eMedinewS17th August 2014, Sunday

Dr K K AggarwalPadma Shri, Dr B C Roy National Awardee and DST National Science Communication Awardee

Dr KK Aggarwal

President, Heart Care Foundation of India; Senior Consultant Physician, Cardiologist & Dean Medical Education Moolchand Medcity; Editor in Chief IJCP Group, Senior National Vice President, Indian Medical Association; Member Ethics Committee Medical Council of India, Chairman Ethical Committee Delhi Medical Council, Hony. Visiting Professor (Clinical Research) DIPSAR; Limca Book of Record Holder in CPR, Chairman (Delhi Chapter) International Medical Sciences Academy (March 10–13); Hony Director IMA AKN Sinha Institute (08–09); Hony Finance Secretary National IMA (07–08); Chairman IMA Academy of Medical Specialties (06–07); President Delhi Medical Association (05–06), President IMA New Delhi Branch (94–95, 02–04);
For updates follow at :  www.twitter.com/DrKKAggarwal, www.facebook.com/Dr KKAggarwal

MCI Update

This Bill/Notification, pending since 2010, has been recently approved by the General Body of the Medical Council of India (MCI) and is likely to get notified soon.

MEDICAL COUNCIL OF INDIA

NOTIFICATION

New Delhi, the––––May 2010

No.MCI–211(1)/2010(Ethics)/– In exercise of the powers conferred by Section 33 of the Indian Medical Council Act, 1956(102 of 1956), the Medical Council of India with the previous sanction of the Central Government, hereby makes the following Regulations to amend the “Indian Medical Council (Professional Conduct, Etiquette and Ethics) Regulations, 2002:–

(i) These Regulations may be called the "Indian Medical Council(Professional Conduct, Etiquette and Ethics) (Amendment) Regulations 2010"

(ii)They shall come into force from the date of their publication in the Official Gazette.

1. In the "Indian Medical Council (Professional Conduct, Etiquette and Ethics) Regulations, 2002", the following additions/modifications/deletions/substitutions, shall be, as indicated therein:-

3.(i) The title of Section 6.8, as amended vide notification dated 10.12.2009, shall be further amended by deleting the words " and professional association of doctors" as under:–

"6.8 Code of conduct for doctors in their relationship with pharmaceutical and allied health sector industry".

(ii) Section 6.8.1(b); as amended vide notification dated 10/12/2009, shall be substituted as under:

(b) Travel Facilities: A medical practitioner shall not accept any travel facility inside the country or outside; including rail, road, air, ship, cruise tickets, paid vacation; etc. from any pharmaceutical or allied healthcare industry or their representatives for self and family members for vacation or for attending conferences, seminars, workshops, CME Programme; etc. as a delegate.

(iii) Action to be taken by the Council for violation of Section 6.8, as amended vide notification dated 10/12/2009, shall be prescribed by further amending the Section 6.8.1 as under:–

SECTION

ACTION

6.8.1 In dealing with pharmaceutical and allied health sector industry, a medical practitioner shall follow and adheres to the stipulations given below:

 

a) Gifts: A medical practitioner shall not receive any gift from any pharmaceutical or allied health care industry and their sales people or representatives

Gifts more than Rs.1,000/- upto Rs.5000/– Censure
Gifts more than Rs.5000/– upto Rs.10000/– Removal from Indian Medical Register or State Medical Register for 3(three) months
Gifts more than Rs.10000/– to Rs.50,000/– Removal from Indian Medical Register or State Medical Register for six months
Gifts more than Rs.50,000/– to Rs.1,00,000/– Removal from Indian Medical Register or State Medical Register for One Year Gifts more than Rs.1,00,000/–“ Removal for a period of more than one year from Indian Medical Register or State Medical Register/

b) Travel facilities: A medical practitioner shall not accept any travel facility inside the country or outside, including rail, road, air, ship, cruise tickets, paid vacations etc. from any pharmaceutical or allied healthcare industry or their representatives for self and family members for vacation or for attending conferences, seminars, workshops, CME programme etc as a delegate

Expenses for travel facilities more than  Rs.1,000/- upto Rs.5000/–: Censure
Expenses for travel facilities more than Rs.5000/- upto Rs.10000/–: Removal from Indian Medical Register or State Medical Register for 3(three) months
Expenses for travel facilities more than Rs.10000 to Rs.50,000/–: Removal from Indian Medical Register or State Medical Register for six months
Expenses for travel facilities more that Rs.50,000/– to Rs.1,00,000/–: Removal from Indian Medical Register or State Medical Register for one year.
Expenses for travel facilities more than Rs.1,00,000/–: Removal for a period of more than one year from Indian Medical Register or State Medical Register

c) Hospitality: A medical practitioner shall not accept individually any hospitality like hotel accommodation for self and family members under any pretext.

Expenses for Hospitality more than Rs.1,000/- upto Rs.5000/–: Censure
Expenses for Hospitality more than Rs.5000/– upto Rs.10000/–:Removal from Indian Medical Register or State Medical Register for 3(three) months
Expenses for Hospitality more than Rs.10000/– to Rs.50,000/–: Removal from Indian Medical Register or State Medical Register for six months.
Expenses for Hospitality more than Rs.50,000/– to Rs.1,00,000/–: Removal from Indian Medical Register or State Medical Register for One Year.
Expenses for Hospitality more than Rs.1,00,000/-: Removal for a period of more than one year from Indian Medical Register or State Medical Register.

d) Cash or monetary grants: A medical practitioner shall not receive any cash or monetary grants from any pharmaceutical and allied healthcare industry for individual purpose in individual capacity under any pretext. Funding for medical research, study etc. can only be received through approved institutions by modalities laid down by law / rules/ guidelines adopted by such approved institutions, in a transparent manner. It shall always be fully disclosed.

Cash or monetary grants more than Rs.1,000/– upto Rs.50000/– Censure
Cash or monetary grants more than Rs.5000/– upto Rs.10000/–: Removal from Indian Medical Register or State Medical Register for 3(three months)
Cash or monetary grants more than Rs.10000/– to Rs.50,000/–: Removal from Indian Medical Register or State Medical Register for six months
Cash or monetary grants more than Rs.50,000/–to Rs.1,00,000/–: Removal from Indian Medical Register for State Medical Register for one year Cash or monetary grants more than Rs.1,00,000/–: Removal for a period of more than one year from Indian Medical Register or State Medical Register.

e) Medical Research: A medical practitioner may carry out, participate in, work in research projects funded by pharmaceutical and allied healthcare industries.  A medical practitioner is obliged to know that the fulfillment of the following items(i) to (vii) will be an imperative for undertaking any research assignment; project funded by industry- for being proper and ethical. Thus in accepting such a position a medical practitioner shall:-
(i) Ensure that the particular research proposal(s) has the due permission from the competent concerned authorities.
(ii) Ensure that such a research project(s) has the clearance of national/state/institutional ethics committees/bodies
(iii) Ensure that it fulfils all the legal requirements prescribed for medical research.
(iv) Ensure that the Source and amount of funding is publicity disclosed at the beginning itself
(v) Ensure that proper care and facilities are provided to human volunteers, if they are necessary for the research projects(s)
(vi) Ensure that undue animal experimentations are not done and when these are necessary they are done in a scientific and a humane way.
(vii) Ensure that while accepting such an assignment a medical practitioner shall have the freedom to publish the results of the research in the greater interest of the society by inserting such a clause in the MoU or any other document/ agreement for any such assignment.

First time censure, and thereafter removal of name from Indian Medical Register or State Medical Register for a period depending upon the violation of the clause.

f)Maintaining Professional Autonomy: in dealing with pharmaceutical and allied healthcare industry a medical practitioner shall always ensure that there shall never by any compromise either with his/her own professional autonomy and / or with the autonomy and freedom of the medical institution

First time censure, and thereafter removal of name from Indian Medical Register or State Medical Register

g) Affiliation: A medical practitioner may work for pharmaceutical and allied healthcare industries in advisory capacities, as consultants, as researchers as treating doctors or in any other professional capacity. In doing so, a medical practitioner shall always:
(i) Ensure that his professional integrity and freedom are maintained.
(ii) Ensure that patient’s interests are not compromised in any way.
(iii) Ensure that such affiliations are within the law.
(iv) Ensure that such affiliations/employments are fully transparent and disclosed.

First time censure, and thereafter removal of name from Indian Medical Register or State Medical Register for a period depending upon the violation of the clause.

h) Endorsement: A medical practitioner shall not endorse any drug or product of the industry publicity. Any study conducted on the efficacy or otherwise of such products shall be presented to and or through appropriate scientific bodies or published in appropriate scientific journals in a proper way"

First Time censure; and thereafter removal of name from Indian Medical Register or State Medical Register.

(Lt Col (Retd) Dr A R N Setalvad)

Secretary
Medical Council of India

Foot Note: The Principal Regulations, namely; "Indian Medical Council (Professional Conduct, Etiquette and Ethics) Regulations, 2002" were published in Part –III, Section (4) of the Gazette of India on the 6th April, 2002, and amended vide MCI notification dated 22/02/2003, 26/05/2004 & 10/12/2009.

Beware of patients who want to get admitted only for Mediclaim reimbursement

I got a call yesterday, 14th August, from a patient who wanted a consultation with me. I told him to come to my clinic. He told me he wanted to see me early morning at Moolchand so that he could get admitted right away, if required, to get investigated. He came the next morning when I was busy with my Echo schedule. I told my assistant to ask them to get my consultation card made. He refused to pay for my consultation fee and instead asked me to admit him first and then see.

I said, "How can I admit you without seeing a need for it". He said that he wanted reimbursement and would not pay for the pre admission consultation fee. Then I said, “What if you do not need an admission”.

He asked me to send him to the emergency room and admit him first. I said even in ER the charges would be there and will be ore admission charges.

He then brought one person who said that pre hospital bills are not admissible in insurance which was not correct as bills one month prior to admission are reimbursable.

Any way I did not succumb to his request and he walked away.

Lesson: Every day we get a request that someone wants to get admitted in the hospital so that he or she could be investigated fully and get reimbursement from Mediclaim. This is cheating the insurance company and amounts to violation of MCI Code of Medical Ethics Regulations and may attract a suspension of license to practice.

No individual should be admitted to a hospital, unless there is an emergency and admission can be justified. A situation may arise when the same patient may later get admitted through emergency, then it is our duty not to fill the Mediclaim form if the admission was not justified.

News Around The Globe

  • Novel analysis from the Substance Abuse and Mental Health Services Administration (SAMHSA) has revealed that overmedicating with the insomnia drug zolpidem led to a near doubling of emergency department (ED) visits in the United States during the periods 2005–2006 and 2009-2010. The new Drug Abuse Warning Network (DAWN) report was released on SAMHSA’s Web site August 7.
  • A new study published in the Journal of Clinical Endocrinology & Metabolism pointed that women who are deficient in vitamin D are half as likely to conceive using in vitro fertilization compared with women without vitamin D deficiency.
  • Older adults with both depression and mild cognitive impairment (MCI) may have brain biomarkers that suggest an increased risk for accelerated brain aging, leading to the development of dementia, reports a new study published online in Molecular Psychiatry.
  • A new study, published in the journal Cell, suggests that antibiotic exposure during early life may lead to permanent changes in the gut, increasing the risk of later–life obesity and metabolic abnormalities.
  • A new multicenter study revealed that nearly 16% of men and 11% of women are at high risk of stroke due to low education level, smoking and high blood pressure. The study has been published in the journal Stroke.

Rabies News (Dr A K Gupta)

What does humanizing your dog mean?

  1. Talking to your dog like he/she is a person.
  2. Treating your dog like he/she is a person.
  3. Allowing dogs to do what they want because it will hurt their "feelings."
  4. Dressing them up in little doggie clothes.

Remember, humanizing your dog is fulfilling your own human needs, not your dogs. Humanizing dogs does more harm than good.

Cardiology eMedinewS

  • The World Health Organization recommends that adults should consume less than 2 g of sodium per day. A new study has noted that sodium intake above this recommendation accounts for almost 1 in 10 cardiovascular deaths globally each year. The study is published in The New England Journal of Medicine.
  • Regular running as a form of exercise, even running at higher–gear competitive levels, is an effective way to regain and even improve one’s physical status lost in the early days following an acute MI. However, for those with damaged but recovering hearts, there may be a peak exercise threshold that preserves cardiovascular safety; higher than that threshold, CV mortality may start increasing again, suggests a cohort study published August 12 in Mayo Clinic Proceedings.

Pediatrics eMedinewS

  • A new study led by researchers at the Johns Hopkins Children’s Center in Baltimore has stated that children who live in inner-city areas are more susceptible to food allergies. Results of the study are published in the Journal of Allergy and Clinical Immunology.
  • A child's future health is affected by parents’ genes as well as their lifestyle, suggest researchers from The University of Adelaide in Australia. Researchers stated that unhealthy parents may set up their children for poor health, even before they are conceived. The findings are published in the journal Science.

Dr K K Spiritual Blog

How to remove negative thoughts

Darkness is absence of light and similarly negative thoughts are absence of positive thoughts. The answer to negative thoughts is to bring positive thoughts back. Ideal mind is devils workshop and will always think negative. Here are the ways by which you can remove negative thoughts.

  • Think differently as taught by Adi Shankaracharya. Once Menaka approached Arjuna with lust and said that she wanted to have a son like him with him. Arjuna said that why wait for 25 years consider me as you son from today.
  • Think opposite as taught by Patanjali. For example if you are thinking of stealing, then silently start thinking of charity.
  • Think positive as taught by Buddha. Make a list of positive actions to be done today the first thing in the morning and concentrate on that list. Divert your mind to the pending works. This is a type of behavioral therapy.

Wellness Blog

Restricting salt in diet can lower heart disease risk

  • Restricting salt in the diet can lower the risk of developing heart disease by 25 percent and the risk of dying from heart disease by 20 percent.
  • Dietary intake of sodium among Indians is excessively high. Lowering the intake of sodium has been well recognized to lower the blood pressure in hypertensive individuals. A study published in British Medical Journal has shown that reducing salt also has an effect on cardiovascular disease.
  • When people with pre hypertension (blood pressure more than 120/80 and lower than 140/90), reduced their salt intake by about 25 to 35%, they were 25% less likely to develop cardiovascular disease 10 to 15 years after the trial ended. There was also a 20 percent lower death rate from cardiovascular disease among those who cut their salt consumption.
  • Salt restriction is best achieved by avoiding salted, salt cured and salt smoked foods such as lunch meat, hot dogs, ham, olives, pickles and regular salted canned foods, and other prepared foods, which often use more salt than homemade equivalents. Foods we would never think of as salty, such as breakfast cereals, cookies, and even some soft drinks, often contain copious additions of sodium.
  • WHO recommends limiting the salt intake daily to less than 5 grams.

Inspirational Story

Keep Your Dream

I have a friend named Monty Roberts who owns a horse ranch in San Ysidro. He has let me use his house to put on fund–raising events to raise money for youth at risk programs.

The last time I was there he introduced me by saying, "I want to tell you why I let Jack use my horse. It all goes back to a story about a young man who was the son of an itinerant horse trainer who would go from stable to stable, race track to race track, farm to farm and ranch to ranch, training horses. As a result, the boy–s high school career was continually interrupted. When he was a senior, he was asked to write a paper about what he wanted to be and do when he grew up.

That night he wrote a seven–page paper describing his goal of someday owning a horse ranch. He wrote about his dream in great detail and he even drew a diagram of a 200–acre ranch, showing the location of all the buildings, the stables and the track. Then he drew a detailed floor plan for a 4,000–square–foot house that would sit on a 200–acre dream ranch.

He put a great deal of his heart into the project and the next day he handed it in to his teacher. Two days later he received his paper back. On the front page was a large red F with a note that read, "See me after class."

The boy with the dream went to see the teacher after class and asked, "Why did I receive an F?"

The teacher said, "This is an unrealistic dream for a young boy like you. You have no money. You come from an itinerant family. You have no resources. Owning a horse ranch requires a lot of money. You have to buy the land. You have to pay for the original breeding stock and later you'll have to pay large stud fees. There’s no way you could ever do it." Then the teacher added, "If you will rewrite this paper with a more realistic goal, I will reconsider your grade."

The boy went home and thought about it long and hard. He asked his father what he should do. His father said, "Look, son, you have to make up your own mind on this. However, I think it is a very important decision for you." Finally, after sitting with it for a week, the boy turned in the same paper, making no changes at all.

He stated, "You can keep the F and I’ll keep my dream."

Monty then turned to the assembled group and said, "I tell you this story because you are sitting in my 4,000-square-foot house in the middle of my 200–acre horse ranch. I still have that school paper framed over the fireplace." He added, "The best part of the story is that two summers ago that same schoolteacher brought 30 kids to camp out on my ranch for a week." When the teacher was leaving, he said, "Look, Monty, I can tell you this now. When I was your teacher, I was something of a dream stealer. During those years I stole a lot of kids’ dreams. Fortunately you had enough gumption not to give up on yours."

"Don’t let anyone steal your dreams. Follow your heart, no matter what."

ePress Release

Best time to have a heart attack is week days

Fifteen minutes of sun exposure is a must and the best time to have a heart attack is a week day, said Padma Shri, Dr. B C Roy National Awardee & DST National Science Communication Awardee, Dr. K K Aggarwal, President Heart Care Foundation of India and Sr National Vice President Indian Medical Association.

  • 15 minutes of sun exposure must: A research by Dr. Michal Melamed, at Albert Einstein College of Medicine in New York City has discovered that people with low blood levels of vitamin D were found to have a higher incidence of peripheral arterial disease (PAD), potentially dangerous blockages in the arteries of the legs. The study of nearly 4,900 American adults found more than double the incidence of PAD among those with the lowest levels of vitamin D compared to those with the highest levels. Vitamin D is produced when the body is exposed to sunlight. Current guidelines recommend a vitamin D intake of 400 International Units a day for people aged 50 and older. In addition to sunlight, other sources of vitamin D are salmon, sardines, cod liver oil, fortified milk and some fortified cereals. Exposure to sunlight "always calls for a balance. Overexposure raises the risk of skin cancer. The recommendation about 10 to 15 minutes of direct exposure.
  • Best time to have a heart attack is a week day: Your chances for surviving a cardiac arrest are 13.4 percent worse if you are admitted to the hospital on the weekend versus a weekday. Even after taking into account factors such as hospital size and location and the person's age, gender and other illnesses, the lower survival rate remains the same. According to Richard M. Dubinsky, of the University of Kansas Medical Center in Kansas City, a higher death rate among patients admitted on weekends may be due to lack of resources for treating cardiac arrest. The findings come from researchers analyzing a national database containing a 20 percent sampling of all U.S. hospital admissions for cardiac arrest from 1990 to 2004. The analysis included 67,554 admissions. During cardiac arrest, the heart slows or stops working, and brain death can occur in just 4 to 6 minutes.

eMedi Quiz

An increased incidence of cholangiocarcinoma is seen in all of the following except:

1. Hydatid cyst of liver.
2. Polycystic disease of liver.
3. Sclerosing cholangitis.
4. Liver flukes.

Yesterday’s Mind Teaser: A 2–month–old baby with acute icteric viral hepatitis–like illness slips into encephalopathy after 48 hours. The mother is a known hepatitis B carrier. Mother’s hepatitis B virus serological profile is most likely to be:
1. HBsAg positive only.
2. HbsAg and HBeAg positive.
3. HBsAg and HBe antibody positive.
4. HBV DNA positive.

Answer for yesterday’s Mind Teaser: 2. HbsAg and HBeAg positive.

Correct answers received from: Shashank Jalak, Dr P C Das, Dr K Raju, Dr Avtar Krishan, Dr Jainendra Upadhyay, Dr Pankaj Agarwal, Daivadheenam Jella, Arvind Diwaker,Dr Ajay Gandhi, Smriti Aggarwal, Ajay Sinha, dr poonam chablani,

Answer for 16th August Mind Teaser: 2. Tricuspid valve.

Correct answers received from: Smriti Aggarwal

Send your answer to ijcp12@gmail.com

Self-Assessment-Quiz

 

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cpr10 Mantra The CPR 10 Mantra is – "within 10 minutes of death, earlier the better; at least for the next 10 minutes, longer the better; compress the centre of the chest of the dead person continuously and effectively with a speed of 10×10 i.e. 100 per minute."

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Moderate coffee intake protects against stroke

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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 on :

 

Make Sure

Situation: A patient on penicillin antibiotic developed a relapse of fever while still on antibiotic.
Reaction: Oh my God! Why was the antibiotic continued for so long?
Lesson: Make sure that drug fever is always excluded in such situations. Antibiotics are the most common cause of drug fever, accounting for approximately one–third of episodes. This especially applies to beta–lactams, sulfonamides and nitrofurantoin (Am J Med Sci 1987;294:275).

eMedinewS Humor

After 15 years of marriage the wife asked her husband to describe her.

The husband looked at her slowly and without blinking an eye, said, "ABCDEFGHIJK."

"What does that mean?" She asked.
"Adorable, Beautiful, Cute, Delightful, Elegant, Fashionable, Gorgeous and Hot!!!" he replied.

Smiling, the wife asked, "So sweet of you honey. What about IJK?"

He replied, "I’m Just Kidding!

Quote of the Day

Determine what specific goal you want to achieve. Then dedicate yourself to its attainment with unswerving singleness of purpose, the trenchant zeal of a crusader. Paul J. Meyer

Twitter of the Day

Dr KK Aggarwal: Smoking and ulcerative colitis http://bit.ly/HTZaj4 #Health
Dr Deepak Chopra:When I visualize what I want to contribute to the world while I am meditating, I start crying. Any advice? http://bit.ly/DC_Ananda #ananda

medicolegal update

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  1. Dear Sir, Thanks for the updation. Regards: Dr Kartik
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