Friday, August 15, 2008

Pay commission and Doctors

The Cabinet has approved promotions under the Dynamic Assured Career Progression Scheme up to Senior Administrative Grade for doctors with 20 years of service.

Counting of Dearness Allowance on Non-Practising Allowance as on January 1, 2006 for fixing their pay in revised pay bands has also been approved.



Dr Marwah

Saturday, July 12, 2008

Social & Health related message in the prescription

Social & Health related message in the prescription

CGHS has been computerized & prescriptions are generated on line. Social & health message could be inserted in the prescription as header & footer . This could be done very easily. NIC could easily do it with a table of above messages.

By default one message should always be present on the prescription. CMO I/c may have the choice to select / change the message.


Dr Marwah

Thursday, June 19, 2008

Points regarding Cardio or Aerobic exercises ?

Points regarding Cardio or Aerobic exercises ?

Cardiovascular (cardio) exercise refers to exercise that strengthens the cardiovascular system. Aerobic just means in the presence of oxygen, and aerobic exercise refers to exercise that lasts long enough to require oxygen. The same type of exercise satisfies both of these qualifications, and the terms cardio and aerobic exercise are used interchangeably. Aerobic/cardio exercise uses large muscles, usually the legs, in a rhythmic fashion. Examples are running, walking, bicycling, swimming, cross-country skiing, rowing, skating, and machines such as stair steppers and elliptical trainers.

Warming Up

The best way to warm up for aerobic exercise is to start out doing the same exercise you are going to use for the workout at an easy pace for a few minutes. Then launch into a regular intensity workout. For example, if you're going out for a run, start with easy jogging, or even walking, depending on your fitness level. You may need a longer warm up in the morning or in cold weather.

Importance of Cooling Down

After vigorous aerobic exercise it is important to take 10 minutes or so to cool down gradually. Do not stop abruptly. For example, after a long run or jog, walk around and keep moving, rather than just stopping.

Cooling down properly (moving around) redistributes the blood that may have pooled in the extremities when you end your workout, and it prevents muscle stiffness because it allows the metabolic wastes to be worked out of your muscles.

Breathe Through Your Mouth

To improve your aerobic conditioning, you should work hard enough that you just naturally start breathing through your mouth to get enough oxygen. It is sometimes recommended to breathe only through your nose to minimize effects of air pollution, but this limits the intensity of your workout. Avoid pollution by working out early or indoors, if necessary.

Basic Fitness Routine

If you want to get a decent aerobic workout routine going, do aerobic exercise at least three times a week. During your aerobic workouts, try to keep your heart rate between 60-80 percent of maximum for at least twenty minutes. This will improve your cardiovascular fitness.

Sleep Benefits

Sleep duration and patterns can affect sports training and performance. Most people need 7 or 8 hours of sleep, and your body functions at its best when you have regular sleep patterns, generally sleeping at about the same time every night. So if your workouts, practices, or competitions aren´t going well, consider whether you´re getting enough sleep.

Jumping Rope

Jumping rope can be a good aerobic exercise. For most people it´s pretty vigorous, so intervals may be the best way to go. Warm up with some brisk walking, then jump for two minutes, rest a minute or so, jump two, etc. If you can go longer, do it. Add half a minute to your jumping and/or shorten your rest periods if you want to improve your jumping time and make this one of your main exercises. Make sure to choose a surface that isn't too hard. Like other cardio exercises, work at a pace where you´re breathing a little hard but can still talk.

Talk Test

If you don´t want to take your pulse all the time during aerobic exercise, apply the talk test to see if you´re in your training heart rate range. You should be breathing heavier than normal, but still be able to carry on a conversation. Don't push yourself, though--you want to be able to talk but not sing.

Stair Running

Running up stairs is a time-honored way to improve aerobic conditioning. Take them 2 at a time if you're athletic and consider them to be part of your interval training. Even if you're new to exercise, you can benefit from walking up stairs whenever you get a chance. The calories burned will add up, and your conditioning will improve. If you have trouble finding time to exercise, take 10 minutes once or twice a day and walk up and down stairs at work (or before or after). Hold on to the rail if you need to.

Improving Fitness

People who have higher cardiorespiratory fitness have fewer cardiovascular risk factors than people who are less fit, even if the less fit are equally or more active. This means you should improve your cardio (aerobic) fitness by challenging yourself instead of always doing the same workout. Move up a level on your bike or stair stepper, or try interval training: work hard for 2 or 3 minutes, then recover slowly for the same time. On the track, run a lap briskly followed by a slow lap. Do 4-8 intervals after a warm up once or twice a week instead of your regular workout, as a change of pace.


Dr Marwah

Monday, June 16, 2008

THINGS TO KNOW ABOUT BLOOD DONATIONS

WORLD BLOOD DONOR DAY 14 JUNE

THINGS TO KNOW ABOUT BLOOD DONATIONS

  • 90% of individuals that are eligible to donate blood are not currently doing so.

  • Blood donations have a short shelf-life, so regular donors are essential to secure a constant supply.

  • Due to a shortage of blood and ageing populations, the age limits for blood donation acceptability are becoming increasingly flexible: the standard age limits for blood donation are 18 to 65 years of age, but in some European countries this has been lowered to 17 and increased to 70. In some places outside Europe, the lower and higher limits go from 15 with parental consent, to over 70 years of age.

  • Regular blood donors are individuals donating at least twice a year, on a regular basis. They are demonstrated to be the source of safest blood donations. They have regular health checks on the occasion of each donation, and a healthy life style.

  • The prevalence of markers for blood borne infections in blood donations can vary from 0.001 to 7.5 %, related to the category of blood donors. Blood which is found to be infected, for example with Hepatitis B, C or HIV, is disposed of and not used for transfusions.

  • One donated unit of whole blood can save up to 3 lives, through separation and use of its components.

  • Giving blood regularly may itself be good for you. It has been ascribed potential health benefits in coronary artery disease and oxygen-free radical chemistry. Regular blood donation is a life saving treatment for hereditary haemocromatosis and polycitemia vera.

  • The world record in blood donation is held by Maurice Wood in the United States of America, who in 2004 gave his 300th unit of blood.



--
Dr Marwah

Wednesday, May 7, 2008

Central Government Health Scheme — Sheet anchor of staff morale

Central Government Health Scheme — Sheet anchor of staff morale Where welfare measures and commitment to social responsibility are concerned, the Government scores over every private agency. This is vital in building up staff morale and motivation. There will be a perceptible fall in both if serving personnel are forced to wrestle with the vagaries

The Ministry of Health and Family Welfare has initiated a review of the working of the scheme with the help of a commendably comprehensive and eye-opening appraisal of its working by A. F. Ferguson & Co.

Read the views of one of the beneficiary in the newspaper. The link to that is given below.

http://www.thehindubusinessline.com/2008/04/09/stories/2008040950050800.htm



--
Dr Marwah

Friday, April 4, 2008

Guidelines for medical officer for IUCD insertion

Guidelines for medical officer for IUCD insertion


As you all know that intrauterine contraceptive device ( IUCD ) is one of the most effective reversible contraceptive method.


Some important contraindication for its use are :-


  1. Pregnancy

  2. Pelvic inflammatory disease ( PID )

  3. Abnormal vaginal bleeding.

  4. Cancer of cervix or uterus.

  5. H/O ectopic pregnancy.

  6. Congenitally malformed uterus.

  7. Pelvic tumours.

  8. Valvular heart disease.


Cu T should be inserted with care if patient had cesarean section in last three months.


Counselling


Every client should be counselled to help decide to plan his / her family and to choose a method based on informed choice. Whenever possible spouse/partner should be counselled.

Once a client has chosen Cu T as a method for family planning, provide her relevant information and clarify her doubts.

                    1  The likely problems during Cu T insertion and for few months after insertion.

      1. Effectively period.

      2. Need to check whether Cu T is in place .

      3. Need to come for follow up after periods , after 3 months ,every year and report if there is problem like some pain abdomen ,if she misses her period or if she has continuous vaginal bleeding or if she cannot feel the thread.


Timing of Cu T insertion :-


  • -Within some days of last menstrual period ( LMP ) .
  • -4-6 weeks postpartum ( after ruling out pregnancy ).
  • -Immediately after MTP / abortion.
  • -During lactational amenorhoea (after ruling out pregnancy)


Pelvic examination:-

  • Ask the client to empty the bladder and lie on examination table on her back with flexed knees.

  • Autoclave equipments should be ready before hand .

  • Wash and scrub hands and wear sterile gloves.

  • Inspect external genitalia and look for any wart, boil,growth or discharge.

  • Clean the introitus and do the pelvic examination to see the size and direction of uterus and to rule out any pelvic infection or tumour.

  • Insert Sim's speculum.

  • Retract anterior vaginal wall with anterior vaginal wall retractor and inspect cervix for any infection,growth,polyp or discharge.

  • Clean the cervix.

  • Hold the anterior lip of cervix with volsellum and give gentle traction downwards.

  • Insert uterine sound gently ( if uterus is ante verted the curve of the sound should be facing abdomen ). Introduce sound gently into uterus till a slight resistance of fundus of uterus is felt. Determine the length of uterus by placing finger against the sound at the level of external os. . It is normally between 6 – 9 cm.

  • Load the Cu T.

  • Align the flange and the folded arms of Cu T in a horizontal position.

  • Adjust the flange at the measured length of uterus.

  • Grasp the volsellum and introduce loaded Cu T with plunger into the uterus till a slight resistance is felt.

  • Hold the volsellum and plunger with one hand and withdraw the tube downwards.

  • Again gently push the insertion tube until a slight resistance is felt.

  • Remove the plunger.

  • Withdraw insertion tube gently.

  • Cu T the strings 2 – 3 cm. from exernal os.

  • Remove the volsellum and speculum.

  • Wash the gloved hands . Remove the gloves and put them for sterilisation.



The above guidelines are prepared by Dr Sadhna Rajvanshi

--
Dr Marwah

Friday, March 28, 2008

PERIODICAL 100% STOCK VERIFICATION

PROBLEMS RELATED TO STORE

  Inventory shortage / excess vis-à-vis stock register

   Pilferage

   Inefficiency

     Improper checks

    Issue without indents

     Error in posting of entries

 SOLUTIONS

    PERIODICAL STOCK VERIFICATION

  SURPRISE CHECKS IN THE DISPENSARIES ARE THE PART OF PERIODICAL STOCK VERIFICATION

 PERIODICAL 100% STOCK VERIFICATION

      IT'S A REQUIREMENT UNDER GFR RULE 115 ( I).

    TO BE CARRIED OUT ONCE A YEAR

    IT IS DIFFERENT FROM AUDIT.

    A TEAM AND A SUBSTITUTE TEAM, EACH COMPRISES OF CMO, PHARMACIST AND LDC WILL WORK UNDER THE CONTROL OF ADDL. DIRECTOR OF CONCERNED ZONE.

 

TEAM WILL CARRY OUT 100% STOCK VERIFICATION OF ALL THE STORES OF HOSPITALS, DISPENSARIES AND UNITS UNDER THE CONTROL OF RESPECTIVE ZONE

 

A SEPARATE TEAM WILL CONDUCT THE 100% STOCK VERIFICATION OF MSD, AYURVEDIC ,HOMEOPATHIC AND UNANI STORES

 

IN ADDITION TO 100% STOCK VERIFICATION ,THE TEAM WILL SUBMIT THE REPORT OF OBSOLETE/ SURPLUS/ UNSERVICEABLE STORES TO THE ADDL. DIRECTOR (MSD)

 

IN CGHS, THIS ANNUAL EXERCISE ALSO INCLUDES

 

       EXAMINATION OF I P O'S REGARDING PENSIONERS AND GENERAL PUBLIC CARDS.

      MASTER REGISTER  FOR REVALIDATION OF PENSIONER / GENERAL PUBLIC CARDS ACCORDING TO THE CGHS COMPENDIUM.

      EMERGENCY AUTHORITY SLIPS 

    LOCAL PURCHASE PROCEDURE  FOR INDENT OF INADMISSIBLE, FOOD, COSMETICS AND ADVERTISED ITEMS

 

PROCEDURE OF INSPECTION

     ALL THE INDENTS HAVE BEEN ENTERED INTO THE STOCK REGISTER

     VERIFY ALL THE STORE ITEMS INCLUDING DRUGS ( INCLUDING LOCAL PURCHASE) AND NON DRUGS ITEMS

    AN INVENTORY OF DEAD STOCK ARTICLES SUCH AS PLANT, MACHINERY, FURNITURE, EQUIPMENTS AND FIXTURES ETC, SHOULD BE MAINTAINED AT THE SITE OF DEAD STOCK

     INSPECTION TEAM SHOULD VERIFY THE ARTICLES AND RECORD THE RESULT ON THE INVENTORY

     VERIFICATION SHOULD BE DONE IN THE PRESENCE OF PERSON RESPONSIBLE FOR THE CUSTODY OF THE STORE

     ALL DISCREPANCIES NOTICED SHALL BE BROUGHT TO ACCOUNT IMMEDIATELY SO THE STORE ACCOUNT MAY REPRESENT THE TRUE STATEMENT OF THE STORE

     SHORTAGES, DAMAGES AND OBSOLETE/ SURPLUS/ UNSERVICEABLE STORES SHALL BE REPORTED TO THE H O D

      THE INSPECTION TEAM SHOULD GET THE SIGNATURES OF STOCK HOLDER, IN CHARGE OF THE DISPENSARY ALONG WITH SIGNATURES OF HIS TEAM ON EVERY PAGE OF THE REPORT

      PREPARE THE REPORT IN DUPLICATE.( ORIGINAL FOR IAU (HQ) AND DUPLICATE FOR DISPENSARY). MSD AND RESPECTIVE ZONES MAY BE INFORMED REGARDING THE SAME

     VERIFY THE INVENTORY OF DIFFERENT SECTIONS (INJECTION ROOM ,LAB. DRESSING ROOM ETC. ) FROM THE STOCK LEDGER

    COMMENT UPON THE CONDEMNATION REGISTER, BREAKAGE REGISTER.

      DATE OF LAST CONDEMNATION/ DEWEEDING AND SANCTION FOR THE SAME HAS BEEN RECEIVED AND REFLECTED INTO THE STOCK REGISTER

      EXAMINE THE UNCLAIMED REGISTER

      WHETHER INDENT – ISSUE / RECEIPT REGISTER FOR LOCAL PURCHASE MEDICINES IS MAINTAINED?

      WHETHER INDENTS, TOKEN OF RECEIPT TO THE CHEMIST, ARE RETURNED IN TIME?

      WHETHER DISCREPANCIES FOUND DURING LAST YEAR 100% STOCK VERIFICATION ARE RECONCILED AND REPORTED TO THE H O D.


--
Dr Marwah

Sunday, March 23, 2008

World Kidney Day

World Kidney Day

(March 13-2008)
World Kidney Day

World Kidney Day is religiously celebrated on the second Thursday in the month of march each year, in 6 continents, stretching across 80 countries.
The purpose of this health day is to focus on those vital organs-kidneys- that tirelessly function to keep us alive, healthy and fit. Another important goal of the day is to spread awareness among the masses about Chronic Kidney Disease –a condition that it is common, harmful, yet, treatable.

Dr Marwah

The slogan of World Tuberculosis Day 24th march 2008

I Am Stopping TB'
I am stopping TB is more than slogan. It is the start of a two-year campaign that belongs to people everywhere who are doing their part to Stop TB.
This year's World TB Day is about celebrating the lives and stories of people affected by TB: women, men and children who have taken TB treatment; nurses; doctors; researchers; community workers--anyone who has contributed towards the global fight against TB.
The slogan, I am stopping TB , says that everyone can take an active role in helping all people in need gain access to accurate TB diagnosis and effective treatment,

Patients can stop TB by becoming active participants in their own cure and taking all their anti-TB drugs as prescribed.
Health workers can stop TB by staying alert to the symptoms of the disease and providing prompt diagnosis and treatment.
Scientists can stop TB by engaging in needed research to develop new diagnostics, new drugs and new vaccines.
Teachers can stop TB by educating their students about this age-old scourge.
Communities can stop TB by sharing information to help prevent the disease and get treatment to those who need it.


Dr Marwah

Monday, March 17, 2008

Guidelines Updated for Administration of Combination MMRV Vaccine

Guidelines Updated for Administration of Combination MMRV Vaccine


The updated ACIP recommendation now reads as follows: "Combination MMRV vaccine is approved for use among healthy children aged 12 months – 12 years. MMRV vaccine is indicated for simultaneous vaccination against measles, mumps, rubella, and varicella. ACIP does not express a preference for use of MMRV vaccine over separate injections of equivalent component vaccines (i.e., MMR vaccine and varicella vaccine)."

The ACIP also advocated that a work group be convened for in-depth analysis of data regarding the increased risk for febrile seizures after the first dose of MMRV vaccine. On the basis of these findings and other information that becomes available, the CDC, FDA, and ACIP will consider future policy options, communicate updates, and implement further necessary actions.

If you want to read it in details, please visit the following website at the address given below.
http://www.medscape.com/viewarticle/571507
--
Dr Marwah

Computerization in CGHS

Computerization in CGHS

Kidwai Nagar CGHS dispensary was fully computerised on 10 march 2008.
Chemist is not making any entry in the indent submitted by the dispensary since 11th march 2008.
How is he supplying the indent to the dispensary? Probably he is following the old system.
He is not supplying the medicines in the morning. If  he is fined for the delay, he starts misbehaving.


CGHS / NIC server was very slow since morning today. Its very difficult to work in the dispensary.
NIC should do something about server, otherwise it will be a big failure.

NIC bosses should come and work one full day in the dispensary. Then they will realize the
problems faced by the public as well as Doctors working in the dispensary.


Dr Marwah

Sunday, March 16, 2008

Computerisation In CGHS

Kidwai Nagar dispensary is computerised since 10th march 2008.
On 15th march 321 patients attended the dispensary.

Main problems are :

  1. Net is very slow.
  2. NIC server is slow and around 11.00 am either it is very slow or could not be contacted.
  3. Chemist / MSD authority could be issued from the computer but the report can not be generated.
  4. More over Chemist / MSD authority are not serial numbered.
  5. Permission software for investigation and treatment from private recognised hospital is incomplete.
  6. Some items are shown in the inventory but they could not be issued.
  7. Previously indented items if repeated are shown without any choice of selecting as indented/ chemist authority / MSD authority.
  8. Pharmacist cannot find when the patient has drawn the medicine before .
  9. There should be special module for the pharmacist distributing the local purchase medicines.
  10. Linux and Mozila browser are outdated and need to be updated. NIC people are not able to do it in spite of repeated request.

Solutions

  • CGHS should install their own server or NIC should upgrade their server.
  • MTNL connection should be 512 kb connection.
  • There should be a special module for the pharmacist distributing the local purchase medicines.
  • RAM may be increased to 1 GB.
  • Linux and Mozila browser may be updated.
  • NIC should modify the software keeping  above points in view.
  • Provisions should be made so that reports in different formats  could  be generated

Dr Marwah

Saturday, February 23, 2008

Proton Pump Inhibitors

Guidelines on the use of Proton Pump Inhibitors (PPI) in the Treatment of Dyspepsia

    1.1 In patients with documented duodenal or gastric ulcers, a treatment strategy of testing for Helicobacter pylori and, where positive, eradicating the infection is recommended. Long-term acid-suppressing therapy should not be used. Those patients who are H.pylori negative or remain symptomatic after eradication therapy should be treated as described in1.6

    1.2 For patients with a documented non-steroidal anti-inflammatory drug (NSAID)-induced ulcer, who must unavoidably continue with NSAID therapy (e.g. those with severe rheumatoid arthritis), an acid suppressor, usually a proton pump inhibitor (PPI), should be prescribed. After the ulcer has healed, the patient, where possible, should be stepped down to a maintenance dose of the acid suppressor.
    1.2 Patients who have severe gastro-oesophageal reflux disorder (GORD) symptoms or who have a proven pathology (e.g. oesophageal ulceration, Barrett's oesophagus) should be treated with a healing dose of a PPI until symptoms have been controlled. After that has been achieved, the dose should be stepped down to the lowest dose that maintains control of symptoms. A regular maintenance low dose of most PPIs will prevent recurrent GORD symptoms in 70-80% of patients and should be used in preference to the higher healing dose. Where necessary, should symptoms re-appear, the higher dose should be recommenced. In complicated oesophagitis (stricture, ulcer, haemorrhage), the full dose should be maintained. Patients with mild GORD symptoms and/or those who do not have a proven pathology can frequently be managed by alternative therapies (at least in the first instance) including antacids, alginates, or H2RAs (H2 receptor antagonists).
    1.3 Patients diagnosed with non-ulcer dyspepsia (NUD) may have symptoms caused by different aetiologies and should not be routinely treated with PPIs. Should the symptoms appear to be acid-related, an antacid or the lowest dose of an acid suppressor to control symptoms should be prescribed. If they do not appear to be acid-related, an alternative therapeutic strategy should be employed.
    1.5 Patients presenting in general practice with mild symptoms of dyspepsia may be treated on either a "step-up" or a "step-down" basis. Neither group should normally be treated with PPIs on a long-term basis without a confirmed clinical diagnosis being made.
    1.6 In circumstances where it is appropriate to use a PPI and where healing is required, the optimal dose to achieve this should be prescribed initially. Once healing has been achieved, or for conditions where it is not required, the lowest dose of the PPI that provides effective symptom relief should be used.
    1.7 The least expensive appropriate PPI should be used.

--
Dr Marwah

Wednesday, January 30, 2008

Anti-leprosy day 30th January

The martyrdom day of Mahatma Gandhi (30th January) is observed as Anti-leprosy day throughout the world. It is also called "International Anti-leprosy day".
Mahatma Gandhi's cherished dream of a leprosy-eliminated India has come true. Thanks to the support of the various NGOs, national and international bodies along with the Government machinery, the number of leprosy cases has come down from 40 lakhs in 1982 to less than 1 lakh today. Since the Prevalance Rate has come down to less than 1 per 10,000 population in India, the govt. has declared that leprosy has been eliminated.
Leprosy is completely curable today. An air-borne disease caused by mycobacterium leprae, leprosy was a scourge to humanity and it had a lot of misconceptions. Leprosy is a socio-medical problem. Though the number of leprosy cases has come down, the stigma still prevails. A lot need to be done with regard to rehabilitation of persons affected with leprosy (PALs).
India as eliminated leprosy but still we have to eradicate the disease from our country which would be possible by increasing the awareness regarding the // transmission of the bacteria and the treatment regimen to be followed for treating the disease.
World Health Organization is playing a great role in eradication of Leprosy through its free worldwide distribution of Multi-drug Treatment drugs, which is supplied as blister drug packets to India.

Dr Marwah