UDLCO summary:
For more about our work in optimizing clinical complexity using thematic analysis of our own patient case reports in our PaJR driven EHRs and hospital based EMRs, please click on our departmental learning portfolio dashboard and insert thematic analysis in the search engine here: https://
UDHC glossary: https://
UDLC transcripts:
[07/09, 12:41] S: PAJR team must try the Notebook LM https://notebooklm.google.com/
[07/09, 12:42] S: i think it can be enormously useful. You can add all your files to it as a source and it will answer questions based on that. I am trying it with my company documents and i am impressed
[07/09, 12:55] R: Our current challenge is the sheer volume of each one of our jugaad EHRs!
Sample this 👇
Most AI LLMs refuse this kind of voluminous text and then having to feed them in parts is also a load of work!
[07/09, 12:56] Ay: Get someone to develop an API based solution to automate
[07/09, 12:57] S: Not required. Add docs to drive and add as source or just add url of blog page
[07/09, 12:58] Ay: Cool! Tried it with the link above
[07/09, 12:59] Ay: This appears to be a case summary and discussion about a 60-year-old male patient who experienced a slip and fall.
Here is a summary of the information provided:
* The patient initially went to a government hospital on April 15, 2024, after experiencing a slip and fall that resulted in a right hip fracture. He underwent surgery for the fracture.
* On April 25, 2024, he was readmitted to the hospital due to sudden shortness of breath and altered sensorium.
* The patient was diagnosed with altered sensorium, possibly due to metabolic and hypoxic encephalopathy. He was treated with oxygen supplementation, antibiotics, and supportive treatment.
* On May 14, 2024, he was extubated after his oxygen saturation stabilized.
* The patient developed a bedsore, for which he received regular dressings.
* He was discharged on June 3, 2024, and readmitted on June 26, 2024, due to his inability to walk from fixed flexion contractures. He also had difficulty swallowing.
* The patient's consciousness improved, but he was still unable to speak and required a feeding tube.
* He experienced a right lower limb fixed flexion deformity with persistent left external rotation of the hip joint.
* The patient's urinary bladder bleeds stopped.
* On July 1, 2024, the patient's advocate reported that his bedsore was deepening.
* On August 1, 2024, the patient's advocate asked to be addressed in Telugu.
* On August 3, 2024, the patient's advocate was advised to get an orthopedic opinion and consider skin grafting because the intramedullary nail was visible.
* On August 4, 2024, the patient advocate reported that the rod was touching the muscle wall.
* On August 5, 2024, the patient underwent implant removal under local anesthesia.
* On August 12, 2024, the patient was transferred to the AMC after experiencing severe coughing, shortness of breath, and hypoxia.
* On August 13, 2024, the patient showed spontaneous eye opening but experienced antibiotic-induced diarrhea.
* On August 14, 2024, the patient was able to stand with support.
* On August 17, 2024, the patient’s advocate was advised to purchase a specific air cushion for the sacral sore.
* On August 19, 2024, the patient’s advocate reported that he was unable to move his limbs and he was diagnosed with hypotonic quadriparesis.
* On August 20, 2024, the patient's advocate inquired about the swelling in his right leg. It was determined that the non-united proximal fragment of the femur was protruding from the bedsore.
* On August 21, 2024, help was sought for the patient’s wife.
* On August 22, 2024, it was determined that the patient would need a walker.
* On August 24, 2024, the patient received a Romovac.
* On August 26, 2024, the patient was able to stand on one leg.
* On August 28, 2024, the patient underwent surgery and an external fixator was applied.
* On August 29, 2024, the patient received plantar splintage.
The sources provide a detailed timeline of the patient's medical journey, including his initial injury, subsequent complications, and ongoing treatment. They also highlight the challenges faced by the patient, his family, and his healthcare providers in managing his complex condition. The discussions among the medical professionals involved in the patient's care reveal their efforts to provide the best possible treatment and support.
[07/09, 13:00] Ay: 🙂 it's high time folks consider my advice of setting up ashrams and retiring. AI will be running the world.
(We can of course do our human - God knows what - stuff from the ashrams)
[07/09, 13:01] S: No. Domain experts will rule now. @R will now ask the questions and AI will answer. Asking the right questions is key.
[07/09, 13:02] S: Let's say he adds all the cases and then asks questions about trends, he might find something new. He could query about a single case or across all the PAJRs developed so far.
[07/09, 13:03] S: @R i vounteer to work with you on trying it Notebook LM.
[07/09, 13:03] Ay: They can ask questions from the ashrams
[07/09, 13:59] R: Shared the analysis of the EHR by Google notebook LM below:
Prompt: Please do a thematic analysis of the textual content in the link attached: https://24fpatientblog.
Please demonstrate the steps of thematic coding, subcoding and finally share the learning insights from the case content coding
Thematic Analysis of "60M postoperative altered sensorium 2 weeks COPD ventilated extubated Telangana PaJR"
This analysis will examine the textual content from the provided excerpts of "60M postoperative altered sensorium 2 weeks COPD ventilated extubated Telangana PaJR" and demonstrate a thematic analysis using the steps of thematic coding, subcoding, and learning insights.
1. Familiarisation with the Data
The first step is to carefully read through the entire text provided to get a thorough understanding of the content. This includes understanding the context of the information which is presented as an online E logbook for discussing a patient's de-identified health data. The purpose of the logbook is to solve clinical problems with a global online community of experts.
2. Generating Initial Codes
The next step involves going through the data line by line and creating codes for the data that seem important to the research question.
Here are some initial codes:●
Altered Sensorium: The patient presented with altered sensorium, possibly due to metabolic/hypoxic encephalopathy.●
Respiratory Issues: The patient experienced shortness of breath, required intubation and ventilation, and had a history of COPD.●
Hip Fracture & Surgery: The patient had a history of a right hip fracture and surgery.●
Hematuria & Anemia: The patient experienced hematuria, which led to anemia.●
Acute Kidney Injury: The patient developed acute kidney injury, which was both pre-renal and post-renal.●
Bed Sores: The patient developed bed sores on the right and left gluteal regions.●
Infections: Blood cultures showed the growth of Acinetobacter, and throat swab cultures revealed Pseudomonas aeruginosa.●
Nutritional Support: The patient received Ryle's tube feedings and protein powder.●
Medications: The patient was prescribed a range of medications, including antibiotics, analgesics, and medications for delirium and alcohol withdrawal.●
Physiotherapy: Physiotherapy was recommended to address the patient's physical limitations and aid in recovery.
3. Searching for Themes
After creating the initial codes, the next step is to start grouping codes that seem to go together or tell a similar story about the data.
Here are some potential themes that emerge from the codes:●
Post-Operative Complications: This theme can encompass codes like altered sensorium, respiratory issues, infections, and bed sores.●
Underlying Health Conditions: This theme includes codes such as COPD, hip fracture, hematuria, anemia, and acute kidney injury.●
Medical Management: Codes like nutritional support, medications, physiotherapy, and consultations with various specialists can be grouped here.●
Rehabilitation and Recovery: This theme focuses on the patient's progress, challenges faced, and interventions aimed at restoring function and improving quality of life.
4. Reviewing Themes●
Post-Operative Complications: The patient experienced numerous complications after his hip surgery, including delirium, respiratory distress, infections, and bedsores. This highlights the complexities of post-operative care, particularly in older adults with pre-existing conditions.●
Underlying Health Conditions: The patient's pre-existing conditions, including COPD, alcoholism, smoking, and the recent hip fracture, likely contributed to the development of these complications. This underscores the importance of understanding and managing comorbidities in a holistic care plan.●
Medical Management: The patient's care involved a multidisciplinary approach, with interventions from physicians, surgeons, nurses, physiotherapists, and other specialists. This demonstrates the importance of coordinated care in managing complex medical cases.●
Rehabilitation and Recovery: The patient's journey toward recovery involved addressing physical limitations, such as contractures and difficulty walking, as well as cognitive impairments like Broca's aphasia. This highlights the importance of rehabilitation in maximizing a patient's functional independence and overall well-being.
5. Defining and Naming Themes
The next step is to define and refine the identified themes and give them clear and concise names that accurately represent the data. Here are the refined themes with their definitions:●
Post-Operative Complications: This theme captures the array of medical issues that arose following the patient's hip surgery, including delirium, respiratory failure, infections (Acinetobacter, Pseudomonas aeruginosa), and the development of severe pressure ulcers. These complications highlight the challenges of managing surgical recovery in older adults with multiple comorbidities.●
Comorbidities and their Impact: This theme reflects how the patient's underlying health conditions, including COPD (chronic obstructive pulmonary disease), history of alcoholism and smoking, and the recent hip fracture, interplayed to create a complex medical picture. These pre-existing conditions likely increased the patient's vulnerability to post-operative complications and posed challenges in his overall management and recovery.●
Multidisciplinary Care Approach: This theme illustrates the involvement of various healthcare professionals in the patient's care, including physicians, surgeons, nurses, physiotherapists, and other specialists. This collaborative approach aimed to address the patient's diverse needs, manage complications, and facilitate recovery. The logbook itself reflects this multidisciplinary approach as it is used as a communication tool amongst healthcare professionals.●
Challenges in Rehabilitation and Functional Recovery: This theme encompasses the patient's ongoing journey to regain mobility, function, and independence. This included addressing physical limitations like knee contractures, muscle weakness, and difficulty walking, as well as cognitive impairments like Broca's aphasia, which affected his speech. The theme highlights the long-term commitment and multifaceted interventions required to support his rehabilitation and improve his quality of life.
6. Subcoding
In this stage, each theme is examined carefully, and subthemes are generated that contribute to the overarching message of the theme.●
Theme: Post-Operative Complications○
Subtheme: Respiratory Distress and Ventilation: Detailing the instances of shortness of breath, oxygen supplementation, intubation, and the challenges of weaning off the ventilator.○
Subtheme: Infection Control and Management: Focusing on the identification of Acinetobacter and Pseudomonas aeruginosa, the use of various antibiotics, and the ongoing challenges of preventing and treating infections.○
Subtheme: Pressure Ulcer Development and Treatment: Charting the progression of bedsores, the use of dressings and wound care, and the complexities of managing these wounds in the context of immobility and underlying health conditions.●
Theme: Comorbidities and their Impact○
Subtheme: COPD and Respiratory Vulnerability: Examining how the patient's history of COPD might have contributed to his respiratory complications and the need for prolonged ventilation.○
Subtheme: Impact of Alcohol and Smoking: Discussing the potential long-term effects of alcohol and smoking on the patient's overall health and their likely contributions to his existing comorbidities.●
Theme: Multidisciplinary Care Approach○
Subtheme: Coordination and Communication Among Specialists: Highlighting the roles of different specialists involved in the patient's care, such as the general physician, surgeon, urologist, psychiatrist, ophthalmologist, and physiotherapist. This also includes online consultations from a neurorehabilitation specialist at AIIMS Dehli and an MD Physiatrist.○
Subtheme: Patient and Family Education and Support: Detailing the communication between the healthcare team, the patient, and his family regarding his condition, treatment options, and expected outcomes. The online format of the log books facilitates communication amongst the patient, family and healthcare team.●
Theme: Challenges in Rehabilitation and Functional Recovery○
Subtheme: Addressing Physical Limitations: Focusing on the physiotherapy interventions aimed at improving the patient's knee contractures, muscle strength, and mobility.○
Subtheme: Managing Broca's Aphasia: Discussing the impact of Broca's aphasia on the patient's communication and exploring potential speech therapy interventions to aid in his recovery.
7. Learning Insights from the Case Content Coding
The thorough process of thematic analysis, from coding to defining subthemes, reveals a rich understanding of the patient case.
Some key learning insights include:●
Complexity of Care in Older Adults: Managing medical conditions in older adults with multiple pre-existing conditions requires a comprehensive approach that considers the interplay of various factors.●
Critical Role of Communication and Coordination: Effective communication and coordination among healthcare professionals, patients, and families are crucial for optimal patient care and decision-making. This is especially highlighted through the online platform utilised to discuss and improve the patient's treatment plan.●
Importance of Early Rehabilitation: Beginning rehabilitation interventions early in the patient's journey is essential to address physical limitations, prevent further decline, and promote functional recovery.●
Impact of Social Determinants of Health: The patient's social history and lifestyle choices, such as smoking and alcohol consumption, likely contributed to his health challenges, underscoring the importance of addressing social determinants of health in care plans.
Through the systematic approach of thematic analysis, the text reveals a nuanced and multi-layered story of the patient's medical journey, offering valuable insights for healthcare professionals involved in similar cases. The online platform of the E logbook is a valuable tool in coordinating patient care, providing opportunities to share expertise, and improving patient outcomes.
[07/09, 14:58] Indian Health IT Prof: Now ask the gpt 4 model to do a timeline chart of the events....and then ask her (gpt4) a list of ashrams....truly gpt4 and llm s have changed the world...most people will have to take voluntary retirement😃
[07/09, 20:31] R: Made my day
[07/09, 20:36] S: Mine too. I am still exploring
[07/09, 20:37] S: I am going to change my PHR. Moving from Google photos to Google NotebookLM
