AUGUST 2016 THE DOCTOR’S PEOPLE · A world renowned physician & Medico-legal practitioner, Mr. Kenneth Glasner observes-“Fear of litigation rests with all of us. At the least

AUGUST 2016

Year : 07 Pages : 19Volume : 84 New Delhi : 125

THE DOCTOR’S PEOPLEA SELF - IMAGE IS

THE PREPARATION FOR

STRONG, POSITIVEBEST POSSIBLE SUCCESS.

- Joyce Brothers

Our regular Features

Beautiful lifein stories

Life isAwesome

Editor’s Point of viewSanjay K. Mishra.

Medico Legal writes

Dear Doctor, The growing demand of safety measures and emphasis on healthcare safety has spawned a dramatic increase in scientific knowledge about improvements in the patient care and managing risk in clinical situations. Identifying the nature and the sources of risk are important elements in quality and safety improvements. In India, Apex started this movement of spreading necessary risk awareness among the medical fraternity 15 years back and for its part, AICL contributes to a more thorough understanding of the nature of medico -legal risk in medical care through its analyses, a range of experts and many of running and closed cases.

A world renowned medical risk analysis group mentions that “It is widely recognized that most patient safety incidents result from a flawed systems and failures in processes. Because these incidents are often complex, involving multiple players and contributing factors, systems thinking approaches, such as the patient safety incident analysis (formerly called root cause analysis), can be useful for identifying the potential multiple contributory causes of unintended outcomes.” Indeed, different regulatory bodies state that the most effective way to reduce error in medicine is to focus on system-level improvements.

While reducing system-level risks may yield the greatest improvements in the patient safety, healthcare providers are personally responsible for the patient safety in the direct care they provide to their patients. In some cases, a health care provider’s personal characteristic place them at higher risk of a legal action. Today the headlines of newspapers and breaking news of channels creates an entirely different perspective about this life saving profession and in total it must be said and underlined that risk can’t be taken for granted. We, at Apex are committed to this cause and has been doing all the possible homework to create a safer and aware platform of medical practice in India. It is always possible to combine a program of risk and quality management with a marketing approach that will make your practice stand out as a leader in health care. Our risk management program is essentially the establishment of systems and standards that will prove both your compliance with laws and concern for your patients' fears and perceived needs.

A world renowned physician & Medico-legal practitioner, Mr. Kenneth Glasner observes-“Fear of litigation rests with all of us. At the least it is a monstrous nuisance and at the worst it can destroy a medical doctor's assets. Many of us will be named in an action some time in our professional lives as it reflects a strong societal trend. What matters is that you can defend yourself. If your risk management program is strong enough, it will have repaid its costs many times. If your service component is strong enough that patients judge your practice to be at or above their expectation, then your practice will build on word-of-mouth referrals.” Today when the market is flooded with so many Medico-legal associations who offer their services in throw away price, we firmly stand with our moral responsibility. We hope you understand that it is not the easiest job to tackle with the cheapest way. Cheap is the last refuge for the marketer who can't figure out how to be better. Hope you will enjoy reading this issue and for anything we are just a phone call away. We are now operating with a dedicated 24 hours technically crafted call centre (7506-75-75-75) to be reached anytime. Do visit our website www.aiclindia.com for everything you need related to your membership, medico - legal queries or just to study any valuable piece. Wishing you the world of happiness and secure practice ahead!

Apex RegardYours truly

Sanjay K. [email protected]

Editor’s Point Of View

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PUBLISHED BY MR. VIJAY ARORA, 54, VINOBA PURI, LAJPAT NAGAR - 2, NEW DELHI - 24,

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Editorial AssetsVijay Arora. (M.B.A. L.L.B)Yatindra Singh Bisht.

Sanjay K. Sabran.

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EditorBeautiful Life Through Stories

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Medical News Update

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BEAUTIFUL LIFE IN STORIES

A guy met one of his school mates several years after school and he could not believe his eyes. His friend was driving one of the latest sleek Mercedes Benz cars. He went home feeling awful and very disappointed in himself.

He thought he was a failure. What he didn't know was that his friend was a driver and had been sent to run errands with his boss's car.

Aminat nagged at her husband always for not being romantic. She accused him for not getting down to open the car door for her as her friend Mary's husband did when he dropped her off at work. What Aminat didn't know is that Mary's

husband car had a faulty door that could only be opened from the outside.

Sulaiman's wife went to visit one of her long time friends and was very troubled within for seeing the 3 lovely kids of her friend playing around. Her problem was that she had only one child and have been struggling to conceive for the past five years. What she didn't know was that one of those kids who was the biological child of her friend had sickle cell and had just a year to live; the other two are adopted.

Life does not have a universal measuring tool so create yours and use it. Looking at people and comparing yourself with them will not make you better.

Swabhavakripna was a poor Brahmin who lived alone in a small village. He had no friends or relatives, and used to beg for alms for his living. He was also a miser, and kept whatever little food he received as alms in an earthen pot that he hung beside his bed. He kept a watch on the pot, and ate from the pot only when he was very hungry One day, he received a large quantity of rice gruel (porridge). He filled his pot with the rice gruel, and ate the remaining. He was so happy to have his pot full; he could not take his eyes off the pot as he lay awake in his bed. After a long time, he fell asleep and started dreaming about the pot full of rice gruel. He dreamt that there was a famine in his village. He sold his pot full of rice gruel for hundred silver coins. With this money he bought a pair of goats. His goats gave kids in months and he traded all goats for some buffaloes and cows.

Soon, even the buffaloes and cows gave the kids, and they gave a lot of milk He started trading milk and milk products like butter and curd in the market. This way, he became a very rich and popular man. He kept dreaming that he then bought some horses and a large rectangular house with four buildings.

He became popular, and another wealthy Brahmin was so impressed that he offered his beautiful daughter for marriage. Soon after, they got married in a lavish ceremony. His wife gave birth to a son, who was named Soma Sharma. But his son was very naughty. He would play and make noise all day. One day, the Brahmin asked him to stop, but he would not listen. Even his mother could not hear him shout as she was busy with her chores. Swabhavakripna became very angry, he kicked his wife. As he was in a dream, he kicked in air and his leg hit his earthen pot. The pot broke and all the rice gruel spilled down. This woke him up.

At once, he realized that he had been dreaming. He also realized that all the rice gruel he had saved and was happily dreaming about was lost. He was shattered. The wise indeed say: One should not build castles in the air.

Dealing with negativity does not need a good aptitude, but good attitude. To find negativity in an extremely positive situation requires you to just be human. But to find positivity in an extremely negative situation requires you to be an evolved human. Such human evolution is not a matter of chance; it is a matter of choice! A problem dealt with positivity is spelled as an opportunity. Hidden within calamitous problems are hidden opportunities. In the Mahabharata, when Arjuna visited the heavens, he was cursed by Urvashi (for refusing her sensuous advances) to become a eunuch. He converted that calamity into an opportunity by using it to his advantage during the one year of exile he spent incognito.

FACTS OF LIFE

THE BRAHMIN'S DREAM

THE POWER OF A POSITIVE ATTITUDE

Krishna converted the calamity caused by the thousand-hooded demoniac snake Kaliya into an opportunity to exhibit his dancing skills to the residents of Vrindavan. He converted a threat into theatre.You cannot solve a problem with the same mindset that caused the problem. In the Ramayana, instead of arguing with Keikeyi and trying to claim his rights over the throne, Rama dealt with the situation from a higher level. He disclosed that he was in fact waiting for such an opportunity where he could unload his burden of responsibilities and learn from the sages in the forest. When an eagle is attacked by a flock of crows, it chooses to fly higher and out of the crows' reach rather than fight back. Rather than delve into negative situations, Rama chose to focus on the positives awaiting him.Problems are your best chance to prove your maturity. Anyone can fake maturity in fair weather, but to act maturely in tough climates is a sign of a seasoned traveller. In the Mahabharata, the Kauravas cheated the Pandavas by giving them barren land named Khandava Prastha as their share. They accepted it gratefully and worked hard transforming it into Indra Prastha, a realm better than the heavens. A problem when seen from proximity and with clarity appears small. The same problem when seen from a distance and with obscurity appears gigantic. When a good attitude comes in contact with a bad problem, the result is an inspirational story.

She breezed into my office one cold September morning. I'd been enjoying a hot cup of Starbuck's finest and surfing the web for local news. The famous lexical semanticist Professor Edgar Nettleston had been found dead, a gunshot wound to the head. The police verdict was suicide. She held out an elegant hand as she floated towards me and I glimpsed a wedding band with a stone the size of a peanut M&M. "I'm Edith Nettleston." "Sorry about the old man." "I'm not. He loved me, but he loved words more. I'll be brief. My husband was working on a paper that will rock the very foundation of lexical semantics. It's worth a fortune in lecture tours, but nobody can find it. I believe his suicide note is a clue to its whereabouts." She removed a scrap of paper from her blouse. "edith. i'm not going to whine, i've had a good life. i've found wealth and happiness as a teacher, a seller of knowledge. but i find myself depressed beyond hope ... and so i'm choosing the hour and manner of my own demise. i have treated you badly. i demanded you dyed your brown curls blonde. i thought i could buy you when i should have won your love. i called you a witch. i'd complain: where's the woman i married? i said you ate too much. if i wanted change, i could have used a carrot rather than a stick. you probably wanted to wring my neck. forgive me. farewell." "It's all written in lower case. My husband was a stickler for correct grammar. I refuse to believe it doesn't mean something." "Mrs. Nettleston, I think I can help you. There's a couple of odd things about this letter. Firstly, as you say, it's written entirely in lower case. Mr. Nettleston was a world-renowned lexical semanticist, not a teenager texting his BFFs." "Secondly, it has a more than usual number of homophones, words where there is another word with the same sound but different spelling and meaning. When dealing with a lexical semanticist, that's surely no accident." "If we read those homophones in order, we have: whine, seller, hour, manner. And translating to their homophones: Wine cellar our manor." Several hours later, we arrived at the Nettlestons' country house and immediately headed for the basement. A flip of a light switch revealed tunnels filled with rows of dark bottles. "Where is it? It would take years to search this place." "Not so fast, Mrs. Nettleston. First, I have to ask you something: your wedding ring diamond, how large is it? "It's eight carats. Edgar wouldn't stop talking about it." "That's what I feared." I pulled out my trusty revolver. "How you must have hated him and his lexical semantics! You figured you'd kill him and keep the money from the paper yourself. You forced him to write that suicide note, thinking you knew where it was. But he was suspicious and he'd already hidden it. And he had another surprise for you: the rest of the note, it doesn't reveal where the paper is, it reveals his killer. The final homophones: dyed buy won witch where's ate carrot wring. That is: died by one which wears eight carat ring." As the cops left with Mrs. Nettleston I took a quick trip round the maze of tunnels. It didn't take me long to find it. Most of the wine lay unpacked on racks, but in one corner two cases sat stacked, one on top of each other. Carefully, I opened the lower one.

THE CASE OF THE LOWER CASE LETTER - Jack Delany

LIFE IS AWESOME70 Year Old Tries To Row Across The Atlantic: ‘My Cabin Nearly Became My Coffin’

Massive Snake skin Found Near River Where 10 - Foot Snake Was Recently Spotted

Stein Hoff gives up dream, 850 miles out at sea.Stein Hoff left New York City on May 15 in a rowboat, hoping to cross

the Atlantic in 90 days ? a daring stunt only a handful of brave adventurers have achieved.

His journey ended Aug. 6, after a fierce storm left the 70-year-old Norwegian stranded 850 miles out at sea.

Hoff was rowing to the Isles of Scilly in England as a tribute to a similar journey made in 1896 by George Harbo and Gabriel Samuelsen ? the first people to row across the Atlantic.Hoff’s 24-foot boat was equipped with GPS navigation, a water filtration system, and solar panels to keep the electronics charged.Before he was rescued, Hoff had to face 30-to-40 foot waves and winds gusting to 60 mph, according to Ripley’s Believe It Or Not!, which sponsored the trip.“Many times I thought that little cabin was to become my coffin as the boat was knocked-down and rolled over numerous times,” he wrote, according“My boat was thrown around and about so violently a couple of times so that it pounded into the sea with loud thumping noise and vibration. I thought it might split. But it did not […] There was tremendous damage to my equipment. All oars cracked and floppy, one broke completely and was washed away.” g to Ripley’s. Hoff sent off an emergency signal that was picked up by Norwegian officials and Her Majesty’s Coast Guard. The Ludolf Oldendorff, a cargo ship, was only a few hours away and rescued him.Hoff was still battered and bruised when the ship docked in Quebec nine days later. He has since been reunited with his family.Although he won’t be continuing the rowing part of his trip, Hoff still plans to visit his original destination, the Isles of Scilly.“It is a sort of pilgrimage, I suppose,” he said. “But Isles of Scilly is also a charming and fascinating place. After that, I can return to a more normal life again in Norway.”

Locals worry, it's the skin of the snake that got away. But one group of herpetologists says it's all a sham.

An elusive 10-foot-long snake dubbed “Wessie” is giving a Maine community the shakes for the second time in two months. But not everyone is convinced the creature is even real.Police announced that a 12-foot-long snake skin was discovered near the Riverbank Park in Westbrook, Maine, at about 3 p.m. on Saturday. Westbrook police told The Huffington Post Monday that at its widest, the skin is around 4 inches in diameter. Someone found it near a boat launch, authorities said.It is close to the area where, in June, two local officers reported seeing a roughly 10-foot-long snake eats a large mammal and swim away.

This Instagram Account Captures Indian Train Journeys From The Window Seat

The creature, which evaded capture, went on to supposedly brag about its life on the lam in a parody Twitter account.But because of a lack of photo evidence of the snake and the intact condition and curious placement of the skin in the police photo, some have suggested that it’s all a hoax.

The great Indian railways.

A crowd-sourced photography project on Instagram is an ode to Indian train journeys, with its images and videos of scenes inside and outside the

train. "The Window Seat Project is all about travelling in trains and asking people what kind of India do they see when they look out from the window

seat," filmmaker and the account's founder Shanu Babar said.The result is a melange of images comprising crisscrossing train tracks, diverse set of travellers, bustling stations, railway crossings, and train food and snacks. There is also an illuminating juxtaposition between the sweeping landscapes being traversed by the trains and the cramped spaces inside the carriages as evoked by images of crowded seats and feet dangling from the upper berths.Babar initiated the project in 2015 as part of his postgraduate dissertation at the Symbiosis Institute of Communication in Pune. Babar, along with four friends, travelled across the western coast, the Deccan region and southern India to shoot a travelogue. They began uploading 10-15 second snippets of their journey on Instagram and Facebook. Later, he began crowd-sourcing photographs of other travellers using the #WindowSeatProject, and now receives photos from all over the country."I hoped to capture the changing landscapes, terrain and weather along with the changing responses of the people, all the while maintaining a continuous thread of what India is," Babar said. "And if there is one thing that connects the whole of India in one thread, it is the trains.”

Top Bizarre True Stories

This list was compiled by the co-editor of the Fortean Times, a Journal of Strange Phenomena, a monthly British magazine.

1. Bees who pay their respectsMargaret Bell, who kept bees in Leintwardine, about 7 miles from her home in Ludlow, Shropshire (England), died in June 1994. Soon after her funeral, mourners were amazed to see hundreds of bees settle on the corner of the street opposite the house where she had lived for 26 years. The bees stayed for an hour before buzzing off over the rooftops. The local press ran a photograph of the bees hanging on the wall in a cluster.

2. Phantom Car CrashOn December 11, 2002, two motorists called police to report seeing a car veering off the A3 trunk road with headlights blazing at Burpham in Surrey. A thorough search uncovered a car concealed in dense undergrowth and the long-dead driver nearby. It turned out that the crash had actually happened five months earlier when the driver, Christopher Chandler, had been reported missing by his brother.

3. Enigmatic Earth DivotAm irregular shaped hole, about 10ft by 7ft with 2ft vertical sides, was found on a remote farm near Grand Coulee, Washington State, in October 1984. It had not been there a month earlier. ‘Dribblings’ of earth and stones led to a three-ton grass-covered earth divot 75 ft away. It was almost as if the divot had been removed with a gigantic cookie cutter, except that roots dangled intact from the vertical side of both hold and slab. There were no clues such as vehicle tracks and an earthquake was thought very unlikely.

4. Balloon BuddiesLaura Buxton released a helium filled balloon during celebrations for her grandparents’ gold wedding anniversary in Blurton, Staffordshire, in June 2001. Attached to the balloon was her name and address and a note asking the finder to write back. Ten days later she received a reply. The balloon had been found by another Laura Buxton in the garden hedge of her home in Pewsey, Wiltshire, 140 miles away. Both Lauras were ages 10 and both had a three year old black Labradors, a guinea pig, and a rabbit.

5. Hum Misty for MeA noise a bit like amplifier feedback had been heard for three years coming from the right ear of a Welsh pony called Misty, according to the Veterinary Record (April 1995). It varied in intensity but stayed at a constant pitch of 7 kHz. Hearing a buzzing in one’s ears is called Subjective Tinnitus; much rarer is when others can also hear the noise. This is called Objective Tinnitus and the cause is still largely a matter of debate.

6. Whirlwind ChildrenA nine-year old Chinese girl was playing in Songjian near Shanghai, in July 1992 when she was carried off by a whirlwind and deposited unhurt in a treetop almost two miles away. According to a wire report from May 1986, a freak wind lifted up 13 children in the oasis of Hami in Western China and deposited them unharmed in sand dunes and scrub 12 miles away.

7. Riverside MysteryGloria Ramirez, 31, died of Kidney failure at Riverside General Hospital, California, in February 1994, after being rushed there with chest pains. Emergency room staff were felled by ‘fumes’ when a blood sample was taken. A strange oily sheen on the woman’s skin and unexplained white crystals in her blood were reported. A doctor suffered liver and lung damage, and bone necrosis. At least 23 other people were affected. One hypothesis was that Ramirez, who had had cervical cancer, had taken a cocktail of medicines that combined to make an insecticide (organophospate) but tests yielded no clue.

8. Boulders in TreesIn April 1997, a turkey hunter in Yellowwood State Forest, Indiana, came upon a huge sandstone boulder wedged between three branches of an oak tree about 35 feet from the ground. The arrow shaped rock was estimated to weight 500lb. Subsequently, four more large boulders were found wedged high up in trees elsewhere in the forest. All were in remote areas. None of the trees were damaged and there were no signs of heavy equipment begin used or of tornado damage and no one recalled any mishaps involving dynamite anywhere nearby.

9. Helpful VoicesWhile on holiday a woman, referred to by the British Medical Journal (1997) as AB, heard two voices in her head telling her to return home immediately. Back in London the voices gave her an address that turned out to be a hospital’s brain scan department. The voices told her to ask for a scan as she had a brain tumour and her brain stem was inflamed. Though she had no symptoms, a scan was eventually arranged and she did indeed have a tumour. After an operation, AB heard the voices again: ‘We are pleased to have helped you,’ they said ‘Good-bye.’ AB made a full recovery.

10. La Mancha NegroA Hazard unique to Venezuelan highways is a slippery goo called La Mancha Negra (the black stain), although it is more of a sludge with the consistency of chewing gum. Although the government has spent millions of dollars in research, no one knows what the goo is and where it comes from, or how to get rid of it. It first appeared in 1987 on the road from Caracas to the airport, covering 50 yards, and spread inexorably every year. By 1992 it was a major road hazard all around the capital and it was claimed 1,800 motorists had died after losing control. The problem remains to this day.

11. Postcard FarewellWhen Jim Wilson’s father died in Natal, South Africa, in April 1967, both Jim, living in England, and his sister Muriel, living in Holland, were informed. Muriel contacted her husband who was on business in Portugal, and he flew to South Africa right away. Changing planes at Las Palmas airport in the Canary Islands, he bought a postcard showing holidaymakers on Margate Beach, Natal, and sent it to Muriel. It was she who noticed that the photograph showed her father walking up the beach.

12. Notecase from the SkyIn October 1975 Mrs Lynn Connolly was hanging washing in her garden in the Quadrant, Hull, when she felt a sharp tap on the

top of her head. It was caused by a small silver notecase, 63mm by 36.5mm, hinged, containing a used notepad with 13 sheets left. It was marked with the initials ‘SE’, ‘C8’, ‘TB’ (or ‘JB’) and ‘Klaipea’, a Lithuanian seaport. No one claimed it at the police station, so it was returned to Mrs Connolly. It seems likely it fell only a short distance, but from where? If it had dropped from a plane, it would have given her more than a tap.

13. Fiery PersecutionThe village of Canneto Di Caronia on Sicily’s north coast has been plagued by mysterious fires. The trouble began on January 20, 2004, when a TV caught fire. Then things in neighbourhood houses began to burn, including washing machines, mobile phones, mattresses, chairs and even the insulation on water pipes. The electricity company cut off all power, as did the railway company, but the fires continued. Experts of all kinds carried out tests, but no explanation was found. The village was evacuated in February, but when people returned in March the fires resumed. Police ruled out a pyromaniac after they saw wires bursting into flames.

14. Bovine EnigmaOn June 28, 2002, in the middle of a spate of unexplained cattle mutilations in Argentina, something macabre was found in a field near suco, west of Rio Cuarto in San Luis province. Nineteen cows were stuffed into a sheet metal water tank, closed with a conical cap. Nine were drowned, the rest barely alive, having endured freezing temperatures, not to mention the shock of their lives.

15. Boy Turns into a YamThree pupils of the Evangelist Primary School in the northern Nigerian town of Maiduguri rushed into the headmistresses office in March 2000 and said that a fellow pupil had been transformed into a yam after accepting a sweet from a stranger. The headmistress found the root tuber and took it to the police station for safe-keeping. Following local radio reports, hundreds of people flocked to see the yam and police were hunting for the sweet-giver. What happened next failed to reach the media.Source: The Fortean Times

Medical News Update

Season of Conception May Affect Fetal Brain Growth

Blood Test Might Someday Predict Your Stroke Risk

Source : Health Day NewsChildren conceived during the winter are more likely to have learning disabilities, and a mother's exposure to sunlight may play a role, a new study suggests.Sunlight triggers the body to produce vitamin D, which is important to brain development, the researchers said.They analyzed data from more than 800,000 children in Scotland. Of those conceived between January and March, just under 9 percent had learning disabilities, compared with 7.6 percent of those conceived between July and September.The first three months of pregnancy are a crucial time for brain development. Previous studies have shown that low vitamin D levels in the mother can impair fetal brain development.In the United Kingdom, there is generally not enough sunlight in January to March for pregnant mothers to naturally produce vitamin D, the study authors said. Though this study did not directly assess vitamin D levels, the researchers said they are "the most plausible explanation" for their findings.The study was published Aug. 23 in the American Journal of Epidemiology."The results of this study show that if we could get rid of the seasonal variation, we could prevent 11 percent of cases of learning disabilities," study co-author Jill Pell said in a journal news release. Pell is director of the University of Glasgow's Institute of Health and Wellbeing.Pell noted that children in the study were born before adoption of 2012 guidelines that recommend vitamin D supplements during pregnancy."It is important that pregnant women follow the advice to take vitamin D supplements and also that they start supplements as early in pregnancy as possible; ideally when they are trying to get pregnant," she said.

Source : HealthDay NewsIn the doctor's office of the future, a simple blood test might gauge a patient's odds of suffering a

stroke someday, new research suggests.A team of Canadian researchers measured levels of blood-borne chemical signals, or "biomarkers," in the blood of more than 3,200 people.The patients averaged 61 years of age and were tracked for an average of nine years. During that time, 98 of them did suffer a stroke.Elevated levels of four of the biomarkers were linked with increased stroke risk, the team reported in the Aug. 24 online edition of the journal Neurology.

High blood levels of the chemical homocysteine indicated a 32 percent higher risk compared to people with the lowest levels, the researchers found. And high levels of three other biomarkers --

vascular endothelial growth factor, C-reactive protein, and tumor necrosis factor receptor 2 -- also indicated a similar heightening of stroke risk, the investigators said.

"Identifying people who are at risk for stroke can help us determine who would benefit most from existing or new therapies to prevent stroke," study lead author Dr. Ashkan Shoamanesh, of McMaster University in Ontario, said in a journal news release.Two cardiologists agreed the idea has merit."This study is important because it may help to identify patients at high risk for future stroke and implement preventive measures beforehand, and not in reaction to a stroke," said Dr. Akira Todo, who directs the Stroke Program at Northern Westchester Hospital in Mount Kisco, N.Y.Dr. Andrew Rogove is medical director of stroke at Southside Hospital in Bay Shore, N.Y. He called the work "both interesting and important.""Stroke affects nearly 800,000 Americans each year, and it is the fifth leading cause of death and a leading cause of disability in the United States," he noted."If there were more biomarkers available to identify people at risk of stroke, this would invariably lead to prevention therapies, to lower the number of stroke victims," Rogove said.

Still, Shoamanesh cautioned that this research is still in its early days, and more work on the blood test is needed."Our study does not provide evidence that these markers are validated well enough to be implemented in clinical practice," he said.

Excess Weight Tied to Higher Risk for Many Cancers, Experts SaySource : HealthDay NewsStaying slim throughout your life might lower your risk of developing at least eight types of cancer, an international cancer research group says.Those include cancers of the stomach, liver, gallbladder, pancreas, ovary and thyroid. The list also includes a form of brain cancer known as meningioma, as well as a type of blood cancer called multiple myeloma.What's more, the latest research builds on the findings of an earlier review by the International Agency for Research on Cancer (IARC), which is part of the World Health Organization. That research found that those who avoid gaining weight can curtail their risk for developing five other types of cancer, including cancer of the colon, esophagus, kidney, breast and uterus."The review certainly concluded crystal clear, as you say, that obesity causes cancer," noted Dr. Graham Colditz, who chaired the IARC review group. "And hence the conclusion that there is cancer prevention through avoiding obesity."Dr. Clifford Hudis, chief executive officer of the American Society of Clinical Oncology, reacted to the findings with caution, stressing that "cause and effect is not proven."He added that it's premature to conclude that "obesity is the cause of any individual's cancer.""All we can say is that there is an association between obesity and increased risk of many common malignancies," he noted.But if obesity does play a role in cancer risk, the stakes are enormous.For example, IARC researchers point to data gathered in 2013 and 2014 that indicated that roughly 640 million adults and 110 million children and adolescents are now obese worldwide. In the United States, nearly 71 percent of adults over 20 are overweight or obese, according to the U.S. Centers for Disease Control and Prevention.The study authors added that carrying excess weight -- whether in the form of being overweight or obese -- is, in fact, responsible for the death (due to any cause) of roughly 4.5 million men and women worldwide every year.IARC's latest review examined more than 1,000 studies conducted all over the world, involving both men and women.Some of the studies assessed excess weight in terms of body-mass index (BMI), a standard measurement of body weight that classifies obesity as reflecting a BMI of 30 or more, and overweight as reflecting a BMI between 25 and 29.9.Other studies assessed excess weight based on waist circumference measurements.In addition to highlighting eight specific weight-associated cancers, the team also broadly concluded "that the absence of excess body fatness lowers the risk of most cancers," perhaps by keeping hormone production and inflammation in check.However, a lack of reliable data made it impossible to draw additional links between excess weight and a host of other cancers.A lack of human subjects in the reviewed studies also made it impossible for Colditz and his colleagues to determine whether overweight or obese individuals can reduce their risk for cancer by shedding pounds.However, the team pointed to a number of animal studies that indicate that weight loss may have a "cancer-preventive effect.""[So] the best advice," said Colditz, "is first avoid further weight gain." Colditz is also the associate director of prevention and control at the Siteman Cancer Center at Washington University School of Medicine in St. Louis.And, for those already overweight, he said, "Weight loss will lower risk of diabetes, heart disease and stroke as well as cancer, so there are many good reasons to get back into shape, balance the food we eat with sufficient exercise, and avoid more weight gain or get some pounds off."The study was published Aug. 25 in the The New England Journal of Medicine. It was funded in part by the American Cancer Society and the U.S. Centers for Disease Control and Prevention.

Serious Heart Problem a Family MatterSource : HealthDay News

A potentially deadly heart problem can run in families and occur at similar ages, a new study suggests.An aortic dissection is a sudden tear in one of the body's main arteries. "Family history is very important and is one factor in our 'guilt by association paradigm' for identifying patients at risk," said study co-author Dr. John Elefteriades, of the Aortic Institute at Yale-New Haven Hospital in Connecticut.

Amphetamines Polluting Some Urban Streams: StudySource : HealthDay News

Medications and illegal drugs are polluting streams in and around at least one major U.S. city, new research reveals.Scientists say this pollution comes with ecological consequences -- areas in some streams have high enough concentrations of the stimulant amphetamine to alter the bottom of the aquatic food web."Around the world, treated and untreated wastewater entering surface waters contains pharmaceuticals and illicit drugs that originate from human consumption and excretion, manufacturing processes, or improper disposal," study author Sylvia Lee said in a Cary

Institute of Ecosystem Studies news release."We were interested in revealing how amphetamine exposure influences the small plants and

animals that play a large role in regulating the health of streams," said Lee. She conducted the research when she was a postdoctoral researcher at the Cary Institute.

For the study, the researchers measured the concentrations of medications and illegal drugs at six sites in streams flowing from a city to a rural area. The researchers collected the samples in 2013 and 2014.The streams originated in Baltimore, Md. The stream sites involved the Gwynns Falls watershed as well as two rural streams from the Oregon Ridge watershed.The researchers detected many substances in the water, including amphetamines -- a biologically active, highly addictive drug. Amphetamines are commonly used to treat conditions such as attention-deficit hyperactivity disorder (ADHD).People also abuse stimulants, such as methamphetamine, ecstasy and cocaine, and those end up in streams. Levels of illegal drugs were highest in the streams closest to the city, the study found.After taking these field samples, the researchers conducted an artificial stream experiment to show how amphetamine affects stream life."We have every reason to suspect that the release of stimulants to aquatic environments is on the rise across the globe, yet little is known about the ecological consequences of this pollution," said study co-author Emma Rosi-Marshall, a freshwater ecologist at the Cary Institute."We found that when artificial streams were exposed to amphetamine at a concentration similar to what we found in parts of the Gwynns Falls watershed, there were measurable and concerning effects to the base of the aquatic food web," she said.The researchers monitored the effects of the drug for three weeks and found that amphetamine suppressed the growth of biofilms, changed the composition of bacteria and a type of algae, called diatoms. Insects in the polluted streams also emerged earlier."As society continues to grapple with aging wastewater infrastructure and escalating pharmaceutical and illicit drug use, we need to consider collateral damages to our freshwater resources," said Rosi-Marshall.

Researchers reviewed the family histories of 90 people treated for an aortic dissection. Among those cases, more than half of those within the same families occurred within a 10-year age span. The risk increased within certain age groups, the researchers found.For instance, when they looked at patients whose aortic dissection occurred between ages 30 and 49, they found that 71 percent of other family members' dissections occurred in that age range. Among patients whose aortic dissection occurred between 60 and 79, they found 80 percent of other family members' dissections occurred after age 50.The results were published online Aug. 25 in the Annals of Thoracic Surgery."If a family member suffered an aortic aneurysm or aortic dissection, chances are at least 1 in 8 that you may experience something similar in the future," Elefteriades said in a journal news release.These findings allow "us to better appreciate the playbook of aortic dissection. Knowing how dissection operates -- in this case, at what age dissections are likely to occur in a specific family -- permits us to combat it more effectively and save many lives," Elefteriades said.In many cases, aortic dissection occurs in people with an aortic aneurysm, a balloon-like bulge in the aorta. Each year, a ruptured or dissecting thoracic aortic aneurysm is the primary or contributing cause in more than 15,000 deaths in the United States, according to the U.S. Centers for Disease Control and Prevention.However, up to 90 percent of patients with an aortic dissection in the first part of the aorta (ascending aorta) can be saved with emergency surgery. But as many as 40 percent of patients with aortic dissections die instantly, and risk of the death increases 1 percent with every hour that diagnosis and surgical repair are delayed, according to background notes with the study."If patients are approaching the age at which one of their family members suffered an aortic dissection, they need to be very vigilant," Elefteriades said. "If patients have aneurysms in their family, get checked. If they have premature sudden death in their family, get checked. If they themselves have an aneurysm, comply with regular follow-up visits."With many thoracic aortic aneurysms, a full, normal life expectancy can be restored after protective aortic surgery, Elefteriades added.

For Uncontrolled Tremor, Ultrasound Instead of Brain Surgery?Source : HealthDay NewsPatients with uncontrolled shaking caused by a condition called essential tremor may get relief with a new noninvasive ultrasound procedure, a study finds.The movement disorder involves involuntary tremors in the hands or feet, and sometimes the voice is shaky, said Dr. Max Wintermark, a professor of neuroradiology at the Stanford Neuroscience Health Center in Palo Alto, Calif. "It's called 'essential' because we don't know what is causing it."In some cases, essential tremor keeps people from feeding themselves, writing or carrying out other everyday activities. It's estimated that more than 7 million people have the condition in the United States.The standard medications, drugs called propranolol and primidone, only help as many as 60 percent of patients, and they lose effectiveness over time. Until now, when drugs failed, doctors could only offer brain surgery -- including deep brain stimulation -- as a potential treatment, the researchers said.Focused ultrasound, a noninvasive technique, is "a new treatment option that is available for patients with essential tremor," said Wintermark, who wasn't involved in the study. He termed this advance "exciting."Based on this trial, the U.S. Food and Drug Administration in July approved the technique to treat essential tremor. Israel-based InSightec, the device maker, funded the research.Here's how focused ultrasound works: Sound waves guided by MRI are sent into an area of the brain called the thalamus to kill cells causing the tremor, researchers explain."This technology allows you to destroy those tremor cells completely in a noninvasive procedure that takes a day," said study co-author Dr. Travis Tierney, a pediatric neurosurgeon at Nicklaus Children's Hospital in Miami.Previously, doctors might have suggested electrical stimulation, but with that approach, he said, "you have to make an incision and put in a complicated pacemaker system with an electrode in the brain that stays with the patient for the rest of their lives."According to Tierney, Medicare and other insurers will cover the ultrasound procedure. He said it's FDA-approved for those aged 22 and older who have failed medical therapy.For the study, Tierney and colleagues randomly assigned 76 patients with moderate-to-severe essential tremor who had not responded to medical treatment to focused ultrasound or a sham procedure. Patients completed a quality-of-life questionnaire at the start of the study and periodically for one year.Neurologists saw videotapes of patients and assessed improvements in tremor, according to the report published Aug. 25 in the New England Journal of Medicine.The researchers found that three months after treatment, those receiving focused ultrasound experienced an improvement in their hand tremor greater than those getting the sham procedure. The improvement lasted for at least a year.After treatment, most patients were tremor-free, Tierney said.The outcomes were as good as those seen with deep brain stimulation, Tierney added. If the tremor recurs, the procedure can be repeated to kill any tremor cells that were missed the first time, he said.Ultrasound patients also saw an improvement in measures of disability and quality of life, compared with those who received the sham procedure, he said. They could now feed themselves foods like soup or cereal if they couldn't before.Side effects associated with focused ultrasound included problems walking in 36 percent of the patients, which persisted for one year in 9 percent. Numbness in the hand and face occurred in 38 percent, and remained in 14 percent a year after therapy, the study says.Tierney and other experts said the benefits of focused ultrasound aren't limited to essential tremor."Focused ultrasound opens the door to treat other disorders of the brain," said Dr. Neal Kassell, a professor of neurosurgery at the University of Virginia.The technique is already being studied in Parkinson's disease, obsessive compulsive disorder, depression, epilepsy and brain tumors, said Kassell, who is chairman of the Focused Ultrasound Foundation.Although he predicts it will become a standard therapy, Kassell said focused ultrasound is not a panacea for every patient or every neurological disorder. "But it's one more good, solid noninvasive therapy that will . . . improve outcomes and decrease cost of care," he said.

"More work is needed on the ecological fate of these pollutants and the threat they pose to aquatic life and water quality. Ultimately, solutions will lie in innovations in the way we manage wastewater," she added.The findings were published Aug. 25 in the journal Environmental Science & Technology.

Synthetic Fentanyl Fueling Surge in Overdose Deaths: CDCSource : HealthDay NewsDeaths from overdoses of the synthetic narcotic fentanyl have surged in recent years, U.S. health officials say in a troubling new report.As more fentanyl was sold illegally on the streets, the number of fatal overdoses jumped 79 percent in 27 states from 2013 to 2014, the government report found, while law enforcement seizures of the drug increased 426 percent in eight of those 27 states."Fentanyl is a powerful opioid that is 50 to 100 times more potent than morphine, and it is available by prescription, but evidence indicates that illicitly made fentanyl is more likely a powder mixed with heroin and or sold as heroin," said report author R. Matthew Gladden. He's a behavioral scientist at the U.S. Centers for Disease Control and Prevention.The fentanyl crisis is being driven by products made illegally, not by the diversion of prescription fentanyl, Gladden noted.Recently, the U.S. Drug Enforcement Administration reported that synthetic fentanyl was showing up mixed with prescription narcotic painkillers, and "this is a new and emerging threat," Gladden said.Most of the victims of these overdoses were men and those aged 15 to 44, the researchers reported.Eight states from the 27 studied were more dramatically affected than the others: Massachusetts, Maine, New Hampshire, Ohio, Florida, Kentucky, Maryland and North Carolina.In those states, the synthetic opioid death rate (mostly fentanyl) jumped 174 percent during 2013-2014, the researchers said.In addition, seven states reported an increase of more than 100 deaths in 2013-2014 tied to synthetic opioids (mostly fentanyl), the authors said.The report was published Aug. 26 in the CDC's Morbidity and Mortality Weekly Report."The sharp increase in overdose deaths indicates a need for an urgent response, not just in the states that are currently impacted but in other states, because the problem seems to be spreading and taking on new dimensions," Gladden said.For example, heroin spiked with fentanyl may be responsible for 75 overdoses in Indiana and Ohio since last Friday. More than 30 overdoses occurred in Cincinnati last weekend, with 33 more overdoses -- including one death -- in the city since Tuesday. Authorities responded to 14 overdoses -- including one death -- late Tuesday and early Wednesday in Jennings County, Ind., USA Today reported.But one expert noted even more deadly compounds might have been added to those drugs."It's likely that the heroin being distributed on the streets in the recent string of overdoses in Cincinnati may have contained such illicitly manufactured compounds as carfentanil and a drug known as W-18," said Dr. Robert Glatter. He's an emergency physician at Lenox Hill Hospital in New York City.Both compounds are most likely manufactured in China and sold online to dealers in the United States, who use them to produce the heroin and fake Oxycontin pills they sell on the street, he said.Carfentanil, which is used as an elephant tranquilizer, and W-18 are nearly 10,000 times more potent than morphine, he noted. And W-18 is almost 100 times more potent than fentanyl, Glatter added."People who buy heroin from dealers on the street may not even be aware that they are taking the drug," he said. "Dealers often cut their heroin with such synthetic drugs to make their supply last longer, while also making it more potent."In a separate MMWR report, researchers honed in on Florida and Ohio. In Florida, drug seizures rose 494 percent, and deaths rose 115 percent. In Ohio, they rose by 1,043 percent and 526 percent, respectively.According to Gladden, a multi-pronged approach is needed to quell the fentanyl epidemic."We need to get information about these overdoses, so we can respond faster with more knowledge," he said.In addition, availability of naloxone (Narcan), which can reverse the effects of a narcotic overdose, has to be increased, "so people can get treatment as quick as possible to save their lives," Gladden said.However, fentanyl is so toxic that a single dose of naloxone might not be enough to reverse an overdose, so patients or bystanders should call 911 in the event of an overdose, he said.Gladden believes doctors need to be cautious about prescribing narcotics for pain, because it's important to prevent abuse and addiction in the first place.U.S. Surgeon General Dr. Vivek Murthy is also hoping to prevent addiction from occurring. For the first time ever, the Surgeon General is sending a letter to all practicing physicians in the country urging them to educate themselves on the safer prescribing of opioid painkillers to lessen the risk of addiction."We arrived at this place on a path paved with good intentions. Nearly two decades ago, we were encouraged to be more aggressive about treating pain, often without enough training and support to do so safely," Murthy wrote."Many of us were even taught -- incorrectly -- that opioids are not addictive when prescribed for legitimate pain," Murthy said. "The results have been devastating.”

Should doctors encourage patients to record consultations?

By Dr. (Prof.) Mahesh Baldwa,M.D, D.C.H, FIAP, MBA, LL.B, LL.M, PhD (law)SENIOR PEDIATRICIAN & MEDICOLEGAL ADVISORFormerly Assistant Professor of Pediatrics at T.N. Medical College and Nair Hospital, Mumbai-400008Ex. Asst. Professor JJ Hosp, Grant medical collegeEx. Professor, paper setter & examiner of law to postgraduate students of the University Department ofLaw, University of MumbaiBaldwa Hospital, Sumer Nagar, S.V. Road, Borivali (West) Mumbai 400 0922. Dr. Sushila Baldwa, MBBS, MD, consultant, Apollo clinic (part of Apollo Hospital),Kandivali West, Mumbai3. Dr Namita Padvi, MBBS, MD,DNB, PGDML, Fellowship in Pediatric Anesthesiology,Assistant Professor of Pediatric medicals at T.N. Pediatric Medical College and NairHospital, Mumbai-4000084. Dr Varsha Gupta, MBBS, MD, PGDML, Senior resident in department of pathology,Government medical college, Kota, Rajasthan

In India rarely when a mishap occurs some patients use their smart phone / pen recorders to record talk with the doctor as piece of evidence to be produced in court, without permission of the doctor.

1. When both parties agree that they wish to record the consultation.2. When a patient is unable to write or read notes written by doctors, which is the case in India more often than usual3. The recording consultations for training purposes and review purpose. In the case of training, there are strict rules

governing who may play the recording and when and how it must be destroyed so the identity of the patient is not revealed to strangers.

In western countries legally doctors are not permitted to record consultations without the consent of the Patient party. In India some doctors install CCTV camera’s in their consulting rooms but not in examination rooms/area. In the United States, recording is subject to the laws developed for wire-tapping. In western countries because of legal restriction on doctors to record the consultation, doctors should encourage patients to record consultations.

Indian patients are not so illegally inclined in recording Doctors consultations as compared to western countries. In fact Indian doctors have fitted CCTV camera’s in clinic and hospitals, displaying signs boards that the areas under CCTV surveillance.

Introduction:

Indian scenario recording doctors talk

Doctors in the west cannot record doctor patient talk consultation:

Compulsory or mandatory recording of the consultation should be done for

1. The act of recording becomes like measuring of performance, alters the way the doctor-patient discussion goes on. 2. Medical consultation/advice alters if recorded. When doctor speaks, he is slower and with half an eye to posterity,

even though consent from the patient is received or tacit. Patients are also inhibited, even if they say they are content to be recorded, and they speak and act in a more guarded way.

1. It is presumed that the doctor does not know everything on first consultation/ occasion. It requires a series of consultations before arriving as justifiable diagnosis.

2. It is wrong for either doctor or patient to record consultations with the intention of deliberately entrapping or tripping up the other party, and this implies that ending of a doctor-patient relationship.

3. Usually recording of the consultation has become a sham, with one party intending to catch the other out. It does not matter whether there is litigation in prospect. This is not what doctors or patients should do to each other to outwit each other.

General negative effects of encouraging patients to record consultations:

Consultations Recording may change in the behavior of the patient as well as doctors:

3. Consultations may take longer and both parties are more circumspect in what they say. 4. The interference with the consultation goes beyond the professional relationship.5. Recording interferes with the precious doctor-patient relationship making doctors react defensively

Misuse of recording 1. With any recording comes a risk of misuse. 2. The recording can be given to third parties without both parties’ permission; it can be used as evidence about the

doctor, the patient, or other people who are being discussed in some way by the patient, or rarely, by the doctor during the consultation; it can be published as “entertainment” on social media; or it can be (mis)used by the media.

3. The only way to mitigate these risks is for the doctor and the patient to have a copy of the recording so that both know what truly transpired.

Situation in western countries versus India1. Although doctors should usually permit recording by patients (because it is the patient’s consultation and a legal

right), they should not encourage it.2. Any recording should be done with mutual consent and copies given to both parties.3. Recording if done it will lead to better practice and shared decision making. What concerns doctors in India that if

the recording is given to patients routinely it may lead to defensive medical practice and also put a doctor-patient relationship in jeopardy.

4. In western countries doctors encourage patients to record their meetings openly to help improve patient care, encourage more evidence based medicine and shared decision making, and increase trust and openness.

Recording all consultations can lead to Trust and openness. Doctors who are willing to be recorded will be viewed as having nothing to hide. A similar development is the Open Notes concept in the United States, which enables patients to comment on the accuracy of their electronic medical record.

1. Routine consultation recording can not only be reviewed by patient party, other doctors as well as treating doctor himself for self-assessment. Treating doctor if forgot to mention alternative approaches, he can rectify the situation.

2. Treating doctor may share more information to help compare alternatives in next visits.3. Treating doctor may indicate about probabilities of harm as well as the likelihood of benefit o treatment proposed.4. Treating doctor may can look for evidence sources and see where such medical references are cited.5. Treating doctor may look for national or local guidelines when he reviews his recorded consultation. 6. Treating doctor may use recorded consultation as a tool to help the patient party to make informed decisions. 7. Treating doctor will automatically become a patient centric and help patient to achieve his health preferences.8. Treating doctor can practice evidence based medicine and shared decision with patient party9. The Treating doctor should keep in mind the possibility of medico-legal use by him or patient party both.10. Recordings of recording all consultations considered as admissible evidence in law courts in western countries as

well in India.

1. By far the strongest argument for encouraging patients to record Consultations is that it is likely to improve the quality and safety of patient care. No studies have shown improved patient, but it would be odd, if clinicians did not adhere to good practice if recording is done.

2. There may be some negative effects on doctors if consultation recording given to patient became Routine thing in India. Doctors might order more tests and generate more referrals and more follow-up visits. This kind of defensiveness may well lead to over-diagnosis, over-treatment, and increased costs to patient party.

3. Routine consultation recording will lead to better practice, greater reliance on evidence, and greater patient engagement, which prevents unwanted medical treatments.

Will to recording all consultations lead to improved patient care

Will to recording all consultations lead to Shared decision making

Conclusions: