January 14 2015, Wednesday
editorial
 

(…Contd.)
Dr I congratulate the team lead by Dr. Jitendra B Patel and Dr. Narendra Saini for their excellent work in IMA.


I also take this opportunity to thank Dr. Jitendra B. Patel and his team for fittingly organising this annual medical conference of Indian Medical Association at Ahmadabad.


The ordinary member of the organisation is the strength of the association. I request your whole hearted support to me and Hon. Secretary General Dr.K.K.Agarwal to convert my dream about IMA into a reality in a year.

Our Motto

“Dedicate for a Healthier India”
(…Contd.)
Read More ...
eMedipics
 
IMA,IJCP,HCFI

Health Check Up and CPR 10 Camp at G B S S School, No-2, Ambedkar Nagar on 19th December 2014
editorial
Difference between fog and smog
 
Dr KK AggarwalWhenever the humidity is high, air movement is less and the temperature is low, fog is the automatic result. It reduces visibility and more accidents are reported on the roads including delay in both railway and airlines services. When the level of pollution is high in the atmosphere, the pollutant particles get mixed into the fog reducing its visibility further and the resultant is called as smog.Smog is very dangerous to both lungs and the heart.
  1. High sulfur dioxide contents lead to precipitation of chronic bronchitis.
  2. High nitrogen dioxide contents lead to precipitation of asthma.
  3. High particulate matter (PM10), air pollutants sized between 2.5 to 10 microns, can damage the lungs and precipitate asthma due to air flow and inflammation.
  4. High contents of particulate matter (PM 2.5), air pollutants less than 2.5 micron in size can enter the lungs and damage the lung lining. They can also be absorbed and cause inflammation of the heart arteries.
  5. Patients with asthma and chronic bronchitis should get the dose of their medicine increased during smog days. One should avoid exerting in the presence of smog.
  6. It is better to avoid walking during smog hours.
  7. One should drive slowly during smog hours.
  8. Heart patients should stop their early morning walk during smog hours.
  9. Remember to take the flu, pneumonia vaccine.
IMA,IJCP,HCFI
Quote of the Day
And in the end, it's not the years in your life that count. It's the life in your years. Abraham Lincoln
 
News on Maps
CPR 10
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Make Sure
Situation: A patient with LDL cholesterol 100 mg% and hsCRP 3 developed MI
Reaction: Oh my God! Why was a statin not started earlier?
Lesson: Make sure that all patients with even normal cholesterol are considered for statins if the hsCRP is high.
 
No need to panic over swine flu, IMA says
Doctors sought to assuage widespread "paranoia" stoked by the swine flu outbreak on Monday, when the death of a 44-year-old woman pushed up this year's toll to four. In a letter to the Union health secretary, the Indian Medical Association (IMA) pointed out that the seasonal flu was a far more fatal threat than H1N1, with a death rate at least 10 times higher. "More people die in the country because of normal flu than swine flu. But every time news is published about swine flu, it creates panic in the society. The (prices of) flu drugs, investigation and consultation become sky high whenever there is a panic in the society," the IMA says in the letter.

Pointing out that swine flu kills one in 10 lakh people every year, as opposed to the one in a lakh killed by the seasonal flu, the IMA has urged the Centre to issue ads informing the public about the fact. The association has also asked the ministry of health and family welfare to issue guidelines to medical practitioners in the national Capital, asking them to be careful while giving any views on influenza.

"People should not panic at all. If adequate preventive measures are taken at the right time, there are less chances of mortality," IMA secretary general Dr K.K. Aggarwal.

As many as seven fresh cases of swine flu were reported from the national Capital on Monday, taking the total number of confirmed cases in January to 50. Doctors say people should be able to differentiate between the two kinds of flu on their own.

Like seasonal flu, swine flu can lead to more serious complications, including pneumonia and respiratory failure. It can also worsen conditions like diabetes and asthma.

City doctors are also witnessing a new trend among patients, who they say have been seeking to purchase the drug Tamiflu as a preventive method.

"People are coming to us with symptoms of seasonal flu and asking for Tamiflu. Tamiflu cannot be given for routine influenza," said Dr Sanjeev Bagai, vice-chairman and director, Manipal hospital.

Monday saw Delhi's fourth swine flu fatality: a 44-year-old woman with a history of uncontrolled diabetes died at a private hospital in West Delhi. According to sources, the woman was brought to the hospital with complaints of breathlessness.

"Her condition was already serious when she was admitted. She had a history of diabetes and her blood pressure was also high," said Dr Charan Singh, nodal officer for swine flu in Delhi.
IMA to have sentinel event reporting mechanism on its website
Dear colleague,

IMA is committed to patient safety. Modern system of medicine is full of omissions and commissions leading to adverse events, a good number of which are preventable. We seek your co-operation in compiling and analysing them and doing root cause analysis (RCA) which is very basic to prevention of errors and good medical practice.

Each IMA member is requested to report on the website (confidential) in the enclosed format. Member’s personal identity is not sought along with place of working. Data to be sought is only to be used for specific purpose.

FORM
Date of event:
Age of the patient:
Sex:
State:
City:
Routine/ emergency:
Location: Ward/ OT/ Casualty or ER/ ICU/ Ambulance/others
Person Involved: Ward boy/ nurse/ senior resident/junior consultant/senior consultant/others
Sentinel event: Please tick the relevant category
M
  1. Death of a patient during / immediately after anesthesia / surgery
  2. Wrong patient operated
  3. Wrong side operated.
  4. Accidentally leaving gauge/ instrument/ any other material
  5. Patient injury during shifting/ any harm to patient in OT e.g. electrical burn/ embolus unrelated to surgery
  6. Maternal death or disability associated with delivery in a low risk pregnancy
E
  1. Break down of equipment leading to injury to staff/ doctor e.g. OT table/ trolley /stool
  2. Anesthesia machine failure/ ventilator failure
  3. Wrong use of equipment
  4. Wrong medication
  5. Contaminated medicine
  6. Patient /attendant staff slipping leading to injury
  7. ABO incompatibility
  8. Fresh IUD unnoticed
S
  1. Complaint of baby exchange
  2. Baby abduction
  3. Patient abduction/ absconding
  4. Sexual assault of patient/ attendant
  5. Attempted suicide
  6. Impersonation
  7. Violence in HCO
  8. Electric shock to anybody accidental
  9. Violence in HCO
  10. Any event leading to media coverage/ police action or public unrest
Miscellaneous.......
Description of event:
Outcome: No harm/ Prolonged stay/ morbidity/death/others
Your root cause analysis:
Was it preventable:
Your suggestion/s:
Please help others to learn from your experience and help your organization bring down errors and complications "It may be part of human nature to err, but it also part of human nature to create solution, find alternatives and meet the challenges."

IMA National Coordinator:
Dr C M Bhagat cmb4849@icloud.com]
ESIC to shut its medical colleges
The Employees State Insurance Corporation (ESIC) has decided to shut its medical colleges as this is not its core function, leading to the students protesting the move here Monday.

The corporation has expressed its inability to meet the objectives to establish medical colleges and training institutes to serve the insured and non-insured persons of the ESIC scheme.

"The ESIC should exit the field of medical education entirely as it is not the core function of the ESIC and other objectives is unlikely to be met," said the order issued at an ESIC meet held Dec 4.

It was also decided to hand over the ongoing medical colleges and other medical education institutions, having separate infrastructure, to state governments willing for such a transfer.

Though it has been running hospitals under the scheme for the purpose, the ESI Act was amended in 2010 to allow it to set up medical colleges. Presently, 13 such institutions are in various stages of construction.

Currently the corporation runs seven medical colleges including a dental college in north Delhi's Rohini area, with few others in various stages of construction. They are estimated to be over Rs.10,000 crore.

The corporation during the meeting has also urged all the medical colleges not to undertake any further admissions as the medical programmes will continue only till the admitted students pass out or are adjusted by medical colleges of the state governments.

The students studying in the existing medical colleges under the ESIC, however, have claimed that due to the ESIC's order, the faculties and administrative staffs have already tendered their resignations which is a reason the recognition of Medical Council of India (MCI) could be withdrawn.

"Every medical college has to have a required number of students, teachers and administrative staff to get recognised by the MCI. But due to the ESIC decision all the faculties have started leaving the institutions," Chandra Mohan, president of the ESIC students association, told IANS.

"If the MCI withdraws its recognition, none of the students are going to get any medical degree," Mohan, who is also a student of ESIC Dental college in Delhi, added.

The students will also stage a protest Tuesday at Jantar Mantar against the decision of the corporation.
THE DRUGS AND COSMETICS (AMENDMENT) BILL, 2015
(z) “notification” means a notification published in the Official Gazette and the word “notified” shall be construed accordingly;
(za) “proprietary medicine” means-

(i) in relation to Ayurvedic, Siddha or Unani Tibb systems of medicine all formulations containing only such ingredients mentioned in the formulae described in the authoritative books of Ayurveda, Siddha or Unani Tibb systems of medicine specified in the First Schedule, but does not include a medicine which is administered by parenteral route and also a formulation included in the authoritative books as specified in clause (a);

(ii) in relation to any other systems of medicine, a drug which is a remedy or prescription presented in a form ready for internal or external administration of human beings or animals and which is not included in the edition of the Indian Pharmacopoeia for the time being or any other Pharmacopoeia authorised in this behalf by the Central Government after consultation with the Drugs Technical Advisory Board constituted under section 5;

(zb) “prescribed” means prescribed by rules made under this Act;

(zc) “sponsor” includes a person , a company or an in situation responsible for the initiation, financing and management of a clinical trial;

(zd) “State Drugs Laboratory” means laboratory established or designated by the State Government under section 6;

(ze) “State Licensing Authority” for the purposes of this Act means the State Drugs Controller by whatever name called;

(zf) “Schedule” means Schedule appended to the Act
Medicolegal
IMA,IJCP,HCFI
IMA to create awareness on organic farming
Is hydrophobia a sign of rabies in dogs?

With drug addiction and rising cancer instances in the state, the IMA has planned to initiate a programme in Punjab to create awareness about organic farming where the use of pesticides and insecticides is far less. “Another problem crippling the state is mental health. We are focusing on these two issues in the state,” said Dr Aggarwal.
 
The Year in Medicine 2014: News That Made a Difference
7. State and Federal Health Insurance Exchanges Launch

After a difficult enrollment period because of problems with the Healthcare.gov website last fall, the health insurance exchanges authorized by the Affordable Care Act launched on January 1. Open enrollment closed on March 31. In May, the Department of Health and Human Services announced that more than eight million people had enrolled. In May, a new survey by the Medical Group Management Association found that most group practices are participating in new insurance exchanges, but they are grumbling about it, mostly because of administrative hassles and narrow provider networks. (Source: Medscape)
News around the Globe
  • Men waiting to become fathers for the first time experienced hormonal changes before their babies were born, and levels of some hormones appeared to be associated with those of the men's wives, reported a new study. There were declines in testosterone and estradiol but no changes in cortisol or progesterone. The study was published online in the American Journal of Human Biology.
  • The US Food and Drug Administration (FDA) has approved carbidopa/levodopa enteral suspension for the treatment of motor fluctuations in patients with advanced Parkinson's disease. The approval came after the success of a 12-week, phase 3, double-blind, multicenter trial.
  • Transjugular intrahepatic portosystemic shunt (TIPS) does not seem to improve colectomy outcomes in patients with concomitant primary sclerosing cholangitis (PSC) and ulcerative colitis, suggests a retrospective study published online in Gastroenterology Report.
  • A large number of elderly adults with diabetes and in poor health are being treated to tight glycemic targets with insulin or sulfonylureas, potentially placing them at increased risk for severe hypoglycemia, suggests a new study published online January 12 in JAMA Internal Medicine.
  • Two new studies have shown that limiting alcohol consumption, adding more plant foods to the diet, and losing excess weight can help reduce the risk of developing cancer. The first study is published online in Cancer Causes & Control and the second study is published in the American Journal of Clinical Nutrition.
Media
IMA,IJCP,HCFI
Cardiology eMedinewS
  • A diet high in fat and exposure to certain bacteria, including Porphyromonas gingivalis and Chlamydia pneumoniae, alter distinct gene pathways and cause atherosclerosis, suggests a new study published in BMC Genomics.
  • More than 10% of patients in a representative sample of US cardiology clinics were "inappropriately" taking aspirin for primary prevention of CVD; which means that their 10-year risk for CVD was less than 6%, reported a new study published in the January 20, 2015 issue of the Journal of the American College of Cardiology.
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
https://www.youtube.com/watch?v=Mc3kKDXKWvs
Kishan, SM Heart Care Foundation Fund,
Post CHD Repair
https://www.youtube.com/watch?v=OTEG7toVkAQ
Deepak, SM Heart Care Foundation Fund,
CHD TOF https://www.youtube.com/watch?v=rjOel0aaqt0
Dr KK Spiritual Blog
Makar Sankranti: Uttarayana: The Medical Importance

An extremely auspicious day, Lohri marks the sun’s entry into the ‘Makar Rashi’. The next day after lohri is Makar Sankranti. One can remember lohri as the last day of winter and maker sankranti as the first day of summer.

The word Sankranti means “change of direction” and the sun changes its direction north words on the day of makar Sankranti.

The period, beginning from 14 January (Makar Sankranti) lasting till 14 July, is known as Uttarayana ("Uttar" North and "ayan" movement towards). It is also the last day of the month of Maargazhi (Dhanur), which is the ninth month of the lunar calendar. The Bhagawad Gita deems it as an extremely sacred and auspicious time when Lord Krishna manifests himself most tangibly. Bhishma Pitamah in Mahabharata also waited for this period (not day) to leave his body. Uttarayana is considered to be the holiest half of the year. In Bhagavad Gita, the Lord says, "I am Uttarayana among the Ayanas."

In chapter 8 shloka 24 Lord Krishna has said "Those who know the Supreme Brahman attain that Supreme by passing away from the world during the influence of the fiery god, in the light, at an auspicious moment of the day, during the fortnight of the waxing moon, or during the six months when the sun travels in the north."

The earth, farthest from the sun at this point of time, starts its journey towards the sun, thus ending the coldest month of the year (peak winter), Paush, and announcing the start of the month of Magh.

As per “Puranas”, Dakshinayana (the other six month period) is the night of the deities where as Uttarayana is their day. It’s the time to start a dip in Ganges at sun rise and at sunset and say good bye to winter foods.
Video of the Day
Dr K K Aggarwal head on with Arnab Goswami of Times Now on MCI Issues
h t t p : / / w w w . t i m e s n o w . t v / D e b a t e -
WhistleblowerDumped/videoshow/4468283.cms
Heart Care Foundation of India announces the Mrs Abheeta Khanna Oration on Excellence in Sports and Health
https://www.youtube.com/watch?v=6Ktz5-iUINE
Betiyan Hain Anmol, Bachao Dil Se, Medanta joins hands with Heart Care Foundation of India
https://www.youtube.com/watch?v=TGEGauzE0kg
Rabies News (Dr A K Gupta)
The IM dose of Verorab (PVRV) and Abhayrab (PVRV) is 0.5mL; that of Rabipur (PCEC) and PVRV (Coonoor) is 1mL. Is the ID dosage of all vaccines uniformly 0.1mL?

The ID dosage of all approved vaccines is uniformly 0.1 mL per ID site irrespective of their IM dosage
 
Wellness Blog
Early (Wet) vs late (Dry) winter

Winter can be divided into wet and dry winter. Wet winter is characterized by fall in temperature along with high humidity. Environmentally, we see fog and smog during this season. Dry or late winter on the other hand is characterized by absence of fog, smog and presence of chilly airy winds.

Most hypothermia illnesses occur in dry late winter. The transition phase between wet and dry winter is on Lohri. In terms of Ayurveda, it means shifting from Kapha to Vata atmosphere. The onset of dry winter is also the time for accelerated movement disorders in the body. Accelerated hypertension, arrhythmias, paroxysmal atrial tachycardia (PAT), brain hemorrhage, heart attack etc. all occur at the start of dry late winter.

Unpublished compilation of data has also shown that maximum temporary pacemakers are also put during this season.

The correct lifestyle in this season has been defined in Ayurveda and it involves reducing consumption of stringent, bitter and pungent foods.
 
eMedi Quiz
A 30-year-old man came to the outpatient department because he had suddenly developed double vision. On examination it was found that his right eye, when at rest, was turned medially. The most likely anatomical structures involved are:

1. Medial rectus and superior division of oculomotor nerve.
2. Inferior oblique and inferior division of oculomotor nerve.
3. Lateral rectus and abducent nerve.
4. Superior rectus and trochlear nerve.

Yesterday’s Mind Teaser: A lesion of ventrolateral part of spinal cord will lead to loss (below the level of lesion) of:

1. Pain sensation on the ipsilateral side.
2. Proprioception on the contralateral side.
3. Pain sensation on the contralateral side.
4. Propriception on the ipsilateral side.

Answer for yesterday’s Mind Teaser: 3.Pain sensation on the contralateral side.
Correct Answers received from: Dr Avtar Krishan, Tukaram Pagad, Raju Kuppusamy.
Answer for 12th Jan Mind Teaser: 2.Hypovolemia.
Correct Answers receives: Raju Kuppusamy, Dr Janiendra Upadhyay, Takaram Pagad, Dr Avtar Krishan.
 
IMA in the News
  • IMA says no need to panic over swine flu: Mail Today
  • http://epaper.navbharattimes.com/details/21454-36526-1.html
  • http://epaper.navbharattimes.com/details/21346-37119-1.html
IMA in Social Media
https://www.facebook.com/ima.national 27791 likes
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https://www.facebook.com/imayoungdoctorswing 235 likes
Twitter @IndianMedAssn 710 followers
http://imahq.blogspot.com/
http://www.ima-ams.org/
http://www.imacgpindia.com/
http://www.imacgponline.com/
http://www.ima-india.org/ima/
www.indianmedicalassociation.info
Events
IMA,IJCP,HCFI
Drug Alert
MINISTRY OF HEALTH AND FAMILY WELFARE
(Department of Health and Family Welfare)
NOTIFICATION
New Delhi, the 31st July, 2013


G.S.R.520(E).- Whereas the Central Government was satisfied that the use of the drug pioglitazone and all drug formulations containing pioglitazone was likely to involve risk to human beings and whereas safer alternatives to the said drug are available.

Whereas, the Central Government was satisfied that it was necessary and expedient to regulate by way of suspension, the manufacture for sale, sale and distribution of the said drug in the country in public interest, and accordingly in exercise of the powers conferred by section 26A of the Drugs and Cosmetic Act, 1940 (23 of 1940), the Central Government suspected the manufacture for sale, sale and distribution of pioglitazone and all formulations containing pioglitazone for human use through the notification number G.S.R.379(E) dated 18th June, 2013;

Whereas, the drugs Technical Advisory Board has examined the issue of suspension of manufacture and sale of the said drug on 19th July, 2013 and has recommended that the suspension of the drug should be revoked and allowed to be marketed promotional literature of the drug;

Now, therefore, on the basis of the recommendations of the Drugs Technical Advisory Board, the Central Government hereby revoke the notification G.S.R.379(E) dated 18th June, 2013 subject to the following conditions as recommended by the Drugs Technical Advisory Board;-

THE GAZETTE OF INDIA: EXTRAORDINARY

PART II-SEC.3(i)

“Pioglitazone and all formulations containing Pioglitazone for human use is allowed to be manufactured for sale, sale and distribution subject to the condition that the manufacturers shall mention the following on their package insert and promotional literature of the drug:
  1. The drug should not be used as first line of therapy for diabetes.
  2. The manufacturer should clearly mention following box warning in bold red letters.
Advice for healthcare professionals:
  • Patients with active bladder cancer or with a history of bladder cancer, and those with uninvestigated haematuria, should not receive pioglitazone
  • Prescribers should review the safety and efficacy of pioglitazone in individuals after 3—6 months of treatment to ensure that only patients who are deriving benefit continue to be treated. Pioglitazone should be stopped in patient who do not respond adequately to treatment (eg, reduction in glycosylated haemoglobin HbA1c)
  • Before stating pioglitazone, the following known risk factors for development of bladder cancer should be assessed in individuals: age, current or past history of smoking, exposure to some occupational or chemotherapy agents such as cyclophosphamide, or previous irradiation of the pelvic region
  • Use in elderly patients should be considered carefully before and during treatment because the risk of bladder cancer increases with age. Elderly patients should start on the lowest possible dose and be regularly monitored because of the risk of bladder cancer and heart failure associated with pioglitazone.
{F.No.4-01/2011-DC/Piogl}
ARUN K.PANDA. jt. Secy.
For Suggestions
IMA Protecting Health Information Policy

MCI Code of Ethics Regulations Applicable
  • MCI 7.14 "The registered medical practitioner shall not disclose the secrets of a patient that have been learnt in the exercise of his/her profession except – 1. in a court of law under orders of the Presiding Judge; 2. in circumstances where there is a serious and identified risk to a specific person and/or community; and 3. notifiable diseases. In case of communicable/notifiable diseases, concerned public health authorities should be informed immediately.
  • MCI Oath Declaration: a. I will respect the secrets which are confined in me.
  • MCI 7.17 " A registered medical practitioner shall not publish photographs or case reports of his / her patients without their permission, in any medical or other journal in a manner by which their identity could be made out. If the identity is not to be disclosed, the consent is not needed.
IMA Self Code of Conduct on Protected Health Information
Definitions

1. Health information
Health information means any information, whether oral or recorded in any form or medium, that–
(A) is created or received by a health care provider and
(B) relates to the past, present, or future physical or mental health or condition of any individual, the provision of health care to an individual, or the past, present, or future payment for the provision of health care to an individual.

2. Individually identifiable health information
Individually identifiable health information is information that is a subset of health information, including demographic information collected from an individual, and:
(1) Is created or received by a health care provider
(2) Relates to the past, present, or future physical or mental health or condition of an individual; the provision of health care to an individual; or the past, present, or future payment for the provision of health care to an individual; and
(i) That identifies the individual; or
(ii) With respect to which there is a reasonable basis to believe the information can be used to identify the individual.”

Protected health information (PHI) is the term used for all types of health information and is the term commonly used for the purpose of law.

a. It includes individual’s health information and his/her demographic information.
b. Information meets the definition of PHI if, even without the patient’s name, if you look at certain information and you can tell who the person is then it is PHI.
c. The PHI can relate to past, present or future physical or mental health of the individual.
d. PHI describes a disease, diagnosis, procedure, prognosis, or condition of the individual and can exist in any medium – files, voice mail, email, fax, or verbal communications.
e. PHI is any information if it contains the following information about the patient, the patient’s household members, or the patient’s employers:
  • Names
  • Dates relating to a patient, i.e. birthdates, dates of medical treatment, admission and discharge dates, and dates of death
  • Telephone numbers, addresses (including city, county, or zip code) fax numbers and other contact information
  • Social Security numbers,
  • Medical records numbers
  • Photographs
  • Finger and voice prints
  • Any other unique identifying number like PAN Number.
Recommendations
 
  1. Whether the patient is an ordinary citizen or a VIP; a professional or a celebrity; rich or poor, each expects their protected health information to remain confidential and secure.
  2. Not only do the patients deserve privacy and information security, it’s the law.
  3. If any employee is receiving health care services he or she also expects the same level of secrecy as a non employee.
  4. If a co-worker is receiving health care services we have no right to access his or her protected health information without patients consent.
  5. If one of our family member, spouse or friend is being treated by another doctor we may be tempted to look in their medical record to check on their care or review test results. However, if we don’t have the consent from the patient this is NOT allowed.
  6. We do see interesting and complex cases, but unless we are part of the treatment team we are not authorized to do so.
  7. If we see a news story about an accident or illness for one of the patients, just because we work in that medical set up does NOT give us the right to access the patient’s information. Being “curious” is NEVER a legitimate business reason to invade someone’s privacy.
  8. We should not display the operation theatre list on the hospital public notice boards where the identity of the person getting operated gets disclosed to public, other OT staff or other operating surgeons.
  9. We should not call the name of a person who has just undergone surgery in the public address system so as to inform the relations
  10. We should not announce the name of a person outside the Intensive care areas to identify the relations of the patient.
  11. At the time of admission, we must ask the patient and take a written consent as to whom he or she authorizes to seek information about his or her health condition. If the admitted patient is medically sick only the next to kin should have the right to seek the information.
  12. Never disclose the information (PHI) of a patient to visitors coming personally or calling you to get the information.
  13. If some of our colleagues call us to seek information make sure he has the consent of the patient or the authorized person.
  14. Similarly never disclose the information to the media unless you have the consent of the authority to declare so.
  15. Never disclose the health information to the hospital PRO.
  16. Never disclose the health information to the hospital authorities unless you have the permission.
  17. Never disclose the health information to the local police authorities unless you have the permission from the court.
  18. Never disclose the health information to the advocates unless you have the permission from the patient or an authorized person.
  19. Never issue a duplicate discharge ticket, death certificate or case file to unauthorized person.
  20. Always keep a list of notifiable diseases in your table.
10 Innovations in Medicines
10. Open Payments Data Release Has Big Gaps

On September 30, the federal government published information on 4.4 million payments worth almost $3.5 billion from drug and device makers to almost 1360 teaching hospitals and 546,000 physicians, dentists, podiatrists, and other clinicians on its new and controversial Open Payments website. The idea behind the website, created by the Affordable Care Act, is to spotlight and deter potential conflicts of interest that might cause a clinician to lose sight of a patient's best interest, such as prescribing an expensive brand-name drug when a generic would do. The American Medical Association and others had expressed concern about the data's accuracy, urging CMS to delay the data release until March 31, 2015, saying that physicians needed more time to review the payments. Site outages and difficulty registering plagued the data release. (Source: Medscape)
Inspirational Story
The Cross Room

The young man was at the end of his rope. Seeing no way out, he dropped to his knees in prayer.

"Lord, I can't go on," he said. "I have too heavy a cross to bear." The Lord replied, "My son, if you can't bear its weight, just place your cross inside this room. Then open another door and pick any cross you wish."

The man was filled with relief. "Thank you, Lord," he sighed, and did as he was told. As he looked around the room he saw many different crosses; some so large the tops were not visible. Then he spotted a tiny cross leaning against a far wall.

"I'd like that one, Lord," he whispered. And the Lord replied, "My son, that's the cross you brought in."
Dr Good Dr Bad
IMA,IJCP,HCFI
Dr KK Spiritual Blog
You look at people the same way as you are

Honest people regard everybody as honest and dishonest people regard everybody as dishonest. It all depends on the type of people you interact with. If you do not take bribe, nobody will come and offer bribe to you and you will feel everybody is honest. If you take bribe then everybody will come to you to offer bribe and you will feel that everybody in the society is dishonest.

Never judge people with you personal experience. I recall one of the doctors saying that every doctor takes and gives bribe because he was running an imaging centre and every doctor who approached him asked for a bribe. But he did not take into consideration the doctors who did not approach him.
Pediatrics eMedinewS
  • Pediatric patients who listened to 30 minutes of songs by singers of their choosing, or audio books, had a significant reduction in pain after major surgery, reported a new study published in Pediatric Surgery.
  • Children referred to a specialist on account of behavioral problems may have undiagnosed fetal alcohol spectrum disorders (FASD), suggests a new study. The findings are published online January 12 in Pediatrics.
IJCP Book of Medical Records
IJCP Book of Medical Records Is the First and the Only Credible Site with Indian Medical Records.
If you feel any time that you have created something which should be certified so that you can put it in your profile, you can submit your claim to us at: www.ijcpbookofmedicalrecords.com
  • First person and NGO to trained Maximum Number of Police People trained in Hands only CPR10 in one day
  • "First NGO and doctor to provide "hands on training" to 11543 people in "Hands Only CPR 10" in one day.
  • First individual doctor and NGO to provide "hands on training" to 8913 females in "Hands Only CPR 10" in one day.
eMedinewS Humor
The Amazing Kitchen Logic

Joe was a housekeeper who had this habit of drinking from his boss' wine bottle and replacing it with water. The boss, James, did suspect him but tolerated it for a while. But when this became a daily routine, James decided to do something to trap Joe.

Accordingly, James replaced his drink with a French wine which changed colour when water is added to it. Joe, not aware of the trap, took a few swigs and added water as usual. The wine changed colour from red to milky white. Joe realized he was in for trouble but was determined to get out of it.

James told his wife about Joe's misdoings and that he would make Joe accept his follies.

So he shouted, "Joe!!!" Joe answered from the kitchen, "Yes boss?"

James, "Who drank my wine and added water in the bottle?"

There was no answer from the kitchen. The boss repeated the question, still no answer. The angry boss marched to the kitchen and threatened Joe, "What the hell is going on? When I call your name you respond with 'Yes Boss' and when I ask you a question, you remain silent. What impertinence!!!"

Joe said, "It is like this. In the kitchen, you can hear only your name being called. You don’t hear anything else that is said, I swear."

James, "How is that possible? All right, I will prove you wrong. You stay right here in the hall with Madam, I will go to the kitchen and you ask me a question, OK?"

So the boss went to the kitchen.
Joe shouted, "Boss!!!"
Boss, "Yes Joe?"
Joe, "Who becomes intimate with the maid in Madam's absence?"
Silence - no reply. Joe again, "Who made the maid pregnant?"
No reply. Joe, yet again, "And who arranged for her abortion?"

James came running from the kitchen and said, "You are right Joe. When one is in kitchen, one can't hear anything but one's name. That's bloody strange.
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Press Release of the Day
Obama visit, short term exposure to pollutant air not risky: IMA

Short term exposures to air pollutants does not result in fatal outcomes and the effects are usually mild and reversible, said Padma Shri Awardee Dr A Marthanda Pillai National President and Padma Shri Awardee Dr K K Aggarwal Honorary Secretary General Indian Medical Association in a joint statement.

The experts said that short term exposure is only hazardous to children, elderly and individuals with chronic disease of respiratory or circulatory system.

Air quality index (AQI) is a composite indicator of air quality developed by Environment Protection Agency, USA.

President Obama has earlier visited countries with high levels of air pollution such as Afghanistan, Poland, Senegal, China, Brazil, Egypt, Saudi Arabia and India. Afghanistan has similar pollution levels. During his last visit to India, he had visited Agra, which had substantial particulate matter in ambient air.

The latest air quality data by Environmental Protection Agency shows that air quality in various parts of the United States had exceeded the cutoff values for adverse health effects. In California, air quality had reached as high as 473. The AQI in Delhi has been ranging between 250 and 300.

Yearly average of New Delhi and Beijing are almost similar and pollution has not grown to a scale of visible public problem in New Delhi unlike Beijing. Pakistan has the highest polluted regions such as Peshawar and Rawalpindi compared to all other cities in the world, added Dr. Muhammed Shaffi, a public health expert.

"The pollution levels in Delhi are comparable to Beijing and many other countries. Even though the United States has very low pollutant levels, the air quality index has touched unhealthy levels in some periods. Therefore it is unscientific to assume a different effect in Indian cities as short term exposure will have only minor effects on a healthy individual. It's unfair to link air pollution in Delhi with a possible health hazard for Obama," said Dr Aggarwal.

However those who are living in Delhi may have long-term exposure effects of pollution and they need to safeguard themselves.

Air Quality Index of 0-50 is good; 51-100 is moderate; 101-150 is unhealthy to sensitive groups and 151-200 is unhealthy to all. An AQI of 250-300 is very unhealthy and can cause significant aggravation of heart or lung disease and premature mortality in persons with cardiopulmonary disease and the elderly. It can have significant increase in respiratory effects in general population. People with heart or lung disease, older adults, and children should avoid all physical activity outdoors. Everyone else should avoid prolonged or heavy exertion.

An AQI of 300-500 is hazardous to health. It can cause serious aggravation of heart or lung disease and premature mortality in persons with cardiopulmonary disease and the elderly. It is also associated with serious risk of respiratory effects in general population.

Everyone should avoid all physical activity outdoors; people with heart or lung disease, older adults, and children in particular should remain indoors and keep activity levels low.
Reader Response
Dear National President and HSG, Vanakkam, You have taken up the much needed facility of the hour....that of a full-fledged forensic lab, matching up to the latest international standards...not a single one but at strategic locations in India... This request coming from the largest medical professional organisation will definitely have a good response. LET IMA'S LIGHT ALWAYS SHINE through your efforts for the benefit of our society Please follow it up, so that we get positive result. Wish you all a happy Sankranthi. Regards: Dr LVK Moorthy PP IMA TNSB