Health Care Is 'High-Risk Business': WHO

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Health Care Is 'High-Risk Business': WHO
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By Stephanie Nebehay

GENEVA (Reuters) Jul 21 - Millions of people die each year from medical errors and infections linked to health care and going into hospital is far riskier than flying, the World Health Organization said on Thursday.

"If you were admitted to hospital tomorrow in any country... your chances of being subjected to an error in your care would be something like 1 in 10. Your chances of dying due to an error in health care would be 1 in 300," Dr. Liam Donaldson, the WHO's newly appointed envoy for patient safety, told a news briefing.

This compared with a risk of dying in an air crash of about 1 in 10 million passengers, according to Dr. Donaldson, formerly England's chief medical officer.

"It shows that health care generally worldwide still has a long way to go," he said.

Hundreds of millions of people suffer infections linked to health care each year. Patients should ask questions and be part of decision-making in hospitals, which must use basic hygiene standards and WHO's checklist to ensure safe surgical procedures were followed.

More than 50 percent of acquired infections can be prevented if health care workers clean their hands with soap and water or an alcohol-based handrub before treating patients.

Of every 100 hospitalized patients at any given time, 7 in developed and 10 in developing countries will acquire at least one health care-associated infection, according to the United Nations agency.

"The longer patients stay in an ICU (intensive care unit), the more at risk they become of acquiring an infection," it said. Medical devices such as urinary catheters and ventilators are associated with high infection rates.

'HIGH-RISK BUSINESS'

Each year in the United States, 1.7 million infections are acquired in hospital, leading to 100,000 deaths, a far higher rate than in Europe where 4.5 million infections cause 37,000 deaths, according to WHO.

"Health care is a high-risk business, inevitably, because people are sick and modern health care is delivered in a fast-moving, high-pressured environment involving a lot of complex technology and a lot of people," Dr. Donaldson said.

A heart operation can involve a team of up to 60 people, about the same number needed to run a jumbo jet, he said.

"Infection is a big problem, injuries after falls in hospitals is a big problem and then there are problems that are on a smaller scale but result in preventable deaths. Medication errors are common," he said.

Risk is even higher in developing countries, with about 15% of patients acquiring infections, said Dr. Benedetta Allegranzi of the WHO's "Clean Care is Safer Care" program.

"The risk is really higher in high-risk areas of the hospitals, in particular ICUs or neonatal units in developing countries."

About 100,000 hospitals worldwide now use the WHO's surgical safety checklist, which the agency said has been shown to reduce surgery complications by 33% and deaths by 50%.

If the checklist is effectively used worldwide, an estimated 500,000 deaths could be prevented each year, it says.

"Frankly, if I was having an operation tomorrow I wouldn't go into a hospital that wasn't using the checklist because I wouldn't regard it as safe," said Dr. Donaldson.

Services available in Anowara medical Services

The following services are available here
1. FNAC (Unguided).
2. Ultrasonogram guided FNAC
3. CT guided FNAC
4. Histopathology
5. Pap Cytology
6. Exfoliative cytology
7. Mycobacterial Culture and sensitivity
8. Clinical Pathology & Haematology
9. Receptor (ER.PR) study in Breast Cancer
10. Immunocytochemistry-LCA, Cytokeratin, Vimentin, CD20, CD 3, CD 38, CD 99, CD117, CD 138, EMA, CD 15, CD 30, SMA, Calcitonin, TTF1,

11. Spermatogenesis status of testis.
12. Pleural biopsy, fluid aspiration, punch biopsy etc.
13. Telepathology

LETTER OF THE EDITOR OF "THE TIMES OF INDIA" TO THE PRIME MINISTER OF INDIA

Must Read ! Very Powerfully Worded. Bravo - Prakash Bajaj, Editor of Times of India.

LETTER OF THE EDITOR OF "THE TIMES OF INDIA" TO THE PRIME MINISTER OF INDIA

Dear Mr. Prime minister,

I am a typical mouse from Mumbai. In the local train compartment which has capacity of 100 persons, I travel with 500 more mice. Mouse at least squeaks, but we don't even do that.

Today I heard your speech, in which you said, 'NO BODY WOULD BE SPARED'. I would like to remind you that fourteen years have passed since serial bomb blasts in Mumbai took place. Dawood was the main conspirator. Till today he is not caught. All our Bollywood actors, our builders, our Gutka king keep meeting him, but your Government can not catch him. Reason is simple; all your ministers are hand in glove with him. If any attempt is made to catch him, everybody will be exposed. Your statement 'NOBODY WOULD BE SPARED' is nothing but a cruel joke on these unfortunate people of India.

Enough is enough. As such, after seeing terrorist attack carried out by about a dozen young boys, I realize that if same thing continues, days are not far away when terrorists will attack by air, destroy our nuclear reactors and there will be one more Hiroshima.

We the people are left with only one mantra. Womb to Bomb to Tomb. You promised Mumbaikar Shanghai; what you have given us is Jalianwala Baug.
Today only your home minister resigned. What took you so long to kick out this joker? Only reason was that he was loyal to Gandhi family. Loyalty to Gandhi family is more important than blood of innocent people, isn't it?

I am born and brought up in Mumbai for last fifty eight years. Believe me, corruption in Maharashtra is worse than that in Bihar. Look at all the politicians, Sharad Pawar, Chagan Bhujbal, Narayan Rane, Bal Thackray , Gopinath Munde, Raj Thackray, Vilasrao Deshmukh all are rolling in money. Vilasrao Deshmukh is one of the worst Chief ministers I have seen. His only business is to increase the FSI every other day, make money and send it to Delhi, so Congress can fight next election. Now the clown has found new way and will increase FSI for fishermen, so they can build concrete houses right on sea shore. Next time terrorists can comfortably live in those houses, enjoy the beauty of the sea and then attack our Mumbai at their will.

Recently, I had to purchase a house in Mumbai. I met about two dozen builders. Everybody wanted about 30% in black. A common person like me knows this and with all your intelligent agency & CBI, you and your finance ministers are not aware of it. Where all the black money goes? To the underworld isn't it? Our politicians take help of these goondas to vacate people by force. I myself was victim of it. If you have time please come to me, I will tell you everything.
If this has been a land of fools, idiots, then I would not have ever cared to write to you this letter. Just see the tragedy. On one side we are reaching moon, people are so intelligent; and on the other side, you politicians have converted nectar into deadly poison. I am everything Hindu, Muslim, Christian, Schedule caste, OBC, Muslim OBC, Christian Schedule caste, and Creamy Schedule caste; only what I am not is INDIAN. You politicians have raped every part of Mother India by your policy of divide and rule.

Take example of our Former President Abdul Kalam. Such an intelligent person; such a fine human being. But you politician didn't even spare him and instead choose a worthless lady who had corruption charges and insignificant local politician of Jalgaon WHO'S NAME ENTIRE COUNTRY HAD NOT HEARD BEFORE. It's simple logic your party just wanted a rubber stamp in the name of president. Imagine SHE IS SUPREME COMMANDAR OF INDIA'S THREE DEFENCE FORCES. what moral you will expect from our defense forces ? Your party along with opposition joined hands, because politicians feel they are supreme and there is no place for good person.

Dear Mr Prime minister, you are one of the most intelligent persons, a most learned person. Just wake up, be a real SARDAR. First and foremost, expose all selfish politicians. Ask Swiss banks to give names of all Indian account holders. Give reins of CBI to independent agency. Let them find wolves among us. There will be political upheaval, but that will be better than dance of death which we are witnessing every day. Just give us ambience where we can work honestly and without fear. Let there be rule of law. Everything else will be taken care of.

Choice is yours Mr. Prime Minister. Do you want to be lead by one person, or you want to lead the nation of 100 Crore people?


Prakash B. Bajaj
Editor Mumbai-Times of India

Services available in Anowara medical Services

The following services are available here
1. FNAC (Unguided).
2. Ultrasonogram guided FNAC
3. CT guided FNAC
4. Histopathology
5. Pap Cytology
6. Exfoliative cytology
7. Mycobacterial Culture and sensitivity
8. Clinical Pathology & Haematology
9. Receptor (ER.PR) study in Breast Cancer
10. Immunocytochemistry-LCA, Cytokeratin, Vimentin, CD20, CD 3, CD 38, CD 99, CD117, CD 138, EMA, CD 15, CD 30, SMA, Calcitonin, TTF1,

11. Spermatogenesis status of testis.
12. Pleural biopsy, fluid aspiration, punch biopsy etc.
13. Telepathology

Ultrasound-Guided Breast Biopsy

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• What is Ultrasound-Guided Breast Biopsy?
• What are some common uses of the procedure?
• How should I prepare?
• What does the equipment look like?
• How does the procedure work?
• How is the procedure performed?
• What will I experience during and after procedure?
• Who interprets the results and how do I get them?
• What are the benefits vs. risks?
• What are the limitations of Ultrasound-Guided Breast Biopsy?

What is Ultrasound-Guided Breast Biopsy?

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Lumps or abnormalities in the breast are often detected by physical examination, mammography, or other imaging studies. However, it is not always possible to tell from these imaging tests whether a growth is benign or cancerous.

A breast biopsy is performed to remove some cells—either surgically or through a less invasive procedure involving a hollow needle—from a suspicious area in the breast and examine them under a microscope to determine a diagnosis. Image-guided needle biopsy is not designed to remove the entire lesion, but most of a very small lesion may be removed in the process of biopsy.

Image-guided biopsy is performed when the abnormal area in the breast is too small to be felt, making it difficult to locate the lesion by hand (called palpation).

In ultrasound-guided breast biopsy, ultrasound imaging is used to help guide the radiologist's instruments to the site of the abnormal growth.

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What are some common uses of the procedure?

An ultrasound-guided breast biopsy can be performed when a breast ultrasound shows an abnormality such as:

• a suspicious solid mass
• a distortion in the structure of the breast tissue
• an area of abnormal tissue change

There are times when your doctor may decide that ultrasound guidance for biopsy is appropriate even for a mass that can be felt.

Ultrasound guidance is used in four biopsy procedures:

• fine needle aspiration (FNA), which uses a very small needle to extract fluid or cells from the abnormal area.
• core needle (CN) which uses a large hollow needle to remove one sample of breast tissue per insertion.
• vacuum-assisted device (VAD) which uses a vacuum powered instrument to collect multiple tissue samples during one needle insertion.
• wire localization, in which a guide wire is placed into the suspicious area to help the surgeon locate the lesion for surgical biopsy.

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How should I prepare?

You should wear comfortable, loose-fitting clothing for your ultrasound exam. You may need to remove all clothing and jewelry in the area to be examined.

You may be asked to wear a gown during the procedure.

Prior to a needle biopsy, you should report to your doctor all medications that you are taking, including herbal supplements, and if you have any allergies, especially to anesthesia. Your physician will advise you to stop taking aspirin or a blood thinner three days before your procedure.

Also, inform your doctor about recent illnesses or other medical conditions.

You may want to have a relative or friend accompany you and drive you home afterward. This is recommended if you have been sedated.

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What does the equipment look like?

Ultrasound scanners consist of a console containing a computer and electronics, a video display screen and a transducer that is used to scan the body and blood vessels. The transducer is a small hand-held device that resembles a microphone, attached to the scanner by a cord. The transducer sends out high frequency sound waves into the body and then listens for the returning echoes from the tissues in the body. The principles are similar to sonar used by boats and submarines.

The ultrasound image is immediately visible on a nearby video display screen that looks much like a computer or television monitor. The image is created based on the amplitude (strength), frequency and time it takes for the sound signal to return from the patient to the transducer and the type of body structure the sound travels through.

One of four instruments will be used:

• A fine needle attached to a syringe, smaller than needles typically used to draw blood.
• A core needle, also called an automatic, spring-loaded needle, which consists of an inner needle connected to a trough, or shallow receptacle, covered by a sheath and attached to a spring-loaded mechanism.
• A vacuum-assisted device (VAD), a vacuum-powered instrument that uses pressure to pull tissue into the needle.
• A thin guide wire, which is used for a surgical biopsy.

Other sterile equipment involved in this procedure includes syringes, sponges, forceps, scalpels and a specimen cup or microscope slide.

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How does the procedure work?

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Ultrasound imaging is based on the same principles involved in the sonar used by bats, ships and fishermen. When a sound wave strikes an object, it bounces back, or echoes. By measuring these echo waves it is possible to determine how far away the object is and its size, shape, and consistency (whether the object is solid, filled with fluid, or both).

In medicine, ultrasound is used to detect changes in appearance of organs, tissues, and vessels or detect abnormal masses, such as tumors.

In an ultrasound examination, a transducer both sends the sound waves and records the echoing waves. When the transducer is pressed against the skin, it directs small pulses of inaudible, high-frequency sound waves into the body. As the sound waves bounce off of internal organs, fluids and tissues, the sensitive microphone in the transducer records tiny changes in the sound's pitch and direction. These signature waves are instantly measured and displayed by a computer, which in turn creates a real-time picture on the monitor. One or more frames of the moving pictures are typically captured as still images.

Using an ultrasound probe to visualize the location of the breast lump, the radiologist inserts a biopsy needle through the skin, advances it into the mass and removes tissue samples. If a surgical biopsy is being performed, ultrasound may be used to guide a wire directly into the mass to help the surgeon locate the area for excision. With continuous ultrasound imaging, the physician is able to view the biopsy needle or wire as it advances to the location of the lesion in real-time.

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How is the procedure performed?

Image-guided, minimally invasive procedures such as ultrasound-guided breast biopsy are most often performed by a specially trained radiologist.

Breast biopsies are usually done on an outpatient basis.

You will be positioned lying face up on the examination table or turned slightly to the side.

A local anesthetic will be injected into the breast to numb it.

Pressing the transducer to the breast, the sonographer or radiologist will locate the lesion.

A very small nick is made in the skin at the site where the biopsy needle is to be inserted.

The radiologist, constantly monitoring the lesion site with the ultrasound probe, will insert the needle and advance it directly into the mass.

Tissue samples are then removed using one of three methods:

• In a fine needle aspiration, a fine gauge needle and a syringe withdraw fluid or clusters of cells.
• In a core needle biopsy, the automated mechanism is activated, moving the needle forward and filling the needle trough, or shallow receptacle, with 'cores' of breast tissue. The outer sheath instantly moves forward to cut the tissue and keep it in the trough. This process is repeated three to six times.
• With a vacuum-assisted device (VAD), vacuum pressure is used to pull tissue from the breast through the needle into the sampling chamber. Without withdrawing and reinserting the needle, it rotates positions and collects additional samples. Typically, eight to 10 samples of tissue are collected from around the lesion.

After this sampling, the needle will be removed.

If a surgical biopsy is being performed, a wire is inserted into the suspicious area as a guide for the surgeon.

A small marker may be placed at the site so that it can be located in the future if necessary.

Once the biopsy is complete, pressure will be applied to stop any bleeding and the opening in the skin is covered with a dressing. No sutures are needed.

A mammogram may be performed to confirm that the marker is in the proper position.

This procedure is usually completed within an hour.

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What will I experience during and after the procedure?

You will be awake during your biopsy and should have little or no discomfort. Most women report little or no pain and no scarring on the breast.

When you receive the local anesthetic to numb the skin, you will feel a slight pin prick from the needle. You may feel some pressure when the biopsy needle is inserted.

The area will become numb within a short time.

You must remain still while the biopsy is performed.

As tissue samples are taken, you may hear clicks from the sampling instrument.

If you experience swelling and bruising following your biopsy, you may be instructed to take an over-the-counter pain reliever and to use a cold pack. Temporary bruising is normal.

You should contact your physician if you experience excessive swelling, bleeding, drainage, redness or heat in the breast.

If a marker is left inside the breast to mark the location of the biopsied lesion, it will cause no pain, disfigurement or harm.

You should avoid strenuous activity for 24 hours after returning home, but then usually will be able to resume normal activities.

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Who interprets the results and how do I get them?

A pathologist examines the removed specimen and makes a final diagnosis. Depending on the facility, the radiologist or your referring physician will share the results with you.

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What are the benefits vs. risks?

Benefits

• The procedure is less invasive than surgical biopsy, leaves little or no scarring and can be performed in less than an hour.
• Ultrasound imaging uses no ionizing radiation.
• Ultrasound-guided breast biopsy reliably provides tissue samples that can show whether a breast lump is benign or malignant.
• Compared with stereotactic breast biopsy (www.RadiologyInfo.org/en/info.cfm?pg=breastbixr), the ultrasound method is faster and avoids the need for ionizing radiation exposure.
• With ultrasound it is possible to follow the motion of the biopsy needle as it moves through the breast tissue.
• Ultrasound-guided breast biopsy is able to evaluate lumps under the arm or near the chest wall, which are hard to reach with stereotactic biopsy.
• Ultrasound-guided biopsy is less expensive than stereotactic biopsy.
• Recovery time is brief and patients can soon resume their usual activities.

Risks

• Because the vacuum-assisted device removes slightly larger pieces of tissue than other types of needles, there is a risk of bleeding and forming a hematoma, or a collection of blood at the biopsy site. The risk, however, appears to be less than one percent of patients.
• An occasional patient has significant discomfort, which can be readily controlled by non-prescription pain medication.
• Any procedure where the skin is penetrated carries a risk of infection. The chance of infection requiring antibiotic treatment appears to be less than one in 1,000.
• Doing a biopsy of tissue located deep within the breast carries a slight risk that the needle will pass through the chest wall, allowing air around the lung that could collapse a lung. This is a rare occurrence.

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What are the limitations of Ultrasound-Guided Breast Biopsy?

Breast biopsy procedures will occasionally miss a lesion or underestimate the extent of disease present. If the diagnosis remains uncertain after a technically successful procedure, surgical biopsy will usually be necessary.

The ultrasound-guided biopsy method cannot be used unless the lesion can be seen on an ultrasound exam. Clustered calcifications are not shown as clearly with ultrasound as with x-rays.

Very small lesions may be difficult to target accurately by ultrasound-guided core biopsy.

ALEXANDER - The Great's Last 3 Wishes ALEXANDER - The Great's Last 3 Wishes

Alexander, after conquering many kingdoms, was returning home. On the way, he fell ill and it took him to his death bed. With death staring him in his face, Alexander realized how his conquests,his great army, his sharp sword and all his wealth were of no consequence.

He now longed to reach home to see his mother's face and bid her his last adieu. But, he had to accept the fact that his sinking health would not permit him to reach his distant homeland.

So, the mighty conqueror lay prostrate and pale, helplessly waiting to breathe his last. He called his generals and said, "I will depart from this world soon, I have three wishes, please carry them out without fail."

With tears flowing down their cheeks, the generals agreed to abide by their king's last wishes.
1) "My first desire is that", said Alexander, "My physicians alone must" carry my coffin."

2) After a pause, he continued, "Secondly, I desire that when my coffin is being carried to the grave, the path leading to the graveyard be strewn with gold, silver and precious stones which I have collected in my treasury".

3) The king felt exhausted after saying this. He took a minute's rest and continued. "My third and last wish is that both my hands be kept dangling out of my coffin".

The people who had gathered there wondered at the king's strange wishes. But no one dared bring the question to their lips.. Alexander's favorite general kissed his hand and pressed them to his heart.
"O king, we assure you that all your wishes will be fulfilled. But tell us why do you make such strange wishes?"

At this Alexander took a deep breath and said:
"I would like the world to know of the three lessons I have just learnt.

Lessons to be learnt from last 3 wishes of King Alexander...

I want my physicians to carry my coffin because people should realize that no doctor on this earth can really cure any body. They are powerless and cannot save a person from the clutches of death.

So let not people take life for granted.

The second wish of strewing gold, silver and other riches on the path to the graveyard is to tell People that not even a fraction of gold will come with me. I spent all my life Greed of Power, earning riches but cannot take anything with me.

Let people realize that it is a sheer waste of time to chase wealth.

And about my third wish of having my hands dangling out of the coffin, I wish people to know that I came empty handed into this world and empty handed I go out of this world".

With these words, the king closed his eyes.

Soon he let death conquer him and breathed his last. . . .

LESSON TO LEARN:

Remember, your Health is in your own hands, look after it.

Wealth is only meaningful if you can share and also enjoy

while you are still alive, kicking & healthy.

What you do for yourself, dies with you.

But what you do for others will live for ever.

Leave the “Legacy” behind.

Services available in Anowara medical Services

The following services are available here
1. FNAC (Unguided).
2. Ultrasonogram guided FNAC
3. CT guided FNAC
4. Histopathology
5. Pap Cytology
6. Exfoliative cytology
7. Mycobacterial Culture and sensitivity
8. Clinical Pathology & Haematology
9. Receptor (ER.PR) study in Breast Cancer
10. Immunocytochemistry-LCA, Cytokeratin, Vimentin, CD20, CD 3, CD 38, CD 99, CD117, CD 138, EMA, CD 15, CD 30, SMA, Calcitonin, TTF1,

11. Spermatogenesis status of testis.
12. Pleural biopsy, fluid aspiration, punch biopsy etc.
13. Telepathology