Prof. Panditrao has added his original work on the subject of 'Medical Deontology'/Medical Ethics... a Powerpoint version and updated presentation of his editorial on the same topic. He expands his own ideas, priniples and moral values on this very very important but now and virtually neglected topic. The powerpoint presentation has been updated with specific and pertinent examples so that, while training the younger generation, it can become an interactive session
The presentation explains the principles of medical ethics and describes important terms on the subject. Brief descriptions of codes of medical ethics are covered but for details actual documents may be referred.
The presentation explains the principles of medical ethics and describes important terms on the subject. Brief descriptions of codes of medical ethics are covered but for details actual documents may be referred.
Medical Malpractice Ganim Injury Lawyers have far-reaching experience representing medical malpractice claims. If your health care provider has failed to take proper care of you or a loved one, you may have a medical error claim.
Know more details about Medical Malpractice please conatct at (203)445-6542 and also visit: http://ganiminjurylawyers.com/
Medical Malpractice Ganim Injury Lawyers have far-reaching experience representing medical malpractice claims. If your health care provider has failed to take proper care of you or a loved one, you may have a medical error claim.
Know more details about Medical Malpractice please conatct at (203)445-6542 and also visit: http://ganiminjurylawyers.com/
Notwithstanding the unprecedented advances the medical science has achieved, the fundamental value system of it’s practitioners has crumbled to a great extent. The principles and the foundations of the noble profession at present are very shaky and wobbly. The need and greed of lucre is the ‘principal principle’ which seems to be ruling this ‘materialistic’ world. Original guidelines of the Fathers of Medicine seem to be slowly fading away. Therefore it is the necessity in these testing times to introspect deeply and reinvent the vanishing science of ‘Medical Deontology.'
Updated Presentation has been uploaded replete with pertinent examples of the principles to make it more interesting and interactive training session!
EMPHNET Public Health Ethics (PHE): Introduction to public health ethics (phe)Dr Ghaiath Hussein
This is a series of presentations I gave in the Eastern Mediterranean Public Health Network (EMPHNET)'s Public Health Ethics (PHE) course that was held in Amman in June 2014.
It is a revised introduction to public health ethics.
Medical Ethics is what every physician and healthcare worker should know. We need to understand Ethics and its application in various cultures, societies and its changes according to norms and values. Once society will be given health education regarding Medical Ethics many issues can be resolved in a decent manner. It ultimately gives a very positive impression of all the actions which a healthcare worker performs otherwise at times seems inappropriate by society. This is not for the sake of healthcare worker or for the patients it is primarily for the whole community.
What are the rights of patient? role of ethical committee and parameters of a physician all need to be addressed properly.
History,evaluation,principles and players of bioethics its importance why it is prerequisite to follow ,how to resolve a dilemma which arise during a research and to make considerations in such dilemma
A dissertation is a practical exercise that educates students about basics of research methodology,
promotes scientific writing and encourages critical thinking. The National Medical Commission (India)
regulations make assessment of a dissertation by a minimum of three examiners mandatory. The
candidate can appear for the final examination only after acceptance of the dissertation. An important
role in a dissertation is that of the guide who has to guide his protégés through the process. This
manuscript aims to assist students and guides on the basics of conduct of a dissertation and writing
the dissertation. For students who will ultimately become researchers, a dissertation serves as an
early exercise. Even for people who may never do research after their degree, a dissertation will help
them discern the merits of new treatment options available in literature for the benefit of their patients
National Education Policy 2020 What is in it for a student, a parent, a teach...Prof. Mridul Panditrao
Ministry of Human Resource Development of Government of India has projected an elaborate and all-encompassing National Education Policy 2020 (NEP2020). Before independence, the education in India was under the complete control of the “Masters, the British Empire.” The education policies, like the one drawn by Macaulay, as would be obvious, were not for providing any quality education to the Indians, but to churn out the “Babus;” clerks and bureaucrats, to serve the masters, pure and simple. After independence, the society went through series of changes, policies were charted and certain reforms were brought in, but the impact was still not achieved. In 2015, the GOI adapted, “2030 Agenda for Sustainable Development (SD)” and since then the impetus has been initiated. The final culmination of a long drawn and all-inclusive process is NEP2020. NEP2020 has been a very elaborate planning document. The salient features of the issues, principles, aims, vision, challenges and solutions have been dealt with in this article. The main focus has been on the higher education and its implementation. Due importance also has been accorded to other issues such as vocational education, research and online and digital education to mention a few. Overall, it is a commendable and a very positive step forward on the part of the government. Only the time will judge, how much net effective output is actually garnered.
Pantoea dispersa: Is it the Next Emerging “Monster” in our Intensive Care Uni...Prof. Mridul Panditrao
Prof. Mridul Panditrao, discusses, a case report; presentation, with unusual symptoms, unusual lab findings, unusual progression, but the same old ususal fatal outcome, in spite of trying everything. The main cause of thisultimately turned out to be Uncommon Genus Pantoea species dispersa. He adds the lextensive literatute Review too
Prof. Mridul Panditrao, dwells upon, the newer applications of Ketamine, good old friend of anaesthesiologists, a trusted weapon! Now is making a strong comeback for diverse indications like chronic/ neuropathic pain and major depressive disorders, in addition to its traditional applications of peri-operative analgesia.
Professor Mridul M. Panditrao, deals with this basic, complicated but very important topic for not only post- graduates but also for under-graduates. Various complicated issues have been discussed in detail, mainly from clinical point of view.
Prof. Mridul Panditrao wants to share his much acclaimed CME lecture in ISACON 2014, Madurai, India and many other places, on one of the very very important but often ununderstood and neglected essential topics in Anesthesia..... Vaporizers!!
Prof. Mridul M. Panditrao adds another presentation to his collection. This is another Faculty lecture that was delivered at International conference on pain ... ISSPCON 2014, at Mumbai/Bombay, 7th Feb to 9th Feb 2014.
Prof. Mridul M. Panditrao has added another of his very important, useful and in vogue topic to his collection. This is his well acclaimed andwell received faculty lecture at recently concluded International conference on Pain... ISSPCON 2014, at Mumbai/ Bombay from 6th to 9th Feb. 2014.
Professor Panditrao expresses his views about the day to day challenge, faced in clinical practice. Considered to be a simple surgery, but the anesthetic management is very challenging because of the primary pathology, co-morbidities and repeated surgeries involved.
Strict Glycemic Control in Critically ill patients: The Demise of another ver...Prof. Mridul Panditrao
Prof. Mridul M. Panditrao tries to explain the pros and cons about the good strategy, whcih became controversial and almost obsolete. He also tries to tract the whole aspect of the phenomenon and reviews/ RCTs/
Strict (Tight) Glycemic control (SGC/TGC), as it is called, was and still is a good strategy. It can be defined as maintenance of the blood glucose level in the range of 80-110 mg /dl. with help of dose variable and intensive insulin therapy (IIT). Since its introduction, there have been conflicting reports of its efficacy and complications. This resulted in slow but steady neglect of this very good idea leading to its almost complete demise.
An effort has been made in this review, to impartially analyze all the available evidence and try to find the reasons for the negative publicity which led to the neglect or worse still, the wrong use of this protocol. Some suggestions for fair and proper implementation of the strategy are put forward.
etc/
The Anesthesiologist, especially young, faces a major challenge when faced with very ill/ severly moribund, elderly, cachwexic patients with history of fall and lower extremity fractures for elective or ortho surgical procedure. Prof. mridul m. panditrao, explains various problems faced especially with GA, and the best alternatives. Two different approaches of Combined spinal epidual are discussed, with use of adjuvants and also his own randomizede trial and experience.
My memorable case! AN UNANTICIPATED CARDIAC ARREST & UNUSUAL POST-RESUSCITATI...Prof. Mridul Panditrao
ABSTRACT
A case report of a primigravida, who was admitted with severe pregnancy induced hypertension
(BP 160/122 mmHg) and twin pregnancy, is presented here. Antihypertensive therapy was
initiated. Elective LSCS under general anaesthesia was planned. After the birth of both the babies,
intramyometrial injections of Carboprost and Pitocin were administered. Immediately, she suffered
cardiac arrest. Cardio pulmonary resucitation (CPR) was started and within 3 minutes, she was
successfully resuscitated. The patient initially showed peculiar psychological changes and with
passage of time, certain psycho-behavioural patterns emerged which could be attributed to near
death experiences, as described in this case report.
Ropivacane: A new break through in regional and neuraxial BlockadeProf. Mridul Panditrao
Prof. Mridul M. Panditrao, discusses the merits and demerits of all the three, local anaesthetics, viz; loidocaine, bupivacaine and the new comer, Ropivacaine, their pharmacology, structual differences, comarison, dosing guide and his own experince and a controlled comparative trial
Prof. Mridul M. Panditrao, from his University/ medical College days, gives tips on how to write your synopsis for your dissertation after you have registered and started your MD/ MS training programme. he also gives ideas/ steps to come up with a well constructed synopsis. Very useful for the first year MD/ MS PG students
Here prof. mridul M. panditrao, shares his personal views on the most controversial and problematic issues of dealing with the pharmaceutical industry and their representatives. The clinicians are constantly exposed to lure and lucre of these issues. He wants to guide the upcoming, young and promising clinicians about the ethical/ unethical aspects and hopw to maintain your own, clinician's morality when dealing with these set of personnel. he also dwells upon the vanishing science of medical deontology
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
3. PROF. MRIDUL M. PANDITRAO
Consultant
Department of Anesthesiology
PHA’s Rand Memorial Hospital
Freeport, The Bahamas
4. Introduction
Whenever We deal with a Patient-“Simple & Pertinent question!”
• “Was I ‘Good’ to my patient?
• (“Did I do everything ‘Good’ and nothing
‘Bad’ ??)”
• (Was there any ‘vested interest’ involved or
was I purely ‘altruistic’ ???)
5. Introduction
• Unprecedented advances the Medical Science
• The fundamental Value System
• The Principles and the Foundations of The “Noble
Profession”
• The need and greed of Lucre
• The ‘Principal Principle’
• Ruling this ‘Materialistic’ world.
6. Introduction
• Original guidelines of the Fathers of Medicine
• The necessity in these testing times
• To introspect deeply
• Reinvent the vanishing science of
‘Medical Deontology’.
7. ‘Medical Deontology’.
The term is constituted by two words,
Deon(Greek) – ‘duty’ or ‘obligation’
Logos(Greek) – meaning opinion, word ….
and
Defined as
“ A discipline for the study of norms of conduct for
the health care professionals, including moral and
legal norms as well as those pertaining more
strictly to professional performance!”
Fineschi V, Turillazzi E, Caten C.The new Italian code of medical ethics. Journal ofMedical Ethics 1997; 23: 239-244. jme.bmj.com
8. Definition
“Set of
Ethical Standards and Principles of behavior
of Medical Practitioners while executing
their professional duties
Professional Ethics of Medical Workers
Principles of Behavior of Medical Personnel
directed toward gaining maximum
benefit of treatment for the patients!”
10. Sub divisions
Medical Jurisprudence or Law
• Jur (Latin) meaning Law …….. prudentia
(Latin) meaning knowledge
• Also known as Forensic Medicine,
• Can be defined as the “science which applies
the principles and practice of the different
branches of medicine to the elucidation of
doubtful questions in courts of justice”
11. Sub divisions
Medical Ethics
• ethica (Latin) from (Greek) ethice –
• teaching of morals,
• defined as a “system of moral principles:
that applies values and judgments to the practice
of medicine”
• As a scholarly discipline it encompasses
– its practical application in clinical settings
– as well as work on its
•
•
•
•
History,
Philosophy
Theology
Sociology
12. Sub divisions
Medical Hodegetics from (Arabic - ُ ُِ)أخالقيَّ ُ الط
ْ ِ ات ب
• literally means, guidelines for the study of
medicine.
• The guidelines which cover the ideal principles
which must be learnt while studying medicine
as were once envisioned by the ancient
“Fathers of the Medicine!
13. Duties of Medical Practitioners
Two main types of duties
Scientific - the section of medical science,
studying ethical and moral aspects of medical
workers’ activity
Practical – the area of medical practice
the tasks of which are the formation and
application of ethical standards and rules of the
professional medical activities
14. Medical Deontology includes :Problems of
Observing medical confidentiality
The extent of the medical worker’s responsibility
for the life and health of the patient
Relationships of medical workers to each other.
15. Triad of Medical deontology
Problems of inter-personal mutual relations in three basic directions
The
Patient
,
Medical
Worker
Patient’s
Relatives
Medical
worker
16. Historical Aspects
Plethora of literature from circumspective and
varied backgrounds
Indian “The Book of Life” (“Ayurveda” 30th
century B. C.)
“The Laws of Hammurabi” (Laws of
Ancient Babylon, 18th century B. C.),
“About the physician”, "The Oath" and "The Law“
by Hippocrates (5th -4th centuries B. C.)
The term "ethics", meaning “a concept of human
morals” introduced by Aristotle (384-322 B. C.).
17. Historical
• towards the middle Ages:
– “The Canon of Medical Science” and “Ethics” by
Ibn Sina (Avicenna, 10-11 centuries),
– Jeremy Bentham (English philosopher, lawyer,
priest; 1748-1832),
• who introduced the notion of Deontology as meaning
“… the teaching on the due behaviour of a person while
achieving his end” (18 century).
18. Historical
Some references in Russian medicine,
Matvey Yakovlevich Mudrov (1776-1831)
• “The Word Concerning Piety and Moral Qualities of a
Hippocratic Physician”
• “The Word Concerning the Ways of Teaching and
Learning the Practical Medicine”
Nikolay Ivanovich Pirogov (1810-1881) are
noteworthy
• “Letters from Heidelberg” and
• “The Diary of an Old Doctor”.
19. Historical
The controversial Nuremberg process(1947),
• depicting the Verdict to the Nazi physicians,
(“The Nuremberg Code”,)
• postulates not only legal
• also moral regulations of medical /human
experiments.
20. Historical
Post 1947
• World Medical Association was created
• Its main actions were:
–
–
–
–
–
–
the adoption of “The Geneva Declaration”
the oath of a physician – the doctor (1948),
the International Code of Medical Ethics (1949),
“The Helsinki Declaration of Human Rights” (1964)
“The Helsinki-Tokyo Declaration” (1975), and
“The International Declaration on Human Rights”
(1983).
21. Quotes!
In the ancient Indian Medicine Teacher used to
tell to his disciples:
• “You now leave your passions, anger, greed,
madness, vanity, pride, envy, roughness,
buffoonery, falsity, laziness and any vicious
behavior. From now on, you will have your hair
and your nails shortly cut, wear red clothes,
conduct a pure life”.
A passage from the ancient Indian Book of Medicine : “AYURVEDA”
22. Quotes!
Ibn Sina (Avicenna) had already demanded a
special approach to the patient:
• “You should know that every separate person
possesses the special nature inherent in him
personally. It seldom happens, or it is absolutely
impossible, that somebody would have the nature
identical with his”
23. Primary Principle
PRIMUM NON NOCERE !
(Latin) - FIRST, DO NO HARM
• This maxim is & must always be the
Main Ethical Principle in Medicine!
24. Values in Medical Deontology
Six of the fundamental values/principles are:
•
•
•
•
•
•
Autonomy
Beneficence
Non-Maleficence
Justice
dignity
Truthfulness and Honesty
25. Values/principles
Autonomy
• the patient has the right to refuse or choose
their treatment. (Voluntas aegroti suprema
lex.)
• The principle of autonomy recognizes the rights
of individuals to self determination.
• This is rooted in society’s respect for
individuals’ ability to make informed decisions
about personal matters.
26. Values/principles
Beneficence
• a practitioner should act in the best interest of
the patient. (Salus aegroti suprema lex.)
• The term beneficence refers to actions that
promote the wellbeing of others.
• In the medical context, this means taking
actions that serve the best interests of
patients.
27. Values/principles
Non-Maleficence
• embodied by the primary principle
• "first, do no harm," or the Latin, primum non
nocere
• Many consider that should be the main or
primary consideration (hence primum):
• & it is more important not to harm your
patient, than to do them good!
30. Values/principles
Truthfulness & Honesty
the concept of Informed Consent has increased
in importance since the historical events of the
• “Nuremberg Trials of Nazi Doctors
&
• Infamous Tuskegee syphilis study (1932-72)
31. Additional Principles
We can add some more principles such as
• Medical privacy - allows a person to keep their
medical records from being revealed to others.
• Confidentiality - is commonly applied to
conversations between doctors and patients
– This concept is commonly known as patient-physician
privilege
– Legal protections prevent physicians from revealing
their discussions with patients, even under oath in
court of Law
32. Additional Principles
• Fidelity - is the quality of being faithful or loyal to
one’s patients as if it is the service rendered in
relation with the cause of ‘LORD ALMIGHTY’
• Veracity- Truth telling or Obligation to full and
honest disclosure,
– of the information, concerns or any such matter,
– in context with a patient’s health/ disease state to
himself/herself and their near and dear ones.
33. Epilogue
• Providing service with adequate skill, precision
and expertise is not enough
• but what matters the most is to judge, if it was
appropriate, necessary and not tinged with
‘vested interest’
• If and when we are questioned by our own
morality, about these issues
• then we must stop there for a moment,
introspect and be our own ‘Devil’s Advocates’, if
necessary.
34. Epilogue
• The ‘stark and naked materialism’
• monstrous proportions
• society on the whole has started looking at the
physician community
• with very suspicious and negative attitude
35. Epilogue
As the medicine is technologically evolving,
• There is a paradigm shift towards the protocol based
practice,
• So that there is very little margin for error!!
• Sadly, in the pursuit of ‘perfection’, ‘standardization’ and
‘quality’,
• The clinicians tend to forget, that we are not dealing with
the ‘mechanical objects’, but living beings!
• Requiring to be treated with the attitude of respect,
understanding and kindness!
• Which according to them, may have much more
significance than only ‘quality assurance’.
36. Epilogue
• On the other hand, even the physicians/clinicians
• should not be considered as, the
perfect mechanical devices or robots
• The picture is painted in only either black or
white, viz;
– ‘there can only be and must be the perfection in the
service
– if there is error that needs to be punished’,
• as is usually projected by the popular media and
legal fraternity
37. Epilogue
• These advocates of model of perfectionism,
maintain,
– that, the better efforts will lead to perfection in the
service, especially in medicine,
– As we are dealing with living human beings
– So if there is error, that needs to be punished severely
and swiftly
– because then there will be no further room for error.
• This ideology fundamentally is flawed,
• Because, nobody, even its advocates are not
‘perfect’ themselves.
38. Epilogue
We
• Medical professionals are also to certain
extent adding fuel to the ‘fire’
• By getting embroiled in the ‘blame game’ and
‘mud-slinging’ in the event of ‘an error’
• All these usually tend to culminate
• Into nasty, ugly and avoidable legal wrangles.
39. Epilogue
• The attitude on the part of doctors, while
dealing with their patients/ their relatives is of
• divulge only what is ‘ needed to know’
• Because the process becoming more and
more complex
• This ‘lack of communication’ can be
considered as one of the main causes of
‘litigation’.
40. Conclusion
• As this vicious process of self- perpetuating and selfdestructive hostilities,
• Is relentlessly unfolding,
• WE the Senior members of Medical Profession/ Teachers/
Trainers need to seriously ponder over the prevailing
situation and start re-inventing,
• The now almost certainly forgotten/ near extinct science of
“ Medical Deontology”
• In the interest of ‘Future Generation’ of the physicians!
41. Conclusion
• A physician should behave according to these
principles while he(she) treats his(her)
patient.
• These principles were also moral virtues of
the physicians in the past!!!!
42. Conclusion
• It is my conviction, passionate belief and moral
principle
• “To try and adhere to these principles as solemnly
and sincerely as possible”
• It is recommended to all the practicing,
experienced and conscientious doctors
• Try to inculcate these values, goals, moral
attitude and aptitude in the
“Younger generation of medical professionals!”