February 10  2015, Tuesday
editorial
Rise and fall of Nuclear Cardiac Imaging
Dr KK Aggarwal The use of nuclear myocardial perfusion imaging declined substantially in a large integrated healthcare system during a recent 5–year period, reports Medpage.

Following an increase in use from 2000 to 2006 at Kaiser Permanente Northern California MPI use dropped by a relative 51% through 2011 according to Edward McNulty, MD, of Kaiser Permanente Medical Center in San Francisco.

Replacement by cardiac CT and stress echocardiography did not explain the pullback from using MPI, the researchers reported March 26 issue of JAMA.

The fact that greater declines were observed amongst lower–risk subsets (outpatients and younger persons) suggests MPI use became more discriminating (used preferentially in higher–risk persons), as per the authors.

Other reasons may be "more recently, factors potentially discouraging use, such as appropriate use criteria, declining reimbursement, radiology benefits managers, and more publicized concerns about the health effects of radiation have emerged."
eMedipics
IMA,IJCP,HCFI
CPR 10 Training Camp NDMC
News Around the Globe
  • The US Food and Drug Administration (FDA) has expanded the approved use of ranibizumab injection (0.3 mg) to treat diabetic retinopathy in patients with diabetic macular edema (DME).
  • Optimal use of modern contraceptives could avert an estimated 15 of 16.7 million unwanted pregnancies each year in 35 low- and middle-income countries, suggested a demographic health survey published online in Human Reproduction.
  • Pregnancies diagnosed with preeclampsia in the preterm period have a very high relative risk for fetal death, revealed the findings of a population-based cohort study published in the March issue of Obstetrics & Gynecology.
  • Body image dissatisfaction (BID) is common in individuals with inflammatory bowel disease (IBD) and may be associated with lower health-related quality of life, reported studies conducted in Ireland and the United States. Both studies are published online in the February issue of the journal Inflammatory Bowel Diseases.
  • Increasing the hours of hemodialysis each week does not affect quality of life, but it does have a positive influence on other parameters, including blood pressure, suggests a new study presented at the American Society of Nephrology 35th Annual Dialysis Conference.
Dr KK Spiritual Blog
The Scientific Aspects of Prayer

It is natural for us to promise or offer to pray for someone who suffers from sickness. So many people believe in the power of prayer that it has now caught the attention of scientists and doctors. Today most hospitals and nursing homes are building prayer rooms for their patients, based on the principle that a relaxed mind is a creative mind. During prayer, a person is in touch with the consciousness, and is able to take correct decisions. Most doctors even write on their prescriptions “I treat He cures”.

Medically it has been proved that the subconscious mind of an unconscious person is listening. Any prayer therefore would be captured by the patient building inner confidence and faith to fight terminal sickness. We have seen the classical example of the effect of mass prayer on a person’s health in the case of Amitabh Bachchan’s illness.

“Praying for health is one of the most common complementary treatments people do on their own,” said Dr Harold G Koenig, co-director of the Center for Spirituality, Theology and Health at Duke University Medical Center.

About 90% of Americans and almost 100% Indians pray at some point in their lives, and when they’re under stress, such as when they’re sick, they’re even more likely to pray.

More than one-third of the people surveyed in a recent study published in the Archives of Internal Medicine said they often turned to prayer when faced with medical concerns. In a poll involving more than 2,000 Americans, 75% of those who prayed said they prayed for wellness, while 22% said they prayed for specific medical conditions.

Numerous random studies have been conducted on this subject. In one such study, neither the patients nor the healthcare providers had any idea who was being prayed for. The coronary care unit patients didn’t even know there was a study being conducted. And, those praying for the patients had never even met them. The result: While those in the prayer group had about the same length of hospital stay, their overall health was slightly better than the group that didn’t receive special prayers.

“Prayer may be an effective adjunct to standard medical care,” wrote the authors of this 1999 study, also published in the Archives of Internal Medicine. However, a more recent trial from the April 2006 issue of the American Heart Journal suggests that it’s even possible for some harm to come from prayer. In this study, which included 1,800 people scheduled for heart surgery, the group who knew they were receiving prayers developed more complications from the procedure, compared to those who had not been a focus of prayer.

Many patients are reluctant and do not discuss this subject with their doctors. Only 11% patients mention prayer to their doctors. But, doctors are more open to the subject than the patients realize, particularly in serious medical situations. In a study of doctors’ attitudes toward prayer and spiritual behavior, almost 85% of the doctors thought they should be aware of their patients’ spiritual beliefs. Most doctors said they wouldn’t pray with their patients even if they were dying, unless the patient specifically asked the doctor to pray with them. In that case, 77% of the doctors were willing to pray for their patient.

Most people are convinced that prayer helps. Some people are ‘foxhole religious’ types and prayer is almost a reaction or cry to the Universe for help. However, many people do it because they’ve experienced benefit from it in the past.

If a patient wants to pray and feels it might be helpful, there’s no reason he should not. If he believes that prayer might work, then he should use it.
IMA,IJCP,HCFI
Cardiology eMedinewS
  • Researchers have determined that two mutations on a single gene can interact in a way that lowers the carrier's risk for a heart attack. The variants are found in a gene called DBH, which regulates an enzyme involved in the conversion of dopamine to norepinephrine. The research is published in a recent issue of the journal Circulation Research.
  • A large meta-analysis has found that women with type 1 diabetes have more than twice the risk of dying from heart disease compared with men who have the condition. The study is published in The Lancet Diabetes & Endocrinology.
Pediatrics eMedinewS
  • Babies born prematurely are more likely to develop asthma, but they grow out of it, reported a new study published in the medical journal PLos One.
  • In a study published in Frontiers in Cellular and Infection Microbiology, researchers from the UNC School of Medicine and UNC College of Arts and Sciences found that a baby's diet during the first few months of life has a profound influence on the composition, diversity, and stability of the gut microbiome. These factors, in turn, influence the baby's ability to transition from milk to solid foods and may have long-term health effects. Exclusively breastfed babies are better equipped for the transition to solids and potentially an early life with fewer stomach woes.
Make Sure
Situation: A patient with acute heart attack died on the way to the hospital
Reaction: Oh my God! Why was the patient not accompanied by the doctor?
Lesson: Make sure that all heart attack patients are accompanied by the doctor to the hospital so that chest compression CPR can be given, if the heart stops, on the way.
Event
IMA,IJCP,HCFI
Medicolegal
(Contributed by Dr MC Gupta, Advocate)

Q. What should a doctor do when:
  • A victim of sexual assault/rape victim voluntarily comes for treatment to the hospital after the incident but she (or her guardian) does not want that the matter may be reported to the police?
  • A child is brought for treatment by the mother and the doctor suspects that it is a victim of sexual abuse by a near relative but the mother does not want to report the matter to the police?
What is the applicability of section 39 CrPC, section 174 CrPC and section 202 IPC in such cases?

A.
  • When anybody comes to know that a crime has been committed, it is part of his responsibility and duty toward the public that he should report the same to the appropriate authorities.
  • A doctor has to deal with medico–legal cases. I would classify medico–legal cases into the following categories:
    • Those cases that are brought to the doctor by the police;
    • Those cases that have to be mandatorily informed to police under Section 39 CrPC;
    • Those cases where the doctor suspects foul play (such as rape; child abuse; stab wound etc.)
    • Those cases where the injury or death appears to be accidental but is likely to be a subject of litigation in future (such as a roadside accident).
A sexual offence belongs to the category ‘c’ above. The doctor should ordinarily report such cases to the police but should not do so when the person concerned specifically withholds consent for such reporting and requests professional confidentiality. However, if the doctor has reason to believe that the victim maybe either incompetent to give or withhold free and informed consent (minor; unsound mind; coercion or fear or undue influence), he would be within his rights to act in the best interest of such victim and override the requirement of professional confidentiality and report the matter to the concerned authorities.
  • Some offences have to be mandatorily reported to the authorities as per the provisions of Section 39 of the Code of Criminal Procedure, 1973, titled "Public to give information of certain Offences". The section is reproduced below:
"(1) Every person, aware of the Commission of, or of the intention of any other person to commit any offence punishable under any of the following sections of the Indian Penal Code (45 of 1860), namely:

××××××
××××××××
××××××××

shall, in the absence of any reasonable excuse, the burden of proving which excuse shall lie upon the person so aware, forthwith give information to the nearest Magistrate or Police officer of such Commission or Intention."
  • Section 174 of CrPC titled "Police to inquire and report on suicide etc." refers only to cases where death has been caused by suicide, animal, machinery or accident etc.
  • Section 202 IPC, is titled "Intentional omission to give information of offence by person bound to inform" and reads: "Whoever, knowing or having reason to believe that an offence has been committed, intentionally omits to give any information respecting that offence which he is legally bound to give, shall be punished with imprisonment of either description for a term which may extend to six months, or with fine, or with both." It is clear that the words "which he is legally bound to give" refer to section 39 CrPC.
  • The offences of sexual assault mentioned in the question do not fall within the purview of Section 39 CrPC. Hence there is no mandatory requirement that a doctor should report the same to the police.
  • The doctor concerned may face the following situations and he/she should act accordingly as indicated below:
    • When the patient/victim/guardian has no objection to the crime being reported to the police: The doctor should inform the police.
    • When the patient/victim/guardian appears to the doctor to be competent to give free and informed consent and expressly states (in writing, under signature, with a witness) that he/she does not want a police report: The doctor should not inform the police. However, it is likely that some time in future, the police may ask the doctor about the particular incident. Hence it is important that the doctor should keep the record of the patient in sufficient detail in safe custody because it may be the subject of litigation in future.
    • When the doctor thinks that it is likely that the victim/guardian is a minor or not of sound mind or is under influence or fear or is acting against the interests of the victim––The doctor should feel free to breach the confidentiality clause and should report the matter to the police
Dr Good Dr Bad
Situation: A patient with skin disease needed circumcision and wanted to know whether mediclaim covers it or not.
Dr. Bad: It will not be covered.
Dr. Good: It will be covered.
Lesson: Circumcision is excluded unless it is necessary for treatment of a disease.

(Copyright IJCP)
IJCP Book of Medical Records
IJCP’s ejournals
IMA,IJCP,HCFI
Twitter of the Day
Dr KK Aggarwal: Smoking may dull taste buds By Dr KK Aggarwal http://youtu.be/NMIK16PyBrY?a via @YouTube
Dr Deepak Chopra: There is one experience that brings joy or happiness to every living being. The experience of love http://bit.ly/DC_Ananda #ananda
CPR 10
Total CPR since 1st November 2012 – 101090 trained
Rabies News (Dr A K Gupta)
Can a vaccinated dog transmit rabies? How effective is dog vaccine?

If a potent veterinary vaccine is given correctly as per pre–exposure schedule, it will mostly prevent rabies in the vaccinated dog, unless the exposure is severe. Ideally, its sera should be tested for protective antibody titer level but this is rarely practicable due to scare facilities in our country. Consequently, PEP vaccination is recommended following bites even by vaccinated dogs. It has been noted that:
  1. 6% of dogs found rabid have a reliable pre–exposure rabies vaccine history and that
  2. 40% of dogs’ vaccinated only one time lost most of their immunity 4–6 months later.
  3. Post Exposure Prophylaxis (PEP) vaccination is not very successful in dogs
eMedi Quiz
The earliest immunoglobulin to be synthesized by the fetus is:

1. IgA.
2. IgG.
3. IgE.
4. IgM.

Yesterday’s Mind Teaser: In post-operative intensive care unit, five patients developed post-operative wound infection on the same day. The best method to prevent cross infection occurring in other patients in the same ward is to:

1. Give antibiotics to all other patients in the ward.
2. Fumigate the ward.
3. Disinfect the ward with sodium hypochlorite.
4. Practice proper hand washing.

Answer for yesterday’s Mind Teaser: 4. Practice proper hand washing.

Correct Answers received from: Dr Avtar Krishan, Daivadheenam Jella.

Answer for 8th Feb Mind Teaser: 4. Ethylene oxide gas.

Correct Answers receives: Dr KV Sarma, Dr Avtar Krishan, Daivadheenam Jella, Dr Thulasi.
News on Maps
Video of the Day
Sameer Malik Heart Care Foundation Fund
The Sameer Malik Heart Care Foundation Fund is a one of its kind initiative by the Heart Care Foundation of India instituted in memory of Sameer Malik to ensure that no person dies of a heart disease because they cannot afford treatment. Any person can apply for the financial and technical assistance provided by the fund by calling on its helpline number or by filling the online form.

Madan Singh,

SM Heart Care Foundation Fund, Post CAG

Kishan, SM Heart Care Foundation Fund,

Post CHD Repair


Deepak, SM Heart Care Foundation Fund,
CHD TOF
About the Editor

Padma Shri, National Science Communication and Dr B C Roy National Awardee, Honorary Secretary General IMA, Immediate Past Senior National Vice President IMA, Professor of Bioethics SRM University, Sr. Consultant Medicine & Cardiology, Dean Board of Medical Education, Moolchand, President Heart Care Foundation of India, Chairman Legal Cell Indian Academy of Echocardiography, Editor in Chief IJCP Group of Publications & eMedinewS, Member Ethics Committee Medical Council of India (2013-14), Chairman Ethical Committee Delhi Medical Council (2009-14), Elected Member Delhi Medical Council (2004-2009), Chairman IMSA Delhi Chapter (March 10- March13), Director IMA AKN Sinha Institute (08-09), Finance Secretary IMA (07-08), Chairman IMAAMS (06-07), President Delhi Medical Association (05-06)
IMA NEWS
IMA SLIM Initiative Draft
5 Orthopedic tests you don't need
  1. Imaging studies are not indicated for acute back pain: There is no indication for performing Plain X rays or MRI for patients with acute onset low back pain. Imaging studies do not contribute to majority of cases in general and MRI, on the other hand may show normal age related findings which may be interpreted as abnormal. Moreover, most of these episodes are self limiting. MRIs and x-rays are seldom needed to diagnose non specific back pain of less than 12 weeks duration, and usually are only performed if “Red Flag Signs” suggesting infection, fracture, malignancy or cauda equina syndrome are present, or, the standard back pain treatments are not effective.
  2. MRI is unnecessary for diagnosing Osteoarthritis: Weight bearing or standing Anteroposterior, lateral and skyline view X rays are adequate to diagnose osteoarthritis of the knee joint. Knee x-rays give much more useful information about the alignment, bone quality, and the extent of any degenerative changes within the knee. Patients with knee pain should have x-rays before an MRI is considered, unless there is suspicion of a more serious or uncommon condition. X-ray should come before MRI in the majority of knee osteoarthritis cases.
  3. MRI is unnecessary for acute Tendo Achilles Rupture: Tendo Achilles rupture may occur in middle age persons. Diagnosis can be made easily by history and physical examination. MRI is time consuming, expensive, and can lead to treatment delays. Clinicians should rely on the history and physical examination for accurate diagnosis of the acute tendo achilles rupture. MRI should be reserved for ambiguous presentations and subacute or chronic injuries for preoperative planning.
  4. Bone Densitometry assessment by DXA is not indicated in low risk patients: Bone densitometry can diagnose Osteoporosis by measuring areal bone density and expressing it as number of Standard Deviations more or less than the expected (Peak) Bone Mass in healthy young adult (T –Score). Bone density measurement by T- Score is meant to diagnose osteoporosis in Post menopausal women and is not applicable to Premenopausal women or men under 50 who are assessed by the Z score. Z –Score is bone density of the person tested expressed as the number of standard deviations more and less than the expected bone density of the age, sex, size, weight and ethnicity /race matched healthy individual.

  5. Several risk assessment tools are available to quantify the risk of osteoporosis in postmenopausal women. Those at low risk of osteoporosis do not need assessment of bone density. On the other hand, there are specific criteria that are used to determine when bone density test is appropriate. Moreover, once a patient is on treatment for osteoporosis, the bone density measurement should not be repeated before 2 years unless specifically indicated as for example, in patients on high doses of steroids.
  6. Routine Blood investigations are unnecessary for patients with acute trauma
    • In patients with Mild to Moderate Injury: If airway, breathing and circulation are stable and not predicted to deteriorate, no blood tests are required in these patients unless there are specific medical indications.
    • In patients with Serious Injury: Airway or breathing may be compromised. Circulation is stable with less than 2 liters fluid requirement. Such patients are advised for Full Blood Count and blood grouping. Kidney Function Tests (KFT) is needed only if the injured is >60 years age or has known pre-existing co-morbidity.
    • In patients with serious injuries requiring blood transfusion: Patients with poor perfusion and ongoing hemodynamic instability; such patients need Complete Blood Counts, Kidney function tests and cross matching.
Coagulation studies are not indicated in acute trauma unless the patient is taking oral anticoagulants; if so, INR should be done.

Liver Function Tests are to be done only if hepatic injury is suspected.

References
  1. Grover F Jr, et al. Is MRI useful for evaluation of acute low back pain? J Fam Pract. 2003 March;52(3):231-2.
  2. Wilk V, et al. Evidence and practice in the self-management of low back pain: findings from an Australian internet-based survey. Clin J Pain 2010;26(6):533-40.
  3. Boden SD, et al. Abnormal magnetic-resonance scans of the lumbar spine in asymptomatic subjects. A prospective investigation. J Bone Joint Surg Am 1990;72(3):403-8.
  4. O'Shea KJ, et al. The diagnostic accuracy of history, physical examination, and radiographs in the evaluation of traumatic knee disorders. Am J Sports Med 1996;24(2):164-7.
  5. Garras DN, et al. MRI is unnecessary for diagnosing acute achilles tendon ruptures. Clin Orthop Relat Res 2012;470(8):2268–73.
  6. Lane JM, et al. Osteoporosis: current modes of prevention and treatment. J Am Acad Orthop Surg 1999 Jan;7(1):19-31
  7. Emergency Department Orientation Handbooks for RMO / Interns and Registrars, Liverpool Hospital, 2002.
  8. Blood Testing Guidelines for Trauma Patients, Liverpool Hospital Policy and Procedure Manual, 2000.
IMA for changes in medical insurance policy

The Hindu: The Indian Medical Association (IMA) has written to chairman of the Insurance Regulatory and Development Authority of India (IRDA), T. S. Vijayan, seeking his intervention “in looking at revising the current policies which could be injurious to the health of community”.

Writing to the regulatory body, IMA national president Dr. A. Marthanda Pillai noted: “Medical insurance claims often insist on 24-hour admission. The duration should be decided by the team of doctors and not the policy. Shorter the duration, less will be the chances of hospital acquired infection and re-admission rates. In fact there should be bonus if the admission is short and re-admission rates are lower.”

The Association has noted that the insurance claim should not insist on intravenous line for admission.

“Most of the time the cash facilities are denied if the doctors have not used IV lines. Doctors are forced sometimes to give IV-drugs which are against the WHO policy of safe syringe practices. On the other hand, bonus should be given for not using UV lines and switching early from IV to oral therapy,” said IMA honorary secretary general Dr. K. K. Aggarwal.

IMA has demanded that the IRDA must prevent delay in post discharge processing which at times can be up to six hours. This unnecessarily occupies the bed and there are more chances of hospital acquired infections, the letter noted.

“IRDA should not appoint non-allopath doctors to process claims and raising technical questions. It ends up in injustice to the community. It must make sure that no agencies mushroom for getting TPA empanelment. This has started happening. Make sure that there is no brokerage, commission and fees etc. by agents in the process of empanelment,” warned Dr. Aggarwal.

IRDA must allow all government-approved nursing homes for cashless empanelment, the IMA noted in its letter. “Finally the claim payments need to be enhanced as the premiums have been revised by 40 per cent,” said Dr. Aggarwal.
Congratulations to Team IMA
IMA webinar a hit with 3487 visitors, 14872 page visits & 15764 hits on IMA Website.
IMA National Leaders Meet
Clinician – Patient Communication
Vinay Sharma, New Delhi


"A bad wound heals but a bad word doesn't" Persian proverb Communication Skills is a necessity, not an option!IMA,IJCP,HCFI
IMA Initiative for Safe Sound
Chairman: Dr. K A Seethi
National Coordinator: Dr. C. John Panicker

Concept: Noise is unwanted sound. Generally sound louder than that required for communication is unwanted. Noise is a silent killer. It has severe adverse effects on blood pressure, blood sugar and on vital organs like heart, brain, lungs, liver, endocrine glands etc. Noise induced deafness is the commonest cause of permanent deafness, second only to presbycusis which itself is a long-lasting effect of noise exposure. Even animals and inanimate things are affected by loud sounds.

India is one of the noisiest places in the world. Western countries though developed much more than India, have identified these ill-effects and taken effective measures to control this menace. The main issue in India is lack of awareness of this problem.

Indian Medical Association a frontrunner for all health problems has the responsibility to bring this issue before the public and to the administrators. With this concept the Initiative for Safe sound is taken up as a project of IMA. As the name implies we need sound, but it should be used in a safe way.

Health issues of noise pollution.
  1. Effect on the ear.
    1. Temporary Threshold shift (TTS) mean temporary deafness due to exposure to loud sound for a short period of time. This usually happens when exposed to sounds of 100 dB or more.
    2. Permanent Threshold shift (PTS) when exposed repeatedly or the intensity of sound is high (more than 110 dB), permanent deafness can occur.
    3. Presbycusis is the deafness occurring in the old age. Even though there is a genetic predisposition it is the cumulative effect of whatever sounds we hear in our lifetime.
    4. Other effect in the ear includes tinnitus and vertigo. This is more pronounced in patients with Meniere’s syndrome.
  2. Effects on vital organs
    1. Cardiovascular system: Loud sounds more than 80 dB produce constriction of blood vessels and this increases blood pressure. Other effects include increase in heart rate, precipitation of ischemic heart diseases in susceptible persons etc.
    2. Respiratory system: Increased respiratory rate and precipitation of asthma.
    3. Gastrointestinal system: Acid peptic diseases, bowel disorders like IBS, constipation etc.
    4. Endocrine system: Increased secretion of ACTH, corticosteroid and adrenaline.
    5. Reproductive system: Irregular menstrual cycles, infertility, decreased libido, and sterility.
    6. Neurological and mental effect includes:
      • Headaches.
      • Loss of sleep.
      • Irritability.
      • Decreased cognitive functions.
      • Lack of concentration and inability to do skilled works.
      • Emotional changes.
      • Precipitation of seizures and mental illness in susceptible persons etc,
Social effect includes learning difficulty and social tensions.

What IMA can do?

We need to form Safe Sound Initiative groups involving prominent public persons like journalists, lawyers, teachers, business people, religious leaders, politicians and artists. This should be under respective state branches and similar groups should be formed in each districts and main cities.
The main objective of this group should be to educate public, especially students and young generation on this health issue, conducting seminars and classes for industrial workers and public. Booklets/ leaflets on ill effects of noise pollution, in the local language, should be distributed in secondary and higher secondary schools to the students.
Producing short publicity videos, if possible involving celebrities and to show it in TV Channels and cinemas.
Provide helpline for public so that they can complain on any noise-related issues without getting directly involved. The IMA can take up these complaints with respective offenders or administrators to get relief for the victims.
The volunteers of Safe Sound initiative and members of IMA can visit schools/ colleges and take classes on ill effects and remedial measures and request them to be the volunteers for Safe Sound.
Students are the best media for disseminating social and scientific information.
Pressurize the local and State Govt to implement whatever laws at present available and the issues of noise pollution and also request for more stringent laws at the National and State level.

As guardian of the health of the Nation, Indian Medical Association has to take up the leadership in educating and controlling this grave health issue so that India is a better place to live. Tip of the day for safe and effective strength training

Cut back if you aren't able to finish a series of exercises or an exercise session, can't talk while exercising, feel faint after a session, feel tired during the day, or suffer joint aches and pains after a session.

Medscape Family Physician Lifestyle Report 2015

Family Physicians Burnout and Daily Alcohol Use

The latest statistics from the CDC on US alcohol consumption reported a prevalence of previous-year drinking of 70.5% and a prevalence of past-month excessive drinking of 29.7%. Medscape responders have very light to moderate drinking habits, and no difference was seen between those who are burned out and those who are not. Slightly over one third of all family physician responders said they didn't drink at all, and slightly less than half claimed to have less than one drink per day.

(Source: Medscape)
 
Media
IMA,IJCP,HCFI
Inspirational Story
The value of sincerity of purpose

A story is told of a man who approached three workers who were doing the same job. "What are you doing?" he asked each one of them separately and got different answers. "I am cutting the stones" replied the first. "I am earning my livelihood" replied the second. "I am building a mosque" replied the third. Each of the three workers saw himself linked to a different purpose each, one was to that extent, different from others, although all worked alike and were engaged in the same task.

Our two hands with which we work are in no sense different from the hands of any other person.

The value of what we do depends upon the quality of the inner purpose in our heart with which we do our work.
Quote of the Day
Anxiety does not empty tomorrow of its sorrows, but only empties today of its strength. Charles Spurgeon
IMA in Social Media
https://www.facebook.com/ima.national 28064 likes

https://www.facebook.com/imsaindia 46091 likes

https://www.facebook.com/imayoungdoctorswing 537 likes

Twitter @IndianMedAssn 782 followers

http://imahq.blogspot.com/ www.ima-ams.org

http://www.imacgpindia.com/ http://www.imacgponline.com/

http://www.ima-india.org/ima/

www.indianmedicalassociation.info
Reader Response
  1. Dear Sir, Thanks for providing us the useful information. Regards: Dr Kanak
Wellness Blog
Routine ECG Does Not Help

In populations of older adults, prediction of coronary heart disease (CHD) events through traditional risk factors is less accurate than in middle–aged adults. It has been shown that electrocardiographic (ECG) abnormalities are common in older adults and might be of value for CHD prediction. However, performing routine ECG among asymptomatic adults is not supported by current evidence and is not recommended by the US Preventive Services Task Force and the American College of Cardiology Foundation/American Heart Association. The aim of the study by Auer and colleagues was to determine whether baseline ECG abnormalities or development of new and persistent ECG abnormalities are associated with increased CHD events.
IMA Videos
IMA Humor
This older man was on the operating table awaiting surgery and he insisted that his son, a renowned surgeon, perform the operation as he was about to receive the anesthesia he asked to speak to his son. "Yes dad, what is it?"

"Don’t be nervous, son. Do your best and just remember, if it doesn’t go well and if something happens to me, your mother is going to come and live with you and your wife."
Press Release of the Day
IMA Mental Health Initiative

Mental health has been neglected for too long in our country. Fostering the health of our people should be a priority. According to WHO, among the 10 diseases causing maximum Global Burden of Disease, five are mental and substance use disorders.

IMA will encourage mental health activities through all its 1700 branches. Since there is a glaring treatment gap, mental health through Primary Care will be encouraged said Padma Shri Awardee Dr A Marthanda Pillai National President and Padma Shri Awardee Dr K K Aggarwal Honorary Secretary General IMA.

IMA will undertake mental health awareness programmes at a national level and World Mental Health Day will be observed on Oct 10 and Week in association with Indian Psychiatric Society and World Psychiatric Association, added Prof Roy Abraham Kallivayalil, Chairman, IMA Mental Health Initiative.

Adequate training in Psychiatry and examination during MBBS is a must. IMA will take up this matter with MCI.

IMA will help establish Psychiatry Units in all Taluks and District Hospitals of the country. Uniform De-addiction Protocols for general practitioners would be started.

Regarding the new Mental Health Care Bill being introduced the Lok Sabha, IMA feels that the proposed Bill is severely deficient in many respects. General Hospital Psychiatry Units should be outside the purview of this Bill. MHC Bill in its present form is unacceptable to IMA and the same should be withdrawn or thoroughly revised in consultation with IMA and Indian Psychiatric Society.

The Proposed new Mental Health Care Bill: IMA Objections

It is a bill that is meant to promote and protect the rights of the mentally ill, but falls short of the expectations and the mandate of the very bill itself.

The mentally ill, being vulnerable sections of society, need their rights protected in all circumstances and the mandate “protection of the rights of the mentally ill during delivery of treatment” is a very narrow view of the rights of the mentally ill.

As the bill seeks to bring in all types of mental health care facilities under its ambit where admission procedure, discharge policy, treatment decisions will be placed under the control of non experts/non professionals, it will delay and deprive timely treatment of many.

It will stigmatize mental illness and artificially delink the treatment of mental illness from that of physical illness thus compromising on the quality of care.

In India, there are not enough psychiatric hospitals to take care of the mentally ill and the right of families to get them treated has been taken away in the bill.

Moreover, several concepts such as that of a nominated representative, advance directive, and exclusion of families from treatment decisions and responsibilities are extremely negative provisions, totally alien to Indian society, which will be unenforceable and lead to the severely mentally ill being exploited, disrupting the social fabric of society by social exclusion, roaming on the streets as they will neither be in hospitals nor in homes.

Free, easy, convenient access to treatment of mental illness in general hospitals has been curbed. No distinction is made between the services or care centres treating minor mental illnesses or such major illnesses that have good prognosis and potential for quick recovery, from those, where patients have severe illnesses with impaired reasoning and insight who either do not voluntarily seek treatment or do not have families to bring them into treatment or are in need of long term supervised care in hospitals.