Educational Strategies to Promote Clinical Diagnostic Reasoning
N Engl J Med 2006; 355:2217-2225. https://www.nejm.org/doi/full/10.1056/nejmra054782
Judith L. Bowen, M.D
Department of Medicine, Oregon Health and Science University, Portland, USA
Updated by NEJM Healer, 16 June 2022
Summarized by the Editor, The KAUVERIAN, 18 June 22
Introduction
- The personal histories that clinicians and patients bring to each encounter play a significant role.
- The diagnosis is co-created by the patient and the diagnostic team, which can include a broad array of health care professionals.
- Clinical teachers are to observe learners and provide feedback as part of an “educational alliance,” aimed at improving learning.
Clinical Teachers
Clinical teachers differ from clinicians in a fundamental way. They must simultaneously foster high-quality patient care and assess the clinical skills and reasoning of learners in order to promote their progress toward independence in the clinical setting.
Clinical teachers must diagnose both the patient’s clinical problem and the learner’s ability and skill.
Medical practice now focuses on shared decision-making and collaborative practice. Thus, teachers should promote awareness of interdependence among patients, families, and other members of the health care team when reasoning through clinical problems with learners.
A major departure from the classic physician-centered approach, this new team includes the patient, treating clinicians, nurses, pharmacists, physical therapists, radiologists, pathologists, and others.
In the clinical setting, the patient’s health and care are the focus. Clinical problems may involve many organ systems.
This report focuses on how clinical teachers can facilitate the learning process to help learners make the transition from being diagnostic novices to becoming expert clinicians.
Diagnostic Reasoning
Clinical teachers observe learners gathering information from patients, medical records, imaging studies, results of laboratory tests, and other health care providers. On the basis of their observations, and through the discussion of clinical cases, teachers draw conclusions about the learners’ performance, including their reasoning processes.
The first step in diagnostic reasoning, which is based on knowledge, experience, and other important contextual factors, is always data acquisition which may include elements of the history, the findings on physical examination, and the results of laboratory testing and imaging studies.
Another early step is stating the problem, also called problem representation, usually as a one-sentence summary defining the specific case.
To state the problem concisely and appropriately, the resident must have clinical experience with similar patients and must be able to recognize the information that establishes one disease as the diagnosis while ruling out other possibilities. The way the clinical experience is stored in memory either facilitates or hinders the ability to formulate the problem.
Expert clinicians store and recall knowledge as diseases, conditions, or syndromes – “illness scripts”.
These representations trigger clinical memory, permitting the related knowledge to become accessible for reasoning. Knowledge recalled as illness scripts has a predictable structure: the predisposing conditions, the pathophysiological insult, and the clinical consequences.
Constructed on the basis of exposure to patients, illness scripts are rich with clinically relevant information. Their content varies for each physician and among physicians.
With experience, clinicians also store memories of individual patients, and the recollection of a particular patient often triggers the recall of relevant knowledge. The defining and discriminating clinical features of a disease, condition, or syndrome become “anchor points” in memory. In the future, recollection of such stored experiences expands the clinician’s ability to recognize subtle but important variations in similar cases.
Both nonanalytic and analytic reasoning strategies are effective and are used simultaneously, in an interactive fashion. Nonanalytic reasoning, as exemplified by “pattern recognition,” is essential to diagnostic expertise, and this skill is developed through clinical experience. Deliberative analytic reasoning is the primary strategy when a case is complex or ill defined, the clinical findings are unusual, or the physician has had little clinical experience with the particular disease entity. Clinicians often unconsciously use multiple, combined strategies to solve clinical problems, suggesting a high degree of mental flexibility and adaptability in clinical reasoning.
By prompting the learner to reason aloud or eliciting the learner’s uncertainties, the clinical teacher can uncover the reasoning process used by the learner. In responses to the teacher’s questions “What do you think?” weak and strong diagnostic reasoning can be readily distinguished.
Learners whose discussion is poorly organized, characterized by long, memorized lists of causes of isolated symptoms, or only weakly connected to information from the case may reason poorly. They do not connect stored knowledge with the current clinical case because they lack either experience with such cases or basic knowledge.
Learners with strong diagnostic reasoning skills often use multiple abstract qualifiers to discuss the discriminating features of a clinical case, comparing and contrasting appropriate diagnostic hypotheses and linking each hypothesis to the findings in the case. The discussion between such a learner and the clinical teacher is often quite concise and may be so abbreviated that its result, the diagnosis, appears to be a lucky guess. In such situations, the teacher may need to ask additional questions that probe the learner’s reasoning or uncertainties to be sure that reasoning, rather than luck, brought the diagnosis to light. Strong diagnosticians can readily expand on their thinking.
Recommendations for Clinical Teachers
Clinical teachers can use several strategies to promote the development of strong diagnostic reasoning skills. The recommendations that follow are drawn from research on how doctors’ reason.
Experience with patients is essential for establishing new connections in memory between learned material and clinical presentations, for developing illness scripts, and for developing the ability to reason flexibly with the use of analytic reasoning and pattern recognition. As learners listen to patients’ stories, learn to transform these stories into case presentations, develop their own illness scripts, and learn to reason about clinical information, teachers can use case-specific instructional strategies to help learners strengthen their skills.
Articulating Problem Representations
Failure to generate an appropriate problem representation can result in the random generation of hypotheses that are based on isolated findings in the case. When the case presentation or discussion is disorganized, the clinical teacher can prompt the learner to create a one-sentence summary of the case.
However, teaching learners to articulate problem representations as an isolated teaching strategy is insufficient. Rather, problem representation must be connected to the type of clinical problem – a connection that facilitates the learner’s retrieval of pertinent information from memory.
In the teaching environment, several learners with different levels of expertise may be involved in the same case, and eliciting the learners’ various problem representations will help the clinical teacher to understand their different perspectives and learning needs. In complex, ill-defined clinical cases, more than one problem representation may need to be considered. The discussion of the different problem representations will help novice learners to appreciate the complexity of the case as well as their own early, limited understanding. Teachers should articulate their own problem representations to demonstrate the type of summary they seek from learners. Teachers can then reason aloud, linking the summary statement to their own illness scripts and highlighting the discriminating features clinicians seek in the history and physical examination for the consideration of appropriate diagnostic possibilities.
Strategies for Comparing and Contrasting
Novice learners often generate numerous possible diagnoses for any given case. To prioritize such a lengthy list, they should be encouraged to compare and contrast possible diagnoses on the basis of the relationship among the actual clinical data on the case, typical presentations for each diagnostic possibility, and the relative probabilities of different diagnoses. Forcing learners to prioritize the list of diagnostic possibilities and explain their justifications helps them to create linkages between the clinical findings in the case and relevant diagnoses, bolstering their ability to develop pertinent illness scripts.
The development of elaborate illness scripts and pattern recognition involves knowledge of the typical presentation of a problem as well as the many atypical presentations or variations on the typical one. It is important for novice learners to begin by creating in memory an anchor prototype of the typical presentation, rather than giving equal consideration to a number of undifferentiated possibilities. Early in their training, medical students should be assigned to evaluate patients with common problems – ideally, problems for which there are prototypical presentations. After the features of the prototype have been solidified in memory, additional clinical exposure to similar problems can offer a basis for comparison with the prototypical case, providing learners with an appreciation of atypical or subtle findings.
Varying Expectations According to Developmental Level
The teacher’s expectation of evidence of strong reasoning should vary according to the stage of training of the learner, but the learner’s developmental level is often related more to the extent of clinical experience with the case at hand than to the year of training. First-year residents, for example, may have clinical reasoning skills that are as advanced as those of senior residents when it comes to common clinical problems that they saw frequent as medical students. Thus, although the stage of training is somewhat helpful to the teacher in determining expectations of and roles for learners, specific questioning strategies are necessary to probe the understanding and elicit the uncertainties of learners at any level. Several different strategies can be used, but open-ended questions are especially useful for assessing the learner’s clinical reasoning ability. Using this or other similar frameworks, clinical teachers can evaluate a learner’s performance on the basis of the expected performance at different developmental levels
Providing Cognitive Feedback
The clinical teacher should provide the learner with specific cognitive feedback. The teacher should point out diagnostically meaningful information in the data on the case, identify redundant or irrelevant findings, and highlight the discriminating features, including their relative weight or importance for drawing conclusions as to the correct diagnosis. When a learner suggests a possible but not plausible diagnostic consideration, the teacher can ask the learner to describe the key features of a prototypical case and then to compare the prototype with the findings in the case at hand.
Encouraging useful Reading Habits
Learners should be encouraged to read about their patients’ problems in a way that promotes diagnostic reasoning, rather than to read about topics in a rote-memorization fashion, without context.
The organization of knowledge stored in memory facilitates the recall of key concepts for application to the next relevant clinical case. To enhance their organization of knowledge and their understanding, novice learners should read about at least two diagnostic hypotheses at the same time, comparing and contrasting the similarities and discriminating features. Clinical teachers should encourage reading that promotes conceptualization rather than memorization and provides learners with an opportunity to share what they have learned, testing what has been understood well enough to be explained and reinforcing the importance of self-directed learning.
Some medical textbooks are better organized than others to encourage learning by comparing and contrasting diagnostic considerations. The judicious use of the original literature, even by novices, can be an effective clinical learning tool, especially when it provides important new organizing principles or pathophysiological insight that have yet to permeate textbooks. Learners should be encouraged to identify progressively broader and more complex issues, explore them more deeply, and apply the principles of evidence-based medicine in arriving at answers.
In summary, clinical teachers can promote the development of diagnostic reasoning while simultaneously diagnosing both the patient’s disorder and the learner’s abilities. To do so, however, they must have an appreciation of clinical learning theory and practice and an accurate understanding of the clinical problem in question. Such an undertaking requires that the teacher accompany the learner to the bedside or examination room and perform an independent assessment of the patient and, at the same time, assess the developmental stage and clinical reasoning ability of the learner.
Ensuring the quality of patient care and modeling professionalism while promoting diagnostic reasoning skills constitute the true art of clinical teaching.
Highlights from the Annotations, updated 16 Jun 2022
- Teachers should promote awareness of interdependence among patients, families, and other members of the health care team when reasoning through clinical problems with learners. The goal of this interdependence is to reach the best diagnostic outcome possible, mindful of how unconscious bias influences clinical reasoning. Interdependence also includes the concept of shared decision making.
- Subsequent research showed that the context can significantly impact diagnostic accuracy.
- In addition, sociocultural theories impacting clinical reasoning have led to the concept that diagnosis is a social activity developed through interactions among patients, health care professionals, and the environment.
- The role of clinical teachers in supporting learners’ effective practice remains critical. Clinical teachers observe learners and provide formative feedback using several approaches.
- A wide array of tools are available to assess clinical reasoning with varying advantages and disadvantages by method.
- Direct observation of learners in the authentic clinical environment is essential. Workplace-based assessments can be used to assess moment-in-time clinical reasoning.
- Innovations in screen-based simulations of patient encounters present emerging opportunities in prospective assessment of reasoning in a standardized manner and at a large scale, although assessing clinical reasoning in simulation cannot replace observations in authentic clinical settings.
- Formative feedback – “no-stakes” feedback for learning – is crucial for learning in clinical settings. An updated approach can be framed as part of an “educational alliance” whereby feedback shifts from a transactional delivery of information to a conversation for improving learning in the context of a supportive educational relationship.
- The diagnostic reasoning process can be considered forward in nature, from data to diagnosis, or backward in nature, from hypothesis to diagnosis (the hypothetico-deductive approach). Some visual diagnoses are made rapidly through pattern recognition.
- Since the publication of this article, published problem solving exercises to illustrate the clinical diagnostic reasoning process have become commonplace. NEJM regularly publishes such exercises in the form of Clinicopathological Conferences (CPCs) and Clinical Problem Solving (CPS) articles.
- Early in the patient encounter, the problem representation activates a search for a list of possible solutions (i.e., a differential diagnosis) using a combination of fast (pattern recognition) and slow (diagnostic schemas) thinking. As data are obtained, the problem representation becomes more focused, and the differential diagnosis is refined. This iterative process results in the natural evolution of an initial unsolved problem into a refined specific summary statement of the patient’s problem with justification for the leading diagnosis and other plausible or “do-not-miss” diagnoses.
- A succinct problem representation connected to a short list of two or three diagnostic possibilities should be encouraged. This shorter differential diagnosis could give learners more time to explain which discriminating findings lead to the prioritization of the leading diagnosis over other less-likely diagnoses.
- Clinicians store knowledge of specific diseases or syndromes in their memory as illness scripts that work for any variation of the disease or condition under consideration. Illness scripts consist of three components: epidemiological risk factors, pathophysiology, and clinical findings.
- Coupling illness script theory with probabilistic reasoning can augment the learner’s ability to estimate the likelihood of a diagnosis.
- The responsibility for patients who need more or less specialized care may be transitioned from one clinician to another. These transitions are common in the modern health care system. When transitions interrupt clinical reasoning process, the opportunity to learn from practice may be lost. Follow-up and feedback may help to minimize diagnostic errors. Physicians are motivated to follow up to learn the outcome of the subsequent reasoning process. In fact, follow-up has been described as part of expert diagnostic practice.
- Teachers should encourage learners to keep track of and follow-up on patients’ outcomes as an important learning strategy to improve clinical diagnostic reasoning.
- The clinical teaching recommendations highlight the development of robust, accurate illness scripts, which is the core principle of clinical reasoning teaching and learning. Because developing illness scripts for every disease is impossible, teachers should emphasize that learners should focus on the development of robust, accurate illness scripts for typical presentations of common and cant-miss diagnoses in their fields of interest. Through experience, learners will revise these scripts throughout their training.
- Illness script knowledge should include a general sense of the following:
- The base rates of diseases (e.g., in adult patients presenting with dyspnea, the most common causes include asthma, chronic obstructive pulmonary disease [COPD], pneumonia, and heart failure)
- The value of clinical findings (e.g., d-dimer is useful for ruling out pulmonary embolism [PE] in a patient with a low probability of disease, but not helpful in ruling out PE in other patients).
- Teaching basic principles of Bayesian reasoning can inform the traditional intuitive and analytic diagnostic reasoning that most clinicians use.
- For effective teaching, meeting learners where they are, or applying specific techniques that target the learner’s level of clinical experience, is essential.
- A qualitative study that examined clinician-educators during medicine rounds identified the following four strategies for cultivating clinical reasoning:
- Emphasizing organization and prioritization
- Accessing prior knowledge
- Thinking aloud
- Analyzing the literature
- Knowledge remains essential, but not sufficient, for effective diagnostic reasoning. The role of context cannot be overstated.
- Teachers should also promote awareness of the characteristics of clinical expertise and its development; breaking down the path to expertise into more explicit steps can help learners understand how to improve their diagnostic reasoning performance.
Conclusion
Acquiring diagnostic reasoning expertise requires practice with many cases in many contexts. Deliberate practice in simulation settings is one approach.
Maximizing quality of clinical experiences requires learners to reflect on their performance to identify gaps in their knowledge and diagnostic skills and develop goals and strategies to fill the gaps.
Learners should select clinical experiences that enable them to improve their areas of diagnostic weaknesses. Because actual practice is limited by the opportunity and randomness of clinical encounters, learners could supplement experiences with clinical problem-solving exercises provided in many journals, applications, and podcasts, focusing on their areas of diagnostic weakness
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- Role of a paramedic in inter-hospital transfer
- Golden Hours in Safer Hands
- Through rough, crowded roads and stagnant waters – we race against time to reach you!
- Editorial
- Author Instruction
- Nana M, et al. Diagnosis and Management of COVID-19 in Pregnancy. BMJ 2022;377:e069739.
- MICS CABG with LIMA and Left Radial artery, harvested by Endoscopic technique: An ultrashort report
- Ultra-Short Case Report
- An interesting case of Bilateral Carotid aneurysms
- A Case Report
- Uterine artery embolization: Saving a mother and her motherhood
- Acute Abdomen – Sepsis – CIRCI: A Success Story
- Diagnostic Image
- Learning from Experience – Intra Operative, Chapters 19 and 20
- The Consultation Room
- Journal Scan
- Recommended Readings
- Editorial
- Kauverian eMedical Journal
- Cardiothoracic surgery in the COVID era: Revisiting the surgical algorithm
- Review
- Corona warrior award
- Case Series
- Takotsubo cardiomyopathy
- Learning from Experience – Chapters 3 and 4
- The Consultation Room – Chapters 41 to 45
- Journal scan
- Recommended Reading
- DIAGNOSTIC IMAGE
- Poem from Staff Nurse
- Editorial
- Author Instruction
- Male V. Menstruation and COVID-19 vaccination
- Efficacy and doses of Ulinastatin in treatment of Covid-19 a single centre study
- Electronic registries in health care
- A case report
- Anaemia in pneumonia: A case report
- Successful treatment of two cases of rare Movement Disorders
- Analysis of variance Two-Way ANOVA
- Learning from Experience – Chapters 5 and 6
- The Consultation Room
- Journal Scan
- Recommended Reading
- Diagnostic Image
- Poem from Staff Nurse
- Editorial
- Kauverian eMedical Journal
- An obituary, farewell to a very dear friend
- ‘Vitamin D’: One vitamin, many claims!
- Implantation of Leadless Pacemaker in a middle-aged patient: An ultra-short case study
- ABO-incompatible renal transplant at ease
- Basal cell adenoma parotid: A case report
- A case report
- Learning from Experience – Chapters 7 and 8
- The Consultation Room
- Journal Scan
- Recommended Reading
- Diagnostic Video
- Poem from Staff Nurse
- Editorial
- March – the Month for Minds to dwell on Multiple Myeloma
- Covid Report
- Research Protocol
- New Arrows in our Quiver, to direct against SARS-CoV-2 variants
- Out-of-hospital cardiac arrest
- Last on the list: A diagnosis seldom considered in males
- Giant T wave inversion associated with Stokes: Adams syndrome
- Learning from Experience – Intra Operative, Chapters 9 and 10
- The Consultation Room
- Definitions of probability
- Journal Scan
- Recommended Reading
- Diagnostic Video
- A Thanksgiving to Cardiac Surgeons
- Editorial
- Kauverian eMedical Journal
- Research Article
- Research Protocol
- Saving the unsavable
- Case Report
- Case Report
- Letters to the Editor
- Diagnostic Image
- Learning from Experience – Intra Operative, Chapters 13 and 14
- The Consultation Room
- Journal Scan
- Recommended Readings
- Editorial
- Author Instruction
- SIGARAM – The Club for Children with Diabetes
- The hope for a better tomorrow
- An unusual complication of polytrauma:
- An enigma at the ER
- Dynamic examination of airway
- Journal Club
- Journal Club
- Journal Club
- Conditional Probability
- Diagnostic Image
- Learning from Experience – Intra Operative, Chapters 15 and 16
- The Consultation Room
- Journal Scan
- Recommended Readings
- EDITORIAL
- Kauverian eMedical Journal
- Junior nurses in Kauvery Hospital on the frontline against the COVID-19 pandemic
- Emergency Medicine, the Emerging Specialty: Leading Light on the entrance to the Health Care Pathway
- Battle of two drugs: Who won? – An unusual presentation
- Return of the native and a resurrected foe: A case of Rhinocerebral Mucormycosis
- Covert invader- atypical presentation of neuronal migration disorder
- Fragile heart: an unusual cause of chest pain
- Goldberger’s ECG sign in Left Ventricular Aneurysm
- Congenital absence of bilateral Internal Carotid Artery: A case report
- The Power of Purple
- Beads of Nature’s Rattle
- Case Report
- Diagnostic Image
- EDITORIAL
- Kauverian eMedical Journal
- Modification of Management Strategies, And Innovations, During SARS Cov2 Pandemic Improved the Quality, Criticality and Outcomes in In-Patients “Rising to the occasion”, the mantra for success in the COVID -19 pandemic
- Time in Range (TIR) In Diabetes: A Concept of Control of Glycemia, Whose Time Has Come
- Kauvery Heart Failure Registry- A Concept
- Shorter Course of Remdesivir In Moderate Covid-19 is as Efficacious as Compared to Standard Regime: An Observational Study
- CASE REPORT
- Lymphoepithelial Carcinoma: A Case Report of a Rare Tumour of The Vocal Cord
- Diabetic Keto Acidosis (DKA), Associated with Failed Thrombolysis with Streptokinase in Acute Myocardial Infarction
- LEARNING FROM EXPERIENCE – CHAPTERS 1 AND 2
- The Consultation Room
- Journal scan
- Recommended Reading
- DIAGNOSTIC IMAGE
- Notes to Nocturne
- Editorial
- Kauverian eMedical Journal
- Caring for nobody’s baby
- Special Report
- Research Article
- The curious case of a migrating needle on the chest wall
- Foreign body: A boon at times
- Cardiorenal Syndrome
- What My Grandmother Knew About Dying
- Endovascular Therapy for Acute Stroke with a Large Ischemic Region. N Engl J Med. 2022
- Letter to the Editor
- Clinical outcomes of Coronary Artery Disease in Octogenarians
- Diagnostic Image
- Learning from Experience – Intra Operative, Chapters 11 and 12
- The Consultation Room
- Journal Scan
- Recommended Reading
- colours
- Editorial
- Author Instruction
- Ultrashort Case Report
- Cochlear Implantation: Expanding candidacy and Cost Effectiveness
- Spontaneous Pneumomediastinum in COVID 19 – Tertiary Care Centre Experience in South India
- Amoxycillin Induced Anaphylactic Shock: A Case Report
- An Unusual Cause of Seizures: A Case Report
- Case Report
- Educational Strategies to Promote Clinical Diagnostic Reasoning
- Rheumatic Rarities
- Types of sampling methods in statistics
- Diagnostic Image
- Learning from Experience – Intra Operative, Chapters 21 and 22
- The Consultation Room
- Journal Scan
- Recommended Readings
- Editorial
- Author Instruction
- Journal Scan
- Myeloma
- Posterior Reversible Encephalopathy Syndrome (PRES)
- Prophylactic orthopaedic surgery
- Subclavian steal: An interesting imaging scenario
- Spondylo-epi-metaphyseal dysplasia (SEMD)
- The bleeding windpipe
- Learning from Experience – Intra Operative, Chapters 23 and 24
- The Consultation Room
- Diagnostic Image
- Recommended Readings
- Editorial
- Editorial Board
- Physician, Protect thyself
- Foetal Medicine, the Future is here!
- Japanese Encephalitis: A common menace
- Carpometacarpal dislocation with impending compartment syndrome
- Heterotopic pregnancy
- Femoral Trochantric and Proximal Humerus Fracture, from Diagnosis to Rehabilitation
- My Father’s Heart Block
- EPS page
- CRT CSP Cases
- Journal scan
- Learning from Experience – Intra Operative, Chapters 25 and 26
- The Consultation Room
- Recommended Readings
- Editorial
- Editorial Board
- Multiple Sclerosis: An overview
- A flower born to blush unseen
- Guest Editorial
- Radio-frequency ablation as an effective treatment strategy in a case of VT storm post STEMI
- Lymphatic malformation of tongue
- Bilateral anterior shoulder dislocation in epilepsy: A case report and review of literature
- An unusual cause of Stridor
- Monoclonal Antibodies (mAbs) – the magic bullets: A review of therapeutic applications and its future perspectives
- Write the Talk
- Press release and Comments
- Probability Distribution of Bernoulli Trials
- Journal Scan
- Recommended Readings
- poem-v4i4
- Editorial
- Editorial Board
- Research
- Research
- Lambda-cyhalothrin and pyrethrin poisoning: A case report
- Good Enough
- The Monoclonal antibodies (mAbs): the beginning
- Comprehensive trauma course 2022: Trauma Management & Kauvery
- Comprehensive trauma course 2022: Introduction to Comprehensive trauma course
- Diagnostic Image
- Learning from Experience – Intra Operative, Chapters 27 and 28
- The Consultation Room
- Recommended Readings
- Poem
- Editorial
- The Brave New World of Anaesthesia
- Anesthetic considerations in Wilson’s disease for fess: A case report
- The painful story behind modern anaesthesia
- Anesthesia considerations for Ankyslosing Spondylitis
- Total intravenous anaesthesia: An overview
- Risk stratification for cardiac patients coming for non-cardiac surgeries
- The Anaesthesiologist’s role in fluoroscopic guided epidural steroid injections for low back pain
- Awake Craniotomy
- Malpositioned central venous catheter: Step wise approach to avoid, identify and manage
- Benefits outweighing risk: Neuraxial anaesthesia in a patient with Spina Bifida with operated Meningomyelocele
- Pain free CABG: newer horizon of minimally invasive cardiothoracic surgery a walk through anaesthesiologist perspective
- Stellate Ganglion Block: A bridge to cervical sympathectomy in refractory Long QT Syndrome
- Venous Malformation in Upper Airway – Anesthetic Challenges and Management: A Case Report
- Editorial
- USG guided peripheral nerve block in surgery for hernia
- Anaesthesia and morbid obesity: A systematic review
- Patient-Controlled Analgesia
- Parapharyngeal abscess of face and neck: Anesthetic management
- 3D TEE, a boon for the diagnosis of Left Atrial Appendage thrombus!
- Anaesthetic management of difficult airway due to retropharyngeal abscess and cervical spondylosis
- Expect the unexpected – Breach in continuous nerve block catheter
- Lignocaine nasal spray: An easy remedy for Post Dural Puncture Headache
- Potassium permanganate poisoning and airway oedema
- Angioedema following anti-snake venom administration
- Editorial
- Editorial Board
- Ra Fx ablation of Atrioventricular nodal reciprocating tachycardia
- Pace and Ablate Strategy: Conduction system pacing with AV junction ablation for drug refractory atrial arrhythmia – A novel approach
- Why Cardiac Resynchronization Therapy (CRT) For complete heart block? A case discussion
- Pacemakers and Bradyarrhythmias in Diabetic Mellitus
- Outcomes of Total Knee Arthroplasty in patients aged 70 years and above
- An approach to CBC for practitioners
- Acute cerebral sinus venous thrombosis with different presentations and different outcomes: A case series
- Diet and nutritional care for DDLT: A case study
- Vaccine for Dengue (Dengvaxia CYD-TDV)
- Diagnostic Image
- Learning from Experience – Intra Operative, Chapters 31 and 32
- Recommended Readings
- காவிரித்தாய்
- ATLAS OF HAEMATOLOGY AND HEMATOONCOLOGY
- Editorial
- Editorial Board
- Case reports and Case series:
- Usefulness of NEWS 2 score in monitoring patients with cytokine storm of COVID-19 pneumonia
- Treatment approach for extensively Drug-Resistant Tuberculosis (XDR-TB)
- Modified Lichtenstein mesh repair, for a patient of Coronary Artery Disease, Heart Failure and with Implanted Cardioverter- Defibrillator
- Fever-induced Brugada Syndrome
- Pulmonary Thrombo Embolism: When to Thrombolyse?
- Ultra-Short Case Report
- Learning from the failure of Nebacumab
- Journal scan
- Learning From Experience Intra Operative Chapters 29 and 30
- Recommended Readings
- Poem
- Editorial
- Editorial Board
- Heart transplantation: Life beyond the end of life
- Azithromycin to Prevent Sepsis or Death in Women Planning a Vaginal
- Medial retropharyngeal nodal region sparing radiotherapy versus standard radiotherapy
- Proximie: Patient safety in surgery – the urgent need for reform
- Analysis of femoral neck fracture in octogenarians and its management
- Adult Immunisation in Clinical Practice: A Neglected Life Saver
- “Icing” The Eyes
- Doppler vascular mapping in Arterio Venous Fistula (AVF)
- Cosmesis and cure: Radiotherapy in basal cell carcinoma of the dorsum of nose – A case report
- Pulmonary Hypertension and Portal Hypertension
- Comprehensive review of Drug-Induced Cardiotoxicity
- Statistics – Data Collection – Case Study Method
- Atlas of Haematology and Hematooncology
- PRE-OPERATIVE Chapters 1 and 2 – Learning from Experience
- Chapter 2. Uncertainties in medicine in spite of advances
- No Splendid Child
- Editorial
- Editorial Board
- A Young Girl Lost in the Storm
- ECMO as a bridge to Transplant: A case report
- Renal anemia – from bench to bedside
- Mission Possible
- New kids on the block – Update on diabetic nephropathy therapy
- Infections – Trade off in Transplants
- To Give Or Not to Give – Primer on Bicarbonate Therapy
- Sialendoscopy: Shifting paradigms in treatment of salivary gland disease
- Gait imbalance in a senior due to Chronic Immune Sensory Polyneuropathy (CISP)
- Statistics – Mcnemar Test
- Atlas Of Haematology And Hematooncology
- PRE-OPERATIVE Chapters 3 and 4 – Learning from Experience
- Changing trends a challenge to the already trained
- Journal scan
- Recommended Readings
- EDITORIAL
- EDITORIAL BOARD
- PREGNANCY POST-RENAL TRANSPLANT
- BALLOON-OCCLUDED RETROGRADE TRANSVENOUS OBLITERATION
- REVERSE SHOULDER ARTHROPLASTY FOR ROTATOR CUFF ARTHROPATHY
- THE AMBUSH A TEAM APPROACH
- ENDOSCOPIC TRANS-SPHENOID APPROACH FOR PITUITARY ADENOMA EXCISION
- A STUDY ON PRESENTATION AND OUTCOME OF BULL GORE INJURIES IN A GROUP OF TERTIARY CARE HOSPITALS
- A CASE OF INTERNUCLEAR OPHTHALMOPARESIS AS THE FIRST MANIFESTATION OF MULTIPLE SCLEROSIS
- GRANULOMATOSIS WITH POLYANGITIS AND LUNG INVOLVMENT (WEGENER’S DISEASE)
- RITUXIMAB (RITUXAN, MABTHERA) IN THE TREATMENT OF B-CELL NON-HODGKIN’S LYMPHOMA
- STATISTICAL SIGNIFICANCE
- Atlas Of Haematology And Hematooncology
- PRE-OPERATIVE CHAPTERS 5 AND 6 – LEARNING FROM EXPERIENCE
- Chapter 4: Diagnostic process often reversed
- Journal scan: A review of 25 recent papers of immediate clinical significance, harvested from major international journals
- Recommended Readings
- ஆரோக்கியம் நம் கையில்
- வெற்றியின் பாதை
- Editorial
- Editorial Board
- Prevalence of vitamin D deficiency in a multi-speciality hospital orthopaedic outpatient clinic
- Esomeprazole induced Hypoglycemia
- Dynamic external fixator for unstable intra articular fractures of Proximal Interphalangeal Joint (PIP): “Suzuki” frame
- How to Practice Academic Medicine and Publish from Developing Countries? A Practical Guide, Springer Nature, 2022
- WINTNCON 2022 – Scientific Program
- Pulmonary Thrombo Embolism: A state of the art review
- Role of Artificial Intelligence in improving EHR/EMR and Medical Coding and billing
- Monoclonal Antibodies: Edrecolomab and Abciximab
- Atlas of haematology and hematooncology
- Journal scan
- Learning from Experience – Intra Operative, Chapters 31 and 32
- What doctors must learn: Doctor, look beyond science
- Recommended Readings
- I Whisper Secrets In My Ear
- EDITORIAL
- Instructions for Authors
- Mismatched Haploidentical Bone Marrow Transplantation in a 10-year-old boy with relapsed refractory acute lymphoblastic leukemia, at Trichy
- ST-Segment Elevation is not always Myocardial Infarction
- Acyanotic Congenital Heart Disease, repaired, evolves into a Cyanotic Congenital Heart Disease and presents with an atrial tachycardia
- Family medicine – caring for you for the whole of your life. A Lost and Found Art
- The Principles and Practice of Family Medicine
- Complete Heart Block
- Sick Sinus Syndrome (SSS)
- The First Ever National Award Comes to Kauvery Hospital Chennai & Heart City for Safety and Workforce Category in IMC RBNQA Milestone Merits Recognition 2022
- Diagnostic Image
- PRE-OPERATIVE CHAPTERS 7 AND 7 – LEARNING FROM EXPERIENCE
- Chapter 5: Super-specialist – boon or bane
- Journal scan: A review of 42 recent papers of immediate clinical significance, harvested from major international journals
- RECOMMENDED READINGS
- நேரம் ஒதுக்கு
- மருத்துவரின் மகத்துவம்
- EDITORIAL
- Instructions for Authors
- Surgical Management of Covid-19 Associated Rhino-Orbito-Cerebral-Mucormycosis (Ca-Rocm) – A Single Centre Experience
- Knee Joint Preservation Surgeries
- Guest Editorial Comments
- Ventricular Septal (VSR) closure with ASD device
- Newer Calcium Debulking Angioplasty technique of Orbital Atherectomy
- An hour-long CPR to restart the heart
- VT or SVT with aberrancy?
- Pituitary Neuroendocrine Tumor (PitNET)
- VSD Device Closure
- PDA Device Closure
- Iron Deficiency Anemia, Post MVR
- Torsades de Pointes
- Quality improvement project to Reducing the Malnutrition Rate of ICU patients from 43% to 20%
- Long term use of Amiodarone in Cardiac patients: A Clinical Audit
- Statistical Independent Events and Probability
- PERI-OPERATIVE Chapters 9 and 10 – Learning from Experience
- Journal scan: A review of 40 recent papers of immediate clinical significance, harvested from major international journals
- EDITORIAL
- Kauverian Medical Journal
- First da Vinci Robotic Surgery in Carcinoma Prostate: A Case Report
- Black burden or Taylor the saviour: A case report
- Analysis of differences in Oncology practice between the United Kingdom and India
- A Case of Takayasu Arteritis
- Idiopathic Dilated Pulmonary Artery (IDPA)
- ECG Atlas
- Unusual cause of Dysphagia: A case report
- Tu Youyou: The scientist who discovered artemisinin
- Continuing Nursing Education (CNE) on Risk assessment tools, to assess vulnerable patients at Kauvery Hospital, Tennur
- DIAGNOSTIC IMAGE
- PRE-OPERATIVE CHAPTERS 11 AND 12 – LEARNING FROM EXPERIENCE
- OLD AND NEW – MAKE THE BEST OF THE TWO
- Journal scan: A review of 30 recent papers of immediate clinical significance, harvested from major international journals
- Recommended Readings
- EDITORIAL
- INSTRUCTION TO AUTHORS
- A pregnant patient with DKA, septic shock and a lactate mystery
- Radical Thymectomy in Myasthenia Gravis through Partial Sternotomy approach: A report on three patients
- In-utero blood transfusion in two etiologically distinct anaemic fetus
- RARE CAUSE OF PULMONARY HYPERTENSION
- Acute Rheumatic fever is still an enigma
- A remarkable journey: Managing LQTS in a 43-year-old female with recurrent syncope and seizure
- An unusual case of Acute Coronary Syndrome
- Reversible cause of severe LV Dysfunction in Left Bundle Branch Block
- A case study on Rhino-Orbital-Cerebro- Mucormycosis
- Snakebite and its management
- Total Elbow arthroplasty in Post Traumatic arthritis
- Wellens Syndrome: An ECG finding not to miss!
- Dr. C.R. Rao Wins Top Statistics Award a look back at his pioneering work
- PRE-OPERATIVE Chapters 13 and 14 – Learning from Experience
- Chapter 7. Doctor-patient relationship
- Journal scan: A review of 30 recent papers of immediate clinical significance, harvested from major international journals
- EDITORIAL
- INSTRUCTION TO AUTHORS
- FROZEN ELEPHANT TRUNK (FET) PROCEDURE IN A 52 YEARS OLD CHRONIC AORTIC DISSECTION PATIENT
- DIAGNOSING AND MANAGING EISENMENGER SYNDROME IN A YOUNG MALE
- STEMI EQUIVALENT BUT STEMI!
- TEMPORARY HEAL CAN POSSIBLY KILL!
- UNDERSTANDING PUBERTY
- THE IMPORTANCE OF STATISTICS IN HEALTHCARE
- JOURNAL SCAN: A REVIEW OF 44 RECENT PAPERS OF IMMEDIATE CLINICAL SIGNIFICANCE, HARVESTED FROM MAJOR INTERNATIONAL JOURNALS
- DIAGNOSTIC IMAGE
- PRE-OPERATIVE CHAPTERS 15 AND 16 – LEARNING FROM EXPERIENCE
- CHAPTER 8. DOCTOR-DOCTOR RELATIONSHIP
- EDITORIAL
- GUEST EDITORIAL
- CLINICAL AUDIT: AN INTRODUCTION
- YOUNG ACS AUDIT
- CLINICAL AUDIT: ANAESTHESIA
- CLINICAL OUTCOME IN ICU PATIENTS
- RATE OF MALIGNANCY IN INDETERMINATE OVARIAN CYST – A PROCESS AUDIT
- PATTERNS OF NEEDLE DISPOSAL AMONG INSULIN USING PATIENTS WITH DIABETES MELLITUS: AN AUDIT
- CONTINUOUS PATIENT MONITORING – LIFE SIGNS
- AGE IS JUST A NUMBER!
- SVT WITH LEFT BUNDLE BRANCH BLOCK FOLLOWING GASTRECTOMY
- COMPLEX AORTIC DISSECTION WITH MULTIFACETED CLINICAL PRESENTATIONS
- EDITORIAL
- POST-OPERATIVE SORE THROAT IN GA: A CONCERN
- NEONATAL HLH: OUR EXPERIENCE
- CLINICAL REVIEW MEET 16TH NOV 2023: CHALLENGES IN SETTING UP A NEW HSCT CENTRE IN A TIER-2 CITY IN INDIA
- CARDIAC BIOMARKERS: CLINICAL UTILITY
- HIRAYAMA DISEASE: A CLINICAL-RADIOLOGICAL REVIEW
- ECG AS A WINDOW OF OPPORTUNITY: FOR HYPERKALEMIA
- EFFECTIVENESS OF ROOD’S APPROACH BASED PAEDIATRIC OCCUPATIONAL THERAPY MANAGEMENT: ON CHILDREN WITH CONGENITAL MUSCULAR TORTICOLLIS
- ELTROMBOPAG, A NOVEL THROMBOPOIETIN (TPO) RECEPTOR AGONIST: AN OVERVIEW
- HENOCH-SCHONLEIN PURPURA
- SUBMANDIBULAR GLAND SIALADENITIS SECONDARY TO SUBMANDIBULAR CALCULUS
- LEAN HOSPITALS
- STATISTICS BLACK-SCHOLES MODEL
- PERI-OPERATIVE CHAPTERS 17 AND 18 – LEARNING FROM EXPERIENCE
- CHAPTER 9. BUILDING BLOCKS OF PATIENT CARE
- JOURNAL SCAN: A REVIEW OF 30 RECENT PAPERS OF IMMEDIATE CLINICAL SIGNIFICANCE, HARVESTED FROM MAJOR INTERNATIONAL JOURNALS
- EDITORIAL
- INSTRUCTIONS TO AUTHORS
- ROTATHON-SERIES OF SUCCESSFUL ROTA CASES LAST 2 MONTHS: AN AUDIT
- OUTCOMES OF AKI AUDIT IN KAUVERY
- ETIOLOGY, CLINICAL CHARACTERISTICS AND OUTCOMES OF PATIENTS WITH ACUTE PANCREATITIS IN KAUVERY CANTONMENT HOSPITAL (KCN), TRICHY
- USE OF BLOOD PRODUCTS AND STEROIDS IN THE MANAGEMENT OF DENGUE AT KAUVERY TRICHY HOSPITALS: A CLINICAL AUDIT
- A CLINICAL AUDIT: ON THE MANAGEMENT OF ECTOPIC PREGNANCY
- DIABETIC KETOACIDOSIS WITH HIGH ANION GAP METABOLIC ACIDOSIS
- HYPOKALEMIC PARALYSIS FROM DISTAL RENAL TUBULAR ACIDOSIS (TYPE-1)
- DELAYED PRESENTATION OF INTERMEDIATE SYNDROME IN A PATIENT WITH ORGANOPHOSPHORUS POISONING: A CASE REPORT
- SCAPULA FRACTURES: DO WE NEED TO FIX THEM?
- SPONTANEOUS CSF RHINORRHEA
- DANCING WITH DIABETES: AN UNUSUAL CASE OF CHOREA HYPERGLYCEMIA BASAL GANGLIA SYNDROME
- CONVALESCENT RASH OF DENGUE
- ECG ATLAS 2
- MI MIMICKER
- PERFORATION PERITONITIS-A CASE REPORT
- APPLICATION OF EVIDENCE BASED PRACTICE CARE FOR INDIVIDUALS WITH SPINAL CORD INJURY WITH FUNCTIONAL DIFFICULTIES: ROLE OF THE OCCUPATIONAL THERAPY PRACTICE GUIDELINES
- METHOTREXATE INDUCED MUCOSITIS AND PANCYTOPENIA: A CONSEQUENCE OF MEDICATION ERROR IN A PSORIASIS PATIENT
- POST OPERATIVE CHAPTERS 1 AND 2 – LEARNING FROM EXPERIENCE
- CHAPTER 10. NURTURING SELF
- விடாமுயற்சி வெற்றி தரும்
- JOURNAL SCAN: A REVIEW OF 26 RECENT PAPERS OF IMMEDIATE CLINICAL SIGNIFICANCE, HARVESTED FROM MAJOR INTERNATIONAL JOURNALS
- EDITORIAL
- EDITORIAL BOARD
- LIMB SALVAGE IN EXTREMITY VASCULAR TRAUMA: OUR EXPERIENCE
- MANAGEMENT OF URETHRAL CATHETER RELATED PAIN IN RENAL TRANSPLANT RECIPIENTS: A CLINICAL AUDIT
- NO PAIN VEIN GAIN WITH PRILOX IN PAEDIATRIC POPULATION
- GUIDELINE-DIRECTED MEDICAL TREATMENT (GDMT) OF HEART FAILURE AT KAUVERY HOSPITALS: A CLINICAL AUDIT
- PATIENTS STORY: DIGNITY MATTERS
- PATIENTS STORY: DIGNITY MATTERS
- VIDEO PRESENTATION- CT CORONARY ANGIOGRAPHY
- DRUG INDUCED HYPERKALEMIA
- ADULT NEPHROTIC SYNDROME
- EXPLORING COMPLEX CARDIAC CASES: INSIGHTS FROM DIVERSE PRESENTATIONS IN MID-AGED WOMEN
- CARDIOMYOPATHY AND ITS ECHO FINDINGS
- THE STRESS TEST ON THE TREADMILL
- POST OPERATIVE CHAPTERS 3 AND 4 – LEARNING FROM EXPERIENCE
- CHAPTER 11. BALANCE IN LIFE BEYOND BANK BALANCES
- JOURNAL SCAN: A REVIEW OF 30 RECENT PAPERS OF IMMEDIATE CLINICAL SIGNIFICANCE, HARVESTED FROM MAJOR INTERNATIONAL JOURNALS
- காணும் பொங்கலும் மனித மன மாற்றமும்
- EDITORIAL
- INSTRUCTIONS TO AUTHORS
- PREVALENCE OF STREPTOCOCCUS PNEUMONIAE SEROTYPES IN AND AROUND TRICHY AND ITS CLINICAL RELEVANCE
- ANAESTHETIC MANAGEMENT OF A PATIENT WITH HUGE GOITER: A CASE REPORT
- EUGLYCEMIC DIABETIC KETOACIDOSIS A RARE CAUSE FOR DELAYED EXTUBATION
- SUCCESSFUL PREGNANCY IN ASD PATIENT – COMPLICATED BY SEVERE PULMONARY ARTERIAL HYPERTENSION
- ENDOCRINE COMPLICATION OF GROWTH HORMONE SECRETING TUMOR: A CASE REPORT
- EFFICACY OF EARLY DIAGNOSIS AND DEVELOPMENT APPROACHES OF PAEDIATRIC OCCUPATIONAL THERAPY ON ACUTE DISSEMINATED ENCEPHALOMYELITIS: A CASE REPORT
- POST OPERATIVE CHAPTERS 5 AND 6 – LEARNING FROM EXPERIENCE
- CHAPTER 12. MILES TO GO – BEFORE TEACHING BECOMES LEARNING
- JOURNAL SCAN: A REVIEW OF 26 RECENT PAPERS OF IMMEDIATE CLINICAL SIGNIFICANCE, HARVESTED FROM MAJOR INTERNATIONAL JOURNALS
- காவேரி – 25
- POEM – மண்ணில் பிறந்தது சாதிப்பதற்குத்தான்
- Editorial
- Video – Left main disease: Is it still a Surgeons Domain
- Propofol and the unspoken pain
- Thrombocytopenia in pregnancy: Experience from a tertiary care centre of a tier 2 city in South India
- Snake envenomation and its managements
- Essentials of Advanced Cardiac Life Support
- Video – Sepsis Management
- The phantom Block: Ogilvie’s
- Airway Management in an Adult with Subglottic Stenosis: Overcoming Ventilation Challenges with a Small Endotracheal Tube ”
- Descending thoraco-abdominal aortic aneurysm rupture with left massive hemothorax –diagnosis and emergency management
- C-IIH (Chronic IIH Imaging in Headache) study: Hospital-based pictorial review of Chronic IIH variants Neuroradiologist’s perspective
- Diagnostic Image: Small bowel diverticulosis
- Occupational therapy interventions for Schizophrenia: A systematic review
- Post-Operative Chapters 23-25
- Chapter 21. How to communicate need for further tests or referral for second opinion?
- Journal scan: Journal scan: A review of 13 recent papers of immediate clinical significance, harvested from major international journals
- Poem- கருணையின் வடிவமே தானம்
- Poem – நீ உன்னையறிந்தால்
- Editorial
- Liver biopsy in children: A single centre tertiary care experience
- A prescription audit for medication safety in a tertiary care centre of Tamilnadu, India
- An update on critical care nutrition
- Geriatric pharmacotherapy and polypharmacy
- Neurofibromatosis with Autoimmune hemolytic anemia: Bystander or intriguer
- Video Presentation – ABC of CBC
- Procedure Video: A Complex Left Main Coronary Artery occlusion successfully rescued by Bifurcation angioplasty
- Neurogenic Dysphagia in Subdural Hematoma: A case report
- Diagnostic Image: Pellets in the abdominal cavity, found on Laparotomy
- Diagnostic Images: Hydatid cyst in the lung
- CME Proceedings: Cutting edge in lab medicine
- Journal scan: A review of images in clinical medicine of immediate clinical significance, harvested from major international journals
- Chapter 22. How to respond to inappropriate patient requests?
- முதுமையும் ஆரோக்கியமும்
- Editorial
- Recurrent or persistent pneumonia: A case series with discussion
- Video – Clinical Utility of Adenosine in Cardiac Arrhythmias
- Human MetaPneumoVirus ( HMPV) Management of severe pneumonia, with respiratory failure
- Case Report: The medical implications of a bicuspid aortic valve discovered serendipitously in a young man
- Abducens nerve palsy in a young adult after COVID-19 infection
- Seizure-induced Takotsubo cardiomyopathy mimicking STEMI: A case report
- Electrocution: A comprehensive review
- Case report: Surgical management of a colloid cyst
- A successful abdominal aortic stenting
- Ultra short Case report and video: CPB (EUS guided celiac plexus block for chronic calcific pancreatitis)
- Diagnostic Images: Total occlusion of left cervical ICA
- Diagnostic Images: Osteoid osteoma
- Diagnostic Images: Cytology smear for mucinous carcinoma Stomach
- Journal scan: A review of images in clinical medicine of immediate clinical significance, harvested from major international journals
- Chapter 23. How to communicate risks involved in management?
- மக்களின் நம்பிக்கைக்கு மாகாவேரி
- EDITORIAL
- EDITORIAL BOARD
- Audit Appraisal: An overview
- Intra Ventricular antibiotics: Our experience
- Transfusion Reactions: A clinical audit
- Postoperative pain management
- Rising concerns of Carbapenem resistant Enterobacteriaceae and the options available: An overview
- Ultrashort case report on VF storm in immediate Post CABG Period—‘Angry Purkinje Syndrome’
- Lynch syndrome, diagnostic challenges and management: A case report
- Bilateral posterior shoulder fracture – dislocation due to seizure, an uncommon injury: A case report
- Navigating amlodipine overdose: A multi-disciplinary approach in a 23 year old female
- Exploring the interplay between sleep patterns and behavioural characteristics in individuals with Autism Spectrum Disorder (ASD)
- POST OPERATIVE Chapters 7 and 8 – Learning from Experience
- Chapter 13. Art of communication and counselling
- Journal scan: A review of 20 recent papers of immediate clinical significance, harvested from major international journals
- மருத்துவமனையின் தேவதையே
- மருத்துவ சிந்தனை விருந்து
- Editorial
- Instructions for Authors
- Cardiac surgery in an octogenarian Indian population
- Mycotic Aortoiliac Aneurysm: A case series
- The Scorpion Block—A Sting operation
- Arterial Thoracic Outlet Syndrome: A case report
- Infective endocarditis in adult congenital heart disease: A case report
- Takotsubo cardiomyopathy: A case report
- Cerebral Venous Thrombosis (CVT): A case report
- Hemophagocytic Lymphohistiocytosis in Dengue
- A prospective observational study on the prescription of Guideline Directed Medical Treatment (GDMT) for Heart Failure at Kauvery Heart City
- Guideline-Directed Medical Treatment (GDMT) of Heart Failure at Kauvery Hospitals: A clinical audit
- POST OPERATIVE Chapters 9 and 10 – Learning from Experience
- Chapter 14. How to keep updated in busy medical practice?
- Journal scan: A review of 15 recent papers of immediate clinical significance, harvested from major international journals
- சிந்தனையே சிறப்பு
- தோல்வியே வெற்றியின் பாதை
- Editorial
- Results of Mechanical Thrombectomy in acute stroke: A case study in a Tier 2 city in India
- A clinical audit—cost effective way of managing superficial chest wound infections post sternotomy
- Dental implants: Our experience and expertise
- A non-randomized retrospective study on the management of pediatric septic arthritis
- Analysis of femoral neck fracture in octogenarians and its management
- Airway management of a huge thyroid: A case report
- Cardiac Arrhythmias in the ER setting
- Effectiveness of tactile-spatial oriented approach based paediatric occupational therapy intervention for children with Infantile Hemiplegia
- Corporate citizenship in healthcare: Nurturing social responsibility
- Guillain-Barré syndrome: A case report
- POST OPERATIVE Chapters 11 and 12 – Learning from Experience
- Chapter 15. How to be rational in practice?
- Journal scan: Elsevier’s Medicine, Current Issue, Volume 52 Issue 6, June 2024, Seminar on Poisoning
- Recommended Readings
- இயற்கை சொல்லும் செய்தி
- Editorial
- Instructions for Authors
- A rare organism causing septic arthritis of hip joint
- ICD implant in 6 year old with Jervell and Lange-Nielsen (JLN) syndrome
- A clinical audit on Bariatric/Metabolic surgery
- Clinical audit on Nil per Oral (NPO)
- A non-randomized clinical study on heat stroke
- Stress cardiomyopathy with posterior reversible encephalopathy syndrome in Eclampsia
- Intro-Reversible Cerebral Vasoconstriction Syndrome (RCVS): An ultra-short case report
- A 2 am Tamponade: Critical call to action
- Immune Checkpoint Inhibitors, and in combination with JAK inhibitors: The modelling for the future
- Optimizing the patient journey in hypertrophic cardiomyopathy—Patient and clinician perspectives: Summary of CME from Medscape
- ER Intervention
- Diagnostic Images/Videos
- A randomized controlled trial: Different types of blinding
- Journal scan – June
- Journal scan – July
- Post-Operative Chapters 13, 14
- Chapter 16. How to enjoy medical practice?
- Driving business growth with 5S and lean strategies: A transformative session for corporations in the Trichy region
- Poem: 25 – வருடங்களாக காவேரி
- Editorial
- A Data Audit: Tool for Good Clinical Practice
- Ortho rehab audit at Kauvery Hospital, Trichy
- Endovascular Thrombectomy in young patient with a stroke – surgical procedure decompressive craniotomy
- Secondary HLH (Hemophagocytic Lymphohistiocytosis): An ultra-short case report
- Prone ventilation: A case series
- Dermatologic Emergencies: A case series
- Managing DKA at the ER
- Podcast – Managing DKA at the ER
- Insertion of tunneled hemodialysis catheter through the collateral vein adjacent to the thrombosed right jugular vein.
- Access failure with dysfunctional tunnelled haemodialysis catheter in the presence of exit-site infection
- Video – A multidisciplinary approach to preventing sudden cardiac death
- Dasatinib in pediatric Chronic Myeloid Leukemia: An overview
- Dyslipidemia management: Indian perspective
- Pharmacological stress testing: Assessing heart health without exercise
- Journal scan: A review of 15 Ethics with clinical significance, harvested from a major international journal
- Post-Operative Chapters 15 and 16
- Chapter 17. How to find time for the family
- Poem – உனக்காக நீ
- Editorial
- An audit: A silent disease-Osteoporosis
- An approach to antibiotic therapy: A primer for all specialties
- Audit on pediatric Cholesteatoma
- Clinical audit: ER to ICU transit time
- A case report on Multiple myeloma: Value of pre and post-treatment MRI
- Unrelated donor bone marrow transplantation in 3 year old with Acute Myeloid Leukemia
- Infective endocarditis: A case series
- A Retrospective observational study on Scrub typhus paediatric population in Kauvery Hospitals, Trichy
- Clinical Pharmacy Approach: To a patient on multiple anticonvulsants for “Difficult to control’’ seizure disorder
- An analysis of the Urea to Creatinine Ratio (UCR) in different cardiac surgeries
- Journal scan – 1
- Journal Scan – 2
- Post-Operative Chapters 17 and 18
- Chapter 18. How to be legally safe in medical practice?
- Poem – காவேரியின் மாரத்தான்
- Poem – ஆரோக்கியம் என்னுடையது
- Editorial
- Clinical audit on antibiogram
- Renal transplantation in marrow dysfunction: A case series
- Empowering lifesavers: Impact of BLS and PALS training for PICU and critical care nurses
- Myotonia congenita: A case series
- Utilization of Inj. Sovateltide: A novel injectable formulation
- Retroperitoneal sarcoma: A report of two cases
- Traumatic simultaneous bilateral femur and tibia shaft fracture in an 8-year-old male child: An unusual case report
- Echocardiography in the assessment of shock
- Plasma combats angioedema: A case report
- A case report and video presentation on a 9-year-old boy who underwent PAPVC
- Interventional Radiology: Large gastric varices
- Interventional Radiology: A case of active PV bleeding post-D and C day 12
- Diagnostic Images: Exencephaly
- A short case report on Hyperdontia (extra teeth)
- Post-Operative Chapters 19 and 20
- Chapter 19. How to deal with incurable disease?
- CII CFO Excellence award: A recognition of exceptional leadership
- Journal scan
- Poem – மறுக்காதே மறவாதே
- Editorial
- An audit: Microvascular Free Flaps
- DSME Programs – Lessons learned
- Surgical Reconstruction Of Acromio Clavicular Joint Dislocation Using Double Endobutton – A Case Report
- Complex Iliac Artery And Venous Reconstruction In Case Of Polytrauma – Case Report
- Basics of statistics- from of a clinician’s perspective
- A comprehensive review on Rabies: Clinical aspects and treatment
- Lateral Medullary Syndrome – Case Report
- Postpartum ischemic stroke – case report
- Proning Saves Lives
- Video – A challenging case of Recurrent craniopharyngioma with supra and infra tentorial cyst and hydrocephalus
- Event: Update on Atrial Fibrillation
- Investigating the Role of Activity-Based Configurational Developmental approach in Managing Mitochondrial Leukodystrophy in Children
- Post-Operative Chapters 21 and 22
- Chapter 20. How to deal with failure of treatment
- Journal scan: A review of 12 recent papers of immediate clinical significance, harvested from major international journals
- Poem – தன்னம்பிக்கையும் விடாமுயற்சியும்
- Extraordinary Edition of the Kauverian
- Editorial
- Renal Transplant and outcomes at Kauvery Hospitals, Trichy
- Infection control practices in operation theatre: A review
- Clinical and endoscopic profile of GI bleed patients at Kauvery Hospital (KCN): A clinical audit
- A case report on rapidly worsening anterior mediastinal mass with metastasis
- Psychological comorbidities in diabetes: An overview
- Management of Cardiac arrhythmias in cardiac critical care
- Fracture neck of femur with alkaptonuria: A case report
- Complex polytrauma: Being “switched on’’ as a vascular surgeon
- PRES (Posterior Reversible Encephalopathy Syndrome): A case series of PRESsing concern
- A successful ERCP in a patient immediately after the PTCA for his recent MI
- Two case reports: What I observed on my elective at Kauvery Hospital at Alwarpet, Chennai
- A shadow of experience as an observer in Kauvery Hospital, Alwarpet, Chennai
- SLE, APS, Pregnancy in Kauvery Hospital, Cantonment
- Monthly Heart Failure audit report on GDMT in Heart City, December 2024
- An ultra-short case report: Reverse Shoulder Arthroplasty
- Diagnostic Images for Ochronosis: One history clinches the diagnosis
- Diagnostic Images: Saccular aneurysm
- Diagnostic Images: Tumor cells in a pancreatic neuroendocrine tumor
- Journal scan: A review of images in clinical medicine of immediate clinical significance, harvested from major international journals
- Chapter 24. How to prepare yourself to survive violent patient encounter?
- மகளிர் தினம்
- Editorial
- Interventions and their impact on Sepsis prevention at NICU
- Evaluation of cefepime-enmetazobactam against ESBL and AmpC β-lactamase producing Gram-negative bacteria: In- vitro study
- Interventions in Acute Ilio-Femoral DVT – 5 Years Institutional Experience
- Molecular diagnosis of infectious diseases
- Monthly Heart Failure audit report on GDMT in Heart city, January 2025
- Assessment of anthropometric parameters and clinical profile as predictors for OSA severity in a tertiary care hospital in South India
- Acute Pulmonary Embolism, highlights of a Kauvery Post Graduate Lecture
- Podcast: Surgical Site Infection – An Overview
- Video: Pathologists’ Role in the Diagnosis in Critical Clinical Situations – A Case-Based Discussion
- A case series: On patients with arrhythmias
- Intravenous Fluid Therapy: A comprehensive review
- A twisted ankle tale: Closed reduction of medial subtalar dislocation in the Emergency department.
- Appendiceal mucosal schwann cell proliferation – rare incidental finding in a case of subacute appendicitis
- Subarachnoid Hemorrhage Due to Ruptured PICA Aneurysm: Endovascular Management and Surgical Intervention
- An ultra-short case report: A patient with severe TVD with LV dysfunction
- An ultra short report with procedural video on SVC obstruction following a stenting
- Diagnostic Images on Molluscum Contagiosum
- Diagnostic Images: Osteomyelitis of L2 Vertebrae
- Journal scan: A review of images in clinical medicine of immediate clinical significance, harvested from major international journals
- Chapter 25. Doctor, are you happy in life?
- Poem: Glaucoma – The Silent Veil
- மருத்துவரின் மகத்துவம் – 2
- Editorial
- Effectiveness of intraoperative periarticular infiltration in Total Hip Arthroplasty (THA): A clinical audit
- Plasmapheresis & Hemofiltration in poisonings
- Approach to seizures in children: A comprehensive review
- Total Parenteral Nutrition
- Dancing Dragons: A tale of 2 Intriguing Cases
- Multifocal Giant Cell Tumor of the Wrist: Radiologic-Pathologic Correlation and Review of Diagnostic Challenges
- Aortic Dissection: A case report
- Bullous Pemphigoid: A case report
- Chondromyxoid fibroma excision and bone grafting: A case report
- Insights from Diabetes on Wheels: A community-based screening
- An intriguing challenge of unveiling the unexpected: Peripartum cardiomyopathy
- ECMO: The last resort for refractory beta-blocker overdose
- Giant Cell Tumor of talus in a 14-year-old child treated by curettage and cementation: A case report
- Parquet poisoning survival: A rare triumph over a deadly herbicide
- Pituitary Apoplexy with Hypopituitarism: A rare presentation with refractory hyponatremia
- Type 3c Diabetes Mellitus secondary to chronic calcific pancreatitis
- Tuberous sclerosis complex: “When Genes Go Off Script
- Spinal stability restored: A case of odontoid fracture post-trauma
- An ultra-short series of hand replants in quick succession
- First successful neonatal percutaneous cardiac intervention done in Maa Kauvery & Heart city, Trichy.
- Successful Surgical Management of Bilateral Temporomandibular Joint Ankylosis in a Pediatric Patient
- Case Report: Fracture C1 & C2 (Type 3) vertebrae with Atlanto-Axial Dislocation (AAD)
- Diagnostic Image of Fistuloplasty
- Journal scan: A review of images in clinical medicine of immediate clinical significance, harvested from major international journals
- Chapter 26. ‘Mens sana in corpore sano’ – healthy mind in healthy body
- வாழ்வியல் அனுபவம்
- Editorial
- When life paused: A family’s journey through traumatic brain injury
- Early and short term outcomes of an indian bioprosthetic valve at mitral and aortic positions
- Management of Hyperglycemia
- Jigsaw puzzle: A case series on chronic pain condition
- Challenging case of tropical Pyomyositis with metastatic MRSA infection in a De Novo HIV Patient
- Intraventricular astrocytoma causing seizures in a young male
- Silent danger uncovered: Early detection of urinary bladder tumour during routine health screening—a case study
- Mycobacterium leprae, in a case of Hansen disease – Lepromatous type
- A heartfelt beginning: Myopericarditis revealing mixed connective tissue disease
- Clues in the chemistry: Diagnosing Paget’s disease of bone
- Cold Truths in a hot land: Hypothermia unmasked by hypoglycemia in an elderly diabetic
- A case of Plummer Vinson syndrome in an elderly female
- Paradoxical embolism: A video presentation of a case report
- Successful Mechanical Thrombectomy: Two case reports
- TIPS Procedure for severe portal hypertension
- Enhancing patient safety: Innovations in advanced signal detection for pharmacovigilance – A narrative review
- EPS RFA for SVT due to redo-accessory pathways using advanced open window 3D electro-anatomical mapping
- Rest to Recover: How sleep rebuilds mind and body
- CRP levels are influenced by lifestyle and dietary modifications
- An overview of onco-pharmacy in multiple myeloma
- Journal scan
- Editorial
- A case series on ABO -incompatible renal transplantation in a tertiary care hospital, Southern Tamil Nadu
- From first step to final chapter: My journey through Kauvery Hospitals
- Young women and CAD: A retrospective clinical audit at Kauvery Heart City
- Outcome audit: Clinical outcome of stage 2 frozen shoulder treated with Manipulation Under Anaesthesia (MUA) + injection
- Outcome of traumatic brain injury patients with concomitant chest injuries: A retrospective single–center based study
- Consenting and decision making in management of patients
- When fever lingers, think beyond the usual: Consider Kikuchi-Fujimoto disease
- Localizing value of internuclear ophthalmoplegia
- Clinical Snapshots: From the Daily Rounds of My Residency
- Be aware of false positive treadmill traces
- Diagnostic Image: Perineural infiltration
- Achieving better outcomes from intervention by clinical pharmacists
- The role of homocysteine levels as a risk factor of ischemic stroke events: a systematic review and meta-analysis
- The French Paradox: Myth, fact and challenges
- Robotic redo extended hellers cardiomyotomy: An ultra-short report with procedure video
- An ultra-short report on Mechanical thrombectomy for a basilar artery thrombosis
- Diagnostic Images with procedure video: Infarcts in Left temporo occipital lobes
- Middle Meningeal Artery (MMA) embolization, an ultra-short case report and discussion
- Case report of valentine artery: A rare anatomical variation
- The Proceedings of CP Conclave: The Brave New World of Clinical Pharmacy
- Journal scan: A review of images in clinical medicine of immediate clinical significance, harvested from major international journals
- Poem – மருத்துவர் தின வாழ்த்துக்கள்
- Poem – மன அலையின் கூச்சல்