Why do we need to swim upstream in healthcare research?

The answer comes from a parable that's very common in the public health community. This is a parable of three friends. Imagine that you're one of these three friends who come to a river. It's a beautiful scene, but it's shattered by the cries of a child, and actually several children, in need of rescue in the water. So you do hopefully what everybody would do. You jump right in along with your friends. The first friend says, I'm going to rescue those who are about to drown, those at most risk of falling over the waterfall. The second friend says, I'm going to build a raft. I'm going to make sure that fewer people need to end up at the waterfall's edge. Let's usher more people to safety by building this raft, coordinating those branches together. Over time, they're successful, but not really, as much as they want to be. More people slip through, and they finally look up and they see that their third friend is nowhere to be seen. They finally spot her. She's in the water. She's swimming away from them upstream, rescuing children as she goes, and they shout to her, "Where are you going? There are children here to save." And she says back, "I'm going to find out who or what is throwing these children in the water." From Rishi Manchanda’s TED talk: http://www.ted.com/talks/rishi_manchanda_what_makes_us_get_sick_look_upstream/transcript?language=en#t-520480

An ideal community health worker may need all the three attributes described in the parable above?

Current day modern medicine and all our medical education is mostly Hospital Based and focused on Rescue and this is one of the characteristics we can expect in most of our community health workers but again training them to the desired levels can be challenging though not impossible especially with the help of technology one can see this being ushered in through 'home-healthcare?

Rescuer Attributes/Myer’s Brigg’s Typologies: Sensory reflexes, Feeling

Raft building in healthcare has been delegated to administrators, policy makers and politicians but raft building needs to begin in the community and the CHW is well positioned to initiate it again with the help of technology that has the power to connect him/her with decision makers?

Raft Builder Attributes/Myer’s Brigg’s Typologies: Extroverted, Sensory, Thinker, and Judgmental.

Upstream swimmers in Healthcare are very few and are generally thought to be taken up by people labelled health activists but this is a role often left to patient’s relatives or even patients themselves. The role of a CHW here is perhaps paramount?

Upstream swimmers Attributes/Myer’s Brigg’s Typologies: Intuition, Thinking, Feeling, Perception

I have used Myer Brigg's typologies and anyone wishing to figure out their own typology can just click on this link:http://www.humanmetrics.com/cgi-win/JTypes2.asp#questionnaire There are 72 yes/no questions but once you answer them it may be fun to diagnose your own typology and see what kind of community health work you are suited for?

Addressing the needs of ASHAs and other CHWs in India

Currently healthcare education (even in India) is moving from a traditional curriculum to one that is based on assessing and developing 'competencies,' where the application of 'knowledge' in 'real professional' endeavors take center stage. More here

If you go through the above link you shall also find a predominant emphasis on formative assessment than on summative.

We have tried to incorporate all these attributes in our own CHW engagement program with Mission Arogya and a few Indian Medical Colleges who are interested in supporting CHWs as a vital link between individual patients in the community and hospital based health-professionals. This is aimed at facilitating 'information' transfer between 'individual patients' (in the form of 'de-identified individual patient data' aka 'particular' evidence) and 'health-professionals' (in the form of health professional outputs to patients expressed as evidence based knowledge) with resulting feedback learning loops.

All this narrative data automatically gets collected and tagged in the searchable web-repository as 'practice based evidence.'

We believe that IT enabled ability to store all this 'interactive' and 'reflective' data generated by patients with the help of CHWs and processed further by health-professionals can serve as a valuable tool to develop transparency (thus providing real time working needs assessment) and accountability (thus providing a formative assessment tool for all the workers).

Both the needs assessment as well as learning competency assessment can be done for every participant through a thematic analysis of the narrative data that is generated in participatory conversations (such as here : scroll down after link opens) as well as in uploaded patient data (such as here : enter first three numbers of the pin code of locality--currently most data are from two pilot locations 736 and 462). The learning-portfolios of the CHWs uploading patient data can be traced (and currently manually analyzed) through the website audit trails.

As always language is currently the strongest barrier and perhaps next generation mobile based IVR interfaces (with voice to text conversion and translation) for the entire process described above can make things easier?

UDHC botanical names list

The botanical names idea was to relate to health. Safeguarding the health of the 'Earth' lies to a large extent in protecting trees and other beings in our immediate environment and using 'botanical names' could be one way of gradually spreading plant awareness along with bodily health awareness? Even though they are unwieldy they have a first and last name (and one can after the permitted zip code add a numerical unique id in between the first and last name). In our current UDHC website as soon as the user registers s/he is automatically provided a name from a botanical names database. We may gradually ask some long term patients (who in near future would own their web based open health records and botanical user names) to plant their user-name (the real plant) and tend to it as well as their health and record. Surely any human can find a small plot of land to do that (even if he doesn't own the land).

We use the list available from this website where users can also visit and gain more details about the plants they are named after. 

Sharing the names of the plant list here again below:

# ABELMOSCHUS ESCULENTUS (L.) Moench
# ABELMOSCHUS MOSCHATUS (L.) Medic
# ABROMA AUGUSTA L.
# ABRUS PRECATORIUS L.
# ABUTILON INDICUM (L.) Sw.
# ACACIA CATECHU Willd.
# ACACIA FARNESIANA (L.) Willd.
# ACACIA NILOTICA (L.) Willd. ex Del. ssp. INDICA (Benth.) Brenan.
# ACACIA PENNATA Willd.
# ACACIA RUGATA (Lam.) Mer.
# ACALYPHA INDICA L.
# ACAMPE PAPILLOSA Lindl.
# ACANTHUS ILICIFOLIUS L.
# ACHYRANTHES ASPERA L.
# ACORUS CALAMUS L.
# ACRONYCHIA PEDUNCULATA (L.) Miq.
# ACTINODAPHNE ANGUSTIFOLIA Nees.
# ADENANTHERA PAVONINA L.
# ADHATODA ZEYLANICA Medic.
# ADIANTUM CAPILLUS -VENERIS L.
# ADIANTUM INCISUM Forsk.
# ADIANTUM PHILIPPENSE L.
# ADINA CORDIFOLIA Benth & Hook.
# AEGLE MARMELOS (L.) Corr.
# AGANOSMA DICHOTOMA K. Schum.
# AGERATUM CONYZOIDES L.
# ALANGIUM SALVIFOLIUM (L. f.) Wang.
# ALBIZIA CHINENSIS (Osbeck.) Merr.

# BACOPA MONNIERA (L.) Pennel.
# BALIOSPERUUM MONTANUM (Willd.) Muell.- Arg.
# BAMBUSA ARUNDINACEA (Retz.) Willd.
# BARLARIA CRISTATA L. var. dichotoma Prain
# BARLARIA STRIGOSA Willd.
# BARLERIA PRIONITIS L.
# BARRINGTONIA ACUTANGULA (L.) Gaertn.
# BARRINGTONIA RACEMOSA (L.) Spreng.
# BASELLA ALBA L.
# BAUHINIA ACUMINITA L.
# BAUHINIA MACROSTACHYA Wall.
# BAUHINIA MALABARICA Roxb.
# BAUHINIA PURPUREA L.
# BAUHINIA VARIEGATA L.
# BEGONIA ROXBURGHII DC.
# BELAMCANDA CHINENSIS Leman.
# BENINCASA HISPIDA (Thunb.) Cogn.
# BIOPHYTUM SENSITIVUM (L.) DC.
# BIXA ORELLANA L.
# BLUMEA BALSAMIFERA DC.
# BLUMEA CLERKEI Hook. f.
# BLUMEA LACERA (Burn.f.) DC.
# BOEHMERIA MALABARICA Wedd.
# BOERHAAVIA DIFFUSA L.
# BOESENBERGIA LONGIFLORA Kuntze.
# BOMBAX CEIBA L.
# BORASSUS FLABELLIFER L.
# BORRERIA ARTICULARIS (L. f.) F. N. Will.
# BOSWELLIA SERRATA Roxb.
# BRASSICA NIGRA (L.) Koch.
# BREYNIA RETUSA (Dennst.) Alston
# BRIDELIA RETUSA (L.) Spreng.
# BRIDELIA STIPULARIS Bl.
# BUCHANANIA LANZAN Spreng.
# BUETTNERIA PILOSA Roxb.
# BUTEA MONOSPERMA (Lam.) Taub.

http://www.mpbd.info/plants/C-cat.php#medicat

# CAESALPINIA BONDUC (L.) Roxb.
# CAESALPINIA DIGYNA Rottl.
# CAESALPINIA PULCHERIMA Sw.
# CAJANUS CAJAN (L.) Huth.
# CALYCOPTERIS FLORIBUNDA Lam.
# CALLICARPA MACROPHYLLA Vahl.
# CALLICARPA TOMENTOSA (L.) Merr.
# CALOPHYLLUM INOPHYLLUM L.
# CALOTROPIS GIGANTEA (L.) R. Br.
# CALOTROPIS PROCERA R. Br.
# CAMELLIA SINENSIS (L.) O. Kuntze.
# CANARIUM BENGALENSE Roxb.
# CANNABIS SATIVA L.
# CANNA INDICA L.
# CANSCORA DECUSSATA Roem. & Sch.
# CANSCORA DIFFUSA (Vahl.) R. Br.
# CAPPARIS ZEYLANICA L.
# CAPSICUM FRUTESCENCE L.
# CARDIOSPERMUM HALICACABUM L.
# CAREYA ARBOREA Roxb.
# CARICA PAPAYA L.


# DACTYLOCTENIUM AEGYPTIUM (L.) Beauv.
# DALBERGIA LANCEOLARIA L.
# DALBERGIA LATIFOLIA Roxb.
# DALBERGIA SISSOO Roxb.
# DALBERGIA SPINOSA Roxb.
# DALBERGIA STIPULACEA Roxb.
# DALBERGIA VOLUBILIS Roxb.
# DATURA METEL L.
# DAUCAS CAROTA L.
# DENDROCALAMUS STRICTUS (Roxb.) Nees.
# DENDROPHTHOE FALCATA (L. f.) Ett.
# DERRIS ELLIPTICA Benth.
# DERRIS INDICA (Lamk.) Bennet.
# DERRIS ROBUSTA Benth.
# DERRIS TRIFOLIATA Lour.
# DESMODIUM GANGETICUM (L.) DC.
# DESMODIUM HETEROCARPON (L.) A. DC.
# DESMODIUM TRIFLORUM (L.) DC.
# DESMODIUM RETROFLEXUM DC.
# DESMODIUM PULCHELLUM Benth.
# DIPTEROCARPUS TURBINATUS Gaertn.
# DIPTEROCARPUS GRACILIS Bl.
# DIPTEROCARPUS ALATUS Roxb.
# DIPLOCLISIA GLAUCESCENS (Bl.) Diels.
# DIOSPYROS MALABARICA (Desr.) Kostel
# DIOSPYROS MONTANA Roxb. Var. CORDIFOLIA (Roxb.) Heirn.
# DIOSOCOREA PENTAPHYLLA L.
# DIOSCOREA HISPIDA Dennstedt
# DIOSCOREA HAMILTONII Hook. f.
# DIOSCOREA BULBIFERA L.
# DIOSCOREA BELOPHYLLA (Prain) Haines
# DIOSCOREA ALATA L.
# DIMOCARPUS LONGAN Lamk.
# DILLENIA PENTAGYNA Roxb.
# DILLENIA INDICA L.
# DIGERA ALTERNIFOLIA Asch.
# DODONAEA VISCOSA (L.) Jacq.
# DROSERA BURMANII Vahl.
# DRYPETES ROXBURGHII (Wall.) Hur.
# DRYNARIA QUERCIFOLIA (L.) J. Sm.
# DYSOXYLUM HAMILTONII Hiern.
# DYSOPHYLLA AURICULARIA Bl.

# ECBOLIUM VIRIDE (Forsk.) Alst.
# ECLIPTA ALBA (L.) Hassk.
#  (Mart.) Solms.
# ELAEOCARPUS FLORIBUNDUS Blume.
# ELAEOCARPUS SPHAERICUS (Gaertn.) K. Schum.
# ELEPHANTOPUS SCABER L.
# ELEUSINE INDICA (L.) Gaertn.
# ELSHOLTZIA INCISA Benth.
# EMBELIA RIBES Burm. f.
# EMILIA SONCHIFOLIA DC.
# ENHYDRA FLUCTUANS Lour.
# ENTADA PURSAETHA DC.
# EQUISETUM DEBILE Roxb.
# ERYTHRINA VARIEGATA L. var. orientalis (L.) Merr.
# ETLINGERA LINGUIFORMIS (Roxb.) R.M. Smith
# EULOPHIA CAMPESTRIS Wall.
# EUPATORIUM TRIPLINERVE Vahl.
# EUPHORBIA ANTIQUORUM L.
# EUPHORBIA HIRTA L.
# EUPHORBIA THYMIFOLIA Burm. f.
# EUPHORBIA TIRUCALLI L.
# EURYA ACUMINATA DC.
# EURYALE FEROX Salisb.
# EXCOECARIA AGALLOCHA L.
# EXCOECARIA INDICA (Willd.) Muell.-Arg.

# FICUS BENGHALENSIS L.
# FICUS BENJAMINA L. var. comosa (Roxb.) Kurz.
# FICUS HISPIDA L. f.
# FICUS RACEMOSA L.
# FICUS RELIGIOSA L.
# FICUS SEMICORDATA Buch.-Ham. ex Smith.
# FIRMIANA COLORATA R. Br.
# FLACOURTIA INDICA (Burm.f.) Merr.
# FLACOURTIA JANGOMAS (Lour.) Raeus.
# FLEMINGIA MACROPHYLLA (Willd.) O.Ktze.
# FLEMINGIA STROBILIFERA R.Br.
# FLOSCOPA SCANDENS Lour.
# FOENICULUM VULGARE Mill.


# GARCINIA COWA Roxb.
# GARCINIA XANTHOCHYMUS Hook. f.
# GARDENIA CAMPANULATA Roxb.
# GARDENIA CORONARIA Ham.
# GARDENIA JASMINOIDES Ellis.
# GARDENIA RESINIFERA Roth.
# GARUGA PINNATA Roxb.
# GLINUS OPPOSITIFOLIUS (L.) A. DC.
# GLOCHIDION LANCEOLARIUM (Roxb.) Dalz.
# GLORIOSA SUPERBA L.
# GLYCOSMIS PENTAPHYLLA (Retz.) A. DC.
# GMELINA ARBOREA L.
# GNAPHALIUM LUTEO–ALBUM L.
# GNETUM MONTANUM Markgraf
# GOMPHRENA GLOBOSA L.
# GOSSYPIUM HERBACIUM L.
# GRANGEA MADERESPATANA (L.) Poir.
# GREWIA MICROCOS L.
# GREWIA SCLEROPHYLLA Roxb.
# GREWIA SUBINAEQUALIS DC.
# GYMNOPETALUM COCHINCHINENSE (Lour.) Kurz.
# GYNOCARDIA ORORATA R. Br.


    * HABENARIA CONSTRICTA Hook. f.
    * HEDYCHIUM CORONARIUM Koenig
    * HEDYOTIS CORYMBOSA (L.) Link.
    * HEDYOTIS DIFFUSA Willd.
    * HEDYOTIS SCANDENS Roxb.
    * HELIANTHUS ANNUS L.
    * HELICTERES ISORA L.
    * HELIOTROPIUM INDICUM L.
    * HELMINTHOSTACHYS ZEYLANICA L.
    * HEMIDESMUS INDICUS (L.) R. Br.
    * HEMIGRAPHIS HIRTA (Vahl.) And.
    * HEPTAPLEURUM HYPOLEUCUM Kurz.
    * HIBISCUS CANABINUS L.
    * HIBISCUS MUTABILIS L.
    * HIBISCUS ROSA-SINENSIS L.
    * HIBISCUS SABDARIFFA L.
    * HIBISCUS SURATTENSIS L.
    * HIBISCUS TILIACEUS L.
    * HIPTAGE BENGHALENSIS (L.) Kurz.
    * HOLARRHENA PUBESCENCE (Buch.-Ham.) Wall
    * HOMALONEMA AROMATICA Schott.
    * HOPEA ODORATA Roxb.
    * HOYA PARASITICA Wall.
    * HYBANTHUS ENNEASPERMUS (L.) F. Muell.
    * HYDNOCARPUS KURZII (King.) Warb.
    * HYDROLEA ZEYLANICA Vahl.
    * HYGROPHILA AURICULATA (Schum.) Heyne.
    * HYGRORYZA ARISTATA (Retz.) Nees.
    * HYMENODICTYON ORIXENSIS (Roxb.) Mabberly
    * HYPERICUM JAPONICUM Thunb.
    * HYPTIS SUAVEOLENS (L.) Poit.

# ICHNOCARPUS FRUTESCENS (L.) R. Br.
# IMPATIENS BALSAMINA L.
# IMPERATA CYLINDRICA Rausch.
# INDIGOFERA TINCTORIA L.
# IPOMOEA ALBA L.
# IPOMOEA AQUATICA Forsk.
# IPOMOEA BATATUS (L.) Lamk.
# IPOMOEA MAURITIANA Jacq.
# IPOMOEA MAXIMA (L.f.) Don. ex. Sweef.
# IPOMOEA OBSCURA Ker-Gawl.
# IPOMOEA PES-CAPRAE (L.) R.Br.
# IPOMOEA PES -TIGRIDIS L.
# IPOMOEA QUAMOCLIT L.
# ISODON LOPHANTHOIDES (Buch.-Ham. ex D. Don.) Hara
# IXORA ARBOREA Roxb. ex Sm.
# IXORA COCCINEA L.
# IXORA CUNEIFOLIA Roxb.
# IXORA NIGRICANS R. Br. ex Wight & Arn.

# JASMINUM ANGUSTIFOLIUM Vahl.
# JASMINUM SAMBAC (L.) Ait.
# JASMINUM SCANDENS Vahl.
# JATROPHA CURCAS L.
# JATROPHA GOSSYPIFOLIA L.
# JUSTICIA GENDARUSSA Burm.
# JUSTICIA SIMPLEX D. Don.

# KAEMPFERIA GALANGA L.
# KAEMPFERIA PARVIFLORA Wall.
# KAEMPFERIA ROTUNDA L.
# KALANCHOE PINNATA (Lam.) Pers.

# LABLAB PURPUREUS (L.) Sweet.
# LAGENERIA SICERARIA (Mol.) Stan.
# LAGERSTROEMIA INDICA L.
# LAGERSTROEMIA REGINAE Roxb.
# LANNEA COROMANDELICA (Houtt.) Merr.
# LANTANA CAMARA L.
# LAPORTEA CRENULATA Gaud.
# LASIA SPINOSA (L.) Thw.
# LAUNAEA ASPLENIIFOLIA Hook. f.
# LAUNAEA SARMENTOSA (Willd.) Sch.-Bip.
# LAWSONIA INERMIS L.
# LEEA AEQUATA L.
# LEEA CRISPA L.
# LEEA INDICA (Burm. f.) Merr.
# LEEA MACROPHYLLA Roxb.
# LENS CULINARIS Medik.
# LEONURUS SIBIRICUS L.
# LEUCAS ASPERA (Willd.) Link.
# LEUCAS CEPHALOTES (Roth.) Spreng.
# LEUCAS LAVANDULIFOLIA Sm.
# LEUCAS ZEYLANICA (L.) R. Br.
# LIMNOPHILA INDICA (L.) Druce.
# LIMONIA ACIDISSIMA L.
# LINDENBERGIA INDICA (L.) Kuntze.
# LINUM USITATISSIMUM L.
# LITCHI CHINESIS Sonn.
# LITSEA GLUTIONSA (Lour.) Rob.
# LITSEA LANCIFOLIA (Roxb.) Hook. f.
# LITSEA MONOPETALA (Roxb.) Pers.
# LUDWIGIA ADSCENDENS (L.) Hara.
# LUFFA ACUTANGULA (L.) Roxb.
# LUFFA CYLINDRICA (L.) Roem.
# LUVUNGA SCANDENS Buch.-Ham
# LYCOPERSICON LYCOPERSICUM (L.) Karsten
# LYGODIUM CIRCINATUM (Burm.) Sw.
# LYGODIUM FLEXUOSUM Sw.
# LYGODIUM JAPONICUM (Thunb.) Sw.
# LYGODIUM MICROPHYLLUM (Cau.) R. Br.

# MACARANGA DENTICULATA Muell.-Arg.
# MACROSOLEN COCHINCHINENSIS (Lour.) Van Teigh
# MACROTYLOMA UNIFLORUM (Lam.) Verde.
# MADHUCA INDICA Gmel.
# MAESA ACUMINATA DC.
# MAESA INDICA Wall
# MALLOTUS PHILIPPINENSIS Muell-Arg.
# MALLOTUS ROXBURGHIANUS Muel-Arg.
# MANGIFERA INDICA L.
# MANGIFERA LONGIPES Griff.

# NASTURTIUM INDICUM (L.)
# NAUCLEA SESSILIFOLIA Roxb.
# NELUMBO NUCIFERA Gaertn.
# NERIUM INDICUM Mill.
# NICOTIANA RUSTICA L.
# NICOTIANA TABACUM L.
# NIGELLA SATIVA L.
# NIPA FRUTICANS Wurmb.
# NYCTANTHES ARBOR-TRISTIS L.
# NYMPHAEA NOUCHALI Burm. f.
# NYMPHAEA STELLATA Willd.
# NYMPHOIDES HYDROPHYLLA (Lour.) O. Kuntze.

# OCHNA SQUARROSA L.
# OCIMUM AMERICANUM L.
# OCIMUM BASILICUM L. var. Purpuresence
# OCIMUM BASILICUM L.
# OCIUM GRATISSIMUM L.
# OCIMUM SANCTUM L.
# OPERCULINA TURPETHUM (L.)
# OPHIORRHIZA HARRISIANA Heyne
# OPUNTIA ELATIOR Mill.
# OROBANCHE AEGYPTIACA Pers.
# OROXYLUM INDICUM (L.)
# ORTHOSIPHON GRANDIFLORUS Bolding.
# ORYZA SATIVA L.
# OXALIS CORNICULATA L.
# OXYSTELMA SECAMONE (L.)

# PAEDERIA FOETIDA L.
# PAEDERIA LANUGINOSA Wall.
# PANDANUS ODORATISSIMUS L. f.
# PARSONIA SPIRALIS Wall.
# PASSIFLORA FOETIDA L.
# PAVETTA INDICA L.
# PEDILANTHUS TITHYMALOIDES (L.)
# PEPEROMIA PELLUCIDA (L.)
# PERGULARIA DAEMIA (Forssk.)
# PERICAMPHYLUS GLAUCUS (Lamk.)
# PERSICARIA BARBATA (L.)
# PERSICARIA GLABRA (Willd.)
# PERSICARIA HYDROPIPER (L.)
# PERSICARIA ORIENTALIS (L.)
# PHLOGACANTHUS THYRSIFLORUS Nees.
# PHOENIX SYLVESTRIS (L.)
# PHRAGMITES KARKA (Retz.)Trin.
# PHYLA NODIFLORA (L.)
# PHYLLANTHUS ACIDUS (L.)
# PHYLLANTHUS AMARUS Schum.
# PHYLLANTHUS EMBLICA L.
# PHYLLANTHUS MADERASPATENSIS L.
# PHYLLANTHUS RETICULATUS Poir.
# PHYLLANTHUS URINARIA L.
# PHYLLANTHUS VIRGATUS Forst. f.
# PHYSALIS MICRANTHA Link.
# PICRASMA JAVANICA Bl.
# PIPER BETEL L.

# PIPER LONGUM L.
# PIPER NIGRUM L.
# PIPER RETROFRACTUM Vahl.
# PISTIA STRATIOTES L.
# PISUM SATIVUM L.
# PITHECELLOBIUM ANGULATUM Benth.
# PITHECELLOBIUM DULCE (Roxb.) Benth.
# PLUMBAGO INDICA L.
# PLUMBAGO ZEYLANICA L.
# PLUMERIA RUBRA L.
# POGOSTEMON BENGHALENSE (Burm.f.) Kuntze.
# POGOSTEMON PUBESCENCE Benth.
# POLIANTHES TUBEROSA L.
# POLYALTHIA LONGIFOLIA (Sonn.) Thw.
# POLYGALA ARVENSIS Willd.
# POLYGONUM PLEBEJUM R. Br.
# PORTULACA OLERACEA L.
# POTHOS SCANDENS L.
# POUZOLZIA ZEYLANICA (L.) Benn.
# PREMNA CORYMBOSA Rottl.
# PREMNA ESCULENTA Roxb.
# PSIDIUM GUAJAVA (L.) Bat.
# PTEROSPERMUM ACERIFOLIUM Willd.
# PTERYGOTA ALATA (Roxb.) R. Br.
# PUERARIA TUBEROSA DC.
# PUNICA GRANATUM L.


# QUISQUALIS INDICA L.
# RANUNCULUS SCELERATUS L.
# RANDIA DENSIFLORA Benth.
# RANDIA LONGIFLORA Lam.
# RAUVOLFIA SERPENTINA (L.) Benth.s
# RAUVOLFIA TETRAPHYLLA L.
# REINWARDTIA INDICA Dum.
# RHINACANTHUS NASUTA (L.) Kurz.
# RHIZOPHORA MUCRONATA Poir.
# RHYNCHOTECHUM ELLIPTICUM A. DC.
# RICINUS COMMUNIS L.
# ROUREA COMMUTATA Planch.
# RUELLIA SUFFRUTICOSA Roxb.
# RUMEX MARITIMUS L.
# RUMEX VESICARIUS L.
# RUNGIA PECTINATA (L.) Nees.

# SOLANUM ERIANTHUM D. Don.
# SOLANUM MELONGENA L.
# SOLANUM NIGRUM L.
# SOLANUM SISYMBRIFOLIUM Lamk.
# SOLANUM TORVUM Swartz.
# SOLANUM VIOLACEUM Ortega
# SOLANUM VIRGINIANUM L.
# SONCHUS WIGHTIANUS DC.
# SONNERATIA CASEOLARIS (L.) Engl.
# SPHAERANTHUS INDICUS L.
# SPILANTHES CALVA DC.
# SPINACEA OLERACEA L.
# SPONDIAS PINNATA (L.f.) Kurz.
# STACHYTARPHETA INDICA Vahl.
# STEPHANIA GLABRA (Roxb.) Miers.
# STEPHANIA JAPONICA (Thunb.) Miers.
# STERCULIA FOETIDA L.
# STERCULIA VILLOSA Roxb.
# STEREOSPERMUM PERSONATUM (Hassk.) Chatt.
# STEREOSERMUM SUAVEOLENS A. DC.
# STREBLUS ASPER Lour.
# STRIGA LUTEA Lour.
# STROBILANTHES AURICULATUS Nees.
# STRYCHNOS NUX-VOMICA L.
# SUREGADA MULTIFLORA (A. Juss.) Baill.
# SYMPLOCOS RACEMOSA Roxb.
# SYZYGIUM CUMINI (L.) Skeel.
# SYZYGIUM FRUTICOSUM (Roxb.) DC.
# SYZYGIUM JAMBOS (L.) Alston.
# SYZYGIUM OPERCULATUM (Roxb.) Niedz.

# TABERNAEMONTANA DIVARICATA (L.) R.Br.
# TACCA INTEGRIFOLIA Ker.-Gawl.
# TAGETES ERECTA L.
# TAMARINDUS INDICA L.
# TAMARIX DIOICA Roxb. ex Roth.
# TAMARIX INDICA Willd.
# TECTONA GRANDIS L. f.
# TEPHROSIA PURPUREA (L.) Pers.
# TERMINALIA ARJUNA (Roxb.) W. & A.
# TERMINALIA BILLIRICA (Gaertn.)Roxb.
# TERMINALIA CATAPPA L.
# TERMINALIA CHEBULA (Gaertn.) Retz.
# TERMINALIA CITRINA Flaming
# THESPESIA POPULNEA (L.) Sol. ex Corr.
# THEVETIA PERUVIANA (Pers.) K. Schum.
# THUNBERGIA GRANDIFLORA Roxb.
# TILIACORA ACUMINATUM (Lam.) Miers.
# TINOSPORA CORDIFOLIA (Willd.) Hook. f.
# TINOSPORA CRISPA Miers.
# TODALIA ASIATICA (L.) Lam.
# TOONA CILIATA J. Roem.
# TORENIA ASIATICA L.
# TRAGIA INVOLUCRATA L.
# TRAPA BISPINOSA Roxb.
# TREMA ORIENTALIS (L.) Bl.
# TREVESIA PALMATA Vis.
# TREWIA POLYCARPA Benth.
# TRIANTHEMA PORTULACASTRUM L.
# TRIBULUS TERRESTRIS L.
# TRICHOSANTHES BRACTEATA (Lamk.) Voigt.
# TRICHOSANTHES CUCUMERINA L.
# TRICHOSANTHES DIOICA Roxb.
# TRIDAX PROCUMBENS L.
# TRIGONELLA FOENUM-GRAECUM L.
# TRIUMFETTA RHOMBOIDEA N. Jacq.
# TYLOPHORA INDICA (Burm.f.) Merr.
# TYPHA ELEPHANTINA Roxb.
# TYPHONIUM TRILOBATUM (L.) Schott.

# URARIA LAGOPODIOIDES (L.) Desv.
# URARIA PICTA Desv.
# URENA LOBATA L.
# URENA SINUATA L.
# URGINEA INDICA Kunth.
# UVARIA HAMILTONII Hook. f. & Thom.
# VALLISNERIA SPIRALIS L.
# VANDA TESSELLATA (Roxb.) Hook. ex G. Don.
# VERNONIA PATULA (Dryand.) Merr.
# VETIVERIA ZIZANIOIDES (L.) Nash.
# VIGNA MUNGO (L.) Hepper
# VIGNA RADIATA (L.) Wilczek.
# VIGNA SINESIS Endl. & Hask.
# VISCUM ORIENTALE Willd.
# VITEX NEGUNDO L.
# VITEX PEDUNCULARIS Wall.
# VITEX PUBESCENS Vahl.
# VITEX TRIFOLIA L. f.
# VITIS PENTAGONA (Roxb.) Lawson.

# WATTAKAKA VOLUBILIS (L. f.) Stapf.
# WEDELIA CHINENSIS (Osbeck) Merr.
# WIKSTROEMIA INDICA (L.) C.A. Mey.
# WITHANIA SOMNIFERA (L.) Dunal.
# WOODFORDIA FRUTICOSA (L.) Kurz.
# WRIGHTIA ARBOREA (Dennst.) Mabb.
# XANTHIUM INDICUM Koenig.
# XEROMORPHIS ULIGINOSA (Rtz.) Mahes.
# XEROMPHIS SPINOSA (Thunb.) Keay.
# XYLOCARPUS GRANATUM Koen.
# XYLYOCARPUS MOLUCCENSIS (Lour.) Roem.

# ZANONIA INDICA L.
# ZANTHOXYLUM NITIDUM (Roxb.) DC.
# ZANTHOXYLUM RHETSA (Roxb.) DC.
# ZEA MAYS L.
# ZEUXINE STRATEUMATICA Schlechter.
# ZINGIBER MONTANUM (Koenig) Dietrich.
# ZINGIBER OFFICINALE Rose.
# ZINGIBER ZERUMBET Sm.
# ZIZYPHUS MAURITIANA Lamk.
# ZIZYPHUS OENOPLIA Mill.
# ZIZYPHUS RUGOSA Lamk.

Developing a CA firm (CA as in clinical audit) to audit healthcare information toward better transparency and accountability

Our current UDHC passion is spent in trying to develop a unique CA firm (CA as in clinical audit) where Indian health care students activists/enthusiasts/entrepreneurs can interface with patient information requirements to audit the information (in the prescriptions provided by the direct agents of the patients aka clinicians) and you will find a lot of such information in the prescriptions available at the individual patient records here. 

In our work with 'patient centered learning' we have felt this need for training in EBM and we have designed an elective curriculum in 'blended learning' in our institute here which has been attended by students globally.

If you agree to collaborate in further developing a potential transparent health interface (which already exists here), we can train any health entrepreneur who wishes to make a difference here in our institute/practice area (completely hands on) and completely free of cost.These activists/entrepreneurs can then utilize the training to open their own UDHC clinics in their chosen locations on a fee for service model(preferably in collaboration with an medical practitioner)?
 

Patient centred online learning has a lot to give to our patients and health professional trainees that it is a pity we are currently not utilizing a fraction of it! Can we think of expanding our practice area beyond the confines of our academic institute (which mostly functions from 9 AM to 4 PM) and moving it to a private practice community clinic setting where these clinical entrepreneurs are anyway likely to practice in their own future?

The selected graduates need to be savvy in computer mediated communication and learning and we could also have a run in period of 1-4 weeks to decide their suitability for the program.
 

These trained activists/entrepreneurs can also work with govt bodies to perform large scale clinical audit surveys in hospitals and large group practices where clinicians (unwittingly?) engage in non-evidence based practices (unknowingly working in collusion with the drug industry?

Hoping we can collaborate with 'like minded individuals' for this 'Patient centered Clinical Audit and Research Entrepreneurship' development program to currently unemployed/employed Indian graduates looking for clinical-entrepreneurship-career options (and we can help to provide free training) and perhaps this can help pave the way forward to a 'transparent and evidence based healthcare ecosystem' in India?

Inputs in web-based conversations from like minded individual LMI on the above thoughts:

LMI: I have some basic questions which I am elaborating below:

1. When you say we can develop Clinical Auditors and you can train them, I would like to ask that what is the market need for such Clinical Auditors. Who will hire such guys? Hospitals? Regulatory agencies? I need this answer because I believe that any new concept which is being introduced, howsoever revolutionary it may be, it has to be introduced in an evolutionary way so that people responsible for propagating it continue to get commercial or some other benefit out of it. Without a perceived or proven benefit, such initiatives may die their own death. So, to repeat, where will this skill be used and what commercial benefit can the trainees hope to achieve?

2. About entrepreneurs using training to open own UDHC clinics: I am not clear on this model. Till now, UDHC supported clinic is an online network of physicians who are voluntarily giving advice on certain cases for no commercial benefit. How does this get converted into a biz model? I would need to understand this better.
 

Very good ideas need to be cloaked in commercially viable models for them to become big enough to become self-viable and widely adopted. I have lots of hopes in this model but i also feel that someone needs to build a business model around this so that this is not seen as a voluntary or self-improvement or charitable kind of work but as mainstream technology driven initiative having significant impact on patient outcomes. May be a mobile accompaniment app for providers would boost the network.

Reply to the above inputs by 'I':

1) I had initially thought there would be a market need to audit every clinical workflow as much as there is a market need for a chartered accountant CA to audit business workflow. Initially i had 'naively' assumed that the need for a Chartered accountant was a 'felt' need from all business houses who pay the CAs to audit their business so that it gets considerably improved and their business stands to gain from their audits. The current reality is probably different (from what i could gather after talking to a few chartered accountants who said they are asked to audit because of regulatory pressures from the Govt and if there was no 'law' making audit mandatory for business houses they would not thrive at all). :-)

So i guess current clinical auditors do not have any market till we have any such law but i am sure we can still utilize the skills of the UDHC trained workforce (trained not just in clinical audit but primarily in clinical information communication) to fit into our overall basic business model (that may in a manner drive the need for regulatory change to create a niche for Clinical Auditors). More about the business model below:

2) I have recently decided to begin private practice in addition to my hospital based clinical practice and primarily this decision as well as subsequent workflow for the private practice is dependent on the UDHC business model.

The business model (cash-flow and workflow) is something like this:

a) Clinical encounter fee from patient (Let us assume the number 100/- only for simplifying expression of the data): Health professional sees patient in his clinic for a fee and asks his 'trained clinical information communicator entrepreneur/trained clinical health educator/entrepreneur' TCHE to prepare an online record in UDHC (which is more like an evolving case report of the patient with various bits and pieces of available information around the patient strewn coherently for meaningful use) after obtaining informed consent from the patient from the form downloadable here

b)) Fee division: Physician 70/- and TCHE (20/-) for the first and subsequent visits (10/- could go to the online as well as offline managers/developers of this entire workflow).

Workflow: Physician primarily writes on the prescription slips (as per common-current workflow with minimal change pressures for the physician) and this is promptly uploaded on the site (after patient de-identification) by the TCHE who also types out a proper history of the patient in the narrative space on the web based record. See this illustrative example here The TCHE here is our medicine office clerk who is trained to take a clinical history (using her common sense and in Hindi...she is currently not very proficient in English) and input data (again in Hindi using English fonts) to the site. You can also see the uploaded prescriptions that i wrote for the patient and in the same narrative space we have pasted the subsequent conversations around this patient in our processing forum (tabula rasa). We could further train the TCHE (particularly if the candidate has a nursing or pharmacy background) to become a complete physician's assistant (also well trained in medical information processing aka clinical problem solving). You may ask what would distinguish a fully trained TCHE from a very good primary care physician then? Well the TCHE can nurture the information workflow but may not still be able to make the final decision and make the prescription orders. But yes if the same training was given to an MBBS s/he may become a very good primary care physician.

The other important workflow of the TCHE would be to take all the phone calls from the patients for the physician and if indicated enter those conversations into the patient's web based record to keep the physician asynchronously in the loop.In fact this model can be fast tracked with more and more patient users being generated through a telephonic introduction to the physician's and TCHE's practice following which (if the patient is satisfied after the first phone call and a phone call generated web record) the patient could decide to come and meet the physician and TCHE for the first face to face clinical encounter.

The success of the model (as in most health care delivery models) would be heavily dependent on the level of training and learning-sustenance achieved in both the actors (physician as well as TCHEs) and the UDHC website is perhaps in some ways functioning as a differently structured 'web based learning management tool' for these actors (as well as the patient) and the entire information that may rapidly accumulate in this open database can again be 'mined' to gain further insights in health-cognition. In future this can be developed into a sustainable 'home-care' model integrating pharma and nursing trained TCHEs into this model.

Inputs from above like minded individuals on email:

LMI: In this case it is important then to rephrase our clinical auditors to someone who is more "useful" to an organization. It may merely be cloaking the same wine in new bottle but it is necessary to appeal to people's basic understanding that any course or training has to be useful to them and also to an organisation. It may be a good idea to explore the possibility that can your CA training become a module for NABH training? Can we approach NABH and have their stamp or certification involved? This way, the training will attract more people. Now I know that you want only genuinely interested people to come to you but the initial step may be to first target and reach a critical mass of supply and create a demand, if it does not exist.

I: Sure. NABH is a very good idea.  I am already 'informally' training a B Sc undergraduate student who is supported by one of my patients (who is buying his lap-top). I find this initial investment of
a lap top and internet connection a big hindrance among the trainees that i am getting here locally but without that our course may not be able to deliver 90%. :-(

LMI: This is a good example. My question is that why would you think of fee sharing model when the kind of work is actually almost like that of a scribe or a medical transcriptionist or clerk. This appears like there just needs to be a data entry operator who is scanning and uploading most files or dictations. There seems to be little value-add from this scribe. On the other hand, training an MBBS to do this is creating an expensive clerk; and anyway we need to consider the industry preference that doctors don't really like to record computerised records. Can we just not continue to train disadvantaged section individuals to become doctor's scribes for a salary e.g. 5-6k/month or so? e.g a person with lower limb polio or a lower limb amputee can be a good candidate for this job. I am not convinced that MBBS doctors would be best suited for this. But I am open to discuss this. I am sure your idea has a basis which is eluding me.

I: Well i feel we are training people for the long haul and i would like to see each of these trainees go to a Phd level which in turn will raise the academic standing of our model? (See this:here)


LMI: There are some companies I know of, who are using this concept on commercial basis. We can talk about this when we talk, but once again, a TCHE is increasingly looking like a non-physician to me. May be a para-med or asha or anganwadi worker etc.

I: You are right but every TCHE is a potential TCSE (More here)

LMI: Now here is a disconnect. you are terming this project as a "learning management tool" while I am seeing this as a "Network for clinical expert opinion" tool. While the tool is same, I'd need to understand where is this headed. Learning systems, though highly desirable, have poor acceptance with medical colleges' principals who have just about had enough on MCI curriculum compliance. So I am trying to see if this can be sustained as a model which is its own carrot and brings tangible advantages.

I: You are right but this is actually a 'learning network for clinical problem solving tool.' All expert opinions are vetted by comparing with recent best evidence and then the moderator and the patient's primary physician decides what suggestions would best fit the patient's requirements. This is primarily a 'basic-doctor emancipation' tool that allows primary care physicians to be super-physicians utilizing the services of a 'learning-network. The MCI may someday appreciate the fact we can use this model to train a basic doctor much better than all previous models and record all our learning in individual (faculty-students) learning portfolios. :-)

Crowdsourcing toward a Learning healthcare system

This Link to a blog post on Crowdmed shows interesting results on how 'medical diagnosis' thrives on team diversity.

However, medicine isn't just about 'THE' diagnosis which never reaches 100% certainty anyway?

Perhaps this is one of the reasons people have started thinking of creating 'patient centered clinical phenotypes' from patient records rather than just go by a single diagnosis (more here: http://www.ncbi.nlm.nih.gov/pubmed/24914771, http://sites.duke.edu/rethinkingclinicaltrials/ehr-phenotyping/)? For example a patient's life with COPD is perhaps not just entirely about COPD alone and living with a disease or illness may not always mean that the patient's life outcomes will always revolve around the single (or even multiple) diagnosis that we are able to identify?

Another promising development in utilizing team diversity toward clinical excellence is the concept of a Learning Healthcare System that essentially creates a continuous cycle or feedback loop in which scientific evidence informs clinical practice while data gathered from clinical practice and administrative sources inform scientific investigation.

Computer-aided, patient-centered, discovery-based learning through early clinical exposure with a multidisciplinary collaborative team

Introduction: There is a striking deficiency in medical learning competencies attained by medical faculty and students that are hardly ever reflected on or brought to notice in the course of caring for their patients. A biochemist may not know how the HbA1c values that s/he regularly facilitates in his lab is actually utilized by the clinician and patient and the clinician may not realize how the HbA1c values are actually generated in the lab. The undergraduate students need to be trained to become a primary basic doctor who can take care of a rapidly growing patient population but in our current curriculum they end up being taught specialized subjects like biochemistry, pharmacology even before they get to see a patient and get to realize why they need to learn what they are learning, how this knowledge may be applied by them to meet their patient requirements and if their training can allow them to answer queries that arise naturally and not as a result of an outdated curriculum that compels them toward non-contextual rote memorization.This affects current day healthcare practice where a large proportion of health professionals are in danger of becoming apathetic to patient requirements. To resolve the above mentioned problems in current medical education and healthcare, Medical council of India MCI has recently proposed 'early clinical exposure (see this recent debate here:https://groups.google.com/forum/?hl=en#!topic/meu_india/p41ahzTVMvo) and building on it further, we propose a patient-centered computer aided learning project with a ‘learning team’ comprising of first years receiving ‘early clinical exposure’ ECE as well as experienced faculty engaged in blended collaborative learning around ‘individual patients.’

Methods: We shall utilize a mixed methods quasi-experimental study design. In the course of a learning session for 1 year,a team of faculty and students (n=25) will be exposed to regular 'patient encounters' in the inpatient and outpatient wards of LNMC &RC. The group shall also comprise of students from the 1st year MBBS toward effecting early clinical exposure.This team shall capture patient-data at the 'point of care' (in the form of images of clinical findings as well as radiology data) and then subsequently bring them to our 'computer aided learning' CAL lab for further processing.The patients selected will have a sufficient level of clinical complexity likely to generate maximum learning outcomes in terms of patient centered learning questions (detailed here:http://www.pcori.org/research-we-support/pcor/). In the CAL lab the collected 'patient data' shall be uploaded on to a 'patient centered online health record' PCOHR website currently active here:http://www.udhc.co.in/ and currently housing a regularly growing database of patient records here:http://www.udhc.co.in/INPUT/input_directory.jsp
Subsequently the prepared 'patient centered online health record' PCOHR link is shared on to our online social-media based processing forum that has a current global membership of 1000+ members, many of who actively participate in solving patient problems posted to the forum.   All this patient centered 'data collection and processing' activity shall be  subsequently documented in 'patient centered online health records' PCOHRs such as these http://www.udhc.co.in/INPUT/displayIssueGraphically.jsp?topic_id=304 and research publications generated from them such as these http://casereports.bmj.com/content/2014/bcr-2013-202916.full The learning and patient-health outcomes of the CAL group of 'patients, students and faculty' shall be compared with a 'control group' of patients,students and faculty who receive a 'placebo' CAL intervention (after pragmatic randomization and blinding) and the results documented.

Results/Expected Outcomes: This mixed methods study design will document results through qualitative thematic analysis of student-faculty learning insights, qualitative insights on patient-health-outcomes and quantitative estimates in terms of the number of validated participatory learning inputs contributed by each student and faculty and quantitative estimates of patient health in terms of QoL. The results of the impact evaluation of our PCOHR educational intervention strategy will be validated as per currently known paradigms(http://en.wikipedia.org/wiki/Impact_evaluation). An additional feature of note in our project is the utilization of online learning portfolios of students and faculty, which are generated partly automatically online from their documented participatory learning conversations in our currently active online CAL forum. These portfolios will be thematically analyzed to assess the results/learning-outcomes of each faculty and student's CAL activity. The portfolio based quantitative learning points generated around each patient will be compared with the results/outcomes obtained in terms of their respective patient improvement using quantitative QoL estimates (SF36 etc).

Discussion and Implications for Practice: The 'patient-centered learning' process will further involve learning feedback provided to the patient's primary caregiver by our 'computer aided learning' CAL team and then noting the results in comparison to a 'control group' of patients whose providers receive no CAL feedback. Our hypothesis toward the expected outcome of this project is that the CAL team as well as their patients will have respectively better learning as well as QoL outcomes than the control group-team. CAL performed and scaled in an appropriate patient centered manner can go a long way toward improving health professional learning as well as improving patient outcomes and the combination of the two will be instrumental in augmenting national capacity building and transforming healthcare.

SWOT Analysis:

Strengths: Promising solution to current felt need that can bridge gaps in healthcare learning competencies as well as address patient outcome complexities.

Weaknesses: Quasi-experimental and complex study design and consequent potential of study sample selection bias. (Workarounds:ensure transparent and accountable online documentation of entire process that is naturally subject to external peer review in real time)

Opportunities:Potential to scale into a sustainable model of practice based learning toward
improving patient outcomes

Threats: Participant motivation leading to study attrition, patient privacy and confidentiality (Workarounds: regular motivational meets with participants of both groups with real-time transparent documentation of the interaction that transpires between all the stakeholders)

Other ongoing similar programs in our Institute:
Blended learning electives:http://journals.bmj.com/site/marketing/landing-pages/Indian_Caseelectives.xhtml
Past Experience:

http://www.ncbi.nlm.nih.gov/pubmed/?term=rakesh+biswas

http://scholar.google.com/citations?hl=en&user=Sc3HgGAAAAAJ&view_op=list_works&sortby=pubdate
References/Bibliography:

Patient centered research and learning:

http://www.pcori.org/research-we-support/pcor/

Clinical Complexity:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2327227/pdf/wpa010001.pdf

http://www.ajmc.com/publications/issue/2012/2012-9-vol18-n9/impact-of-clinical-complexity-on-the-quality-of-diabetes-care/3

Clinical complexity and teaching learning competencies:http://www.wpba4gps.co.uk/fileadmin/user_upload/secure/mindmaps/PDF_files_for_Competency/Medical_Complexity__Detail_.pdf

Quasi Experimental studies and identifying causation between intervention and effect:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1380192/pdf/16.pdf

https://www.academia.edu/1482786/How_investigating_mediators_and_moderators_helps_explain_intervention_effects

Patient centered learning through a medical-student driven global online community

Introduction:Patient centered learning and research are emerging areas in current movements to transform healthcare and much of this is done through online information exchange in globally connected networks.This process is also termed 'User Driven healthcare which aims at improved healthcare through clinical problem solving utilizing concerted experiential learning in conversations between multiple users and stakeholders, primarily patients, health professionals, and other actors in a care giving collaborative network across a Web interface. The term "user" includes health professionals as well as patients and anyone who uses the web with a user name. These "users" generate an information flow that "drives" the system's workflow (hence the choice of the term "driven"). Our current work attempts to focus on the contributions and learning of the medical student 'user.'
Methods:Qualitative analyses of web-based interactions between the health professional student members of the UDHC network engaged in ‘patient centered learning' around ‘real-patient’ problems uploaded to http://www.udhc.co.in/ by our 'patient information communication manager and research assistant' funded by LN Medical College.Results:All patients suffered from chronic diseases, experienced conventional medical care, were highly motivated, and assisted by a social worker to seek solutions. The patients received multidisciplinary inputs from multiple specialists and generalists. The caregivers felt this was one of the strengths of the system. Students involved with the system have benefited from the impact of learning medicine from real-life situations with real outcomes and consequences.There was some concern regarding the maintenance of patient confidentiality and privacy. A solution was devised by automatic allocation of botanical names and manual de-identification of uploaded files as per standard international HIPAA guidelines.Discussion and Conclusions:Patient centered care has been hidden at the core of medical practice since time immemorial and current information technology (IT) has the potential to amplify it in a radical manner. IT may allow different groups of computer users such as patients as well as health professionals to experience patient centered care in an optimal manner. This presentation describes the work of medical student users with the 'User Driven Health Care' UDHC network that has currently piloted in rural and urban Indian locations with encouraging responses from patients, medical students and global health professionals connected through the web. The network eventually hopes to propagate 'patient centered learning in India and globally such that medical students and health professionals take pride in their teamwork toward making a positive change in their patients' lives. It hopes to in this manner utilize patient centered learning to build a vital bridge between basic and clinical science professionals that may translate bedside patient needs to solutions from the bench.
References:

Go to http://www.udhc.co.in/ and click on inputs and enter 462 to see all the cases uploaded by
our 'patient information communication manager and research assistant' funded by LN Medical College.

1)The User Driven Learning Environment. In R. Biswas, & C. Martin (Eds.), User-Driven Healthcare and Narrative Medicine: Utilizing Collaborative Social Networks and Technologies (pp. 229-241). doi:10.4018/978-1-60960-097-6.ch017 http://www.igi-global.com/bookstore/titledetails.aspx?titleid=41908&detailstype=chapters

2)Understanding Clinical Complexity through conversational learning in medical social networks: Implementing User Driven Health care. In J.P. Sturmberg and Carmel.M. Martin (Ed.), Handbook on Complexity in Health (pp. ). New York, NY. Springer.

3)User driven health care - Answering multidimensional information needs in individual patients utilizing post EBM approaches: A conceptual model.  Journal of Evaluation in Clinical Practice, 2008, 14, 742-749. http://www.ncbi.nlm.nih.gov/pubmed/19018905

4)(2008) Electronic collaboration toward social health outcomes, in (Eds.) Salmon J, Wilson L, Handbook of Research on Electronic Collaboration and Organizational Synergy, Hershey, PA: IGI Global publishing http://www.igi-global.com/chapter/electronic-collaboration-toward-social-health/20208, http://www.irma-international.org/viewtitle/20208/,

5)( 2009)Open Information Management in User-Driven Healthcare, Chapter XVIII, in (Eds) Niiranen S, Yli-Hietanen, and Lugmayr, Open Information Management: Applications of Interconnectivity and Collaboration. Hershey, PA: IGI Global http://www.igi-global.com/chapter/open-information-management-user-driven/27805

6)Revitalizing primary health care and family medicine/primary care in India--disruptive innovation ? Journal of Evaluation in Clinical Practice, 2009 Oct; 15(5):873-80. http://www.ncbi.nlm.nih.gov/pubmed/19811603

7)User Driven Healthcare and Narrative Medicine, IGI Global, Hershey PA, September 2010, http://www.igi-global.com/bookstore/titledetails.aspx?titleid=41908&detailstype=chapters