July 2021 bimonthly blended assessment



Q1. Competency tested for Peer to peer review and assessment :
I have been asked to choose and review one of my batchmate's bimonthly assessment submitted on 1st July, 2021. I have reviewed the assignment submitted by Subhiksha.R, Roll no. 128.
https://rsubhiksha128.blogspot.com/2021/07/128-subhikshar.html

The design of her blog page was aesthetically pleasing and the content was appropriate and well organized. 
Her response to the first question was remarkable. I agree with most of her reviews despite the fact that she was very generous while grading them. Appropriate details of the reviews were highlighted by her and useful feedback was given to the students. 
She seems to have skipped the second question in which we were supposed to add the link of a case we had worked on. This could have been avoided.
The third answer consisted of her critical appraisal of different case presentations. She has skillfully elaborated on the positive points and areas to be corrected in the case presented by our senior colleagues. Her judgement and analysis skills are worthy of praise. 
Her insights in response to question 4, and detailed discussion of important points pertaining to the case of HFrEF with atrial fibrillation made it easier to comprehend the condition of the patient. She has provided the references which was helpful. 
Her reflective observations based on experiences with online clinical postings were interesting to read. 
Overall, she has done a wonderful job with her assignment. She seems genuinely sincere in her efforts.
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Q2. I have been asked to share the link to my own case report of a patient that I connected with and engaged while capturing his/her sequential life events before and after the illness and clinical and investigational images:

https://www.blogger.com/blog/post/edit/3397542797400605911/2218613003859084997
 In the above blog post, I have discussed the case of a 20 year old female with anemia and jaundice in detail. I had the opportunity of working under the guidance of Dr. Madhumita.

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Q3. Testing peer review competency of the examinees :
 
  1. The first report is of a 58 year old male patient who developed abdominal pain after lifting weights. The link to the case presentation is:  https://laharikantoju.blogspot.com/2021/07/58-year-old-male-patient-elog-lahari.html?m=1                                                                                                              The history is thorough and contains all the necessary information related to the case. The investigations performed are described in detail along with dates. A timeline indicating the important stages of disease progression would have been appreciated. Little information about the provisional diagnosis of Acute Kidney Injury (AKI) has been provided. The reasons for such a diagnosis could have been mentioned in a better way.
  2. The second report is that of a 75 year old male patient who came with the chief complain of lower back ache since 10 days.                                                                      http://srinaini25.blogspot.com/2021/07/srinaini-roll-no-33-3rd-semester-this.html       The history including chief complaint, present illness, past history, family history and the history of the investigations performed have been adequately presented. Timeline of the patient's symptomatology would have made the report easier to comprehend. Several images of the results of investigations were attached. The provisional diagnosis was Acute Renal Failure. The treatment utilized were written in excruciating detail.
  3. The link for the case report of a 49 year old female with generalized weakness and vomiting: https://krupalatha54.blogspot.com/2021/07/a-49-yr-old-female-with-generalized.html?m=1                                                                                                      The report was very well written with more than enough evidence to support the statements and observations made by the student. The history, general and systemic examinations along with day wise reports of the various investigations performed were mentioned. Pictorial representations of the investigations helped in improving the credibility of the case report. The steps that led to the provisional diagnosis of Chronic Kidney Disease were not discussed in detail. The treatment methods were appropriately mentioned.
  4. The link for the case repot of a 47 year old male with oliguria and uraemic symptoms is : https://casereports.bmj.com/content/2009/bcr.03.2009.1726                                       This case is similar to the previous one. The information regarding the case seems scarce. However, the case was well presented with appropriate images of the clinical findings. 
  5. The link to the report of a 35 year old female who is a known case of diabetes with shortness of breath: https://ananyapulikandala106.blogspot.com/2021/06/a-35yr-old-female-elog.html                                                                                                                The history contains all necessary points. The investigations have been presented with the appropriate evidence including 2D echo, clinical charts, pictures of the patient's bed sores, etc were impressive. Day wise report of the treatment plan used has been shown.
  6. A 52 year old male with the chief complaint of abdominal distension since 7 days: https://pallavi191.blogspot.com/2021/06/gm-cases_30.html?m=1                        The history has been well represented. However, there is a lack of clarity in the area of provisional diagnosis. Treatment plan has been discussed with necessary details.
  7. A 52 year old male patient with the chief complaint of fever since 4 days and pus in the urine: https://kavyasamudrala.blogspot.com/2021/05/medicine-case-discussion-this-is-online.html?m=1                                                                                                    A timeline depicting the progression of Acute Kidney Injury in this patient would have conveyed the message in a better way. The treatment plan was not detailed enough.
  8. The case report of a 48 year old male with the chief complaint of SOB: https://rishikakolotimedlog.blogspot.com/2021/07/45-year-old-male-with-chief-complains.html?m=1                                                                                                          The information pertaining to the current case has been presented in an orderly fashion. The right points were highlighted. The evidence regarding the investigations performed was well presented. The references used in putting together the case report were given due importance making the report remarkable.
  9. Case report of a 60 year old female patient with SOB and anasarca: https://krupalatha54.blogspot.com/2021/06/this-is-online-e-log-book-to-discuss.html?m=1                                                                                                              The history of present illness, past history along with the information regarding the investigations has been shown in detail. Several images pertaining to the examination and the investigations has been provided.
  10. A 43 year old male with chief complaint of loose stools and pedal edema: https://keerthireddy42.blogspot.com/2021/07/43-yr-old-male-of-nalgonda-came-to.html?m=1                                                                                                            The report is informative and includes the appropriate images of the results of the investigations performed. There is no timeline of the disease progression. 
  11. Case report of a 60 year old female patient with chief complaint of  pedal edema since 10 days and decreased urine output:   https://casescape.blogspot.com/2021/06/acute-kidney-injury-secondary-to.html?m=1                                                                              A detailed account of the patient's history has been mentioned. The investigations ordered have been precisely explained with visual evidence. The provisional diagnosis was not discussed in detail. However, the treatment plan was appropriately described.
  12. The link to the case report of a 31 year old male patient with chief complaint of pain abdomen: http://chavvaclassworkdecjan.blogspot.com/2021/06/pancreatitis-in-chronic-alcoholic-with.html?m=1                                                                                      There was no structure to the history of the patient and the investigations performed weren't described in detail. Only a summary and no step wise explanation of disease progression was given. The case report was not satisfactory. 
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Q4: Testing scholarship competency of the examinees ( ability to read comprehend, analyze, reflect upon and discuss captured patient centered data as in their 'original' answers to the assignment for May 2021):

  1. Problems: Lower abdominal pain, burning micturition, lower back ache after lifting heavy weights, decreased urine output, fever and SOB.                                                  Treatment: Tab PCM and Ultraset for lower back ache, Pantop for diarrhoea, Inj. PIPTAZ for UTI.
  2. Problems: Lower back ache, dribbling of urine, pedal edema, SOB and increased involuntary movements in both upper limbs.                                                                     Treatment: Lasix for edema, Inj. TAZAR for UTI, Tab PCM for back ache, Salbutamol nebulization for SOB.  
  3. Problems: Generalized weakness and vomiting, mass per anum with bleeding, h/o muscle aches for which she is using NSAIDs.                                                                   Treatment: Inj. Erythropoietin for anemia, Zofer for vomiting, Tab NODOSIS for gastritis.
  4. Problems: Oliguria, anorexia, nausea, vomiting. Patient returned 1 month later with severe back ache.                                                                                                               Treatment: Tab PCM for fever, Inj. PIPTAZ for diarrhoea, Inj. NORAD for SOB, Inj. CLEXANE for thrombocytopenia, Levoflox for UTI.
  5. Problems: Type II Diabetes, breathlessness, fever and diarrhoea, back pain, abdominal pain, chest pain.                                                                                                                   Treatment: Inj. MONOCEF and Inj. VAMNCOMYCIN for UTI.                        
  6. Problems: Non healing injury on right foot, suspicion of diabetes, tingling in upper limbs including palms, abdominal distension.                                                                  Treatment: Inj. PIPTAZ for UTI, Tab PCM for fever, Inj. PIPTAZ for pus in urine.
  7. Problems: Type II diabetes, dribbling of urine, suprapubic pain, burning micturition, underwent TURP, fever post surgery, drowsiness, SOB.                                                   Treatment: Inj. Pantop, Inj. PIPTAZ, Inj. Lasix, Inj. Optineuron, Tab PCM.
  8. Problems: SOB, which progressed from grade II to grade III-IV in the past 4-5 days.    Treatment: Tab BISOPROLOL, Tab NITROHART, Tab NICARDIA, Tab GLICIAZIDE.
  9. Problems: Pedal edema, decreased urine output, vomiting and loose stools.                   Treatment: Inj. Lasix for pedal edema, Inj. Pantop for gastritis.
  10. Problems: Loose stools since 20 days, pedal edema, abdominal distension since 20 days, sudden onset bilateral swelling of lower limbs.                                                       Treatment: Inj. Lasix for pedal edema, Tab NODOSIS-XT for metabolic acidosis.
  11. Problems: Pedal edema, decreased urine output, fever since 10 days, DM2, SOB, burning micturition.                                                                                                             Treatment: Zofer for vomiting, Lasix 40mg for pedal edema, Tab NICARDIA for HTN, Tab PIPTAZ for acute pancreatitis.
  12. Problems: Pain in abdomen and epigastric region, non radiating intermittent type. Vomiting, SOB since 2 days.                                                                           Treatment: Inj. Tramadol for pain, IV fluids.
      

---------------------------------------------------------------------------------------------------------------Q5. Testing scholarship competency in logging reflective observations on your concrete experiences of this last month :

At the beginning of this month, we slowly started getting into the habit of interacting with patients as well as our seniors and the faculty. It has been a truly delightful experience. 
Overcoming the initial nervousness and speaking confidently to the patients and their family is a skill one can only develop with practice over time. 
The department of General Medicine has been consistent in its efforts to engage the students in thought provoking and intriguing projects. They have encouraged us to actively participate in the case discussions. Such encouragement is one of the main reasons why more number of students have started involving themselves in the current cases under observation at the hospital. 
Each one of us was assigned an intern who would mentor us in our quests to improve our people skills as well as academic expertise. They have been supportive and have welcomed all our doubts. 
The online learning process can actually be quite interesting and enjoyable if one can put in the right amount of effort and tackle challenges with an ideal mindset. 
Overall, the experiences of the past month have taught me to be more active in my attempts to acquire knowledge and that it is okay to falter and make mistakes while learning. Above all, I have realized how vast the subjects of medicine really are and how we have a long way to go before we can call ourselves experts. 
I'm thankful to be under the guidance of such a wonderful health care team at Kamineni Institute of Medical Sciences, where the main aim is to improve patient care and provide a congenial environment for learning.
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