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      High Numbers of MRI Machine accidents :Are we defaulters?

    • Many operational considerations for MR imaging are similar to those for CT. Differences occur because of fringe magnetic fields, radio frequency shielding, geometry of the magnet bore, and lack of known biological hazard with MR imaging.  The magnet is always on, especially in an MRI that is high-filled 1.5 Tesla or higher. This is so that the cooling of the superconducting magnet can take place and maintain an effective electromagnetic field for image acquisition. If there is some sort of incident or injury that requires a "quench" or purge of the coolant in order to turn off the magnet, the liquid helium must be vented quickly and safely directly into the atmosphere. This is why MRI machines are often on upper floors of hospitals, especially older hospitals. Liquid helium is super expensive and to quench and replenish takes time and lots of money. This is why you can also find videos on YouTube and such of people trying to pry office chairs out of an MRI with two by fours and other non ferrous items. Ignoring Standard recommendations to setup an MRI machine not only caused malfunctioning or low quality imaging, its a life hazard. There were several instances in the recent past, when people and equipment were stuck inside MRI.  Nevertheless, a patient’s condition can deteriorate during MR imaging, requiring emergency intervention. MR imaging systems can interfere with both patient monitoring and cardiopulmonary resuscitation. Appropriate architectural and administrative measures can lessen these difficulties. The long, narrow magnet bore makes it difficult to observe the patient. Locating the operating console near the axis of the magnet provides a better, although still limited, view of the patient being scanned. Fringe magnetic fields may require location of the console relatively distant from the magnet. Magnetic shielding of the video display unit in the console can allow placement closer to the magnet. The window between the magnet room and control or console room usually requires RF shielding, which is often two layers of copper screen or perforated sheet. This shielding reduces patient visibility by light attenuation and by the distracting effect of Moire patterns and reflections. These problems can be reduced by appropriate window selection and attention to lighting details. Charge-coupled device (CCD) television cameras can be operated in relatively high magnetic fields and can be quite helpful in patient monitoring. Medical personnel and/or family members can remain near the patient to monitor or reassure the patient. The magnetic field within the scanner can affect or limit the performance of patient monitoring and communication equipment. For example, the magneto-hydrodynamic effect from flowing blood distorts electrocardiograph signals. Various solutions are being developed for these problems, such as using the main magnetic field as the field for a speaker or piping in sound via airline style head phones or providing a pneumatic squeeze bulb as a call button for the patient. Interfacing these devices with external systems is sometimes difficult. The operation of patient support equipment such as respirators, and infusion pumps can be affected near some types of magnets and other equipment such as stretchers, oxygen tanks and intravenous (IV) poles may be subjected to strong attractive forces near the magnet bore. These problems and difficulties with monitoring will make some patients inappropriate candidates for MR imaging until better solutions are found. MR lmager Site Planning Page 17 Cardiopulmonary resuscitation (CPR) is severely limited adjacent to some magnets because of the possible malfunction of CPR equipment in high fringe fields and the danger of ferromagnetic objects brought by the resuscitation team being attracted toward the magnet. The screening of arriving personnel for ferromagnetic objects is, of course, impossible. The usual solution is to remove the patient, by means of a non-ferromagnetic stretcher stationed in the scan room, to an area where CPR can be carried out. This area might be equipped with an emergency cart, monitors, oxygen and suction. Coordination of this phase of the design with the hospital’s CPR committee may be helpful. Means of preventing other personnel, who have responded to the emergency, from wandering into the magnet room during the activity surrounding CPR, should be considered. Useful means include distance, doors, warning signs and administrative procedures, such as training of the CPR team or assigning a member of the MR Imaging staff to close the magnet room door. Such situations necessitate a means of emergency shut down of the magnet. Claustrophobia and other forms of anxiety may interfere with imaging as well as patient comfort. Helpful solutions include good patient preparation, communication during scanning, someone remaining with the patient during scanning, disguising the intimidating appearance of the magnet, hiding the computer room from patient view, use of warm architectural finishes, keeping the magnet room size undramatic, disguising the vault-like appearance of the RF-shielded door, and making safety procedures and warning signs as nonthreatening as possible, consistent with adequate protection. The warm appearance of carpet must be weighed against the durability and maintenance advantages of traditional floors. Controlled access to the MR lmager suite is necessary because of possible harm to people with ferromagnetic medical implants and harm to people and equipment from unrestrained ferromagnetic objects in the vicinity of the magnet. A single entrance to the suite is helpful in this regard. Provision must be made for housekeeping personnel with floor polishers, for security personnel with keys, radios and guns, and for firemen with air tanks and axes. Non-ferromagnetic mops and buckets in a special closet or a built-in vacuum cleaner with plastic implements can be supplemented by direct supervision and/or training. If a special lock on the magnet door, which is not part of the hospital master key system, is used, emergency access to the key will be required.  
      Is Substance Abuse Among Anesthesiologists Rising?

    • Although it can be difficult to accept, physicians are at risk for the same challenges and illnesses as other people, including drug addiction. Anesthesiologists, in particular, have consistently been shown to have an unusually high rate of drug abuse compared to other physicians. A survey of 260 anesthesiologists from the Medical College of Wisconsin graduating between 1958 and 1988 reported that 32 percent used drugs to “get high” and 15.8 percent had been drug dependent. Physician health programs (PHPs), which are responsible for managing and monitoring addicted physicians, report that anesthesiologists show up in their programs with substance abuse at approximately 2.5 times the rate of other specialties. Anesthesiologists have also been reported to be similarly over-represented in substance abuse treatment centers that specialize in treating physicians. As a result of the high rates of substance abuse among anesthesiologists, some disability insurance companies have even decided to discontinue coverage for anesthesiologists. Why are anesthesiologists particularly vulnerable to drug abuse? Studies point to the following factors: • The proximity to large quantities of addictive drugs • The relative ease of diverting drugs for personal use • A high-stress work environment  • Control-oriented personality • Workplace exposure that sensitizes the brain to substance abuse Drug Abuse Trends Among Anesthesiologists Dr. Gregory Skipper, the former medical director of the Alabama Physician Health Program and current Director of Professional Health Services at Promises Treatment Centers, and colleagues completed a longitudinal cohort study involving 904 physicians consecutively admitted to one of 16 state physician health programs between 1995 and 2001. They analyzed a subset of the data involving 102 anesthesiologists and compared them with other physicians. The main outcome measures included relapse (defined as any unauthorized addictive substance use, including alcohol), return to anesthesiology practice, disciplinary actions, physician death and patient harm. The researchers uncovered a number of drug use trends among anesthesiologists: • The primary drug of choice among anesthesiologists is opioids, such as fentanyl, sufentanil, meperidine and morphine (whereas alcohol is the primary substance of abuse among other physicians). • Anesthesiologists had a higher rate of IV drug use compared to other physicians (41 percent vs. 10 percent). Treatment & Monitoring Help Addicted Anesthesiologists Successfully Return to Work Although anesthesiologists are at increased risk of drug addiction, research suggests that they respond exceedingly well to drug rehabilitation treatment and long-term monitoring. PHPs have achieved remarkable outcomes with physicians and are equally effective for anesthesiologists. Most physicians managed and monitored by PHPs have reported 75 to 90 percent success rates five or more years after completing substance abuse treatment. Despite these statistics, controversy remains surrounding anesthesiologists’ prognoses and ability to return to the operating room. Even with strict monitoring in place, some argue that anesthesiologists should not be permitted to return to anesthesiology practice after receiving substance abuse treatment. These conclusions stem from two poorly designed surveys of training program directors regarding substance-abusing residents, which reported very poor outcomes among addicted anesthesiologists. In contrast, according to Dr. Skipper’s research, which is the first long-term outcome study based on actual data from records of anesthesiologists, most anesthesiologists can safely return to practice if certain safeguards are in place. In his study, anesthesiologists who were treated and monitored for substance use disorders under the supervision of PHPs had excellent outcomes similar to other physicians. At the end of the five-year follow-up period, 71 percent of anesthesiologists and 64 percent of nonanesthesiologists had completed their contracts and were no longer required to be monitored. Although they face greater stigma, the research shows that anesthesiologists: • Were less likely to fail a drug test during monitoring • Were as likely to complete treatment and return to practice • Experienced suicide risks, relapse rates and disciplinary rates that were no higher than other physicians • Did not put their patients at risk of significant harm from relapse Addiction Treatment for Addicted Anesthesiologists Treatment for addicted anesthesiologists typically involves specialized drug rehabilitation programs that provide comprehensive assessments, intensive individual and group therapy for professionals, 12-Step support, and extensive aftercare and relapse prevention planning. Certain long-term monitoring measures have proven particularly effective in deterring substance abuse among anesthesiologists: Long-acting natlrexone administration Regular periodic hair testing (which is more accurate, particularly in detecting opioid abuse, than urine testing) Enhanced security measures in and around the operating room (e.g., using witnesses for drug access and disposal, automated distribution devices, monitoring cameras, and spectrometric scanning of waste) There is a growing body of evidence that the stigma against anesthesiologists returning to work is unwarranted. Although any incidence of overdose, suicide or patient harm is unacceptable, and re-entry must be handled on a case-by-case basis, studies show that addicted anesthesiologists who receive substance abuse treatment and are managed by PHPs have good long-term outcomes, on par with other physicians. Image Source  NurseTogether.com Article: https://www.elementsbehavioralhealth.com
      Meanwhile in India Several Doctors 'Commit Suicide' After watching this

    • Medical Miracles in Indian movies a common appearance. One in every 10 Indian movies patients are cured by super power, miracle medicines and God's blessings. But this one surpassed all the limits. Doctors, please brace yourself, many doctors have already 'committed suicide' and several left medicine forever after watching this. So, watch it at your own risk. The movie Hrudaya Kaleyam is a 2014 Telugu spoof action comedy film directed by Steven Shankar. It stars debutant Sampoornesh Babu in the lead role. The film revolves around Sampoornesh Babu, a petty thief who robs parts in electronic shops and why he robs electronic shops and departmental stores.The movie was considered a hit at Box Office. Learn How to Make an Artificial heart: Yes, you heard me.. An artificial heart is not tough to design. First you have to assess patients vitals by putting the stetho on forehead. Keep your tools ready before proceeding further Human Anatomy Book Physiology Book on Circulatory System An true size heart image for measuring the dimensions Other equipment like hex blade, knives, paints, welder, colors and chemicals Gods blessings   Once you are ready with these please follow the procedure as shown on this video:   Heart Implantation is Easy: Transpiration or more correctly implantation part is rather easy. In the movie, the leading character couldn't perform it himself. However he assisted the doctors by throwing the heart accurately on to patients chest. Doctors did only the suturing and closure of the thorax. Don't miss the suturing procedure.     
      A Leucocyte's Autobiography

    •           By : Mohit Khare Deep within the bones, a place there was, Small and packed, made for a cause. My fathers, forefathers, had all worked here, Leaving behind no chance for flaws. I came to life on one fine night And saw a huge megakaryocyte. He said to me in his heavy voice, ‘Welcome! You are a leucocyte!’ In my home, marrow, I could see, So many cells looking just like me. All waiting on the brink of A big pool of wandering RBCs. Oh boy! I sure was scared to fight, Those frightful bacteria and parasites. But alas! I realised I had no choice, For I was born a leucocyte. So off I swam with all my friends, In plasma, traversing loops and bends. Along the path that was set for us Giggling singing right till the end. But one fateful day, things weren't fine. Someone had smelt a cytokine. Vigilant interleukins apprised us ‘Few bacteria have crossed the line!’  We braced ourselves, for it was time, To unleash our powerful lyzozymes,  Which had been hungry for far too long, All brimming with their lytic enzymes. We scanned the blood from head to toe, Searching for our deadly foe. Ripping their bodies apart, Till they had just no chance to grow. We celebrated our Herculean win But the bacteria had done their sin, For I realised I had been hit By their lethal endotoxin. And thus ended my glorious fight I knew I did my duty right But limited time was all I had For I was but a leucocyte
      Can training 'fake doctors' improve healthcare?

    • Unqualified medics, popularly known as quacks, are routinely arrested in India for posing as doctors. But a charity is now trying to train them in primary medical care. Atish Patel explains why. Sanjoy Mondal opened his small clinic with just a desk and a few plastic chairs in eastern India 15 years ago, after a short stint assisting a doctor working at a government hospital. Although he has not studied medicine, Mr Mondal says he has conducted countless minor surgeries and prescribed drugs to hundreds of patients in a village of mud-walled homes in West Bengal state. Now, the 40-year-old is one of thousands who have been taught the basics of front-line care by a non-governmental organisation which wants to ensure patients aren't harmed by self-taught medics. "I now understand what safe drugs and what unsafe drugs are," Mr Mondal says, boxes of pills piled up behind him on shelves hammered into the sky-blue walls of his dark, dingy clinic. Liver Foundation, the Kolkata-based charity offering the training, says most of India's medical establishment will criticise such a programme because they think unqualified practitioners are the bane of the country's healthcare system. Serious shortage In recent weeks, in southern Tamil Nadu state, authorities launched a crackdown after several children died reportedly after seeking treatment from unqualified medics. Anil Bansal, a former head of the anti-quackery section of the Delhi Medical Council, which registers and oversees the Indian capital's doctors, says "they are cheating the general public" and breaking the law. But the Liver Foundation's founder, Abhijit Chowdhury, believes they should be utilised because India faces a chronic shortage of qualified doctors and medical staff. A new study published last week in Science magazine has assessed the effectiveness of the foundation's training programme. The Healthcare Federation of India says the country has a shortfall of nearly two million doctors and four million nurses. It is most prominent in rural swathes where it is estimated that more than 60% of primary care visits made by villagers are to fee-charging unqualified practitioners like Mr Mondal. In Banbataspur village where he works, villagers say they turn to him because the free primary health centre, several kilometres away, is understaffed and open for just a few hours a week. Mr Mondal says he has treated locals for common illnesses like hypertension, diarrhoea and anaemia. Sanghamitra Ghosh, secretary at West Bengal's state health and family welfare department, admitted it was difficult to retain doctors in remote areas and says unqualified medics are "filling a gap" in an "overburdened healthcare system". More than 100,000 unregistered freelancers practise self-taught medicine in West Bengal, home to some 90 million people. Across India, there's an estimated one million - meaning there are more fake doctors than real ones. Mixed results "I'm more confident in my job," Mr Mondal said about the training he received, which lasted nine months with two classes each week. But has it reduced the risk of medical errors? The new study out last week showed mixed results. It used so-called "mystery clients" trained to pose as patients suffering from three conditions - chest pain, asthma and child diarrhoea. How to detect these ailments were among the things taught to those who had undergone training. To compare care, the mystery clients were sent to trained and untrained informal providers, as well as doctors working in government clinics. The study found that although those who had taken the Liver Foundation course were more likely to adhere to checklists after training and made big improvements in providing correct treatments, it did not affect the unnecessary doling out of antibiotics and other drugs. This is worrying and "one of our goals - harm reduction - in that sense, was not achieved," said Dr Chowdhury, who co-authored the paper along with World Bank economist Jishnu Das, Abhijit Banerjee from MIT and Yale University's Reshmaan Hussam. But the team discovered the situation was worse among trained physicians. They found unqualified providers - trained or untrained - were less likely than doctors at public clinics to give out unnecessary antibiotics and medicine - reinforcing findings from earlier studies. What could explain this? Well for one, the study's authors say, medical knowledge among trained doctors varies dramatically because of differences in the quality of training given at India's medical schools. Second, along with high levels of absenteeism, low effort among doctors working in rural India remains a problem. A study published last year and conducted in the central state of Madhya Pradesh found that because untrained providers spent longer with patients than government doctors on average, they performed no worse on diagnoses and treatment. In other words, what untrained providers lack in terms of classroom time, they made up for in patient contact. Giving incentives to government doctors is of course one approach to rectify this, but the new study's authors point out that efforts in the past have proved difficult. 'Grounds for optimism' With this in mind, and the reality that rural public healthcare infrastructure is scarce (for example, West Bengal has 909 primary health centres in total, far short of the required 2,166, according to official statistics) training quacks - already with a large presence across India - could be more viable and cost-effective, the authors say. There is "some grounds for optimism", they said, because "training was sufficient to improve the clinical practice of the most regular attendees to the point where the performance of these informal providers matched that of better-trained, but presumably poorly motivated, public sector doctors". They added that training fake doctors "offers an effective short-run strategy to improve health care". The West Bengal state government has said it will make this model a reality. Since 2007, it has funded the Liver Foundation's classes in Birbhum - one of the districts in the state where training has been offered. "Training is expected to be scaled up by December and offered to thousands more informal practitioners across the state," says Dr Chowdhury. "They will be known as village health workers and not doctors." But it's likely to face serious resistance. In the past, the Indian Medical Association, a membership organisation for registered doctors, has taken legal action and successfully stopped similar schemes. The same could happen in West Bengal. Source: BBC News
      Medical Doctors Ranked First With Highest IQ Amongst Job Professions

    • How Smart are Medical Doctors? An interesting study published by the University of Wisconsin suggests that doctors (M.D or equiv O.D, dents, etc) have the highest IQ on average. Though I’m not a huge supporter of IQ tests but I would say that most doctors are somewhat smart. However, I would further add that, having a high IQ does NOT make good doctor. Being a good doctor requires more than just book smarts. It requires strong work ethics,  commitment and clear communication skills. Understanding basic science and pathology requires you to be smart. Facing death and the sickness of others requires human compassion. A often neglected, but perhaps more important measurement is Emotional intelligence. Doctors with high EQ care for their patients better. Medicine is both a science and an art. Doctors have to understand bio-mechanisms and lab tests as well as human emotions and feelings. People who are aware of their own emotions and can empathize with others will be more likely to give excellent patient care. Unfortunately, the ever increasing emphasis on test scores (GPA, MCAT, USMLE) may be a bad sign for our future doctors. We are increasing our IQ statistics but consistently neglecting our EQ measurements. Medical schools have acknowledged these problems and have begun pushing for more arts and humanities in medicine. People don’t care how much you know–until they know how much you care. A higher EQ is beneficial for doctors too. A patient is more likely to trust their physician and disclose information if they know their thoughts and ideas will be respected. Even though medical knowledge is growing exponentially and as physicians, we will continually learn medicine, we must not neglect our emotional education either. Doctors treat patients, not diseases.
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