Summer Internship Final Report

Summer Internship Final Report

Students’ lesson in J.K. Hospital, Bhopal 

National Taipei University of Nursing and Health Sciences

Date - 2015/7/24- 2015/8/25

Chapter 1 Practical Training on Clinical Data Collection

Patient information collection

Capturing patient information is the most important things in the hospital.

How can we capture data form the patient ? 

When patient arrived ward , doctor will collect patient’s information including : patient biographical information, personal history, family history and illness history.

1 - Patient with left half-body losing control

Age : 55 ages
occupation : house wife
D/o/A : 27/7/15
C/C : Sudden stoppage  hand & leg

Family history :  

No family history
Personal history : 

DM - 4 years

History presenting illness :

• This patient  seems apparently alight before 2 days ,then she had sudden attack hemiparesis ,which resulted on loss movements left hand and left leg .

Examination : CT scan

• Should the right brain damage, resulting in the left half-body losing control.

2 - Patient with fever 

Age : 54 ages
C/C:  Fever

Family history :  

Diabetes Mellitus to his mother (On Insulin)
Personal history : 

DM - 10 years 

Psoriasis - 10 years 

Angioplasty  2012  

No H/O Burning Micturition, Cold Cough

History presenting illness :

• Fever *3 days before admission
• Weakness *3 days before admission
• A 54 years old male patient, a known case of diabetes presented with the fresh complain of recurrent fever since last three days from the date of admission. Fever was not associated with vomiting or loose motion etc. 
• Fever was relieved when he take the medicine . After taking medicine he got profuse sweating and then he feel shivering, which was relieved by wearing clothes and blankets.

3 - Patient with diabetes

Age : 60 ages
C/C:   bypass surgery : 4.5 years 

since 2 years electronic impulses on touching

Family history :  

Both the parent and grandfather had Diabetes Mellitus
Personal history : 

Consumed tobacco for many year

1 bypass surgery clone

History presenting illness :

• As per patient he was alright 3.5 years.
• Back than he feel electric shock like pain in cardiac regain during pressing and touching he was also complaining of constipation since one years, stool is stony hard in nature he was also complaining or cozying fresh blood during defecation and blurriness of vision.

4 - Patient with loose motions & decreased micturition

Age：82 years old

C/C:

Loose motions (for 3 days)  

Decreased micturition (for 2 days)  

Family history :  

No family history
Personal history : 

No personal history

History presenting illness :

• Patient was apparently alright 2 weeks back and then started experiencing abdominal pain (in the groin) which was sudden in onset and not progressive. It was associated with vomiting and fever with chills and rigors.
• Then he started experiencing loose motions ( 3-4 times a day for 3 days) and no micturition for 2 days.
• He takes tobacco 2-4 times a day for the past 40 years now.
• He also has decreased appetite and weight loss and is on a vegetarian diet.

Examination：

General examination shows pallor and he appears cachectic, shows clubbing in the  left hand.

There are no other positive findings.

Abdominal Exam.

There appears to be bilateral swellings on the sides of the abdomen.

Palpatory, percussion and auscultatory findings are otherwise normal.

5 - Patient with swelling in whole body

Age  : 50 years old 

Sex  : female

Occupation : house wife

D/o/A : 14/7/2015

C/C : swelling in whole body since four month.

Personal history : 

The patient is illiterate, eats mixed diet, no history of any addiction, bowel habits normal but there is urgency and hesitancy during micturition.

Family history: 

No history of similar complaint in other family members.

History of presenting illness: 

• As per my patient she was apparently alright 12 month back but then she developed pain in the epigastric region which was gradual in onset.
• And mild it was non radiating pain with no aggravating and relieving factors.
• 8 month later patient notice generalized swelling in the whole body which was insidious in onset and progressive in nature there was no diurnal variation no aggravating factor but relieved by medication it was associated with distension of abdomen since 3 month.
• No history of fever, vomiting, and nausea, appetite loss and weight loss.

Past history : 

• There is no history of similar complaint in the past, there is no relevant surgical history except of tubectomy, no history of any trauma, no history of any specific illness like diabetes mellitus tuberculosis hypertension jaundice and bronchial asthma .
• There is no history any drug allergy.

6 - Patient with chest pain

Age:45 years

Sex:Male

Occupation:Labour

D/O/A:26/07/15

C/C :

numbness in hands and chest pain

Family history: 

No Family history

Personal history: 

Tobacco -(2-4 times) for 2 years

No Diabetes(DM)

History of presenting illness:

• My patient looks apparently alight before 3 months. 
• Then he started complaining the gradual pain in his chest. 
• The pain was a slow onset, it was followed by the numbness in hands. The problem increases after some exercise or muscular work.

Past history:

• No past history 

 Clinical medical examination

     A. Palpatory

        It is the process of using one's hands to examine the body, especially while perceiving/diagnosing a  

        disease or illness.

       Usually performed by a healthcare practitioner, it is also the process of feeling an object in or on the 

        body to determine its size, shape, firmness, or location (such as a veterinarian would check/feel the 

        stomach of a pregnant animal to ensure good health and successful delivery).

      B. Figure connection test

      There are smiling faces randomly plotted on the sheet. 

       The patient need to connect the smile face on the sheet to test the brain cognitive function.  

     C. Hammer neural test

      Doctor use hammer to nock on the patient’s never close to the join and the see the patient’s respond.

      This test can check the problem from neural or brain.

Disease information we learned

      A. Diabetes

        Diabetes mellitus (DM), commonly referred to as diabetes, is a group of metabolic diseases in which      

        there are high blood sugar levels over a prolonged period.

       Symptoms of high blood sugar include frequent urination, increased thirst, and increased hunger. If left 

       untreated, diabetes can cause many complications.Acute complications include diabetic ketoacidosis         

       and nonketotic hyperosmolar coma.

      Serious long-term complications include cardiovascular disease, stroke, chronic kidney failure, foot 

       ulcers, and damage to the eyes.(Wikipedia)

      B. Hepatitis B 

        Hepatitis B is an infectious disease caused by the hepatitis B virus (HBV) which affects the liver. It can 

       cause both acute and chronic infections. Many people have no symptoms during the initial infection.         

       Some develop a rapid onset of sickness with vomiting, yellow skin, feeling tired, dark urine and 

       abdominal pain.(Wikipedia)

      C .Hepatitis C 

        Hepatitis C is an infectious disease affecting primarily the liver, caused by the hepatitis C 

       virus(HCV).The infection is often asymptomatic, but chronic infection can lead to scarring of the liver 

       and ultimately to cirrhosis, which is generally apparent after many years. In some cases, those with 

       cirrhosis will go on to develop liver failure, liver cancer, or life-threatening esophageal and gastric 

       varices.(Wikipedia)

      D. Malaria

       Malaria is a mosquito-borne infectious disease of humans and other animals caused by parasitic 

       protozoans (a group of single-celled microorganism) belonging to the genus Plasmodium. Malaria 

       causes symptoms that typically include fever, fatigue, vomiting and headaches. 

       In severe cases it can cause yellow skin, seizures, coma or death. The disease is transmitted by the biting 

       of mosquitos, and the symptoms usually begin ten to fifteen days after being bitten.

      If not appropriately treated, people may have recurrences of the disease months later. In those who have 

       recently survived an infection, re-infection typically causes milder symptoms. 

       This partial resistance disappears over months to years if the person has no continuing exposure to 

       malaria. (Wikipedia)

      E. Typhoid 

      Typhoid fever, also known simply as typhoid, is a symptomatic bacterial infection due to Salmonella 

       typhi.

      Symptoms may vary from mild to severe and usually  begin six to thirty days after exposure.Often there 

       is a gradual onset of a high fever over several days.Weakness, abdominal pain, constipation, and 

       headaches also commonly occur. 

        Diarrhea and vomiting are uncommon.Some people develop a skin rash with rose colored spots.

      In severe cases there may be confusion.Without treatment symptoms may last weeks or months.

       Other people may carry the bacterium without being affected; however, they are  still able to spread the 

       disease to others.Typhoid fever is a type of enteric fever along with paratyphoid fever. (Wikipedia)

Chapter 2 Designing a Vertical Hospital Information System for Developing Country

Observation of physician’s daily work in J.K. Hospital

       1. Physician’s order may not be able to deliver efficiently.

       2. Laboratory exam can’t be performed in real time.

       3. Laboratory data can’t be obtained in real time.

       4. Nurse or resident physician have difficulty to understand attending physician‘s writing , so attending 

           physician need to repeat his order to nurses.

       5. Out patient’s don’t have their history information before visiting.

       6. Paper based input form doesn’t have standard format.

       7. Diagnoses and medication are not coded.

       8. PACS image are taken by assistant and shown to physician by a camera.

       9. Paper based “SOAP” has to be entered afterward by assistant.

       10. Physician update new laboratory data on the same sheet of paper.

       11. ICD-10 is coded by human been in medical record office.

       12. Statistical analysis is for government inspection only . Statistical data is not used for  clinical 

              purpose.

       13. Using excel to create statistical table and chart on personal computer in medical record office.

       14. Death record is paper based.

       15. Paper based medical record are stored in medical record office and is index by the last two digits.

Vertical Hospital Information System 

System architecture of EMR for physician to use in ward

1. Physician Order Entry System (1.2.3.4)

(1) Order entry.

(2) Order responses.

(3) Order alarm.

(4) SOAP Standard Interface.

(5) Decision support.

(6) Interface:

       a. EMR

        b. Vital sign chart.

       c. Real time input.

       d. Collect patient information.

2. Electronic Medical Record (5.6.7.8.9.10.11.12.13.15)

(1) Patient Information.

(2) Patient QR code link UID.

(3) Diagnoses and Medicine standard coding.

(4) Link PACS.

(5) Daily information update.

(6) EMR Storage and retrieve in a cloud server.

(7) EMR Repository.

(8) Death report Repository.

3. Integration of RIS LIS PIS 

(1) Use patient UID as primary index.

(2) Print QR code on paper based record to transfer data and to verify data.

(3) Doctor can read patient’s laboratory data at anytime and anyplace.

4. Internet connection

(1) Need to build a local wireless network.

(2) Internet of Things - Using wireless sensor to check patient’s vital sign.

Chapter 3 Experience of India Culture

Bhopal

When we arrive here, we saw the many animals on the road.

The first impression is “Wow , so cool like a zoo.”

In here we saw the many thing different with our country “Taiwan” include here’s food, dress, culture and people.

Here is a nice place. All of our like here many more.    

Agra

Agra is a city on the banks of the river Yamuna in the northern state of Uttar Pradesh, Northwestern India. It is 378 kilometers (235 mi) west of the state capital, Lucknow, 206 kilometers (128 mi) south of the national capital New Delhi and 125 kilometers (78 mi) north of Gwalior. With a population of 1,686,993 (2013 est.), it is one of the most populous cities in Uttar Pradesh and the 19th most populous in India. Agra can also refer to the administrative district that has its headquarters in Agra city. It is a major tourist destination because of its many splendid Mughal-era buildings, most notably the Tāj Mahal, Agra Fort and Fatehpūr Sikrī, all three of which are UNESCO World Heritage Sites.(Wikipedia)

    Jaipur

This article is about the municipality in Rajasthan, India. For its namesake district, Jaipur is the capital and largest city of the Indian state of Rajasthan in Northern India. It was founded on 18 November 1727 by Maharaja Sawai Jai Singh II, the ruler of Amer, after whom the city is named. The city today has a population of 6.66 million, making it the tenth most populous city in the country. Jaipur is known as the Pink City of India.

The city is unusual among pre-modern Indian cities in the regularity of its streets, and the division of the city into six sectors by broad streets 34 m (111 ft) wide. The urban quarters are further divided by networks of gridded streets. Five quarters wrap around the east, south, and west sides of a central palace quarter, with a sixth quarter immediately to the east. The Palace quarter encloses the Hawa Mahal palace complex, formal gardens, and a small lake. Nahargarh Fort, which was the residence of the King Sawai Jai Singh II, crowns the hill in the northwest corner of the old city. The observatory, Jantar Mantar, is one of the World Heritage Sites. Included on the Golden Triangle tourist circuit, along with Delhi and Agra, Jaipur is an extremely popular tourist destination in Rajasthan and India.(Wikipedia)    

Chapter 4 Discussion of Future Collaboration

Future Work Items

We have agreed to work on following courses together (Prof Biswas, Prof Hsu, National Taipei University, Kuldeep & Me). All these courses will be in collaboration. Prof Hsu has assured me to get us more students from different backgrounds and also he will help us to get collaboration with different associations.

# Structure of the course:

1 week course - certificate program

2 weeks course - advanced certificate program

1 month course - diploma program

course is open through out the year.

venue - JK Hospital, Bhopal anyone from any field can join program for the students also (student need to cover his all expenses) course is free.

# another course

Second collaboration can be UDHC online course - clinical data mining, decision making, practice

data from udhc and taiwan can be merged (if available).students may need to have some technical skill to take this course. - 2 months for this one

2 weeks for the programing skills

5 weeks for project or group study

1 week for project submission and assessment

we can combine online courses with the medical informatics courses

# research 

data can be assessed from UDHC, Tabula rasa

several questions need to be mentioned (prof biswas you need to send some)

patients complications due to diabetes

analyze lab data

compare results between two countries

discuss on the climate and other environmental factors

# faculty and student exchange

based on scholarship 

# start medical informatics course in LNMC JK hospital

1-2 week intensive courses