CPS - January 2022

I have been given the following Assignment in an attempt to read, comprehend, analyze, reflect upon and discuss captured patient centered data.

 QUESTION 1

Please go through one of  the case reports in the conference link shared above and provide your critical appraisal of the captured data in terms of completeness, correctness and ability to provide useful leads to analyze the diagnostic and therapeutic uncertainties around the cases shared.

Solution

The link for the case I have reviewed is : BLOG

Positives

1.       1. Ethically sound as the patient is deidentified.

2.     2.  Good pictorial representation of the development of signs and symptoms along with follow up.

3.      3. Case history is well described with proper timeline.

4.     4.  Periodic update given on the consecutive results.

 

Negatives

1.      1. Overall organization of the blog can be improved

3.     2.  Personal history is not well explained.

 

QUESTION 2

Please analyze the linked case report current patient data by first preparing a problem list for each patient in order of perceived priority (based on the shared data) and then discuss the diagnostic and therapeutic uncertainty around solving those problems. 

Solution

QUESTION 3 

 Include the review of literature around sensitivity and specificity of the diagnostic interventions mentioned and same around efficacy of the therapeutic interventions mentioned for each patient and suggest innovative solutions (mentioning how one may design an ethical trial to scale the proposed innovative solution).

Solution

CASE 3: IATROGENIC CUSHING’S SYNDROME

DIAGNOSTIC INTERVENTION :-

ACTH (CORTROSYN) STIMULATION TEST

What is  ACTH (Cortrosyn) Stimulation Test?

ACTH (Cortrosyn) stimulation test measures the ability of the adrenal cortex to respond to ACTH by producing cortisol appropriately. ACTH is a hormone produced in the pituitary gland that stimulates the adrenal glands.

What abnormal results mean -
This test is helpful in determining if you have:

l. Addison's disease (decreased adrenal output)

2. Low pituitary function

3. Pituitary tumors

4. Acute adrenal crisis

ACTH stimulation testing presented a 100% sensitivity, a 67.3% specificity, and a 68.6% accuracy

(source:- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6616948/#:~:text=We%20found%20that%201%20%C2%B5g,high%20rate%20of%20FP%20results. )

 

THERAPEUTIC INTERVENTION

 The treatment for exogenous Cushing syndrome is gradual withdrawal of the causative drug, with the aim of discontinuing the causative drug if possible. An individual with HPA-axis suppression cannot increase steroid production appropriately during a medical illness or other stress and should receive stress-dose steroids to avoid adrenal crisis.

 

Reference :- https://www.uclahealth.org/endocrine-center/acth-stimulation-test 

 

ALTERNATIVE DIAGNOSTIC INTERVENTION :-

LOW DOSE DEXAMETHASONE SUPPRESS TEST (LDDST)

QUESTION 4 

Share the link to your own case report this month of a patient that you connected with and engaged while capturing his her sequential life events before and after the illness and clinical and investigational images along with your discussion of that case. 

Solution

Blog

QUESTION 5

Please reflect on your patient centered experiences that you had while solving their problems this month. 

Solution 

The COVID-19 pandemic has taken a toll on our college life. As a 2^nd year MBBS student, I have had my fair share of challenges and hard ships, tried grabbing every opportunity I came across, but none of these opportunities presented themselves as clinical work, what I was yearning for.  

 As the situation got better, we were allowed back into college. I was delighted to learn that we can finally take up cases. As we did, we came across a diversity of patients. Some were cooperative, some weren’t. Many were anxious; and some were calm and composed. Despite all the setbacks, ultimately the satisfaction of acquiring clinical experience is immeasurable.

 I thoroughly enjoyed patient interaction. With every subsequent case I took up, I gradually improved my skill of history-taking as well as comfortable patient interaction while keeping the patient at ease.

One of my clinical experiences includes interaction with a female patient. One of my male colleagues was taking her menstrual history which made the patient uncomfortable and hesitant. I intervened to help him out with the same and the patient was relatively more comfortable with me. I took her menstrual history and explained her the importance of being open regarding ones menstrual and sexual history irrespective of the gender of the doctor for improved patient care. 

It was an illuminating experience as it helped me understand the importance of patient education in facilitating improved patient interaction as sometimes the doctor's oldest tool, i.e, talking to the patient helps in clinical problem solving.