Narketpally syndrome: A different approach to medical education and research

From: Marc Jamoulle
MD (UCL 1974), PhD (ULg 2017)
Family physician, Belgium (INAMI 15324119004)
marc.jamoulle AT uliege.be
Associate researcher at HEC-Liège, BAS-SCM, University of Liège, University of Rouen, D2IM & CAMG-UCL, Brussels

hi friends,

in an unknown syndrome, another way to deal with the patient, to learn from the patient, to develop a partnership with the patient, caring while waiting for the cure,

Jamoulle, M., & Soylu, S. (2025). Phenotyping Long COVID in Children in Primary Care: A Case-Based Study Using the Human Phenotype Ontology. ORBi-University of Liège. https://orbi.uliege.be/handle/2268/334447

From: Rakesh Biswas
rakesh7biswas AT gmail.com

This paper illustrates a global patient-centered learning ecosystem, anchored in Narketpally, that adopts a syndromic approach to medical education and research. Rooted in the etymological origins of 'syndrome' ("together we flow"), this approach reframes medical research as a collective, contextual response to individual patient needs.

https://pubmed.ncbi.nlm.nih.gov/40674544/

Methods: The structure of the paper is intentionally modeled as a team-based learning exercise, grounded in our prior Web 2.0-based cognitive tools: CBBLE (Case-Based Blended Learning Ecosystem) https://pmc.ncbi.nlm.nih.gov/articles/PMC6163835/ and PaJR (Patient Journey Record) https://pajr.in/. These are framed against the conceptual scaffolding provided by three key publications: a framework by Sturmberg et al. and two contrasting commentaries by Greenhalgh and Ioannidis.

Results: Through our ongoing CBBLE-PaJR workflow, thematic learning outcomes emerged in response to these frameworks. Sturmberg's stratified realism helped us recognize how individual patient connections, recorded in our daily practice and online learning portfolios, can drive both contextual learning and meaningful changes in patient outcomes. Greenhalgh's commentary inspired our conceptualization of a 'wildebeest river crossing value model,' contrasting population-based efficiency with individual-centered compassion. Ioannidis's critique of methodological rigor highlighted the potential for expanding low-resource, high-impact research through patient-centered designs, particularly in phases 1 and 4 of the clinical trial hierarchy.

Podder, V., Kulkarni, R., Samitinjay, A., Salam, A., Gade, S., Agrawal, M., Surendran, A. K., & Biswas, R. (2025). Narketpally Syndrome and the Embedding of Contextual Values in Real-Life Patient Pathways. Journal of evaluation in clinical practice, 31(5), e70186. https://doi.org/10.1111/jep.70186
[Citation added PJ].
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My source:
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Politicians! Please leave it to the Public ...

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'Kick' - a verb, more often it seems, a noun.	Health and Social Care?
Gent kicking a can Wall poster/photo Corfu Town	... to kick the can down the road!

RCN Congress iii 2025 - Accountability for patients in ambulances

The resolution (with a reading list) on Accountability for patients in ambulances

- drew attention to language once again (yes, well there's a truism: what do you expect!). This time highlighting how corridor care is now variegated. In addition, politically you can circumvent addressing an issue, by referring to 'never events', and 'zero tolerance' as we read:

'This agenda item addresses the urgent issue of accountability, for both registered nurses and the organisations they work for, when patients are cared for in ambulances waiting to access emergency departments.

The resolution comes at a time when, across all four countries, there are unprecedented ambulance handover delays with patients left in vehicles which are neither appropriately staffed nor resourced outside overwhelmed emergency departments. Despite the prolific nature of this practice, there is no clear guidance on accountability. Who is responsible for the care and safety of those patients - the ambulance service, the hospital, the emergency department, or the individual registered nurse providing care?

These delays accessing care and the lack of guidance on who is accountable for the waiting patients, compromises the ability of health care staff to provide good quality care and risks patient safety. It also exposes registered nurses and other health care professionals to professionally, ethically and legally ambiguous situations. It could also contribute to the crisis in nursing wellbeing, raising issues such as moral distress and professional, emotional and physical burnout. It may, therefore, also impact the already perilous recruitment and retention.'

Student nurses, paramedics ... please take note: There is a paper to be written on Hodges' model and the gaps we encounter in health and social care. For Brian Hodges this started with the theory-practice gap; one of four original stimuli for the creation of the model. 

As the idealised standards, quality and safety of care being delivered are surrendered; this gap stands out as the virtual keystone.

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individual - PURPOSES patient safety - distress nurse wellbeing emotional burnout moral distress personal ethics individual responsibilities	procedure delivered care - observation mattress, trolley .. ambulance design instrumentation, noise time - duration logistics - PROCESSES - handover physical resources - beds
communities of PRACTICE team working - coherence team experience - students THE DAMAGE - that is 'BOOK-PASSING' The public's - carer's experience (wither friends and family)	law - guidance - ambiguity POLICY professional accountability risk management organisational responsibility workforce recruitment & retention

Previously: 'RCN' : 'gap' : 'accountability' : 4Ps

'ABCD' mapped to '1234'*

For context [UK politics and policy] please see below ...

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BACKLOGS Person-centred: "Am I there yet?" Service-centred: "Are we there yet?"	AMBULANCES 'Just in TI:ME' [not] Hand-me-over-why-don't-you?
(Social) CARE	DOCTORS DENTISTS

"Sally Warren, director of policy at The King’s Fund,
said that Our Plan for Patients ‘amounts to little more
than tinkering at the edges’ despite containing some
‘sensible’ policies."     https://www.nursinginpractice.com/

Whether tinkering or not, don't forget and do take care around all the edges.
Do 'C' the low-hanging fruit.

[Just to be clear: This isn't about ✔ in boxes.
It's about integrating care, values, quality and safety. ]

https://www.nursinginpractice.com/latest-news/therese-coffeys-plan-for-social-care-only-short-term-solution/

^ and '5' the Spiritual too.

Context:

"Thérèse Anne Coffey is a British politician who has been Deputy Prime Minister of the United Kingdom and Secretary of State for Health and Social Care since 6 September 2022." Wikipedia.

"For Coffey, 'ABCD' stands for ambulances, backlogs, care, doctors and dentists – and rightly so." The Guardian

See also: c/o The Health Foundation

What are the public’s priorities for the NHS? And is the government listening?

Nursing in the Digital Age survey

📢If you haven't yet completed our #Nursing in the Digital Age survey, please do and also share with your colleagues!

We would like to know how you use technology at your work and what effect it has had on workloads ⬇️https://t.co/Qxii5Pm7GY https://t.co/aYCbUsb8DF

— The Queen's Nursing Institute (@TheQNI) June 24, 2022

[and my source]

Nursing In the Digital Age 2022 (2) 

"Smart New World was published by the QNI in 2012 and again in 2016. Ten years later we think it is time to assess the level of progress and development in digital technology you use at work since the report was published. We are particularly interested in any effect (positive or negative) it has had on workloads. 

 We have created a survey to inform this work. It has 31 questions and should take around 8 minutes. Your contribution would be greatly appreciated. It contains no identifying information. Please address any queries to Alison Leary (alisonleary AT yahoo.com) or Dave Bushe dave.bushe AT qni.org.uk Thank you! SurveyMonkey is a third party provider. Please do not enter any patient identifiable or personal data other than your email address if you wish to share it with us at the end of the survey."

https://www.surveymonkey.co.uk/r/NITDASoMe

Healthcare & Nursing: A select sport

Ed Smith: ‘We can’t risk stars’ mental health by playing too much’

Gruelling summer proved to England selector that player welfare is critical

Apparently, cricket is a late arrival to team building around a strong core and leader and then using a selection strategy. According to Wilde (below*), cricket is playing catch up with baseball (1880) football (1990) and rugby in 2010s. Even with a squad and substitution some players can play too much with physical and mental impacts. Delivery of healthcare is no 'game' even though certain aspects are open to gamification. Everyone understands the need to stay 'fresh' and avoid injury (burnout too). Nurses are not the only professionals and team players to experience the paradox of a break. On the one hand it's like you've never been away; on the other it is great to pick up the threads of cases, caseloads, referrals old and new. Key here too is the cover provided by colleagues while you were temporarily 'off the field'.

"Eddie Jones was asked after England's quarter-final
win over Australia if he felt vindicated in his decision
 to drop George Ford. He said, we didn't drop him, we
changed his role - welcome to modern rugby."

In health, the appliance of sport's 'win ratio' is not in dispute. We can test this! What is the satisfaction rating of the patient and family? But, let's broaden things to include the tax-payer and the patient's recovering, staying that way and becoming self-caring as far as possible. What has to be considered is the context, for example, palliative, end-of-life care and the aims of care.

Nurses have no choice but to 'play'. Sometimes an astute manager will recognise that a specific staff member is best suited to deal with a specific referral, or re-referral even.

As you guessed it, 'selection' does not end there. 

If Hodges' model is the compound field of play, then the selection of care concepts is the vital strategy to assure -

• person-centredness;
• integrated care;
• parity of esteem;
• reflective practice;
• critical thinking;
• a learning encounter;
• preventive approaches
• addressing health and other literacies ?
• teamwork ...

Yes, care assessment, evaluation can be a team effort. The significant care concepts (social determinants ... ), associations and priorities, risks and opportunities can be identified by an individual practitioner and also as a collective effort (group case discussion) and always with the patient / carer - guardian.

So, let Play commence  - and congratulations South Africa!

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Simon Wilde, Cricket correspondent, The Big Interview. ‘We can’t risk stars’ mental health by playing too much’. The Sunday Times. October 27 2019. p.9.

https://www.thetimes.co.uk/article/ed-smith-interview-risk-mental-health-cricket-brw2t8lxk

Articulating the Socio-Technical and much more c/o @Atul_Gawande

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John ---- Atul

"The story of modern medicine is the story of our human struggle with complexity. Technology will, without question, continually increase our ability to make diagnoses, to peer more deeply inside the body and the brain, to offer more treatments. It will help us document it all—but not necessarily to make sense of it all. Technology inevitably produces more noise and new uncertainties. Perhaps a computer could have alerted me to the possibility of a genetic disorder in John Cameron, based on his history of skin lesions and the finding of high calcium. But our systems are forever generating alerts about possible connections—to the point of signal fatigue. Just ordering medications and lab tests triggers dozens of alerts each day, most of them irrelevant, and all in need of human reviewing and sorting. There are more surprises, not fewer. The volume of knowledge and capability increases faster than any individual can manage—and faster than our technologies can make manageable for us. We ultimately need systems that make the right care simpler for both patients and professionals, not more complicated. And they must do so in ways that strengthen our human connections, instead of weakening them."

Cameron ---- Gawande "I had more time for his questions now, and I let him ask them. When we were done and I was about to get off the phone, I paused. I asked him if he’d noticed, during our office visit, how much time I’d spent on the computer. “Yes, absolutely,” he said. He added, “I’ve been in your situation. I knew you were just trying to find the information you needed. I was actually trying not to talk too much, because I knew you were in a hurry, but I needed you to look the information up. I wanted you to be able to do that. I didn’t want to push you too far.” It was painful to hear. Forced to choose between having the right technical answer and a more human interaction, Cameron picked having the right technical answer."

Atul Gawande, Why Doctors Hate Their Computers. Annals of Medicine, November 12, 2018 Issue

Drupal - update: users, roles, content and permissions

I just thought I'd provide an update on the new site.

There's still nothing new on the hosting account. I managed to update on localhost from 8.5.0 to 8.5.3. As I went to the Manchester Drupal Sprint two weekends ago I had a couple of errors. Webform was proving awkward but that was probably me the way I tried to remove it in order to update. It appears there have been some problems, but switching on "Logging and errors" I had more errors that weekend and working through with advice and support at the Sprint things resolved!

Poking around has been really useful and thus far I've not had to start from scratch. Webform is updated but I realised previously I have only scratched the module's surface. Then there is Paragraphs! This is the challenge with Drupal and the range of modules available as explained at DrupalCon Nashville. I know, I know, I've picked up pen and paper and am fleshing out users, roles, content and permissions. This is a distraction. There has always been help available - that's the Drupal community. I've someone to chat with now and looking forward to updating Richard and help to get the new site live. Richard was at Szeged my first Drupalcon in 2008. I remember the advice of Chris, Dan and James back then and Phil, Nathan and others since: Just do it!

So I can't keep scribbling on paper - or here...

ERCIM News No. 110 Special theme "Blockchain Engineering"

Dear ERCIM News Reader,

ERCIM News 110

ERCIM News No. 110 has just been published at https://ercim-news.ercim.eu/

In this issue: 

- Special Theme "Blockchain Engineering" coordinated by the guest editors Elli Andoulaki (IBM Research – Zurich), Matthias Jarke (RWTH Aachen University & Fraunhofer FIT) and Jean-Jacques Quisquater (Université catholique de Louvain, Belgium, and research affiliate at MIT).

---

• Call for Proposals - Dagstuhl Seminars and Perspectives Workshops
• European Computer Science Summit 2017, Lisbon, 23-25 October

---

A public sector section includes - "How Distributed Ledgers Can Transform Healthcare Applications".

This issue is also available for download in pdf and ePUB

Thank you for your interest in ERCIM News. Feel free to forward this message to others who might be interested.

Next issues: 
No. 111, October  2017 - Special Theme: "Digital Humanities"
No. 112, January 2018 - Special Theme: "Quantum Computing"

Best regards,
Peter Kunz
ERCIM News editor in chief

Mindsets and Desksets

Trying to pick up the programming handle again (literally in the case of Ruby) has reminded me that it isn't just a matter of mindset, an effective working environment is essential too. At work I noticed how the systems developers frequently use two monitors. The penny has dropped recently as I've realised; on the old BBC micro I actually used two monitors, one of them was a 12inch Philips mono that was really clear for all its limited palette. The other screen was a Grundig portable TV. The BBC micro was brilliant with its varied graphic modes including teletext. Funny that trying to identify what graphic mode you needed to achieve the learning (program) objective, which in turn affected the amount of RAM. Happy virtual juggling times.

Watching display technology evolve at the Which Computer Show in Birmingham, I could never afford a Microvitek proper jobbie. Now though if I feel given some 'progress' I can justify another monitor and reconfig the desk space - then ...