 Hello all, in this presentation we are going to see about clinical social case pro forma. The clinical social case pro forma format which is described in this presentation is given in the link below from which you can download and you can use it in your own settings. If you have not subscribed to the think lateral channel please subscribe. So, before going to the clinical case study pro forma, individually these are all the headings, patient demographic details, family details, clinical details, socio environmental details, physical examination and management. The usual history examination and management that is investigations and treatment is the typical clinical case pro forma. Here it is called as clinical social case pro forma because the social component of the disease or the illness has been added, enquired and we add preventive measures for the disease and we will give suggestions not only for the individuals but also for the family and the community. So, patient demographic details we have name, age, gender, marital status, religion, education, address, occupation, data for admission, OPIP number, ward number, total number of family members. Name then you should know the name clearly when you present in front of the examiner if you mention the name by Mr. X or Mr. Y then the examiners will be impressed. So, whenever possible if you call by name the rapport will be developed with the patient and wherever this age, gender and marital status and all these are all the factors which predispose certain diseases and the disease severity also. The education, occupation, literacy and all are the important factors in determination of the socioeconomic status of the family. These other particulars will help in identifying the patient. Then we have total family members. So, if we ask the total family members in socio demographic details then this so family details we have to add the each family member details by name. So, we have to add X, Y, Z like this. So, age, gender and also what is the relationship to the index case or to the head of the family, what is the education, what is the occupation, what is the monthly income, what is the immunization status in case of children, what is the health status in case of adult. So, we have to ask about the type of the family whether it is the nuclear family, joint family or a three generation family. Nuclear family is the family when the husband and wife live with their own children, when the husband and wife live with their children and with their brothers and their parents that is called a joint family. When three generations that is husband and wife, their father and mother and their children live together then that is called as a three generation family. In India nowadays nuclear family is the most commonest type. So, you can draw the family tree here which can be drawn by representing the female by circle and males by square. If you join them horizontally then they indicate they are married to each other and when you connect a male and a female from above which means they are siblings. So, this is exactly how to draw a family tree. So, you can draw the, write the age inside so that you can convey more information through this family tree. So, if this is your case you can mark an index arrow and then you can mark the case like this and if suppose the person if this is a three generation family sorry then we have to add like this. So, if their mother is living means you can add like this and if the father is not there then you can strike it off. There are various quotes in family tree so that you can convey lots of information and this represents the basic family tree. You have to ask vital events in the family in the past only year that is birth and death, marriage or divorce you have to ask the total family income per month which is divided by the total family members will yield per capita monthly income. So, which will help in the modified BG Prasad's specification for the socio-economic status scale categorization. So, we have to calculate the total family income and the when we divided it by total family and number of family members we will get this per capita income. So, socio-economic scales which is commonly recommended here is modified Kuposama scale in case of urban settings, modified BG Prasad's scale in case of rural settings. Actually modified BG Prasad's scale can be used in rural and urban also, but due to the complexity of other scales and also BG Prasad is not accurate it is not used in urban but only recommended in rural. The complex scales which can be used in rural are Udaipariks and SLI scales, Udaipariks and SLI scales that is standard of living index scale. So, socio-economic status is defined in the given slide that is modified Kuposama scale for urban which is determined by income occupation and literacy IOL that is intraocular lens income occupation and literacy. So, income is here occupation is here and education is here for education the maximum score is 7, for occupation the maximum score is 10, for income the maximum score is 11, for all this IOL the minimum score is 1. So, based on this come adding all these scores we will yield a score of maximum of 29 and the minimum of 1. So, based on these categories further we can classify into upper upper middle lower middle upper middle lower 1 2 3 and 4 or 1 2 3 and 4 respectively. So, this is the modified Kuposama scale for urban why it is called modified is basically it was calculated in around 1980s. So, every year based on this CPA that is Consumers Price Index. So, which is district specific and also every week it differs. So, based on that recent one we can calculate. So, this is the February 2019 calculation if something comes up in 2020 or you can ask your department faculties to calculate for the recent one using this modified Kuposama scale and formulas. So, they can give you. So, now, for the rural and urban but we generally recommend this only in case of rural families. So, VG preserves scale which is given by the formula total family income divided by total family members that is the per capita income. So, based on which upper upper middle middle lower middle and lower classes are classified. So, these are all the cutoffs. So, again based on the CPA we can calculate again based on the CPA we can calculate the recent VGA preserves classification. So, this is 2019 January 1. So, 2020 will come. So, wait for that classification. So, from we are moving on from socio demographic details to clinical details. Clinical details we start with history. History first and foremost is the complaint. Complaint is nothing but what for the patient has come to the hospital. What for the patient has come to the hospital is called as the complaint. History of presenting illness is just describing the illness from a normal apparently normal state to the progress and how he is now. So, how he is now. So, this exact position is the current situation is explained in the history of illness. So, all the positive symptoms has to be described based on this. If suppose we have fever here then how was the onset and what is the duration, how we progressed, what was the relieving factors when it get aggravated. So, that has to be there then we have to describe the situation. From this we have to tell about the negative history any significant negative history. So, from complaints and history of presenting illness we have to direct our all our findings towards a particular diagnosis. So, for this negative history is very important to rule out the other diseases with the history to rule out complications also. So, complications also we have to ask the symptoms for examples in for example in dehydration we can ask for drowsiness and other or for endiabetes we can ask for the symptoms severity or grading we can ask. So, differential diagnosis and related history can also be ruled out through the history of the history of presenting illness. Then we are moving to the clinical details. Clinical details this is the treatment history we are moving to treatment history that is before admission what was the drug taken, what was the dosage and frequency whether there was any similar illness in the past was present and we have to ask about the health care delivery assessment what is the nearest health facility available and how far it is present that also we need to ask and during every episode of the illness what was the response from the patient that we have to respond in the chronological order and based on all the symptoms we have to describe where they have gone and what kind of treatment they have taken based on the place what is the treatment taken whether they have when they have referred and what was the status of the disease all these things we have to discuss in clinical details which is followed by past history. So, past history we have to ask for the certain set of standard diseases which you need to remember these diseases will always affect the severity of other diseases in other subjects, but in case of community medicine diabetes militants hypertension and stroke tuberculosis and all are all cases which can be kept in exams. So, that we have to be very careful. So, we have to we need to ask that is the importance for asking this past history. So, history of drug allergy also should be asked family history. So, there are two types of family history any family history of noncommunicable diseases like diabetes and hypertension will act as a predisposing factor for that person getting the disease. In case of a communicable disease this family history will help in the contact tracing of the disease. So, moving on to the personal history here the behavior is targeted that is alcohol smoking, tobacco chewing and other high risk factors. Some may include sleep and diet also in within the personal history diet also within the personal history and in menstrual in with females we need to ask the menstrual history that is Menarch and the cycles which is regularly regular or not and the frequency what are all the number of days of bleeding and the number of days of cycle. Then the last one in the clinical details is the diet history. So, diet history we need to describe whether the patient is vegetarian or non-vegetarian and what is the staple food which is present this may be rice, ragi or wheat commonly most commonly in our wettings it will be rice. So, what is the frequency of non-vegetarian per week what is the frequency of fruits and vegetarian per week if the frequency is very often then you can reduce it to per day calculation oil usage per month what is the oil usage per month in the family then then here you have to tell according to the 24-hour dietary recall method you have to tell the patient has consumed in the morning around this time he has consumed this meal which has yielded this calorie and this protein and he has taken for the break first too easily like this we have to give the calculation. So, totally we need to calculate here and put it put the daily intake here and we have to estimate the daily requirement based on the gender working capacity and the body weight also. So, all these things we have to consider and we have to calculate the energy requirement and substitute the energy requirement and the protein and we have to mention the sufficiency also sufficiency or insufficiency which can be indicated by excess in case of positive sign and negative in case of deficiency. Now, we have completed socio demographic details and clinical details now we are moving moving to socio families family details now we are moving to socio economic socio environmental factors. So, environment first and foremost is the housing. So, we have to look at whether the house is pukka kachar semi pukka. So, which is defined by the good roof and wall which is wall and floor then it can be defined as a pukka house and any house which has a leaking roof and floor will be considered as a kachar house and any house which has a improper other than concrete and floor impervious, but currently in a good function will be considered as a semi pukka house. Now, we are moving to the over crowding over crowding can be given by three formulas three criteria that is sex separation number of persons per room and also number number of persons per floor space area. Lighting also we can ask the patient whether they can be able to read in all the corners and in the center of the house in the all the rooms thereby we can assess the lighting of the house and we can say adequate or not adequate and remember this is lighting not lightning. We have to mention about ventilation. Ventilation is given by the criteria based on the floor space area and the window space area and the floor space area and the window and door space area combined. So, ideally it should be the window space should be one-fifth of the floor space area and the window and the door space combined should be more than two-fifth of the floor space area that is how we calculate the ventilation. When the when the windows and the door space each other then you can call the cross ventilation is present. Then we have to ask about the water supply where is the source whether the source is from the well or from the corporation that you have to ask and how they are storing how they are storing that water how what are the any household methods of clarification they are doing and whether that water is adequate or not all these things you should ask. Then we we should ask about the latrine facility and whether the latrine is sanitary or not. This sanitary latrine is given by the criteria three criteria one is the 24 hours water supply. I mean 24 hours water supply it is not the pipe water supply or tapped water supply. There should be water always present 24 hours which can be either in a bucket or available through the sink. So, that is the first criteria and the second criteria is the presence of the water seal. The purpose of the water seal is to avoid the is to prevent the flies from entering into the septic tank or the into the feces getting in contact to the feces and the smell from the feces should not come out. So, that is the purpose of the water seal and the third most important is this sewage should be disposed properly into the sewage treatment plant or a septic tank. So, these are all the three criteria to say a latrine sanitary. Then about the solid waste disposal how they are collecting what are all the methods followed how frequently they are collecting how how are they disposing where are they what is the site and how far it is located. So, all these things we need to ask when it comes to solid waste disposal then kitchen and cooking fuel used what are all the kitchen fuel used the kitchen platform whether it is present or not type of fuel and how the raw food and cooked food is stored whether refrigerator is present or not that and all we should ask. Then whether we should we should ask about the hand washing practices whether they are washing before eating before cooking and after defecation with soap and water that we need to ask and we should ask about the pets in the family this will help in the predisposing identifying the predisposition factors were presence of any zoos within the family. And also we should ask about the vector breeding sites whether it is present or not. So, then we this is that was about the environmental factors and this is about the social factors and this social factors remember it cannot be asked as a performer you have to develop a good drapo you have to explore and speak to the patient when the heart sociology is otherwise called as study of human behavior or psychology. So, more it is a connect between the two hearts. So, you have to develop a good drapo and will have a good discussion and explore your objectives. So, you need to identify the knowledge attitude practice of the patient towards the disease. So, what is the attitude of the family towards the patient? What is the attitude of the society towards the patient whether there is the health services which is available or not and the effect of illness whether there is any financial strains and sociological effects and psychological effects on the family that we should assess and after assessing this four important that is socio demographic family, socio environmental and socio environmental factors we need to summarize the history. So, this patient has come is coming from this belonging to the socio economic status according to BG presides or modified copusamis classification of upper middle class say for example, the hailing from this family with complaints of this thing with a significant medical and socio environmental history that you should mention. Then we move on to the physical examination as routine. So, we say the pickle is the pneumonia, PA, CCKLE. So, PIC, Pialar, Tress, Sinosis, Pedaladema, Lymphadema, Clubbing, Pulse whether it is present pulse, the pulse rate, pulse rhythm and other characteristics should be mentioned. The blood pressure as usual as how you present in medicine you need to present all these things as respiratory rate, weight, height and BMA which is calculated by weight divided by height in meter square, weight in kilogram divided by height in meter square. So, he keeps circumference, weighs to circumference and weighs to keep ratio this is most important in case of diabetes and hypertension the other non communicable disease any other general relevant findings in the general examination also should be presented. Then we physical examination is divided into general and systemic examination where RS and we divide it into system RS should be of more focus when we have two cases like TB and ERI when we get it is tuberculosis and acute respiratory infection then we need to focus more on this RS. Then other systems like CVS and L will be more on hypertension, hypertension etc. Then CNS we have when we get leprosy we need to focus more on CNS. Then abdomen, foot examination in case of diabetes is also very important. We have to look for any ulcers how the nail is kept whether it is properly cut and clear then cracks is present or not then color change is present or not all these things we should observe. Then we should observe for any temperature difference and the dorsal is PD satiric pulsation and posterior tibial artery can be felt. Then vibration sense also can be checked which is the first sense to lose in case of all neurological defects. So, from here from history we have moved on to the examination and now we have to come to a particular diagnosis. So, we have to tell replace with the complaints with the diagnosed with this and with the grade what is the grade of the disease and any complications is present or not. So, that you have to mention. Then when it comes to investigations we have to mention about routine investigations and you have to be very careful when you mentioned routine examinations. Some examiners are very fond of it some examiners are some examiners are offensive towards routine investigations. But most important is this confirmation of the diagnosis that is there will be specific gold standard test for that particular disease to diagnose that particular disease that should be mentioned for the confirmation whether it is it already done or which is required and ruling out the complication severity you need to assess. So, you need to identify the grade and severity for that you need to do prescribe some investigations. So, now this is the management. We have medical and social aspects into it and every management part is divided into preventive, promotive and curative measures preventive, promotive and curative measures. So, this is as I told earlier it is not only at the individual level, but also at the family level and the community level. So, in at individual level we have to give the treatment to alleviate the symptoms and to cure the disease and for and advice that is what are all the other non-pharmacological measures which can be done to get out of the illness. So, everywhere we have to divide it into three important thing that is primary prevention, secondary prevention and tertiary prevention. So, every at every level we need to give primary prevention, secondary prevention and tertiary prevention. So, and tertiary prevention. So, and in family level and community level and all you can add one more primordial prevention also apart from this primary and secondary levels. So, in family level we need to identify the any stigma present and the support what patient expects that we need to give to the family family and at the community level we need to identify the pros and cons which is present in the health program and what are all the benefits possible benefits which the patient can get from the government to the patient that you can mention and whatever possible nice recommendation you are giving that intimate it to the patient tell to the patient first then write it in the case sheet because many examiners nowadays check whether you have told it to the patient rather than writing alone. So, these are all the last few slides which has a few additions in anti-natal case. So, that is whenever you are asking anti-natal case in knowledge attitude practice segment we need to ask about the awareness and belief of the mother's nutrition, iodized salt intake is there or not, breastfeeding awareness, immunization awareness, vitamin A, profile access, family planning method, Anganwadi centre where it is located, personal hygiene, warning signs all these things should be asked. The attitude of the mother's towards pregnancy, attitude of the family towards pregnancy, cultural practices during pregnancy and utilization of the health services that we need to know and we need to know about the obstetrics code that is G P L A, we all can be can easily say L is the live births that is total number of live children now not the live births it is the live children now. A means abortion which is less than any day delivery less than 28 weeks will be considered as abortions. Para means which is any delivery which has crossed more than 28 weeks any pregnancy will be considered as gravidha, so that is G. So, EDD is calculated by needle's root that is adding 9 months and 7 days to the first day of last menstrual period. So, thereby we can calculate the EDD and the additions in antinatal case continues here. So, first trimester, second trimester and third trimester we need to ask these specific points that is first trimester we need to ask what is the time of the registration and whether morning sickness was present or not and in the after the first time of registration whether any investigations were done or not and TT was given or not, how many TTs were given and how many IFAs were prescribed, how many IFAs are taken that we should account and any history of drug intake should be asked because any drug intake during the first trimester will cause serious birth defects and weight gains will be usually asked in almost all the trimesters and it will be more significant in third trimester. Then second trimester we should ask about the quickening that is the perceived fetal moments by the mother for the first time, then warning signs then we should ask about the hours of sleeps and rest what they are taking then the antinatal visits what is the recommended antinatal visits what in each visit what they are supposed to do that you have to ask. Then in the abdomen where we inspecting we need to ask about the linear, of course inspect the linear nigra, striogravidum and palpit, all these fundal kite, abdomen, everything, pelvis, pelvis group, second pelvis group is in the purpose is to identify the gestational age and you need to see the whether the calculated gestational age approximates with the real gestational age so that you can identify the baby is small for the date or large for the date and we need to see the fetal head retarded using the fetoscope. So, these are all some of the key points in clinical social case performer. There are all the key points when it comes to clinical social case performer. Hope this presentation was useful to you. The link for downloading this case performer is given in the description so you can download and in the next presentation we will continue with what are all the additions for the new bonds and under file child and the recommendations for each diseases individually based on the primary, secondary and tertiary prevention at the individual family and the community level. So, that will be in the upcoming videos till then you subscribe to the channel click on the bell icon all the best. Thank you.