients, interact online to understand and take decisions on meeting patient requirements.
Here's about how it transformed into the current CBBLE since 2017 at Narketpally : https://www.ncbi.nlm.nih.
CBBLE (pronounced cable) : Case based blended learning ecosystem that is available locally in many institutions and some are connected globally to each other. CBBLE is different from UDHC in that it is not purely online but blended offline and online.
PaJR : The key concept lies in the use of regular patient reported outcomes to locate the phase of illness in a
patient journey. More here : https://
Medical cognition :
Medical cognition research looks at the psychological processes underlying healthcare performance, focusing on in-depth analysis of the perceptual and cognitive processes that lead to observable behavior in all healthcare stakeholders. The focus is on understanding the knowledge structures and mental processes in healthcare brought to bear during cognitive activity (e.g., problem solving and decision making)."(Patel 2001). More about our past work around it here: http://
Clinical complexity consists of a few defining characteristics such as uncertainty, non linearity, unpredictability and yet an overall pattern leading to resolution through attractor states over time. (Greenhalgh 2001) As physician attractors we are uniquely privileged to "be" with our patients regardless of the diagnosis and that is the only way we may know our patient's outcomes where our "being" with them is the most significant (and often overlooked) intervention.
"Decision-making is complex. It is partly based on the dual-process theory of Epstein and Hammond, recently popularized in Daniel Kahneman’s book “Thinking Fast and Slow.” Two families of cognitive operations, called System 1 (intuitive) and System 2 (analytical) thinking, are used in decision-making. System 1 thinking is often described as a reflex system, which is “intuitive” and “experiential” or “pattern recognition”, which triggers an automated mode of thinking.
System 2 is the more “analytical,” “deliberate” and “rational” side to the thinking process. It is pieced together by logical judgment and a mental search for additional information acquired through past learning and experience. The data are then processed carefully, through a conscious application of rules, making it a much slower and cognitively demanding process but more likely to lead to better decisions. The analytical system is engaged usually when there is uncertainty, complexity, or the outcomes give little room for error but there is time to think."
Above quoted from : https://www.ncbi.nlm.nih.
We regularly use "medical cognition" system 1 and system 2 tools to tackle clinical complexity and some of these are are often used through various medical cognitive platforms such as synchronous face to face interactions (often system 1) and asynchronous communication and learning between multiple stakeholders in connected web space (user driven healthcare UDHC, patient journey records PaJR) and blended offline and online to form "case based blended learning ecosystems CBBLE (often a blend of system 1 and 2).
