Disseminating medical literature and knowledge in India in the 1980s: the SMLRT story.

The informed netizen of today is in a state of information overload. With 785 million broadband subscribers and an urban and rural teledensity of 138% and 60%, respectively [1], India is already the second-largest online digital market. Today, in theory, medical journals and textbooks can be accessed by anyone, anytime, anywhere, and at affordable rates. Fifty odd years ago, when the authors entered medical school, the use of computers in medical education was unknown in India, as in other parts of the world. It was in this milieu, thirty-seven years ago, that eleven young Madras (Chennai)-based doctors decided to make medical literature easily accessible, particularly to clinicians in suburban and rural India. The aim was to make relevant, affordable reprints easily available to the practitioner at their place of work or study. Photocopying and using the postal service was the chosen, and indeed the only available, mode of operation. This article will outline the methodology used, trials and tribulations faced, and persistence displayed. At that time, the processes deployed appeared relevant and truly innovative. Over the ensuing years, developments in information technology made the services redundant. Extensive, even revolutionary, changes such as universal digitization and availability of a cost-effective Internet radically changed how medical literature could be accessed in India.

A protocol for the emergency department management of acute undifferentiated febrile illness in India.

BACKGROUND: Fever is a common presenting complaint in the developing world, but there is a paucity of literature to guide investigation and treatment of the adult patient presenting with fever and no localizing symptoms. OBJECTIVE: The objective of this study was to devise a standardized protocol for the evaluation and treatment of febrile adult patients who have no localizing symptoms in order to reduce unnecessary testing and inappropriate antimicrobial use. After devising the protocol, a pilot study was performed to assess its feasibility in the emergency department. METHODS: A protocol was formulated for adult patients presenting with fever who had no clinical evidence of sepsis and no localizing symptoms to suggest the etiology of their fever. Investigations were based on duration of fever with no investigations indicated prior to day 3. Treatment was guided by results of investigations. A pilot study was performed after protocol implementation, wherein data were collected on successive adult patients presenting with fever. RESULTS: During the 6-week study period, 342 patients presented with fever, 209 of whom fit the parameters of the protocol, with 113 of these patients presenting on the 1st or 2nd day of fever. All patients experienced defervescence of fever, with ten patients being lost to follow-up. Of the patients presenting on day 1 or 2 of fever, 75.2% (85/113) defervesced without the need for testing; 53.1% (60/113) experienced defervescence without the need for antimicrobial therapy. CONCLUSION: Implementation of this rational, standardized protocol for the assessment and treatment of stable adult patients presenting with acute undifferentiated febrile illness can lead to reduced rates of testing and antimicrobial use. A prospective, controlled trial will be required to confirm these findings and to assess additional safety outcome measures.

Pre-formatted written discharge summary-a step towards quality assurance in the emergency department.

BACKGROUND: Providing discharge instructions to emergency department (ED) patients is not a standard practice and there is wide disparity in its implementation. There is evidence that ED discharge instructions, especially a pre- formatted one, complements verbal instructions and improves patient communication and management. AIMS: Our aim was to audit the practice of providing a discharge summary in a standardized pre-formatted form to patients visiting the ED at Sundaram Medical Foundation (SMF), Chennai, India. METHODS: Case sheets of 200 patients who visited the ED from 1 July to 31 August 2007 were selected randomly and were assessed for the documentation of the demographic and clinical details in the retained copy of the discharge summary by three medical records personnel independently. Descriptive analysis was used to measure frequency and percentages. RESULTS: All patients (100%) received a discharge summary and a carbon copy of the same was retained in the hospital. Demographic data, diagnosis, prescription and discharge instructions were written in > 80%. Legibility of the three important sections, namely diagnosis, prescription and discharge instructions, were 66, 76 and 65%, respectively. The diagnosis was written in an abbreviated form in 27%. The patient's signature was obtained in 80%, while doctors signed in 89%. Investigation results and follow-up advice were not documented in 85 and 93%, respectively. CONCLUSION: The pre-formatted discharge summary provided more information than a prescription form in terms of the amount of information written by virtue of its structured nature. Deficiencies did reflect a resistance to change current practices in spite of having a structured data sheet. Physician and staff education could overcome this.