Straight from the heart: Affordable ICU Health care

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IMA is the collective consciousness of the medical professionals practicing modern system of medicine and is represented by over 10 lakh doctors directly through its members spread over 32 State Branches and 1750 Local Branches and through FOMA Federation of Medical Associations of India . Through WMA IMA is linked to 112 International Medical Associations. The main objective of IMA is to provide affordable available accessible and accountable quality and safe health care to the public through its members in a stress free environment. The recent Fortis issue has opened a debate on finding and fighting ways to reduce the cost of intensive care. How can affordable health care be achieved IMA is fighting with government for one price one drug one company policy so that cost of 80 of medicine can be reduced. Medicines account for 80 of the total expenditure on healthcare. The government allows the same company to sell the same quality drug at three different costs. On lines of Delhi Government policy patients should be allowed to bring medicines from outside. Only NLEM National list of essential medicines drugs should be prescribed and patient must be explained if any non NLEM drug is prescribed IMA is for providing all emergent services to people which are not within the reach of state government. This can be subsidized by IMA members but should be reimbursed by state governments. Medical profession is not a business and all doctors provide reasonable subsidy to their patients. To continue this subsidy they are entitled for non commercial rates for water electric and property. IMA is for bringing preventable deaths to zero and for that IMA recommends that every preventable death should be audited to find what went wrong so that another such incident does not happen again. Cost of emergent medical care in ICU is 200 on first day of admission 100 on subsequent days and 150 in critical ill terminal patients. Most patients cannot afford terminal care in tertiary care hospitals and this care therefore should be subsidized by the government. Do not resuscitate DNR policy should be enacted by the government so that once a patient develops brain death and or is in a condition of no recovery ventilator care can be stopped. Hospitals should not charge for providing two new bed sheets after the death of a person. At admission weightage should be given to outside tests if done in last 24 hours. These tests need not be repeated. In all corporate hospitals DNB and nursing school should be compulsory so that PG DNB residents and Nursing students are available to serve in ICUs. MCI or DNB should permit one year training fellowship courses in intensive care in these hospitals to reduce the cost of staff. 80 of the cost of intensive care is on fixed cost with 50 on the staff salaries. Better standardization of care practice though protocols and care pathways. Protocolized care for sedation analgesia glycemic control ventilator management and liberation from mechanical ventilation have been shown to reduce variation and improve the outcome of critical illness. Staffing the ICU with a multidisciplinary care team under the supervision of a trained intensivist. Fewer routine care decisions are in the hands of a single individual ultimately reducing unnecessary variability. For example pharmacists and respiratory therapists can standardize length of antibiotic courses and use of low tidal volume ventilation for patients with acute lung injury The frequency of laboratory and radiological tests the use of generic versus name brand drugs and the specific indications for transfusion are all opportunities for physicians to reduce variation in the process and cost of care. Cost control is not just the task of the health policy expert or the hospital administrator it is also the task of the individual ICU clinician. Three areas for improvement. o Standing orders for laboratory studies ECGs and chest x ray films to be eliminated. o Protocols to be developed for the appropriate use of sedation analgesics and neuromuscular blocking agents. o Protocol for weaning from mechanical ventilation should be developed to allow respiratory therapists to proceed through the weaning process A significant method of controlling ICU costs is closely monitoring which patients are admitted and when they are discharged. Lab tests represent a source of cost reduction and physicians must learn to order specific tests and not simply a battery of tests which includes the actual test desired. Limits should be placed on the tests that are ordered in terms of number and frequency. High dependency units HDUs synonymous with intermediate care units intensive observation units step down units or recovery rooms post anesthesia care units PACUs can undertake many of the traditional roles of the intensive therapy unit ITU at a fraction of the cost because costs per patient day are considerably lower in the HDU PACU than in the ITU.

Deficiency of Vitamin D can cause dementia over time

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Deficiency of Vitamin D can cause dementia over time

Many Indians are unaware that they are Vitamin D deficient

New Delhi, 28 November 2017: While the benefits of Vitamin D in reducing the risk of heart disease, multiple sclerosis, and even rheumatoid arthritis have been documented in various studies, a new study has found that deficiency of this Vitamin D can increase the risk of developing dementia. As per the study, people severely deficient in vitamin D were 122% more likely to develop dementia. Despite being a country that receives ample sunlight, about 65% to 70% Indians are deficient in this most essential vitamin.

Vitamin D is not a simple vitamin and impacts virtually every cell in the body. It is synthesized in the skin on exposure to sunshine and is needed to absorb calcium and for bone health. Low vitamin D levels are widely known to harm bones, leading them to become thin, brittle, soft or misshapen. However, it is equally important for the heart, brain, and immune function.

Speaking about this, Padma Shri Awardee Dr K K Aggarwal, National President Indian Medical Association (IMA) and President Heart Care Foundation of India (HCFI) and Dr RN Tandon – Honorary Secretary General IMA in a joint statement, said, “Vitamin D deficiency is linked with metabolic syndrome, heart diseases, and also with fertility. Research now has indicated a possible link to dementia as well. In India, the sun is worshipped as part of various festivals. The month of Magha, Vaishakha, and Kartik are considered as months for Shahi Snans where one is supposed to worship sun early in the morning and eat calcium rich food whether it is Urad Ki Daal or sesame seeds. The Chhat pooja which takes place immediately after Diwali is also linked to sun worship. The Marghshirsha month immediately after the month of Kartik also involves worshipping sun. Karkitpurnima and Vaishakhpurnima are especially known for sun worshiping. The current vitamin D mantra is that 40 days in a year for at least 40 minutes, one should expose 40% of the body to the sunlight either after sunrise or just before sunset.”

Vitamin D2 ergocalciferol is found in food items and our body makes Vitamin D3 cholecalciferol in the presence of sunlight. While both are extremely important, if D2 can be obtained from food, even little exposure to sun can help the body produce D3.

Adding further, Dr Aggarwal, said, “There are several reasons for deficiency of vitamin D. Lack of food fortification policies and more commonly our sociocultural practices, ‘sun-fleeing’ behavior, are major factors contributing to deficiency of this ‘sunshine vitamin’ in India which has abundant sunshine. Many people are unaware that they are vitamin D deficient.”

The following foods are good sources of Vitamin D.

Cod liver oil This oil comes from the liver of the cod fish and is considered extremely healthy. It helps ease joint pains and can be taken in capsule form or oil form.

Mushrooms If you love mushrooms, you are covered. Dried shitake mushrooms are a brilliant source of Vitamin D3 as well as Vitamin B. It is low in calorie and can be consumed daily.

Salmon Salmon is another good source of D3, Omega 3 and protein.

Sunflowers seeds This seed not only have Vitamin D3 but also comes with monounsaturated fats and protein.

Straight from the Heart: International IMA Activities Report 2017

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The Indian Medical Association IMA actively participates in World Medical Association WMA Confederation of Medical Associations in Asia and Oceania CMAAO Commonwealth Medical Association CMA and World Organization of Family Doctors WONCA meetings. Internationally WMA deals with all policies related to health education and regulations related to all the countries in a broad base. Policies with regard to the above issues in Asia and Oceania regions are broadly dealt by CMAAO and that in Commonwealth countries are dealt with by CMA. Of late many have criticized why IMA should participate in such meetings. Here is a brief note International interactions play a major role in deciding most National or International policies. World Medical Association WMA with the help of 112 National Medical Associations periodically develops concurrence statements concurrence declarations and resolutions on subjects of common interest. Such Statements Declarations and Resolutions are revised based on the current day requirements. There are two types of Revisions Minor revision which can be made any time and major revision which can be made after 10 years of a Declaration Statement . All member countries NMAs can raise their national issues even including work conditions of their Resident Doctors like their duty hours etc. through the International bodies. When these International bodies raise an issue even if it relates to individual countries or segments all member countries follow up such matters with the relevant related authorities in those country ies Segment s creating a huge impact on the early resolution of the issue. IMA led two major revisions polices on behalf of WMA both of which were passed in the last WMA General Assembly held in October 2017 at Chicago. o WMA STATEMENT ON HIV AIDS AND THE MEDICAL PROFESSION Adopted by the 57th WMA General Assembly Pilanesberg South Africa October 2006 and amended by the 68th WMA General Assembly Chicago United States October 2017 o WMA RESOLUTION ON TUBERCULOSIS Adopted by the 57th WMA General Assembly Pilanesberg South Africa October 2006 and revised by the68th WMA General Assembly Chicago United States October 2017 IMA is leading the revisions to third WMA policy on assisted reproductive technologies which is likely to get passed in 2018 WMA is in the process of revising the under mentioned policy in their ensuing meeting The following Declaration of Geneva now called The Physicians Pledge has been amended by WMA. Dr KK Aggarwal and Dr A Marthanda Pillai were members of the Working Group on behalf of IMA. As a member of the medical profession I SOLEMNLY PLEDGE to dedicate my life to the service of humanity THE HEALTH AND WELL BEING OF MY PATIENT will be my first consideration I WILL RESPECT the autonomy and dignity of my patient I WILL MAINTAIN the utmost respect for human life I WILL NOT PERMIT considerations of age disease or disability creed ethnic origin gender nationality political affiliation race sexual orientation social standing or any other factor to intervene between my duty and my patient I WILL RESPECT the secrets that are confided in me even after the patient has died I WILL PRACTISE my profession with conscience and dignity and in accordance with good medical practice I WILL FOSTER the honour and noble traditions of the medical profession I WILL GIVE to my teachers colleagues and students the respect and gratitude that is their due I WILL SHARE my medical knowledge for the benefit of the patient and the advancement of healthcare I WILL ATTEND TO my own health well being and abilities in order to provide care of the highest standard I WILL NOT USE my medical knowledge to violate human rights and civil liberties even under threat I MAKE THESE PROMISES solemnly freely and upon my honor Adopted by the 2nd General Assembly of the World Medical Association Geneva Switzerland September 1948 and amended by the 22nd World Medical Assembly Sydney Australia August 1968 and the 35th World Medical Assembly Venice Italy October 1983 and the 46th WMA General Assembly Stockholm Sweden September 1994 and editorially revised by the 170th WMA Council Session Divonne les Bains France May 2005 and the 173rd WMA Council Session Divonne les Bains France May 2006 and amended by the 68th WMA General Assembly Chicago United States October 2017 IMA also organized attended various international conferences as follows o Annual Scientific Meeting of Chinese Medical Association Nanjing China 14 15 January 2016 o International Summit on Air Pollution Health Advisories New Delhi March 10 2017 o 12th World Conference on Bioethics Medical Ethics Health Law Cyprus March 19 24 2017 o 206th World Medical Association WMA Council Meeting Zambia April 15 22 2017 o International Congress of Indian College of Interventional Cardiology Dubai May 4 7 2017 o 10th Geneva Conference on Person Centered Medicine Geneva May 7 10 2017 o Annual Meeting of Swedish Medical Association Sweden May 29 31 2017 o Annual Meeting of the American Medical Association Chicago June 10 14 2017 o BMA Annual Representative Meeting Bournemouth June 25 29 2017 o 32nd CMAAO General Assembly Tokyo September 13 15 2017 o WMA General Assembly Chicago October 11 14 2017 o European End of Life Issues Vatican November 2017 IMA now has direct one to one association and communication with other Medical Associations of the world. IMA has entered into a Memorandum of Understanding for Developing Strategic Cooperation Partnership with the Chinese Medical Association International collaborations o BMA Chair always attends the NATCON of IMA o Presidents of all National Medical Associations are invited in NATCON. o IMA is affiliated to BMA o Nepal Medical Association is affiliated to IMA. o IMA donated drugs worth Rs. 45 Lakh to Nepal Medical Association during the flood disaster in 2015. o Dr A Marthanda Pillai Past National President and Dr KK Aggarwal National President IMA addressed a press conference in Nepal during their visit to Nepal during flood disaster in 2015. o Dr Ketan Desai Past National President IMA served the highest post of WMA as its President during the year 2016 17. o Dr V C Pillai Past National President IMA served as President CMAAO during the year 1992 93. o Dr Vinay Aggarwal Past National President IMA served as President CMAAO during the year 2013. o Dr KK Aggarwal Hony Secretary General IMA served as Vice President CMAAO during the year 2015 16 o Dr KK Aggarwal National President IMA is serving as 1st Vice President CMAAO during the year 2016 17 o Dr KK Aggarwal National President IMA will take over as President Elect CMAAO for the years 2018 19 o Dr. S Arulrhaj Past National President served as President CMA o Dr K Vijaya Kumar Past National President served as Vice President CMA o Dr Ajay Kumar Past National President IMA is serving as Council Member WMA o Many Past National Presidents of IMA Dr Vinay Aggarwal Dr Ajay Kumar Dr A Marthanda Pillai Dr KK Aggarwal National President IMA and Dr RN Tandon Hony. Secretary General IMA have served have been serving on various Committees of WMA CMAAO o An international conference on Person Centered Medicine will be held in November 2018 at New Delhi o IMA will be hosting 2019 CMAAO meeting in September 2019 o WMA raised and supported the Dilli Chalo movement of IMA IMA is an integral part of global medical associations and should continue to lead the world in the field of medicine.

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