Clinical informatics in medical education: A joint venture that holds promise.

Background and Objectives:Healthcare information technology(HCIT) has potential in patient care as well as medical education, but is yet underutilized. With shortage of good clinical material, e-learning helps in supplementing a lecture/demonstration by an online tutorial. This ‘blended learning’ helps in meeting deficiencies of the exclusively traditional methods. Besides, with time constraints, there is a need for collaborative, on-line/web-based learning with a flexibility that would enable the students to learn at leisure. Methods: Seven faculty and 18 post-graduate students(residents) were exposed to the concept of clinical informatics at the BVUMC digital library, various features of Cerner Corporation’s academic education solution(AES), software from US-based company (from Bangalore). Faculty participants were trained in building clinical cases into the system, entering investigations, medications and allergy information. They were trained in usage of message centre -giving and answering assignments, accessing links to medical terminology and reference material. Students had a point-of-learning ability to access medical literature and interdisciplinary management of a clinical case. Cases were built up step by step, so students were encouraged to evaluate and opine on patient’s status and further management. Throughout the course, the system tracked and stored student performance. Results: The software was found to be effective ( significant changes in pre and post test scores). The mean scores out of 20, pre and post test were 12.389 and 14.333. Paired T test and Confidence intervals were used for statistical analysis. T-Value = -5.93 P-Value = < 0.0001, i.e there was a significant increase in the score. Of the students, 88.89% students felt that this experience motivated them for self-learning and that on-line case discussion should become a compulsory part of residents training programme. Of the faculty, 85.71% strongly felt the major advantages were 1)chronic cases-teaching, building a repository of rare cases 2)exposure of students to problem-solving and decision-making 3)flexibility of teaching sessions in terms of time. Conclusions: By adoption of an Electronic-Hospital-Records- cases fed in digital format, students can learn in a simulated environment with interdisciplinary team collaboration and integrated teaching. EMR and HCIT has the potential to revolutionize medical education.

Clinical profile of HIV infection.

OBJECTIVE: To study the clinical profile of human immunodeficiency virus (HIV) infection in children. DESIGN: Prospective. SETTING: HIV clinic at a pediatric tertiary care center in an urban metropolis. METHODS: From August 1994 onwards, 285 HIV positive children were referred to the HIV clinic. These included those intramural deliveries born to HIV positive mothers, those referred from other centers with a positive HIV ELISA (enzyme-linked immunosorbent assay) test and those screened routinely at our center in view of transfusion dependence and found to be HIV positive. After informed consent from either parent, the HIV status of all referred patients was retested by ELISA. RESULTS: Two hundred and thirteen (74.73%) patients were below the age of five years. Vertical transmission as the route of infection was documented in 247 (86.66%), 33 (11.57%) were infected through blood and in 5 (1.75%), the mode of transmission could not be ascertained. The clinical features noted were protein energy malnutrition in 127 (44.56%), pulmonary and extrapulmonary tuberculosis in 84 (29.47%), hepatosplenomegaly in 82 (28.77%), persistent generalized lymphadenopathy in 67 (23.50%), skin lesions in 63 (22.10%), chronic diarrhea in 43 (15.08%), oral thrush in 42 (14.73%), pyrexia of unknown origin in 36 (12.63%), chronic lung disease in 32 (11.22%), chronic hypertrophic parotitis in 27 (9.47%), chronic ottorrhea in 26 (9.12%), recurrent lower respiratory tract infection in 24 (8.42%), neurological manifestations of non-tuberculous origin in 13 (4.56%) and Pneumocystis carinii pneumonia in 11(3.88%). Forty-eight (16.84%) were asymptomatic, 30 (10.52%) died of AIDS during the study period and 39 (13.68%) have been lost to follow up. CONCLUSION: Vertical transmission was the commonest mode of infection. Perinatally infected children become symptomatic by five years of age. Protein energy malnutrition, hepatosplenomegaly and persistent generalized lymphadenopathy were common presenting features. Tuberculosis was the major co-infection. Chronic hypertrophic parotitis and chronic lung disease were distinguishing features of this study. Encephalopathy was associated with poor outcome.

Strategy for preventing vertical transmisssion of HIV : Bombay experience.

OBJECTIVE: To evaluate the efficacy of an interventional regime to reduce the perinatal mode of transmission of human immunodeficiency virus (HIV). DESIGN: Prospective. SETTING: Perinatal HIV clinic at a university affiliated maternity hospital. SUBJECT & METHODS: After adequate counseling, consenting HIV positive women were offered perinatal intervention: (i) administration of 400 mg of zidovudine (AZT) per day for the last 6 weeks of the antenatal period; (ii) delivery by elective Caesarian section before rupture of membrances; (iii) oral AZT powder in the dose of 8 mg per kilogram daily to the infant for the first 6 weeks of life; and (iv) avoidance of breast milk. The infants were scheduled for regular follow-up for at least 18 months. A definitive diagnosis of infectivity in the infant was ascertained by two positive enzyme-linked immunosorbent assays (ELISA) at the age of 9 months and between 15 to 18 months. RESULTS: Of the 107 mother-infant pairs enrolled, 22 infants were lost to follow-up, 15 were under 18 months of age at the time of this analysis and 2 infants died without a diagnosis. Of the remaining 68 infants followed up, 4 tested HIV positive at 18 months. Of the 229 women-infant pairs who did not receive perinatal intervention, 55 infants followed up to 15-18 months were found to be infected. CONCLUSION: This interventional strategy significantly reduced the mother to child transmission of HIV. However, the results need to be substantiated by larger studies.