The authors' objective is to study the effect of eICU (electronic ICU) as a supplementary remote intensive care program on improvement in clinical outcomes. The experiment is designed to determine... Show More

The authors' objective is to study the effect of eICU (electronic ICU) as a supplementary remote intensive care program on improvement in clinical outcomes. The experiment is designed to determine the clinical usefulness before and after evaluation of the effects of eICU program. The setting is two adult ICU of a large 375 bed teaching community hospital in US. The study was undertaken by group of resident physicians after eICU was started to study the impact on few selected parameters in a teaching hospital. A total of 2537Patients admitted to ICU between June 2006 to June 2008 (n= 1310 before and n= 1227 after implementation of the eICU) The eICU Program used intensivists and other healthcare providers to give 24x7 supplemental monitoring and management from a remote location. Supporting software and computer based decision support tool were available. The outcome is to study and compare rate of falls, mortalities, incidence of code blues and length of stay between the two periods before and after the implementation of eICU. In the results no statistical difference was observed in the studied parameters thus showing contrary results to other previous studies. The incidence of code blue (39 vs. 54 with P value of 0.36), length of stay (3.0 vs. 3.1 P value 0.36), mortality rates (77 vs. 90 P value 0.28) and incidence of fall (0 vs. 1 P value 0.28) all show no improve outcomes before and after the implementation of eICU.

This article describes the User Centered Design Process for providing chronically ill patients tools to better self-manage their conditions. Stroke, congestive heart failure and chronic pain are... Show More

This article describes the User Centered Design Process for providing chronically ill patients tools to better self-manage their conditions. Stroke, congestive heart failure and chronic pain are complex conditions in which regulated physical activity can provide real improvement of symptoms and health conditions. In particular the work is focused on how the authors gathered the guidelines from the patients, how they translated them into interface design and how did the patients react to the paper prototypes. Paper prototyping is a quick, inexpensive and easily modifiable way to create intermediate artifacts that can be iteratively modified by early evaluation with intended users.

A medical humanities (MH) module has been conducted at KIST Medical College, Lalitpur, Nepal for the last four years. The students are divided into small groups and case scenarios, role-plays... Show More

A medical humanities (MH) module has been conducted at KIST Medical College, Lalitpur, Nepal for the last four years. The students are divided into small groups and case scenarios, role-plays, paintings and activities are used to explore MH. The module for the fourth batch was conducted from December 2011 to March 2012. In this article the authors provide a brief overview of the MH module, Sparshanam and the learning objectives of different sessions. They provide transcripts of certain role plays conducted during the fourth, fifth and sixth sessions of the module. The role plays were conducted in Nepali with the help and guidance of the facilitators and the written transcripts in English language were provided by different student groups.

The motivation for this paper is based on the assumption that certain patient and health professional users' experiences can serve as a mirror or a model, whether positive or negative, for other... Show More

The motivation for this paper is based on the assumption that certain patient and health professional users' experiences can serve as a mirror or a model, whether positive or negative, for other patients and health professional users/learners. This narrative presents a patient's experience of his complicated and ad hoc journey through the diagnoses and treatment of his vascular system disorder. It then tries to connect this with health professional opinions and other patient experiences toward the collective goal of ‘getting a proper diagnosis and management of vascular disease.' Interspersed are professional narratives in the form of clinical evidence and expert comments towards clinical problem solving around vascular system disorders. User-driven health care implies shared decision making based upon collaborative partnerships between patients and health professionals. This narrative indicates that power imbalances in knowledge, particularly when the patient is ill and vulnerable, can lead to inappropriate and even harmful treatments, when profit appears to be the main driver of the medical industrial complex.

Single case studies are research studies of single participants. They explore new ideas and can suggest extensions in methods and for treatment (Yin, 1984). In this article the case study refers... Show More

Single case studies are research studies of single participants. They explore new ideas and can suggest extensions in methods and for treatment (Yin, 1984). In this article the case study refers only to conditions observed and is limited to what was observed from these comparisons between normal function and patterns of specific conditions. This does not reflect the theory of a formal case study but rather it is an attempt to show the case study and simple computer modelling as learning tools in a complex environment. Critics of case study methodology cite small case numbers as not having grounds for establishing reliability or generalization of findings and that the intensity of exposure needed for thorough case studies could bias the research findings subtracting from researcher objectivity. Early computer models were used to simulate the function of the brain and provide partial answers. They provided insight into the understanding of complex function. In recent history, computer models and case studies have been cast aside in favor of live brain imaging and complex biochemical reactions. It is good to remember that these tools brought us to the place of knowledge we enjoy today and have enlarged diagnostic and treatment choices. They are still valuable and inexpensive methods that can impact the imaginations of neuroscientists and kindle their passions to solve the complexities of the human mind one problem at a time. Greater rigor can be easily maintained by adopting a format whereby a patient would be assessed by a fully standardized neuropsychological battery and the performance then compared to large sample of normative data. The formal study is important for generalization of findings across conditions and can be applied once normative data has been collected as a basis for comparison.

Physicians spend many years immersed (drowning?) in their professional literature. There is no way one can keep up with it and most of it is forgettable and sadly inaccurate. This paper's thesis is... Show More

Physicians spend many years immersed (drowning?) in their professional literature. There is no way one can keep up with it and most of it is forgettable and sadly inaccurate. This paper's thesis is that the arts (literature, music, fine art, film) are vitally important to one's personal and professional development. They provide the Continuous Medical Inspiration that trumps Continuing Medical Education. Although they may not realize it, each of them has personal canon comprised of those works of art that guide them in their daily lives. Herein, thoughts on documenting one's personal canon are provided.