Measles-Rubella initiative: IMA urges support in favor of the campaign

Measles-Rubella initiative: IMA urges support in favor of the campaign About 139 million children in India under the age of 9 months to 10 years are susceptible to Measles and Rubella infection. The medical community needs to support the campaign and accelerate its progress. New Delhi, Jan 03, 2017: India, along with other WHO-SEAR countries, in September 2013, resolved to eliminate measles and control rubella/congenital rubella syndrome by 2020. Accordingly, Ministry of Health & Family Welfare has introduced Rubella vaccine in its Universal Immunization Programmed as Measles-Rubella vaccine. The MR (Measles-Rubella) vaccination campaign is scheduled from February 7 to February 24 and will cover the city schools in its first week. Karnataka, Tamil Nadu, Goa, Puducherry and Lakshadweep are places where the vaccine will be introduced. Padma Shri Awardee Dr. KK Aggarwal, President Heart Care Foundation of India (HCFI) and National President, IMA and Dr RN Tandon, Honorary Secretary General of Indian Medical Association (IMA), in a joint statement said that, “MR vaccine is a single injection and administered by trained professionals. The vaccinations will be free of cost and will target children in the age group of 9 months to 15 years. It is a single injection combined and administered in two doses - one, for children between 9 to 12 months and the second for children between 16 months and 24 months. Unlike the polio drops every child between the age of 9 months and 15 years needs to reach the booths for the vaccination.” 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. As per 2015 data, measles- rubella vaccination coverage has been more than 90% at the national level and about 80% at the district level. The reported incidence rates have reduced up to less than 5 cases per million. “Vaccine availability and management are big challenges to the campaign. Moreover quality training, micro planning & monitoring remain imperative. There is a need to sensitise patients and their relatives through mass level awareness campaigns. Doctors are urged to contribute by making their clinic a part of vaccination center duly coordinated by the state health and family welfare department along with other bodies.”, added Dr. Aggarwal. Vigilant monitoring of adverse effects is also a crucial component of the campaign to improvise existing schemes and strategies. Patient and doctor contribution is of utmost importance in this regard. Caretakers and patients can use IMA PvPI number – 9717776514 – to report adverse events. Source: http://www.measlesrubellainitiative.org/wp-content/uploads/2014/09/Country-Update-India.pdf

Koi Sun to Nahi Raha?’ A Campaign on medical confidentiality

Koi Sun to Nahi Raha?’ A Campaign on medical confidentiality Privacy and confidentiality are important tenets of ethical medical practice. Article 9 of the Universal Declaration on Bioethics and Human Rights of UNESCO states as follows: “The privacy of the persons concerned and the confidentiality of their personal information should be respected. To the greatest extent possible, such information should not be used or disclosed for purposes other than those for which it was collected or consented to, consistent with international law, in particular international human rights law.” 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. The patient is the supreme consent giver, and without such consent, no action on their health record can be taken. The hospital owns the records, but the information therein is owned by the patient. 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 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. IMA wants to streamline the rules relating to medical privacy and confidentiality. ‘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. Through this campaign, we wish to draw the attention of the general public to the rights that they are entitled to. 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. A coding based system can be devised instead so that the full identity of the patient is not disclosed. 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 ethics of doctor-patient confidentiality. IMA intends to highlight these issues and raise awareness about them among the patient and doctor community.

Every preventable newborn death must be audited: IMA

Every preventable newborn death must be audited: IMA IMA organises a workshop on Newborn Care in association with the Trained Nurses Association of India (TNAI) and Heart Care Foundation of India (HCFI). New Delhi, Jan 04, 2017: The Newborn care workshop organised in by IMA today in association with the Trained Nurses Association of India (TNAI) and Heart Care Foundation of India (HCFI) highlighted some critical issues in the context of neonatal and infant healthcare. India ranks the topmost among countries with the highest number of child deaths in the world. In 2015, 1.2 million of the world’s total 5.9 million child deaths, (48% per 1000) live births occurred in India. The majority of these deaths are due to preventable causes. Recognising this issue, IMA has ordered that every newborn death in India must be audited at each level of medical care to prevent further deaths. This is a part of the organisation's undertaking to achieve the United Nations Sustainable Development Goals 2030. Padma Shri Awardee Dr K.K Aggarwal, President Heart Care Foundation of India (HCFI) and National President Indian Medical Association (IMA), stated that “20% of world’s newborn mortality occurs in India. A majority of these are due to preventable causes and can be avoided. Auditing of such mortality cases will ensure that the cases are duly documented. This will help prevent further child deaths in future. This step will also ensure stringency in child care at hospitals across the nation as medical institutions will now have to be accountable to concerned authorities. Along with such stringent measures from the medical community, generating mass level awareness across socio-economic groups across India is also important.” The top most preventable causes of newborn across the world are the following: • Preterm complications • Newborn infections • Birth complications • Mother’s malnutrition Dr R N Tandon, Honorary Secretary General, Indian Medical Association added, “All newborn should be breastfed in the 1st ½ hour to reduce chances of infection.” Ms Anita Deodhar, President, TNAI, in her message, said that nurses and doctors can complement each other in reducing neonatal mortality. Ms P. Kannan, Secretary General, TNAI, stated that "Over 3 lakh children 0-6 years die because of preventable diarrhoea and, all these lives can be saved by giving timely ORS.” Dr Tanvi Pal, Sr. Paediatric Skin Specialist at BL Kapoor Super Speciality Hospital said, “It is a myth that one should remove the white layer on the skin of the newborn and that the mother should clean the cord of the newborn on a daily basis. While massaging the newborn baby is good for the health, avoid vigorous massage in the 1st month.” The workshop also stressed that mass sensitization needs to be encouraged on aspects like immediate and exclusive breastfeeding, hospital birth and postnatal care especially in rural areas; access to adequate nutrition, knowledge of symptoms of danger signs in a child’s health; sanitation, hygiene and vaccinations.

All IMA members should Support MR Campaign

All IMA members should Support MR Campaign Dr KK Aggarwal National President IMA & HCFI India, along with other WHO-SEAR countries, in September 2013, resolved to eliminate measles and control rubella/congenital rubella syndrome by 2020. Accordingly, the Ministry of Health & Family Welfare has introduced Rubella vaccine in its Universal Immunization Programme (UIP) as Measles-Rubella (MR) vaccine. The MR vaccination campaign is scheduled from February 7 to February 24 and will cover the city schools in its first week. Karnataka, Tamil Nadu, Goa, Puducherry and Lakshadweep are places where the vaccine will be introduced. MR vaccine is a single injection and administered by trained professionals. The vaccinations will be free of cost and will target children in the age group of 9 months to 15 years. It is a single injection combined and administered in two doses: one, for children between 9 to 12 months and the second for children between 16 months and 24 months. Unlike the polio drops campaign, every child between the age of 9 months and 15 years needs to reach the booth for the vaccination. 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. It will be coordinated by the state health and family welfare department along with other bodies. What you can do to support the campaign • 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.

IMA Advisory: In every unexplained death give an option to conduct a virtual autopsy

IMA Advisory: In every unexplained death give an option to conduct a virtual autopsy New Delhi, Jan 05, 2017: IMA is for establishing virtual autopsies at the clinical level for non-medicolegal cases. Virtual autopsies can be facilitated by currently available techniques like whole body CT, whole body MRI, post mortem angiography and molecular autopsy. 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, “Virtopsy or virtual autopsy is an alternative to traditional autopsy, conducted with scanning and imaging technology. The methods used are whole body or limited CT and or MRI. One can add to it CT guided post mortem biopsies for histopathological and genetic correlations. CT is well suited to show foreign objects, bone and air or gas distribution throughout the body, whereas MRI sequences are strong in detailing organ and soft tissue findings. A comprehensive analysis of both surface and deep tissue findings may require fusion of CT, MRI and 3D surface data.” Virtual autopsy using the whole body CT scan or MRI can done in no time and will leave no scar which may offer a reliable alternative to conventional autopsy in certain cases. “Virtual autopsy can be the answers in finding the cause of death and also evaluate the cause in unexplained deaths. The same is necessary to prevent further such episodes in the community. It is also the answer for most medicolegal disputes. In every death IMA members should give an option for virtual biopsy with or without mini FNAC/ tissue biopsy. And informed refusal must be noted”, added Dr. Aggarwal. Considering the increasing number of unexplained deaths in the medicolegal and non- medicolegal settings, virtual autopsies may help accelerate the investigation process. Due guidelines for ethical practice of Virtopsy should also be defined to prevent any misuse.

GPs are the backbone of the society: Wake up

GPs are the backbone of the society: Wake up 

• General Practitioners are the backbone of medical practice.
• General Practitioners are mini multi-specialists.
• Family Physicians are first contact and all-purpose doctors.
• General practitioners are the most complete and comprehensive doctors.
• GPs are the foundation stone of Medical practice.
• GPs, wake up now and hoist the flag of affordable medical practice.
• GPs are most relevant in today's India.
• Family Physicians only can lead India's health delivery system.
• GPs are primary health deliverers.
• GPs are the most economical Practitioners, yet the most neglected ones.
• GPs are the most complete and abundant subset of doctors.

Dr KK Aggarwal
National President IMA and HCFI

Indian Medical Association celebrates its Founder’s Day

Indian Medical Association celebrates its Founder’s Day Shi C K Mishra, Secretary Health, Ministry of Health & Family Welfare, Govt. of India commemorates the event by delivering an oration on affordable healthcare IMA leadership speaks out against the Medical Exit Exam - NEXT New Delhi January 07, 2017: The Indian Medical Association is celebrating its Founders Day today. To commemorate the event a State President and Secretaries and National Leadership meet was held at the IMA headquarters this morning. The IMA leaders reached a consensus to oppose the Medical Exit Exam – NEXT at the meeting. An oration will be delivered by Shi C K Mishra, Secretary Health, Ministry of Health & Family Welfare, Govt. of India this evening for over 1000 IMA doctors and influencers on Affordable health care and achievement of sustainable development goals. Having recently taken over as the 88th President of Indian Medical Association, Padma Shri and Dr B C Roy National Awardee Dr KK Aggarwal said, “In today’s IMA leadership meet that saw representation from all Indian States, it was decided that we will unanimously oppose the Medical Exit Exam, now termed as NEXT. It is not fair for a person who has passed his MBBS to give another exam to practice. We are however for the Centralized final MBBS Exam.” IMA under Dr Aggarwal’s leadership in 2017 will be working towards making affordable and accessible healthcare a reality. IMA has proposed the launch of medical centres across India that will offer common surgeries at fixed price of Rs.15, 000/- to the public. Addressing the conference, Dr R N Tandon, Hony. Secretary General, IMA said, “IMA is for reservation of seats for doctors in service who have served in rural areas, but the same should be rationalised and proportional to their number in the States.” The Past National Presidents of IMA – Dr V.C.V Patel, Dr S. Arulrhaj, Dr Ajay Kumar, Dr M. Abbas, Dr Vinay Aggarwal & Dr A. Marthanda Pillai in a joint statement said, "IMA will standardise medical education and launch IMA Clinics. All doctors in the country can participate in the National Health Programmes; that will be certified by IMA as ‘IMA Clinics’.” In 2017 IMA will continue to fight for its demand of capping the compensation provided in medical negligence cases, undemocratic National Commission Bill and a ban on non-MBBS and non-BDS doctors prescribing modern medicine drugs. Some key initiatives that will be launched this year include a mandatory request for organ donation under the ‘Poochna mat bhoolo’ initiative, auditing of preventable mortality and ‘think before you ink’ campaign in 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. This shift in IMA's ideology from ‘What IMA can do' to ‘What IMA should do' will help foster more holistic and community directed goals and visions as IMA strives to touch new heights this year.

Required Request in Every Death: “Puchna mat Bhulo”

Required Request in Every Death: “Puchna mat Bhulo” Dr KK Aggarwal National President IMA IMA is committed to promoting eye and organ donation. To this end, IMA will launch a campaign at branch and state levels called “Puchna Mat Bhulo” to promote “mandatory required request’. All IMA members should, in case of routine death, request the relatives or legal heirs for donation of eyes (in case of death) and organs (in case of brain death). As per Transplantation of Human Organs and Tissues Rules, 2014 any doctor in ICU in a situation of brain stem death, in consultation with transplant coordinator (if available) shall ascertain from the next of kin or the legal heir of the body whether the dead person, while he was alive, had authorised for donation of his or her organs either by filling form 5 or in driving license. If yes, then the RMD is duty bound to request the next of the kin or the legal heir to submit the aforesaid authorisation and sign the declaration/authorisation. Also the doctor SHALL ascertain, after certification of brain stem death of the person in ICU from his or her adult near relative or, if near relative is not available, then, any other person related by blood or marriage, and in case of unclaimed body, from the person in lawful possession of the body the following (a) whether the person had, in the presence of two or more witnesses (at least one of who is a near relative of such person), unequivocally authorised before his or her death as specified in Form 7 or in documents like driving license, etc. wherein the provision for donation may be incorporated after notification of these rules, the removal of his or her organ(s) or tissue(s) including eye, after his or her death, for therapeutic purposes and there is no reason to believe that the person had subsequently revoked the aforesaid authorisation; (b) where the said authorisation was not made by the person to donate his or her organ(s) or tissue(s) after his or her death, then the registered medical practitioner in consultation with the transplant coordinator, if available, SHALL make the near relative or person in lawful possession of the body, aware of the option to authorise or decline the donation of such human organs or tissues or both (which can be used for therapeutic purposes) including eye or cornea of the deceased person and a declaration or authorisation to this effect shall be ascertained from the near relative or person in lawful possession of the body as per Form 8 to record the status of consent, and in case of an unclaimed body, authorisation shall be made in Form 9 by the authorised official as per sub-section (1) of section 5 of the Act; (c) after the near relative or person in lawful possession of the body authorises removal and gives consent for donation of human organ(s) or tissue(s) of the deceased person, the registered medical practitioner through the transplant coordinator shall inform the authorised registered Human Organ Retrieval Centre through authorised coordinating organisation by available documentable mode of communication, for removal, storage or transportation of organ(s) or tissue(s). • "Mandatory" or required request for donation of the organs of patients dying in hospitals is likely to increase the rate of organ harvest and will alleviate the critical shortage of transplantable organs. • “Required request” or “required referral” is defined as “that it shall be illegal, irresponsible and immoral to disconnect a ventilator from an individual who is declared dead following brain stem testing without first making proper enquiry as to the possibility of that individual's tissues and organs being used for the purposes of transplantation”. • IMA policy is that in every death, the doctor should explore about corneal donation. India needs 2 lakh donor eyes per year to take care of corneal blindness. One is able to collect only 25,000 donor eyes per year. For every 1000 population, 7.89 persons die every year. If request is made for eye donation at the time of death and even if 1% people of total deaths donate eyes, one will be able to cover the shortage. IMA Slogans #Puchna mat bhulo: IMA policy is that in every death, the doctor shall explore about corneal donation. #Puchna mat bhulo: India needs 2 lakh donor eyes per year and only collects 25,000 donor eyes. #Puchna mat bhulo: For every 1000 population 7.89 persons die every year. #Puchna mat bhulo: Required request, it is illegal, irresponsible & immoral to disconnect a ventilator from a patient declared brain dead without enquiring possibility of that patients tissues and organs donation #Puchna mat bhulo: IMA member SHALL make the near relative or person in lawful possession of the body, aware of the option to authorise or decline the donation of human organs or tissues or both #Puchna mat bhulo: All IMA members should, in case of routine death, request the near relations for corneal and whole body donation and in situations with brain stem death for organs donations. #Puchna mat bhulo: As per Transplantation of Human Organs and Tissues Rules, 2014: Required request is mandatory.

IMA embraces the Prime Minister’s Digital India Movement; pledge to function in a paperless manner in 2017

IMA embraces the Prime Minister’s Digital India Movement; pledge to function in a paperless manner in 2017 New Delhi, Jan 1, 2017: Technological advancements have helped bridge geographical boundaries in our country. The Prime Minister since the beginning of his term has been pushing Indians to embrace the digital era through his many campaigns and policies. Keeping in line with the dynamics of the changing world, the Indian Medical Association, the only representative voluntary organization of over 2.8 lakh doctors of the modern scientific system of medicine has decided to go digital. The new governing body the organization has already started functioning in a paperless manner since the beginning of their term last week. Through 2017, the Association will amplify key policies and messages to both its 2.8-lakh doctor members and the public at large through the digital medium. Padma Shri Awardee Dr. K.K Aggarwal, President Heart Care Foundation of India (HCFI) and National President Indian Medical Association (IMA), stated that, “IMA is in the process of becoming a paperless Association. It has been our constant endeavor to make the medical profession more transparent and effective along with raising large-scale public health awareness about matters of National importance. We echo our Prime Minister’s belief in the potential of a Digital India and will be using this as a medium to communicate with both doctors and the public.” IMA has already created a digital group called Team IMA, which will make daily communication between over 2500 Central Council Members possible. Since January 2016 year, over 2 lakh doctor members of the IMA are being sent daily updates on the organization and key health matters through the medium of text messages and emails. This will continue in 2017. “The official communications including notifications for CME events, information given out by IMA headquarters, communication from the government to IMA and other periodic updates will all be preceded electronically. There are plans to start publishing our official magazine as an online version too” added Dr. Aggarwal. All official communication sent IMA will be through the digital medium. As part of a project to make theirs a paperless organization, the association has also developed a mobile app to ease communication.

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 endeavor 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 their 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 will 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. Good plans therefore 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 the best in the world. Dr KK Aggarwal National President IMA and HCFI

IMA President Installation

      IMA President Installation

                 1. IMA NATCON 2016 - Sister Shivani Verma on Self-Motivation https://www.youtube.com/watch?v=qoDA0qjg2k0

2. Oath Taking Ceremony - Team Digital IMA (2017-18):  https://youtu.be/1aLCvBpZrjA

3. Dr Ketan Desai, President World Medical Association, addressing during IMA NATCON 2016: https://youtu.be/JqTnhGTlOdw

4. Hon'ble Shri A.R. Kohli, Former Governor, Mizoram speaking during IMA NATCON 2016 https://youtu.be/bIOyOH5Ov6E

5.  Dr K K Aggarwal, National President IMA addresses during IMA NATCON 2016: https://youtu.be/ZbWliJZ2zk0

    

IMA-No Incentive Initiative

IMA-No Incentive Initiative
During the Central Council Meeting in Amritsar, I had said in my presidential speech that IMA will have zero tolerance for unethical practices including sex selective abortions for non-medical purposes and cuts and commissions. And that IMA and the medical profession will boycott any person indulging in unethical sex selective practices. I am happy to note that IMA Bagalkot Branch in Karnataka, under the Presidentship of Dr Shekhar Mane has taken up the “IMA-No Incentive Initiative”. The draft undertaking by the branch states “INCENTIVES in any form cash, cheque, gifts, articles, parties etc. will NOT be given to or taken from any of our colleagues, referring doctors, RMP, quacks, ASHA workers, ambulances, laboratories etc.” Incentive means where no service is attached. The branch also nominated an Ethical & Vigilance Committee comprising of 15 doctors with President and Secretary as ex officio member. If any doctor or hospital violates this model code of conduct, then the complaint can be investigated by this ethical committee. The committee will discuss and counsel the doctor/s involved and send a notice to them directing compliance. The matter will also be brought to the notice of the Executive Committee or General Body for warning. The punitive action includes suspension from the local IMA branch and report to the MCI, KMC and other govt. regulatory authorities for necessary action. In order to discourage crosspathy, the branch further resolved that all modern scientific medicine (allopathic) doctors must stop going to hospitals owned by practicing non allopathic doctors as visiting consultants. Dr KK Aggarwal National President IMA and HCFI

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

Noise pollution: IMA Safe Sound Initiative

Noise pollution: IMA Safe Sound Initiative

The National Initiative for Safe Sound is one of the important social projects of National IMA started two years back. This Initiative has been taken up by IMA as an awareness campaign on the serious health issues of the Noise Pollution.  

Not only is noise a primary reason for permanent deafness worldwide, it also has a lot of deleterious effects on our vital organs like brain and sympathetic nerve system, cardiovascular, endocrine, immune systems etc.  It aggravates all lifestyle diseases including hypertension, diabetes, heart diseases and malignancies.  As you are aware, our country is the noisiest place in the world and at the same time public is hardly aware of these health issues.

Considering all these facts, IMA, under the leadership of Immediate Past President Dr Marthanda Pillai and Honorary Secretary General Dr KK Agarwal initiated this project in 2014. The activities for the National Initiative for Safe Sound continued this year too with the support of National President Dr SS Agarwal.  In the last two years most of the activities were in south India, Maharashtra and Delhi and we could do a lot in this regard in these places.

The incoming National President and present Honorary Secretary General wish to continue this project in a much more effective way by implementing the project in all the states in India. He has asked me, as the National coordinator of IMA National Initiative for Safe Sound, to suggest one senior IMA leader as coordinator in every state, preferably an ENT person (but not necessarily so if a doctor from any other specialty is really interested to take up this project).

Being the IMA State President of your state, I would request you to nominate such a person as the State coordinator of IMA National Initiative for Safe Sound and let me know his email address and telephone number.

Please consider this as urgent as I have been asked by the Honorary Secretary General to give the list of state coordinators by the 18^th of December.

I am copying this mail to our HSG Dr KK Aggarwal, IMA NISS Chairman Dr KA Seethi and Convenor Dr CN Raja.

Expecting your urgent attention and valuable cooperation.

Yours in IMA

Dr John Panicker
Trivandrum, Kerala
National Coordinator, IMA Safe Sound Initiative

Top 10 Advances in Cardiology (AHA)

Top 10 Advances in Cardiology (AHA)

1.     In selective high-risk groups, additional therapies help prevent a second stroke: Previous research has shown that to prevent a second stroke, “aggressive medical management” — treating and controlling high cholesterol, high blood pressure and blood sugar, as well as lifestyle behaviors such as smoking cessation and exercise — is better than stenting. But a study, SAMMPRIS, published in JAMA identified a subgroup of patients at higher risk for a recurrent stroke despite this medical management – and who need stenting. Investigators found that high-risk patients included those who had an old stroke in the area of the blockage, a new stroke or were not on a statin at the time they joined the study.

2.     New possibilities for treating women with heart attacks: The study, in the American Heart Association’s journal, Circulation: Cardiovascular Imaging, found that women had a type of plaque thought to be vulnerable throughout the blood vessels, while in men, they were mostly found in the earliest part of the artery. The way plaques “broke” often was different as well. Men had larger size plaques even though the women in the study had more cardiovascular risk factors.

3.     More options for valve replacements in the elderly: In high risk patients with aortic valve stenosis, treatment means either open-heart surgery or transcatheter aortic valve replacement. This study, which focused on older patients, compared surgery and TAVR by looking at the survival and stroke rates of intermediate-risk patients. The research, published in the New England Journal of Medicine, showed the rates were similar and that use of either procedure would produce similar outcomes.

4.     Long-term study validates less-selective invasive treatment for narrowed neck arteries: In the past, the typical treatment for carotid arteries narrowing was carotid endarterectomy. And now, research, CREST study published in the NEJM and based on a 10-year follow-up, gives stenting more validation as an accepted alternative.

5.     Better together: Managing blood pressure and cholesterol at same time helps lower heart risk: This research, called HOPE 3, is a combination of three articles published simultaneously in the New England Journal of Medicine that, taken together, conclude that reducing both blood pressure and cholesterol is better than doing either alone. It also provide further evidence supporting the benefits of statins in Asian and Hispanic populations.

6.     Evidence we might be able to outsmart our genes: A study in NEJM found that among participants at high genetic risk for cardiovascular disease, a favorable lifestyle was associated with a nearly 50% lower relative risk than those with an unfavorable lifestyle that included smoking, obesity, lack of exercise and poor diet.

7.     Disparity in counseling women and minorities with heart failure: Implantable cardioverter defibrillator (ICD) can be lifesaving by preventing sudden death in people with severe heart failure. But, according to this study of 21,000 patients published in Circulation, women and minority patients eligible for the device far too often aren’t counseled about it. The findings show as many as four out of five hospitalized patients with heart failure eligible for ICD counseling did not receive it, particularly women and minority patients.

8.     Fainting could be a sign of pulmonary embolism in some patients: NEJM: In the past, fainting had not been considered high on the list of signs and symptoms pointing to PE. But researchers in the PESIT study used a diagnostic workup to assess the presence of the embolism and found it was present in about one out of six, or 18 percent, of the patients.

9.     Advancing the treatment of severe strokes: This meta-analysis of patient data from five landmark trials shows the benefits of stent retrievers that snare large clots from the brain. The research published in The Lancet consolidates work that means providing timely treatment for these patients could have a global impact.

10.  Two studies move the needle toward better prevention of heart disease:

·         Lowering blood pressure to below 120/90, compared with 140/90, led to significantly lower rates of death and “cardiovascular events” among adults age 75 and older. The study, published in the Journal of the American Medical Association, extends the results of the recent SPRINT trial and could help clear up inconsistencies in how doctors set blood pressure targets for geriatric populations.

·         Also this year, investigators in a separate project identified a gene variant that determines whether a carrier may have a lower risk of coronary heart disease than those without the gene variation (NEJM). This gene, called ANGPTL4, governs the action of lipoprotein lipase, or LPL, which plays a critical role in breaking down a type of fat in the blood produced by the liver, called triglycerides. High triglyceride levels are a contributor to heart disease risk. In this study, people with a specific genetic variation in the ANGPTL4 gene had lower triglyceride levels, higher “good” HDL cholesterol levels, and lower coronary artery disease risk than those who did not have the mutation.

Dr KK Aggarwal takes oath as IMA’s National President

Dr KK Aggarwal takes oath as IMA’s National President Promises to represent the best interests of over 2.8 lakh registered IMA doctors from across the country New Delhi December 28, 2016: Padma Shri and Dr B C Roy National Awardee Dr KK Aggarwal was today sworn in as the 88th President of Indian Medical Association today. Dr RN Tandon will support him as the association’s Honorary Secretary General. The Indian Medical Association is the largest representative organisation of doctors of modern scientific medicine in the world with over 2.8 lakh-registered members, 1700 local and 30 state branches. The installation of IMA’s new Governing Body took place at its 77th Central Council Meeting – NATCON’16 in the presence of Dr Ketan Desai – President World Medical Association, Dr Jayshree Ben Mehta – President MCI & Mr AR Kohli – Former Governor of Mizoram. Taking his oath as the new IMA National President, Dr K.K Aggarwal said, “It fills me with utmost pride and joy to take on the post of the IMA National President. I vow to take my work forward with dedication, integrity and honesty. I look forward to working with Team Digital IMA. The real strength of IMA lies in its unity and a collective commitment to the betterment of the medical profession, and it is for this reason that the theme for the coming year will be ‘IMA One Voice. The four A’s of universal healthcare- “Available”, “Accessible”, “Affordable”, and “Accountable” will be the guiding determinants of this our policies for the year 2017. Our fight against the unfair nature of the PCPNDT and Clinical Establishment Act, increasing violence against doctors, the undemocratic NMC Act will continue.” Adding to this, Dr Tandon, said that, “IMA has witnessed historic wins over the past two years. I assume this position with the promise to stay committed to the aim of restoring the nobility of the profession and working towards the best interest of the medical fraternity as a whole. This year, IMA will embrace the Digital India initiative by our honorable Prime Minister, and will work paperless from the forthcoming term”. Congratulating the new team, Dr Ketan Desai, President of the World Medical Association added that, “Team IMA 2017’s vision of becoming a digitally superior, cashless and transparent organisation is commendable and heralds a promising future for the medical fraternity. I congratulate the new team and as the World Medical Association’s President, promise my commitment to highlighting the key success and issues faced by the Indian medical fraternity at a global forum.” Mr AR Kohli, Former Governor of Mizoram said, “The medical profession is a noble one, and we must respect those who tirelessly work to help us stay healthy and alive. I congratulate Dr KK Aggarwal and look forward to a more efficient medical fraternity under his able leadership.” In 2017 IMA will continue to fight for its demand of capping the compensation provided in medical negligence cases, undemocratic National Commission Bill and a ban on non-MBBS and non-BDS doctors prescribing modern medicine drugs. Some key initiatives that will be launched this year include a mandatory request for organ donation under the ‘Poochna mat bhoolo’ initiative, auditing of preventable mortality and ‘think before you ink’ campaign in 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 specialized healthcare available to all. This shift in IMA’s ideology from ‘What IMA can do’ to ‘What IMA should do’ will help foster more holistic and community directed goals and visions as IMA strives to touch new heights this year.

Dr K K Aggarwal National President IMA

Dear Colleague Big Thank You I thank all my mentors and colleagues for the confidence shown in me. I am both happy and tense so the responsibility given to me is huge and the time is only one year. But with the help of you all I am sure Team Digital IMA will be able to deliver. Our mission for the year is IMA 1 Voice. Let us all take IMA to a great height. Dr K K Aggarwal Following are the links 1. Website link : http://kkaggarwal.com/Presidential-speech.php 2. Presidential-speech- https://youtu.be/dxo7_Oi_l0E 3. ebook - http://kkaggarwal.com/28speech/index.html 4. HSG ACTIVITY REPORT IMA: http://module.ima-india.org/Natcon2016/hsgreport/ 5. 'Medico-legal Insights -IMA Legal Success Stories & White Papers’ : http://module.ima-india.org/Natcon2016/success_story/ 6. ‘STOP NMC - AMEND IMC ACT IMA Satyagraha 2016’ : http://module.ima-india.org/Natcon2016/stopnmc/ 7. Dr. KK Aggarwal taking over as National President of IMA: https://www.facebook.com/drkkaggarwal/ 8. IMA Natcon 2016 - Sister Shivani Verma On Self Motivation: https://youtu.be/qoDA0qjg2k0 9. Dr K K Aggarwal takes over as the National President of The Indian Medical Association: https://youtu.be/8gSq5fAgmrg