July 14  2015, Tuesday
eMedinewS
editorial
All about depression
Dr KK Aggarwal
  • Depression is a major public health problem as a leading predictor of functional disability and mortality.
  • Optimal depression treatment improves outcome for most patients.
  • Most adults with clinical significant depression never see a mental health professional but they often see a primary care physician.
  • A physician who is not a psychiatrist misses the diagnosis of depression 50% of times.
  • All depressed patients must be specifically enquired about suicidal ideations.
  • Suicidal ideation is a medical emergency
  • Risk factors for suicide are known psychiatric disorders, medical illnesses, prior history of suicidal attempts or family history of attempted suicide.
  • The demographic reasons include older age, male gender, marital status (widowed or separated) and living alone.
  • About 1 million people commit suicide every year globally.
  • Around 79% of patients who commit suicide contact their primary care provider in the last one year before their death and only one-third contact their mental health service provider.
  • Twice as many suicidal victims had contacted their primary care provider as against the mental health provider in the last month before suicide.
  • Suicide is the 10th leading cause of death worldwide and accounts for 1.2% of all deaths.
  • The suicide rate in the US is 10.5 per 100,000 people.
  • In the US, suicide is increasing in middle-aged adults.
  • There are 10 to 40 non–fatal suicide attempts for every one completed suicide.
  • The majority of suicides completed in US are accomplished with fire arm (57%); the second leading method of suicide in US is hanging for men and poisoning in women.
  • Patients with prior history of attempted suicide are 5–6 times more likely to make another attempt.
  • Fifty percent of successful victims have made prior attempts.
  • One of every 100 suicidal attempt survivors will die by suicide within one year of the first attempt.
  • The risk of suicide increases with increase in age; however, young adults and adolescents attempt suicide more than the older.
  • Females attempt suicide more frequently than males but males are successful three times more often.
  • The highest suicidal rate is amongst those individuals who are unmarried followed by those who are widowed, separated, divorced, married without children and married with children in descending order.
  • Living alone increases the risk of suicide.
  • Unemployed and unskilled patients are at higher risk of suicide than those who are employed.
  • A recent sense of failure may lead to higher risk.
  • Clinicians are at higher risk of suicide.
  • The suicidal rate in male clinicians is 1.41 and in female clinicians it is 2.27.
  • Adverse childhood abuse and adverse childhood experiences increase the risk of suicidal attempts.
  • The first step in evaluating suicidal risk is to determine presence of suicidal thoughts including their concerns and duration.
  • Management of suicidal individual includes reducing mortality risk, underlying factors and monitoring and follow up.
  • Major risk for suicidal attempts is in psychiatric disorder, hopelessness and prior suicidal attempts or threats.
  • High impulsivity or alcohol or other substance abuse increase the risk.
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eMedipics
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Over 1500 police PCR van staff trained in CPR 10 (Compression-only CPR, Bystander CPR, First responder CPR)
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News
  • Giving uric acid with intravenous thrombolytic therapy to patients with acute ischemic stroke could help improve 90-day outcomes, particularly in women, suggests new research published in the journal Stroke.
  • Testosterone replacement failed to significantly outperform placebo in a randomized trial of androgen-deficient men with ejaculatory dysfunction. The findings were published July 9 in the Journal of Clinical Endocrinology & Metabolism.
  • Exposure to silica was found to be a risk factor in more than half of one group of male patients with scleroderma and therefore, every male patient with scleroderma should be asked about silica exposure, suggests a retrospective case-control study and systematic literature review. The findings are published in the Seminars in Arthritis and Rheumatism.
  • Chronic back pain sufferers with psychiatric disorders such as depression or anxiety are 75% more prone to opioid abuse, suggests a new study published in the Online first edition of Anesthesiology.
  • A new DNA screening study found that patients with schizophrenia had more rare variants of genes that code for proteins than people not affected by the condition. The findings were published in the journal Nature Communications.
Top News from ADA 2015
Four diabetic ketoacidosis episodes triple risk of early death

In a cohort of adult patients with type 1 diabetes who were hospitalized with diabetic ketoacidosis (DKA), almost all patients survived the hospitalization, but they had an increased risk of early death. After one hospitalization for DKA, patients had a 10% greater risk of dying within 5 years, but after more than four hospitalizations for DKA, they had a 30% increased risk of dying within 6 years, reported Fraser W Gibb, MBChB, PhD, from the Edinburgh Centre for Endocrinology & Diabetes, Scotland. It was also "really quite striking" that the patients had a median age of 31 when they died after multiple DKA hospitalizations, and many died at home, often from "uncertain causes," he said. Session chair Kasia J Lipska, MD, MHS, from Yale University, New Haven, Connecticut, called the findings "very scary (and) sobering." (Source: Medscape)
Cardiology eMedinewS
  • NICE has published a new quality standard which sets out priorities for healthcare professionals on the treatment and management of atrial fibrillation (AF) in adults. The full standard is available online at http://www.nice.org.uk/guidance/qs93.
  • Intensive treatment with rosuvastatin for 18 months led to a regression in atherosclerotic plaques among patients with inflammatory joint diseases, reported an open-label prospective study published in the July issue of Arthritis & Rheumatology.
Pediatrics eMedinewS
  • The identification of a specific genetic mutation associated with growth retardation may be the first proof of the involvement of IGF2/IGF-II in the etiology of the growth disorders such as Silver-Russell Syndrome (SRS) and Beckwith-Wiedemann Syndrome (BWS), suggest German researchers in a paper published online in the New England Journal of Medicine.
  • Extracurricular sports, besides keeping children healthy, also provide benefits in the classroom, helping children remain engaged and disciplined, suggests a new study published in the American Journal of Health Promotion.
Dr KK Spiritual Blog
Understanding the Gunas

The mental state of a person in Vedic language is described in terms of gunas. The present state of mind of any person is a result of mixing of three gunas of nature called tamas, rajas and satoguna. In terms of states of mind they are called tamas, rajas and sattva and the nature of a person is called tamsik, rajsik and satwik.

Whether it is Vedas, Upanishads, Bhagwad Gita or the text of Ayurveda, all talk about these gunas. The Sankhya philosophy also says that a mixture of the three makes the cosmic mind as well as the human mind. Bhagwad Gita talks in great detail about the nature, yagna as well as diet depending upon these gunas.

A satwik diet is one, which makes a person full of satoguna and makes him or her with predominant satwik nature. The same is true for other two gunas. According to Ayurvedic text and in Atharvaveda, any food, which comes from the roots or underground part of the tree, is tamsik in nature. Tamsik foods should not be eaten raw. They should either be slow cooked or soaked in water for hours before consumption.

Foods from the top part of the tree like coconut, fruits, leaves and flowers are satwik in nature and can be consumed fresh, as they are. Food which comes from the middle part of the tree is often rajsik in nature.

Fresh, soaked, sprouted, natural food are often satwik, while old, leftover foods are tamsik in nature. Most satwik foods are naturally white.

Ramayana also has characters with different nature. Kumbhakaran represents a person with tamsik nature, Meghnad & Ravana with rajsik nature and Vibhishan with satwik nature. One can see that the diet of Kumbhakaran was left over foods, onions, radish, carrots and non vegetarian food, all are tamasik.

Shastras also teaches us about satwik food. In Vedic knowledge, God is represented by the consciousness and whatever is offered to God is the one, which is offered to consciousness and hence all offerings to God are soul healing and soul nurturing food items. Only satwik foods are offered to God as one can live on satwik food forever. Examples are dry fruits, fruits and milk. One cannot live on rajsik or tamsik food; hence, they have to be taken in moderation only.

The offerings to God include honey, milk, curd, fruits and vegetables, etc. Panchamrit offered in Puja is a mixture of milk, curd, ghee, honey and sugar is a classical example.

Yogashastra also talks about the role of satwik diet in great detail. It says people who eat less are yogis, people who eat in moderation are bhogis and people who eat a lot are rogis. The synonymous are tamsik for rogis, rajsik for bhogis and satwik for yogis.

In terms of proper diet one should eat dinner lighter than lunch, eat only natural food in the night and follow the principles of moderation and variety.
Events
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Inspirational Story
Good news or Bad news

Robert De Vincenzo, the great Argentine golfer, once won a tournament and, after receiving the check and smiling for the cameras, he went to the clubhouse and prepared to leave. Sometime later, he walked alone to his car in the parking lot and was approached by a young woman. She congratulated him on his victory and then told him that her child was seriously ill and near death. She did not know how she could pay the doctor’s bills and hospital expenses.

De Vincenzo was touched by her story, and he took out a pen and endorsed his winning check for payment to the woman. "Make some good days for the baby," he said as he pressed the check into her hand.

The next week he was having lunch in a country club when a Professional Golf Association official came to his table. "Some of the boys in the parking lot last week told me you met a young woman there after you won that tournament." De Vincenzo nodded. "Well," said the official, "I have news for you. She’s a phony. She has no sick baby. She’s not even married. She fleeced you, my friend."

"You mean there is no baby who is dying?" said De Vincenzo.

"That’s right," said the official. "That’s the best good news I’ve heard all week." De Vincenzo said.

Moral: Good news or bad news? It depends on how you see things. You can be bitter after cheated. Or you can choose to move on with your life.......
Wellness Blog
Donating blood reduces chances of heart attack

One should donate blood at least once in a year. Donating blood regularly has been shown in many reports to reduce chances of future heart attacks. Blood donation is also one of the best charities that one can do as it can save multiple lives through various components taken out of a single blood transfusion.

All those who are going for elective surgery should donate their blood well in advance and the same should be used at the time of surgery.

In the current medical tourism scenario, many patients who are Jehovah’s Witnesses refuse blood transfusion on religious grounds. They do not accept transfusion of whole blood or any of the four major components (blood cells, platelets, plasma and white cells). They are prepared to die rather than receive the blood. They also do not accept transfusion of stored blood including their own due to the belief that blood should not be taken out of the body and stored for any length of time. In such cases, every effort should be made to reduce blood loss, conserve blood and give drugs that can enhance hemoglobin formation.

A new concept called Bloodless Medicine has now become a reality where treatment, surgery and even emergency surgery can be done without using any blood.
Make Sure
Situation: A child with sore throat and enlarged lymph nodes developed fever.
Reaction: Oh my God! Why were antibiotics not given in time?
Lesson: Make Sure that all children with sore throat and enlarged lymph nodes are given antibiotics because such sore throats are Streptococcal unless proved otherwise.
Dr Good Dr Bad
Situation: A patient who was to undergo bypass surgery was found to have albuminuria.

Dr Bad: There is no risk.

Dr Good: There is a risk of kidney injury.

Lesson: A study reported in J Am Soc Nephrol. 2011 Jan;22(1):156-63 concluded that preoperative proteinuria is a predictor of cardiac surgery-associated acute kidney injury among patients undergoing CABG. A simple urine test for presence of proteins before heart surgery can predict which patients may develop kidney–related complications.

(Copyright IJCP)
eMedi Quiz
A primigravida at 37 week of gestation reported to labor room with central placenta praevia with heavy bleeding per vaginum. The fetal heart rate was normal at the time of examination. The best management option for her is:

1. Expectant management.
2. Cesarean section.
3. Induction and vaginal delivery.
4. Induction and forceps delivery.

Yesterday’s Mind Teaser: A hemodynamically stable nulliparous patient with ectopic pregnancy has adnexal mass of 2.5 x 3 cms and Beta hCG titre of 1500 miu/ml. What modality of treatment is suitable for her?

1. Conservative management.
2. Medical management.
3. Laparoscopic surgery.
4. Laparotomy.

Answer for yesterday’s Mind Teaser: 2. Medical Management.

Correct Answers received from: Dr G Madhusudhan, Dr Shangarpawar, Dr A C Dhariwal, Dr Jainendra Upadhyay, Daivadheenam Jella.

Answer for 12th July Mind Teaser: 2. Punch biopsy.

Correct Answers received: Dr Jainendra Upadhyay, Dr K Raju, Dr Poonam Chablani, Dr B R Bhatnagar, Daivadheenam Jella.
eMedinewS Humor
Work Load

Salesman: This computer will cut your workload by 50%. Office

Manager: That's great, I'll take two of them.
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IJCP Book of Medical Records
IJCP’s ejournals
CPR 10
Total CPR since 1st November 2012 – 101090 trained
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
Press Release
Over 1500 police PCR van staff trained in CPR 10 (Compression-only CPR, Bystander CPR, First responder CPR)

Heart Care Foundation of India jointly with Indian Medical Association, Delhi Red Cross Society and Delhi Police has trained over 1500 police PCR staff till today.

Addressing a press meet here today, Padma Shri Awardee Dr K K Aggarwal, Hony Secretary General, Indian Medical Association and Anita Roy Additional DCP Training PCR, said that they intend to train 100% staff of Delhi PCR van by 14th August this year.

“For learning CPR 10, you need not have a CPR certification. Even a common man can learn this simple technique,” said Shri Ashok Chakradhar, noted Hindi Poet and a Padma Shri Awardee.

“You never know, when you will be able to save someone’s life,” he further added.

“Successful CPR needs to be done in the first few minutes of stoppage of the heart, preferably within 10 minutes and that too earlier the better. Only a PCR van can reach the site in the first few minutes and therefore PCR staff is the best bet till effective ambulance service starts,” added Dr Aggarwal.

Dr Aggarwal said that CPR is not meant for patients who are conscious or breathing. It is done only for people who have stopped breathing.

The only thing to remember is to compress the center of the chest by 1 to 2 inches, in the center of the chest between the two nipples, with a speed of at least 100 per minute (not more than 125).

For an effective CPR, the most important aspect is compression. The person on whom CPR is performed should be lying down on a hard surface. The compression has to be done with the heels of the hands placed one over the other in the center of the chest. The weight of the operator should be put on the shoulders and not on the elbows. This can be done by keeping the elbows straight.

Ms Anita Roy, co-addressing the press, said that today PCR vans attend over 250 calls of sickness. By learning CPR 10, police will be able to save many lives.

Compression-only CPR

When multiple trained personnel are present, the simultaneous performance of continuous excellent chest compression, airway protection and proper ventilation is recommended for the management of sudden cardiac arrest as the importance of ventilation increases with the duration of the arrest.

However, if a sole lay rescuer is present or multiple lay rescuers are reluctant to perform mouth-to-mouth ventilation, the CPR can be done using excellent chest compressions alone.

Lay rescuers should not interrupt excellent chest compressions to palpate for pulses or check for the return of spontaneous circulation. They should continue CPR until medical help arrives or the patient wakes up.

For many would-be rescuers, the requirement to perform mouth-to-mouth ventilation is a significant barrier to the performance of CPR.
eIMA News
NCERT book's chapter on 'greedy' pvt hospitals draws IMA protest
Shimona Kanwar & Durgesh Nandan Jha | Jul 13/ TOI

Chandigarh/New Delhi: A chapter in an NCERT textbook on healthcare has become the latest issue of contention between the Indian Medical Association and the government.

It describes private sector as institutions that encourage incorrect practices to earn more money. For example, prescribing unnecessary medicines, injections or saline bottles when tablets can suffice.

The book, social science textbook for Class VII, also has a comic strip titled 'The cost of cure' where a parallel has been drawn between a public and private hospital to highlight the differences.

It shows how private facilities are five star-like with nice music playing and everything clean and shiny. "The doctor asked for many tests... but everyone was so friendly! The lady who took my blood for testing told me so many jokes that I forgot to feel the pain," Aman, has viral fever, describes.

Ranjan, another kid, visited a government hospital for the same problem. "We had to wait in a long queue at the OPD counter. I was feeling so sick that I had to lean on Abba all the time," he recounts.

The boy who visits the private hospital ends up spending Rs 3,500 on too many medicines while the one who went to the government hospital was given only one medicine, costing him Rs 150.

The IMA, which has sent protest letters to both the health and HRD ministries and has threatened to sue the NCERT and the authors if no action is taken, claims the projection of private services is objectionable and must be deleted. "Government hospitals get thousands of crores as grant and still they charge. Private hospitals work on revenue generation model. How can the two be compared," asked IMA secretary general Dr K K Aggarwal.

NCERT director BK Tripathi said he has asked the concerned department to clarify on the controversial paragraphs.
Text Book published by NCERT
Smt Smriti Irani
Minister for Human Resource Development
Government of India

Dear Madam

Indian Medical Association would like to bring your kind and urgent attention on the textbook of social sciences, Class VII, published by the National Council of Educational Research and Training (NCERT), which contains highly objectionable comments about medical fraternity.

As you appreciate, doctors are one of the most respected professionals anywhere in the world and so is the case in our country. It is widely accepted that most brilliant and competitive students gets admission for MBBS course. Their decision is largely influenced by the opportunity to serve human beings that the profession brings, more than any other tangible benefit. The great honour and respect that the society gives to doctors inspires many youngsters to opt to become doctors in their lives. There are many lucrative jobs in the new world, which brings more fame and financial gains. However ‘becoming a doctor’ still tops the list of childhood dreams, since it is one profession that touches the lives of people It is sad to note that the profession which takes pain in alleviating the sufferings of millions of people every day in our country is portrayed in very bad sense by the NCERT in its text book.

On page 26, chapter 2 of the textbook on “Social and Political Life-II”, under the head “Healthcare and equality”, states that, “In India, private services are increasing but public services are not. In order to earn money, these services encourage practices that are incorrect. At times, cheaper medicines, though available, are not used. For example, it is common to find doctors prescribing unnecessary medicines, injections…These services are run for profit.”

Indian Medical Association takes strong exception to the kind of language used in the textbook. Generalizing certain practices, which are rarely seen, leaves a bad imprint on the minds of young generation. A Blanket statement "In order to earn more money, these private services encourage practices that are incorrect" is highly derogatory and is demeaning the invaluable services that Doctor Community has rendered to mankind all these years

Though it has been included in the textbook a few years ago, we kindly request you to take note of this immediately and issue necessary instructions to NCERT to withdraw the statements at the earliest. We also sincerely hope that you will take necessary steps to investigate the matter in-depth and take action against the miscreants.

A sincere and speedy action is requested since these remarks may demotivate many young minds from choosing a career in medical profession as well as leave wrong impressions about doctors in their minds at a very young age

Thanks and regards

Dr A Marthanda Pillai             Dr K K Aggarwal
National President                   Honorary Secretary General
Draft National Medical Device Policy – 2015 reg
No. 31026/91/2015-PI-II
Government of India
Ministry of Chemicals & Fertilizers
Department of Pharmaceuticals
New Delhi, the 03rd June, 2015

To

1. IPA
2. IDMA
3. Association of Indian Medical Devices Industry (AIMED)
4. Federation of Indian Chamber of Commerce and Industry (FICCI)
5. CII
6. PHD Chamber of Commerce
7. ASSOCHAM
8. OPPI
9. AMCHAM

Subject: Draft National Medical Device Policy – 2015 reg.

Sir,

I am directed to enclose a copy of draft National Medical Device Policy-2015 and to request you to furnish your comments/suggestions on the same urgently and latest by six weeks of the date of this letter.

Encl: as above
                                                             Yours faithfully

                                                                  (Raj Kumar)
Under Secretary to the Govt. of India Tele: 23071162
                                                       Telefax: 23385765

Copy to: Shri V.K. Tyagi, Consultant with the request to kindly upload the same on the Department's website.

                National Medical Device Policy - 2015

1. Preamble and Background

1.1 Medical devices industry is a multi-product industry, producing wide range of products. Manufacturing and trade in medical devices is also growing quite steadily. Double digit growth rates indicate its Importance in health care. Medical devices industry mostly depends on imports. Most hi-tech innovative products and technology originate from a well-developed eco-system and innovative cycle which needs to be developed in India to promote indigenous industry and to reduce our dependence on imports.

1.2 It is estimated that the global market for medical devices is over US$ 220 billion. United States of America, with about 45% market share is the dominant market for medical devices in the world followed by European market with a share of 30% and Japan with a share of 10%. Medical devices sector in India is relatively small as compared to the rest of the manufacturing industry, though India is one of the top twenty markets for medical devices, in the World and is the 4th largest market in Asia after Japan, China and South Korea. Although accurate data is not available, an educated guess would place the sector at about Rs. 30,900 Crores in production terms. The medical devices industry can be broadly classified as consisting of (a) medical disposables and consumables (31.3%); (b) medical electronics, hospital equipments, surgical instruments (53.7%); (c) Implants (7.1%); and (d) Diagnostic Reagents (7.9%). Medical devices Industry in India is predominantly import driven accounting for over 65% of the total market and approximately 80% of import in categories (b), (c) and (d).

1.3 At present, the Indian medical devices industry is fragmented into small and medium enterprise category and is primarily manufacturing products such as disposables/medical supplies. Requirement for high end medical equipments are met by multinational companies. It is estimated that there are about 800 manufacturers in the country and based on their turnover, the industry profile of these manufacturers is as given in the table below.

Industry Profile
Turnover
% Distribution
0-10 Cr
65
10-50 Cr
25
50-100 Cr
5
100-500 Cr
3
500+ Cr
2
Source : AIMED

1.4 Various sources expect the Medical Electronics industry to reach around USD 2+ Billion in 2015 growing at a CAGR of 17% for the last five years from a size of USD 850+ Million in 2009. It is believed that the growth will not only sustain but may increase beyond 17%.

1.5 Large multinational corporations (MNC) controlling the global industry backed by multiple approvals, certification of accredited organizations and capacity to produce verified clinical trial record are able to control the major share compared to the home grown devices which lacked standardization, certification or seal of quality approval even from local authority. Lack of national regulation helped the foreign multinational corporations in doing business in this sector. The Drugs and Cosmetics (Amendment) Bill, 2015 for providing a separate chapter for regulation of the complete range of medical devices ls now under legislative process.

1.6 Besides, the others issues facing the Indian medical device industry Include training and capacity building programme, interaction with medical device regulators, policy to promote local manufacture of medical devices, granting subsidies and incentives and promoting higher education relevant to medical devices industry to bring fresh talent and techniques into research and development. There does not exist a single nodal authority for medical device industry.

1. 7 Recognizing this policy deficit, the Government constituted a Task Force under the chairmanship of the Secretary, Department of Pharmaceuticals (DoP) to address issues relating to the promotion of domestic production of high end medical devices and pharmaceutical manufacturing equipment in the country. The Task Force in its report released by Honourable Minister of Chemicals and Fertilizers on 08.04.2015 had made a set of recommendations for the promotion of the medical device industry.

2. Objective:

The National Medical Device Policy-2015 has the objective of strengthening the Make in India drive in medical device sector by reducing the dependence on imports and setting up a strong base for medical devices especially those having critical implications in terms of affordability and availability for patients.

3. Salient Features:

(i) An autonomous body "National Medical Device Authority"(NMDA) to be created under the Department of Pharmaceuticals; which may be headed by an officer of the rank of Additional Secretary/Joint Secretary to the Government of India. The Authority shall have a Member Secretary of the rank of Joint Secretary/Director; two eminent medical practitioners; two eminent medical device technologists or scientists; and Secretary General of Quality Council of India (exofficio). The Authority shall

a. Provide a single window mechanism to the industry with an objective of promotion of the medical device Industry to make the country not only self reliant but also a global hub of production and innovation in medical devices.

b. Be responsible for setting up and managing, through appropriate corporate body/ SPV, Medical Devices Mega Parks of approximately 500 hectares and above, of various specialisations in the vicinity of Centres of Excellence.

c. Create benchmarks as per international best practices and update all the stakeholders on global development.

d. Develop knowledge networks with partners from industry.

e. Identify and prevent creation of unnecessary and unjustified technical barriers to trade especially by new or changing technical regulations.

f. Support and prepare indigenous businesses to face competition, access foreign markets, nd find new business partners abroad.

g. Search, collect, collate and analyse relevant data.

h. Promote, co-ordinate and issue guidelines for the development of risk assessment methodologies and monitor, conduct and forward messages on the risks associated with medical devices to the Central Government, State Governments and other enforcement agencies.

i. Promote networking of national and international organizations within and outside India with the aim of facilitating scientific co-operation, co-ordination of activities, exchange of information, implementation of joint projects and exchange of expertise.

j. Take all such steps to ensure that the public, medical professionals and 1interested part.1es receive rapid, reliable, objective and comprehensive information through appropriate methods and means.

k. Promote general awareness as to medical device safety and medical device standards.

I. Undertake any other task assigned to it by the Central Government.

(ii) The Government on the recommendations of NMDA, subject to availability of Budgetary resources, may consider all or an appropriate mix of the following incentives for both Greenfield and Brownfield units:

a. Preference in government procurement may be considered for medical devices which are being manufactured in India with an additional preference for medical devices manufactured under MSME sector.

b. R&D by agencies like ICMR, DBT, CSIR, DIETY & DoP should be supported/ coordinated through the single window facilitating body.

c. Low cost funding like interest subsidy to MSME

d. Concessional power tariff for up to 5-10 years

e. Provide seed capital, viability gap funding and co-fund start-up projects

f. Support commercialization of innovations

g. Provide longer term view (10 years window) for 200% weighted tax deduction on approved expenditure on R&D as the gestation period in high in this industry.

h. Tax/duty structure to be designed to promote local manufacturing of quality medical devices and diagnostic equipment

i. Minimum/zero duty on the import of raw materials and manufacturing equipments for production of medical devices.

j. Restrictions on import of second hand diagnostic equipment/tools

k. Higher taxes after 5-7 years of usage for imported second hand devices.

I. Incentivize and promote exports in the medical devices sector.

(iii) Institutional framework:
  • Medical device testing centres to be set up preferably in the PPP mode-Common medical device testing facilities can be set up by government in major medical device manufacturing hubs to facilitate testing/ evaluation of medical devices. Recurring expense can be borne by the industry.
  • Designate "Centers of Excellence" (CoE) for supporting product development and validation- The centers having existing requisite facilities and expertise for different categories of medical devices (Example: Department of Electronics and Information Technology (DEITY), Bureau of Indian Standards (BIS), Indian Institute of Technology, Madras (IIT-M), Indian Institute of Technology, Delhi (IIT-D), Indian Institute of Science, Bangalore (IISc-B), Central Institute of Plastics Engineering (CIPET), Defence Research and Development Organization(DRDO). These Centres of Excellence would support:
    • Product development - design and prototyping
    • Validation and certification of the medical use of devices
    • Adopt, implement and advocate policies on efficacy and safety testing
  • Strengthen a Made in India marking (BIS) specific to Medical devices in line with international standards like CE and FDA
  • Set up a Skill Development Committee under National Medical Devices Authority with representatives from Medical devices industry, academia (NIPERs) and Healthcare Sector Skill Council (HSSC) under National Skill Development Council (NSDC), which would:
    • Identify skill gaps and reduce shortages
    • Design curriculum and explore possibilities for on-line/e-learning modules to meet specific requirement of medical device segment
    • The committee would engage with HSSC affiliated Vocational Training Providers as well as potential ITIs, Polytechnic and other institutes for skill development
    • Set up satellite training campus around manufacturing hubs for skill upgrading
    • Liaise across the Medical devices industry for job placements.
    • Provide counselling to candidates seeking skill development and address issues like student loan, scholarships, job placements etc.
  • Since the medical devices sector is highly innovation and technology intensive, it is recommended to create a system where Industry may place/make available their IP in non-core activities available to the exchange which may help technological up-gradation of the sector.
  • Set up/ promote Incubation centers through appropriate incentive structure/cost sharing. Such centers would address gaps in capabilities within R&D infrastructure, testing calibration etc.
(iv) Affordability:
  • The Government may announce a separate policy enunciating the principles for regulating the prices of identified medical devices and implement the same by notifying a separate Medical Devices Prices Control Order (MDPCO).
  • A separate division may be created in National Pharmaceuticals Pricing Authority for pricing of the devices by suitably amending the resolution constituting NPPA.
4. Implementation:

In the first phase, the Department of Pharmaceuticals will within six months, bring a detailed proposal for creation of the National Medical Devices Authority with vision, mission, objectives, constitution, Head Quarters and likely budgetary allocation for appraisal and approval of the competent authority. The Department of Pharmaceuticals will come up with separate proposals for amending the Essential Commodities Act, amending the scope of functions of NPPA, and the National Medical Devices Pricing Policy.
IMA to start hospital for terminally ill patients at Farmagudi
Posted by: Navhind Times July 13, 2015 in Goa News: The Indian Medical Association Ponda will start a community health project at Farmagudi, Ponda namely IMA Ponda Hospice palliative care centre for terminally ill patients, a unique hospital to be built and managed by professional NGO. There are 38 such institutions in the country, revealed the president, Dr Vallabh Dhaimodker.
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Reader Response
I would like to know for how many days Class A hospitals in New Delhi keep their CCTV records for cameras in Emergency, outside Emergency etc. What is the law regarding this? Dr Jayant Navarange, Medico-legal cell Chairman, IMA Maharashtra State Br

eMedinewS: There is no law about maintaining CCTV records in emergency etc.(at least in Maharashtra). However, at least 1 week storage is customary. It is prudent to maintain them for at least 1 month in emergency and for 1 week in non-emergency situations. Of course, if you can store these in external storage devices of large capacity, keep them for 1 year!
Media
IMA,IJCP,HCFI
Over 120 doctors attended the IMA Rise & Shine CME on Vitamin D deficiency in Akola
IMA,IJCP,HCFI
IMA,IJCP,HCFI
Rabies News (Dr A K Gupta)
Is sera testing of IDRV patients for antirabies antibodies necessary as a measure of knowing its efficacy?

Routine sera testing for rabies antibodies to know its efficacy is not required.
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