IMA issues advisory on the use of Sodium Valproate in pregnant women

IMA issues advisory on the use of Sodium Valproate in pregnant women Considering the multiple adverse effects of using Sodium valproate in pregnant women, IMA issues advisory to its 2.8-lakh members across the nation New Delhi, Jan 02, 2017: Sodium valproate or valproic acid is a prescription drug indicated in cases of Epilepsy to control seizures, bipolar disorder and migraine headaches. Clinical research has shown that sodium valproate can cause serious complications in a developing baby and may lead to multiple congenital disorders. According to the Medicines and Healthcare Products Regulatory Agency (MHRA) taking sodium valproate during pregnancy can cause birth defects (10% of cases) or problems in development and learning as the baby grows up (40% of the cases). WHO has already issued an advisory against the use of the drug in women who are pregnant or who have attained childbearing age. Padma Shri Awardee Dr. K.K Aggarwal, President Heart Care Foundation of India (HCFI) and National President Indian Medical Association (IMA), stated that, “In India, sodium valproate is most commonly used to treat seizures associated with epilepsy. In a minority of cases, it is also prescribed for Bipolar disorders. However, taking sodium valproate during pregnancy can increase the likelihood of developing major and minor birth defects including spina bifida and cleft palate. It can also cause neurodevelopmental defects and learning associated disabilities later in life including memory problems, speech impairment and cognitive decline. Moreover, the drug also carries a high-risk in women who are not pregnant but are of childbearing age.” The IMA-PvPI (Pharmacovigilance program of India) nodal center monitors adverse drug events and spurious drug use throughout the country. It’s database reveals that the drug is still being prescribed in India amongst high- risk patients. “Up to 40% of women who take valproic acid during the course of their pregnancy experience adverse effects. This calls for stringent measures in halting the wrongful prescription of this drug. Moreover, this also calls for stronger warnings on the drug’s information leaflets. IMA’s guidelines for Sodium valproate clearly state that doctors must explain the drugs potential risks to an unborn child while prescribing it to women living with epilepsy”, added Dr. Aggarwal. While prescribing sodium valproate to pregnant women with epilepsy, it is imperative to weigh the benefits and risks of the drug properly before taking clinical decisions. The drug should only be used as a last resort where no alternative is available. Doctors should also talk to their patients about avoiding conception while on the drug

Component of a simple consultation

Dr K K Aggarwal
National President IMA and Dr Vijay Agarwal

ACTIVITY	Actions Required	Charges INR
Registering a patient	Capturing demographic details Noting allergies Noting other alerts Storing of data for 3 years (MCI) / 7 Years (Income Tax) Electronic health record keeping (CEA Rule 9)
Consultation Professional conduct, Etiquette and Bioethics	A: Acknowledge patient and introducing yourself L: Patient listening E: Detailed explanation R: Revision in patients own words T: Thanking the patient
History taking	Detailed history taking Making a summary of past voluminous records
Examination	Ensuring privacy & confidentiality; Undressing and examination; Hand washing before and after examination.
Investigations	Planning, Counseling and Documenting
Treatment	Making provisional diagnosis; Writing detailed prescription as per MCI code of ethics. Treatment counseling
Counseling	Diet Mental Fitness Pharmacy Sexual Health Vaccination
Rehabilitation	Exercise Job Vacations
Notification	Notifiable Diseases Communicable Diseases Adverse Reactions Medico Legal Cases Sentinel Events Antimicrobial Resistance Drugs/Devices/Vaccines/ Herbs/Blood reactions
Certificates	Leave, fitness, rest etc.
Consent	Consent Informed refusal Video Consent
Skilled Maneuvers Physical Mental	1, BP in all four limbs 2. Tourniquets test 3. Carotid massage test 4. Epley maneuver 5. Cold pressor test 6. Valsalva test 7. Fundus examination 8. Brain stem reflexes 9. Cognitive functions 10. Risk stratifications 11. Filament neuropathy check 12. Per rectal exam 13. Per vaginal exam 14. Pap Smear 15. FNAC 16. Oral smear 17. Potency testing 18. torch tests for hydrocele 19. Stethoscope test for conductive deafness 20. PAPA. CHACHA, KAKA test
Skilled Procedure Physical Mental	Dressing ( Small, Medium, Large, Special) Removing Foreign Body Gastric Suction Pharyngeal/ Laryngeal Suction
Point of Care Investigations	ECG Blood Sugar SPO2 PEFR Pocket Spirometry Noise Pollution Check PM 1, 2.5, 10 levels CO Monitoring Autonomic functions Driving fitness testing Hb Urine spot test Point of care blood tests ( dengue, malaria, typhoid, chikungunya) Bence jones protein screening test
Observation / Monitoring  if Required (hours)	First dose of drug Syncope Breathlessness Hypotension Allergy reaction After injections
First Aid	Oxygen ( per hour) Nebulization CPR Other first aids Injection Cast Plaster Sling Foreign Body removal

‘Koi sun to nahi raha?’: IMA’s new National President launches campaign on medical confidentiality

‘Koi sun to nahi raha?’: IMA’s new National President launches campaign on medical confidentiality Padma Shri and Dr B C Roy National Awardee Dr KK Aggarwal was sworn in as the 88th President of Indian Medical Association on Wednesday New Delhi, Dec 31, 2016: Privacy and confidentiality are important tenets of ethical medical practice. Patients have a legal right to data privacy, and there are laws in place to guide healthcare professionals about how to store, collect and distribute information. In this case, the patient is the supreme consent giver, and without such consent, no action on their health record can be taken. Padma Shri Awardee Dr K.K Aggarwal, President Heart Care Foundation of India (HCFI) and National President Indian Medical Association (IMA), stated that "IMA wants to streamline the rules relating to medical privacy and confidentiality. Through the ‘koi sun to nahi raha’ campaign, we wish to draw the general public’s attention to the rights that they are entitled to. Data protection and confidentiality are important cornerstones of medical ethics and essential to good practice. Moreover, it is also crucial with respect to patient safety. Patients often share private and intimate details about themselves with their doctors who in turn have an obligation to keep this information safe and private”. Patient-doctor confidentiality helps build trust between the two entities and fosters a trusting environment, which is crucial to encourage the patient to seek care and to be as honest as possible during the course of a treatment. ‘Koi sun to nahi raha?’ is a campaign focused on building and strengthening this trusting relationship. “Apart from existing patient data protection laws and practices, we intend to bring out the discussion in everyday practice. Small but important routine practices in healthcare settings often breach this privacy unknowingly. For instance, IMA is against the operation theatre list being displayed in corridors; this discloses personal and sensitive information about the patients. For the same purpose, a coding based system can be devised so that the full identity of the patient is not disclosed. Moreover, calling out the name of the patient in the corridors outside ICU also falls under this breach. These are small but often overlooked details in daily medical practice, which directly go against the medical ethic of doctor-patient confidentiality. IMA intends to highlight these issue and raise awareness among the patient and doctor community”, added Dr Aggarwal. As a part of IMA’s mandate for the coming term, several innovative initiatives are underway. Mandatory request for organ donation is being implemented under the ‘ Poochna mat bhoolo' initiative. To help document and control preventable mortality, every such preventable death will be duly audited. The concept of ALERT- Acknowledge, Listen, explain, Revise and Thanks is being advocated as a routine practice in a clinical setting. The campaign for ‘think before you ink' is being envisioned in the context of encouraging blood donations. Finally, ‘Jiska koi nahi uska IMA' resonates the ideology that IMA holds above all- the greatest good is in helping those in need. With this vision, IMA plans to make affordable, quality and specialised healthcare available to all under the leadership of Dr KK Aggarwal as it’s National President and Dr RN Tandon as the Honorary Secretary General in the coming year.

Start the New Year today with a change

Start the New Year today with a change

 2016 has gone by and 2017 has come in.....a year has changed.

There has been a change of guards at IMA. A new Team IMA is in place and Team IMA is now Team 'Digital' IMA marking a change in its functioning. This year IMA will strive to be 'paperless' and use social media to connect with its members and the public.

Another major change that has carried over to this New Year is demonetisation, which has altered the financial picture in the country. It is gradually changing the way how transactions take place now  and is making way for a future 'cashless' society. IMA supports the demonetisation drive of our Prime Minister and requests all members to support it wholeheartedly and make their practice cashless.

Health is not mere absence of disease; it is a state of physical, mental, social, spiritual, environmental and financial well-being. As doctors, it is our responsibility to advocate a change in lifestyle or way of life for good health and general well-being not only for our patients but also ourselves.

Follow this routine to make some positive changes in life.

• Monday: Do not indulge in gossip, criticism, condemnation, and/or complaints. When you want to communicate, do so in a nonviolent manner.
• Tuesday: Talk to 25 people whom you have not spoken to for the last 3 months; make a list of your pending work.
• Wednesday: Distribute nonmaterialistic gifts to everyone you meet. Smile, appreciate, encourage, and say a few kind words to others.
• Thursday: Think out of the box and look for new and innovative options. Finally, ask yourself how to choose the best option.
• Friday: Follow nature and do not eat cereals. Eat a diet that is rich in fruits and salads.
• Saturday: Ask yourself as to how you can help yourself, your family, your society, and your nation.
• Sunday: Just enjoy....

Happy New Year 2017!!!

Dr KK Aggarwal
National President IMA
National President HCFI

IMA-MR Campaign IMA-MR Campaign

IMA-MR Campaign IMA-MR Campaign 

India, along with other WHO-SEAR countries, in September 2013, resolved to eliminate measles and control rubella/congenital rubella syndrome (CRS) by 2020. 

Accordingly, Ministry of Health & Family Welfare is introducing Rubella vaccine in its Universal Immunization Programme (UIP) as Measles-Rubella (MR) vaccine. 

The vaccine will be introduced as MR Campaign, targeting children from 9 months up to 15 years, in a phased manner over 2 to 3 years, followed by inclusion of the vaccine in routine immunization.

The campaign targets a large birth cohort of approximately 41 crore children, starting in the 1st quarter of 2017. The campaign will be conducted over a period of 3-4 weeks, where vaccination will first be conducted in schools and later in community through outreach. 

The campaign aims to rapidly build up immunity against measles and rubella, and also provides a second opportunity for vaccination against measles for children left out in routine immunization.

·         Sensitize patients and their relatives.

·         Use IMA PvPI number – 9717776514 – to report adverse events.

You can make your clinic a part of the vaccination center.

Dr KK Aggarwal

National President IMA

A paradigm shift in the thinking of IMA this year

A paradigm shift in the thinking of IMA this year

IMA represents the collective consciousness of 2.8 lakh doctors across 1700 local branches and 31 state branches. To further strengthen the Association, this year we have envisaged a proactive role for IMA: moving on from what “IMA can do” to what “IMA Should Do” or “IMA to Do”.

We have also defined our guiding principles for this year. In 2017, IMA policies will be based on

·           Collaboration rather than cooperation

·           Right action and not convenient action

·           Good plans and not quick plans

·           Good Governance

·          Financial stability

·          Effective time management

·          From professional to community priority

Our endeavour would be a collaborative approach to problem solving or tackling issues and challenges, where, unlike in cooperation, we work together in partnership towards one common goal. A collaborative approach accomplishes more than what can be done at an individual level.

I ask all IMA leaders to close the eyes and imagine themselves as President of IMA for a minute and think of what they could do to help the organization and the community via the Association. And that is what they contribute to the working of IMA.

Give 2 minutes of your time every day to IMA and come out with ideas and plans and submit them to IMA HQs for review and possible implementation.

Right action taken at the right time yields the desired result, which is long-lasting. The path of right action may be tough, yet it is the one we choose to solve a problem, rather than a more convenient action. A convenient action gives immediate gains, while the right action may not give immediate results.

Our aim is not to meet short-term goals. Hence, we want policies to be guided by good plans, which lay down a solid foundation. Good plans increase efficiency of working, facilitate effective utilization of resources, provide direction, promote teamwork and are goal-oriented. The gains from a good plan trickle down generations. Hence good plans are not quick plans.

Governance simply means decision making and implementation of decisions. Good governance has 8 major characteristics as described by the United Nations Economic and Social Commission for Asia and the Pacific. It is participatory, consensus oriented, accountable, transparent, responsive, effective and efficient, equitable and inclusive and follows the rule of law.

Let us all follow these principles in one voice and make the Indian medical profession best in the world.  

Dr KK Aggarwal

National President IMA and HCFI

ADA 2017 Standards of Medical Care in Diabetes

Dr K K Aggarwal, National President IMA

The American Diabetes Association (ADA) has released its new Standards of Medical Care in Diabetes for the year 2017. The guidelines have especially focused on psychological health, access to care, expanded and personalized treatment options, and the tracking of hypoglycemia in people with diabetes.

Some salient features of the new Standards of care include:

·         Guidelines on screening adults and youth with diabetes for diabetes distress, depression, anxiety and eating disorders; a list of situations that warrant a referral to a mental health specialist is also included.

·         An expanded list of diabetes comorbidities now includes autoimmune disease, HIV, anxiety disorders, depression, disordered eating behavior and serious mental illness.

·         New lifestyle management guidelines include a physical activity recommendation to interrupt prolonged sedentary behavior every 30 minutes.

·         Sleep patterns should be assessed as part of overall diabetes care because sleep quality may be associated with blood glucose management.

·         The indications for metabolic surgery have been expanded to include patients with inadequately controlled type 2 diabetes who have a BMI as low as 30 kg/m2 (27.5 kg/m2 in Asian Americans).

·         Any of the four classes of blood pressure medications that have shown beneficial cardiovascular outcomes in people with diabetes - ACE inhibitors, angiotensin receptor blockers, thiazide-like diuretics or dihydropyridine calcium channel blockers - may now be used as first-line treatment for hypertension.

·         Anew insulin algorithm included in the guidelines offers more glucose management options for people with type 2 diabetes.

·         The Standards include a new recommendation to consider the GLP-1 receptor agonist liraglutide and the SGLT-2 inhibitor empagliflozin in patients with diabetes and CV disease (history of stroke or heart attack, acute coronary syndromes, angina or peripheral arterial disease) to reduce risk of death.

·         A level of less than 54mg/dl is now defined as denoting serious clinically important hypoglycemia.

·         To help reduce health disparities, the Standards now recommend people with diabetes receive self-management support from lay health coaches, navigators and community health workers.

The Standards are available online on Dec. 15, 2016, and will be published as a supplement to the January 2017 issue of Diabetes Care.

(Source: ADA Press Release, December 15, 2016)