1. Case 1: Pharyngitis:
A 32 year-old male with 3 days of symptoms, fever to 101, chills, sore throat, tender
lymph nodes and a cough. Diagnosis of pharyngitis is clear.
o Are antibiotics in order?
The antibiotics are not in order as the score is 1. The score of 1 means that it is not
necessary to order for a series of test or to prescribe the antibiotics. It seems to be
viral in nature are most of the cases of pharyngitis are of viral nature for most
adults.
o
See article on strep throat and the MedCalc3000 McIsaac rule and advise on the
next steps applying the concepts illustrated in class.
There is no evidence that a throat culture or any kind of antibiotic treatment will
benefit the patient. The best option for the clinician is proceed ahead with
symptomatic treatment as the evidence suggest to more of a viral infection which
is common in the adults. Also treating the patients with antibiotics for a viral
infection will lead to bacterial resistance and will hence create problems later on
when the same set of antibiotics are being prescribed.
o
Then, please comment on how this entire process might be facilitated by
healthcare IT.
Healthcare IT can provide the tools to the physicians which would help them to
take better informed decisions while diagnosing a patient for a particular aliment.
Electronic Health Records can be designed which would provide an interface
which would link to the MedCalc3000 as in this case from the patients record so
that the physician can make a better informed decision. Lots of work is being in
this direction and we are seeing EHR which have such functionality helping the
clinician’s day in and day out.
2. Case 2:
A 66 year-old female presents 1 day following a trip home from Europe with sudden
onset of shortness of breath and chest pain that is worse when she takes a deep breath.
Her heart rate is 96. She has no history of cancer. Her left leg is slightly swollen.
o Use the article referenced for this session to estimate the patient's clinical
probability of having pulmonary embolism.
The Geneva score as mentioned in the article is the basis of prediction of
pulmonary embolism. The patient had had sudden shortness of breath episodes
and had chest pain which was worsening. The patient has a swollen left leg which
is similar to the case in the article. In the case mentioned above it is only the left
leg that is swollen as compared to the case in the article where both the legs were
swollen for the female patient. Referring the revised Geneva Score and based on
the symptoms as described above its seems that there are intermediate chances
that the patient has pulmonary embolism.
o
How might the next step of similar patients' management be facilitated by
healthcare IT?
When the clinician is entering the all the details in the electronic health record
regarding the various risk factors and the symptoms the system would be
calculating the probability of pulmonary embolism for the patient. It could be a
notes template in which after entering all the results from the test the system will
calculate the probability and bring up more information on the screen giving more
details about the next steps that needs to be taken. This is where the decision
support systems come in handy and will let the clinician know the therapy that is
required and the next steps for treating this particular condition.