As discussed in the meeting on 18.09.2008, following heads of dicussion are being created:
1. Clinical Care.
2. Drug Store.
3. Medical Board.
4. Reimbursement.
5. Sanitation.
6. Staff.
7. Miscellaneous.
Please click on the relevant link and than post comment on it.
5 comments:
Expecting the world to treat u fairly coz u r a good person is like
Expecting the lion not to attack u coz u r a vegetarian. Think about it.. Dr.J BHATIA
We all are non-vegetarian so be sure V could be also attacked. So
be-ware
Dr.Bhatia we are missing your humour post some secondhand jokes-if nothing new is available in the market
satishkgadi
xthgdJune 5, 2008 —The US Preventive Services Task Force (USPSTF) has issued a statement that limited evidence exists to recommend screening adults for type 2 diabetes but that screening may be helpful in those with hypertension, according to a report published in the June 3 issue of the Annals of Internal Medicine.
"More than 19 million Americans are affected by type 2 diabetes mellitus, which is undiagnosed in one third of these persons," write Susan L. Norris, MD, MPH, from the Oregon Evidence-based Practice Center of the Oregon Health & Science University and Portland Veterans Administration Medical Center, and colleagues. "In addition, it is estimated that more than 54 million adults have prediabetes. Debate continues over the benefits and harms of screening and then treating adults who have asymptomatic diabetes or prediabetes."
The goal of this statement was to update the 2003 USPSTF review of the evidence with regard to potential benefits and risks of screening adults for type 2 diabetes and prediabetes in the primary care setting.
The reviewers searched MEDLINE and the Cochrane Library for relevant studies and systematic reviews published in English between March 2001 and July 2007 and included trials and observational studies that evaluated the effectiveness and adverse effects of screening interventions. The efficacy of treatments of diabetes and prediabetes were evaluated with randomized controlled trials of patients with disease for 1 year or less. Trials comparing outcomes among patients with and without diabetes were also reviewed.
The reviewers abstracted relevant data in duplicate using a standardized template, and they synthesized data in a qualitative fashion. A random-effects meta-analysis determined the effects of interventions in prediabetes on the incidence of diabetes.
Limitations of the review were that most of the evidence concerning diabetes treatment came from subgroup analyses vs primary trial data and that participants in intensive lifestyle interventions for prediabetes may not be representative of general prediabetic populations.
"Direct evidence is lacking on the health benefits of detecting type 2 diabetes by either targeted or mass screening, and indirect evidence also fails to demonstrate health benefits for screening general populations," the review authors write. "Persons with hypertension probably benefit from screening, because blood pressure targets for persons with diabetes are lower than those for persons without diabetes. Intensive lifestyle and pharmacotherapeutic interventions reduce the progression of prediabetes to diabetes, but few data examine the effect of these interventions on long-term health outcomes."
Specific recommendations of the USPSTF with regard to screening for type 2 diabetes mellitus in adults are as follows:
Because high blood pressure is a recognized risk factor for cardiovascular complications in people with type 2 diabetes mellitus, blood pressure should be measured.
Asymptomatic adults with no symptoms of type 2 diabetes mellitus or evidence of possible complications of diabetes but with sustained blood pressure greater than 135/80 mm Hg (treated or untreated) should be screened for type 2 diabetes mellitus (level of evidence, B).
For asymptomatic adults with sustained blood pressure of 135/80 mm Hg or lower, no recommendation has been made regarding screening for type 2 diabetes mellitus (grade: I; insufficient evidence).
Screening may be considered on an individual basis when blood pressure is 135/80 mm Hg and when knowledge of diabetes status would facilitate decisions with regard to preventive strategies for coronary heart disease, including consideration of lipid lowering.
To screen for diabetes, 3 tests that have been used are fasting plasma glucose, 2-hour postload plasma, and hemoglobin A1c.
The American Diabetes Association recommends screening with fasting plasma glucose, defining diabetes as a fasting plasma glucose level of 126 mg/dL or greater, and confirming an abnormal result with a repeated screening test on a separate day.
Although the optimal screening interval is still unknown, expert opinion from the American Diabetes Association recommends a screening interval of every 3 years.
Information about the 10-year risk for coronary heart disease must be considered when deciding if screening would be helpful on an individual basis. As a hypothetical example, if the risk for coronary heart disease without diabetes was 17% and the risk with diabetes was more than 20%, screening for diabetes would be helpful because diabetes status would determine lipid treatment. In contrast, if the risk without diabetes was 10% and the risk with diabetes was 15%, screening would not influence the decision to use lipid-lowering treatment, and it would not be indicated.
"Further research is needed to define the benefits and harms of screening average-risk individuals for type 2 diabetes," the review authors write. "We must learn whether early, aggressive glycemic control in persons with diabetes produces improvements in clinical outcomes after many years of follow-up. . . . Further work is also needed to examine the effect of screening and diagnosis on patient self-efficacy, motivation for lifestyle change, and the potential psychological effects of labeling."
Limitations of the review include restriction to studies with mean diabetes duration of 1 year or less; few trials with extended follow-up, which may underestimate the effectiveness of treatment and therefore of screening interventions; difficulty in defining "screened" and "unscreened" populations; participants with prediabetes in studies of intensive lifestyle interventions may not be representative of general prediabetic populations; and flaws in data and assumptions underlying the included trials.
"No direct evidence clearly determines whether screening asymptomatic individuals for diabetes or prediabetes alters health outcomes," the authors of the statement conclude. "Evidence shows that persons with diabetes benefit from control of blood pressure and lipid levels, but studies have not included persons with screening-detected diabetes. Persons with hypertension and type 2 diabetes benefit from lower blood pressure targets than persons with hypertension but without diabetes."
S.No. Financial Year Total Ordinary Working Expenses Total Expenditure on Medical Treatment Percentage
( Demand 3-13) (11-200)
(NET)
1 01-02 (Actual) 28703 439 1.53%
2 02-03 (Actual) 29684 469 1.58%
3 03-04 (Actual) 30637 492 1.61%
4 04-05 (Actual) 33389 541 1.62%
5 05-06 (Actual) 34748 627 1.80%
6 06-07 ( R.E.) 38091 688 1.81%
7 07-08 ( B.E.) 42687 799 1.87%
(B) Expenditure per Employee per year:
S.No. Financial Year Total Expenditure on Per Employee per year
Medical Treatment
1 01-02(Actual) 439 2900
2 02-03(Actual) 469 3180
3 03-04(Actual) 492 3405
4 04-05(Actual) 541 3789
5 05-06(Actual) 627 4428
6 06-07 ( R.E.) 688 4914
7 07-08 ( B.E.) 799 5707
(C) Cost of Medical Treatment per beneficiaries/year:
Free medical treatment is provided to Railway employees & their dependant. At present we take average of 4 members per employee. Retired Railway employees who join RELHS scheme they alongwith their dependants are also entitled of free medical treatment. We take average 2 per member of RELHS
Financial Year No. of Employees & R.E. Total Beneficiaries Total Cost of Medical treatment Cost of Medical treatment per Beneficiaries per year
Head 11-200#
04-05 (Actual) 1428000 6160378 Rs. 541 Crores Rs. 878/-
224189
05-06(Actual) 1416000 6183228 Rs. 627 Crores Rs. 1014/-
259614
Note : From 2003-2004 –Beneficiaries includes R.E.L.H.S.
# This cost is both for Industrial Medicines & also for curative medicines for Indian Railways.
Details about 11-200
(D) Percentage of expenditure in relation to total working expenses:
(Figures are in crore of Rupees)
S.No. Financial Year Total Ordinary Working Expenses ( Demand 3-13) Total Expenditure on Medical Treatment Percentage
( GROSS) (11-200)
1 01-02(Actual) 34673 439 1.27%
2 02-03(Actual) 35956 469 1.30%
3 03-04(Actual) 37432 492 1.31%
4 04-05(Actual) 40719 541 1.33%
5 05-06(Actual) 42843 627 1.46%
6 06-07 ( R.E.) 46696 688 1.47%
7 07-08 ( B.E.) 51783 799 1.54%
(E) Expenditure per year per beneficiaries:
Year. Money spent on medical expenditure Head 11-200 Total Beneficiaries Cost per beneficiary per year
01-02) Rs. 439 crores 63 lakhs Rs. 696
3-Feb Rs. 459 crores 63 lakhs Rs.728
4-Mar Rs. 492 crores 63 lakhs Rs.780
5-Apr Rs. 542 crores 63 lakhs Rs.860
05-06 Rs. 582 crores 63 lakhs Rs.923
7-Jun
Budget)
Health Care Delivery System
1. Steps taken to improve the health care delivery system of Indian Railways
1.1 Power given to Health Unit doctors situated 75 Kms away from Railway Hospital to get the routine Pathological . investigations like blood sugar, blood urea , S. Creatinie, SGOT, SGPT, simple X-rays, etc. from outside. ECG is done by in house system. This has given following advantages:
a) Taken away the harassment faced by Railway employees being referred to Railway Hospitals for routine investigations.
b) Many important diseases which were earlier remained undiagnosed, now they are being diagnosed. Many cases of T.B., Diabetes, IHD has been diagnosed.
In future we will try to reduce the K.M. from 75 KM 25 KM so that more health units can be given these powers.
1.2 Road side Mobile Medical Van:
Railway doctors will be covering each wayside station in the jurisdiction of his line section at least twice a week and provide medical services at their residential place only. Presently this is a pilot project done in one HU each in all 16 zonal railways.
Following Services are to be provided.
a) Consultancy services.
b) Distribution of Medicine.
c) For those Health Units located beyond 75 KM away will be able to get common investigations done.
d) Immunization programme.
e) Maternity & child health programme.
f) Community based medicine.
g) Periodical – specialist services.
h) Health Education
i) Specific therapy like DOTS etc. can be given.
If the pilot project is being found suitable it will be extended to other health units.
1.3 Engagement of Hony. Visiting Specialist:
The present system of Hony. Consultants who are paid Rs.5000/-pm for Central Hospital & Rs.4000/-pm for other Railway Hospitals will be gradually replaced by Hony. Visiting specialists. In total 575 such specialists can be engaged all over Indian Railways. They will be paid Rs.20,000/- pm / Rs.14000/- pm and Rs.7000/- pm for coming to Railway Hospital 6 days/4 days and 2 days per week respectively.
This is expected to provide adequate cover of specialist services in Railway Hospitals wherever our own specialist doctors are not available.
1.4 To call specialist doctors from private sector for having consultations and for surgical operations on case to case basis. They will be paid for their professional services.
This facility will help Railway Hospital authority to provide adequate Specialist treatment in their Railway Hospitals.
1.5 To make anesthetic available, their rate of payment for their professional services has been increased.
For Railway hospitals with number of doctor’s post 9 or below anesthetic can be called without having a regular post of anesthetic in that Railway Hospital
1.6 To provide better Ayurvedic & Homeopathic treatment in Railway Hospital following important changes done.
a) Revised up word remuneration for Ayurvedic and homeopathic doctors
Earlier Revised
For 4 hour/day Rs.4000/-pm Rs.7000/- pm
For 8 hour/day Rs.6000/-pm Rs.10000/-pm
b) Money available for purchase of medicine has been revised up word
Earlier Revised
For Ayurvedic clinic Rs.2000/-pm Rs.6000/- pm
For Homeopathic Clinic Rs.500/-pm Rs.2000/-pm
1.7 To keep CMP (Contract Medical Practitioners) in Railway services their remuneration has been revised up wards from Rs.13000/- pm to Rs.22000/- pm.
By this now most of the posts of Medical officers are being kept filled up.
1.8 Vacant Group’C’ technical posts:
Vacant Group’C’ technical posts can be filled up by contractual engagement till RRB candidates become available.
This has helped to keep all Group ‘C’ vacant posts filled up.
2. Sanctions given in Works Programme over last 2 years
2.1 Sanction of new Railway Hospitals
a) Central Hospital/ECR/Patna for Rs.36.33 crore
b) Divisional Hospital/Agra/NCR for Rs.3 crore
c) Divisional Hospital/Raipur/SECR for Rs.2.5 crore.
d) Divisional Hospital/Nanded/SCR for Rs. 3 crore.
2.2 Extension Programme of Existing Railway Hospital:
a) Mancheswar Hospital/ Bhubneswar to Central Hospital/ ECOR for Rs.1.5 crore.
b) Railway Hospital/Bilaspur/SECR for Rs.4 crore.
c) Railway Hospital/Allahabad/NCR for Rs. 4 crore.
d) Railway Hospital/Jabalpur/WCR for Rs.6 crore.
e) Railway Hospital/Hubli/SWR for Rs.1.5 crore
f) Eastern Railway B.R. Singh Hosptial/Kolkata for Rs.23 crore
3) Further schemes which are underconsideration:
There are many more schemes which are under examination at various stages. Indian Railway Medical Sub centre to provide relief to retired people settled in IRWO Flats & other private apartments, to develop joint venture with partnership with private party etc. are some of them.
Health Intelligence
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