Health Management of serving &:Retired

Health Management of Serving & Retired.


1) The present medical structure is based on age old British Raj. The serving are in good health & veteran are generally ailing.

2) Today is day of multi speciality but our MH are not geared up.Neither they have specialist even at Corp level nor infrastructure .Where as in civil these are available even at district level.

3) The lack of specialists( see list below about 100 specialist  but Our doctors are know all specialist docs  & Lack of professional knowledge leads to poor medical treatment of serving & retired.

This may sound different.

But for your kind a OPD is handled by a Medical officer of Medicine & he has final say.

Zero knowledge of Cardiac specialist + zero availability of infrastructure & zero knowledge of Kindocrinlogist + zero availability of infrastructure

But can give expert ruling ( No better than Jhola shop doctor)

So kindly do not live in illusions & play with life of serving + veteran.

4) Moreover the Doctors are more busy in ACR/ Medical categories.

5) They have good experience in treating healthy patients only.

6) Doctors have limitations .

A) Cost Factor of medicines

B) Lack of knowledge of latest medicine's.

C) Lack of diagnostics equipment.

D) Lack of professional knowledge of sister specialties.

E) Lack of inventory management system.


Although they say availability of medicines to 95% satisfaction level are so .But that is all Farce.

There demand management is on consumption based

But NA items record is not maintained hence demand management suffers from the grass root.

( To give you an example I was head of advisory unit. Various PSU were showing 95 to 97 % satisfaction level.. I was quite imprssed. But was worried over heavy import cost. On detailed study found their false satisfaction level. In instruments Passive Night Vision ( a major unit ) being imported but low technology items were 97% satisfaction. Similarly Engine was being imported but low technology work 97% satisfaction & so on.

D) Similar is fate of medicines..

7) The doctor may be excellent but he cannot diagnose properly without various type of reports of patients.

8) When he cannot diagnose properly then how can he give matching medicine's

9)It is not only the matching medicines but the important is correct dose & correct  as per ailment of person .

Thus medicines should be available in range & depth

10)In medicine the life of medicine plays a vital role. The Normal expariry period is 2 years . But bulk of medicines in Hospital have little life left & few expire after 3 months. The chemical degradation takes place with time. But supplier will push through medicine just to expire.

He makes money on stale medicines .Sometimes even changes grade. For example a patient of insulin has to take a dose of prescribed dose of 800 mg dose two times a day. But supplier  supplier supplies 200 mg dose

See supplier had more money from unsold medicine in market. Of  200 mg & also made more money against single 800 mg dose.

See plight of patient

First he is not getting correct dose in one go thus system will detorate further & in addition in stead of 2 pricks a day he will have to take 8 prick's. A real pain.

11)The truth is that nearly all medications, both over-the-counter and prescription, have some kind of undesirable and sometimes dangerous aftereffects, from muscle aches to death.

12)Mismatch of medicines with different ailments can drastically damage other organ.

Even see simple side effect of Aspirin.


13) Thus our hospitals are not geared up for quality treatments


Recommendations

1) In one go neither special doctors can be placed nor  costly infra be purchased.

2)Internal Management

A)Relieve Hospital specialists from admin paper work of ACR & Medical Categorisation.

B) MH uses local doctors for DMO duties. Similarly  use Specialist doctors for ACR/ Med Cat. From Area/ SubArea/ADS/FD Amb. Extra.

C) Pool up local resources

D) To reduce cost of storage & procurement of medicines . Do it on centralised way on station basis.

E) Carry out ABC & VED analysis. ( details are appended below)

Make ABC & VED matrix for cost effective & better medical care.


These should be compiled in a table to obtain drugs in the following categories - AV, AE, AD, ..Priority- one  BV, BE, BD,. Priority- two
CV, CE. CD.Priority-Three


Better make software for this & update it everymonth.

F) Procure medicine from manufacture (OEM)

Advantages

I) Quality of medicine's will be available.

Ii)Manufacturer will deliver at your door. You save transportation & handling costs.

Iii)Bulk discounts will lower cost of procurement. Overall saving.

IV)Longer life of medicines will be available. Medicines wastage due to expiry date will come as NIL. A great saving.

V) Patients satisfaction will be high due to Quality of medicines & better availability.

VI) Economic Order can be placed.

vii)Cost of Carrying inventory can be reduced.

viii) Reorder cost will be reduced.

F)Medical representative meets specialist during patient time. In civil it is not so .Mostly a day is fixed for them & time 2PM - 3PM. Adopt their way.

3)Dose & power of medicine differ from person to person depending upon ailments & chemical composition.The mismatch of medicine can lead to aggrevate / damage organs .This will be a deficiency of services & lack of medical care. This is punishable as per law of land.

4) Due to lack of infrastructure the alternative is go far Buy Decision in phases & till such time take help from multi specialist hospitals for tests & diagnosis.

5)Gear up hospitals in a phased way for various specialists

6)Do not give 1000 mg when the patient requires 500 mg. Telling patient to break in 2 & use may be mathematically correct . But Clinically highly objectionable.

I) Patients will never be able to make proper dose

Ii( Mismatch if dose will harm patient.

iii) Half cut medicine will be destroyed by environmental effect . See if you cut a Apple & watch after 15 minutes or Make fresh juice & take after 1 hour. So kindly play with life of old veteran.


With best wishes & warm regards


Col Lamba ( one man army)




....

Various specialists

Specialties
Specialty Paths

A

Abdominal Radiology Radiology-Diagnostic
Addiction Psychiatry Psychiatry
Adolescent Medicine Pediatrics
Adult Reconstructive Orthopaedics Orthopaedic Surgery
Advanced Heart Failure & Transplant Cardiology Internal Medicine
Allergy & Immunology
Anesthesiology
B

Biochemical Genetics Medical Genetics
Blood Banking - Transfusion Medicine Pathology-Anatomic & Clinical
C

Cardiothoracic Radiology Radiology-Diagnostic
Cardiovascular Disease Internal Medicine
Chemical Pathology Pathology-Anatomic & Clinical
Child & Adolescent Psychiatry Psychiatry
Child Neurology Neurology
Clinical & Laboratory Immunology Allergy & Immunology
Clinical Cardiac Electrophysiology Internal Medicine
Clinical Neurophysiology Neurology
Colon & Rectal Surgery
Congenital Cardiac Surgery Thoracic Surgery
Craniofacial Surgery Plastic Surgery
Critical Care Medicine Anesthesiology
Critical Care Medicine Internal Medicine
Cytopathology Pathology-Anatomic & Clinical
D

Dermatology
Dermatopathology Dermatology
E

Emergency Medicine
Endocrinology, Diabetes & Metabolism Internal Medicine
Endovascular Surgical Neuroradiology Neurological Surgery
Endovascular Surgical Neuroradiology Neurology
Endovascular Surgical Neuroradiology Radiology-Diagnostic
F

Family Medicine
Family Practice
Female Pelvic Medicine & Reconstructive Surgery Obstetrics & Gynecology
Foot & Ankle Orthopaedics Orthopaedic Surgery
Forensic Pathology Pathology-Anatomic & Clinical
Forensic Psychiatry Psychiatry
G

Gastroenterology Internal Medicine
Geriatric Medicine Family Medicine
Geriatric Medicine Internal Medicine
Geriatric Medicine Family Practice
Geriatric Psychiatry Psychiatry
H

Hand Surgery Orthopaedic Surgery
Hand Surgery Plastic Surgery
Hand Surgery Surgery-General
Hematology Internal Medicine
Hematology Pathology-Anatomic & Clinical
Hematology & Oncology Internal Medicine
I

Infectious Disease Internal Medicine
Internal Medicine
Internal Medicine-Pediatrics
Interventional Cardiology Internal Medicine
M

Medical Genetics
Medical Microbiology Pathology-Anatomic & Clinical
Medical Toxicology Emergency Medicine
Medical Toxicology Preventive Medicine
Molecular Genetic Pathology Medical Genetics
Muscoskeletal Radiology Radiology-Diagnostic
Musculoskeletal Oncology Orthopaedic Surgery
N

Neonatal-Perinatal Medicine Pediatrics
Nephrology Internal Medicine
Neurological Surgery
Neurology
Neuromuscular Medicine Neurology
Neuromuscular Medicine Physical Medicine & Rehabilitation
Neuropathology Pathology-Anatomic & Clinical
Neuroradiology Radiology-Diagnostic
Nuclear Medicine
Nuclear Radiology Radiology-Diagnostic
O

Obstetric Anesthesiology Anesthesiology
Obstetrics & Gynecology
Oncology Internal Medicine
Ophthalmic Plastic & Reconstructive Surgery Ophthalmology
Ophthalmology
Orthopaedic Sports Medicine Orthopaedic Surgery
Orthopaedic Surgery
Orthopaedic Surgery of the Spine Orthopaedic Surgery
Orthopaedic Trauma Orthopaedic Surgery
Otolaryngology
Otology - Neurotology Otolaryngology
P

Pain Medicine Anesthesiology
Pain Medicine Neurology
Pain Medicine Physical Medicine & Rehabilitation
Pathology-Anatomic & Clinical
Pediatric Anesthesiology Anesthesiology
Pediatric Cardiology Pediatrics
Pediatric Critical Care Medicine Pediatrics
Pediatric Emergency Medicine Emergency Medicine
Pediatric Emergency Medicine Pediatrics
Pediatric Endocrinology Pediatrics
Pediatric Gastroenterology Pediatrics
Pediatric Hematology-Oncology Pediatrics
Pediatric Infectious Diseases Pediatrics
Pediatric Nephrology Pediatrics
Pediatric Orthopaedics Orthopaedic Surgery
Pediatric Otolaryngology Otolaryngology
Pediatric Pathology Pathology-Anatomic & Clinical
Pediatric Pulmonology Pediatrics
Pediatric Radiology Radiology-Diagnostic
Pediatric Rheumatology Pediatrics
Pediatric Sports Medicine Pediatrics
Pediatric Surgery Surgery-General
Pediatric Transplant Hepatology Pediatrics
Pediatric Urology Urology
Pediatrics
Physical Medicine & Rehabilitation
Plastic Surgery
Preventive Medicine
Procedural Dermatology Dermatology
Psychiatry
Pulmonary Disease Internal Medicine
Pulmonary Disease & Critical Care Medicine Internal Medicine
R

Radiation Oncology
Radiology-Diagnostic
Rheumatology Internal Medicine
S

Sleep Medicine
Spinal Cord Injury Medicine Physical Medicine & Rehabilitation
Sports Medicine Emergency Medicine
Sports Medicine Family Medicine
Sports Medicine Internal Medicine
Sports Medicine Physical Medicine & Rehabilitation
Surgery-General
Surgical Critical Care Surgery-General
T

Thoracic Surgery
Thoracic Surgery-Integrated Thoracic Surgery
Transplant Hepatology Internal Medicine
U

Urology
V

Vascular & Interventional Radiology Radiology-Diagnostic
Vascular Surgery Surgery-General

...... .

Medical equipment  is designed to aid in the diagnosis, monitoring or treatment of medical conditions.

Types

There are several basic types:

Diagnostic equipment


includes medical imaging machines, used to aid in diagnosis. Examples are ultrasound and MRI machines, PET and CT scanners, and x-ray machines


Treatment equipment


includes infusion pumps, medical lasers and LASIK surgical machines


Life support equipment is used to maintain a patient's bodily function. This includes medical ventilators, anaesthetic machines, heart-lung machines, ECMO, and dialysis machines.


Medical monitors allow medical staff to measure a patient's medical state.


Monitors may measure patient vital signs and other parameters including ECG, EEG, and blood pressure.


Medical laboratory equipment automates or helps analyze blood, urine, genes, and dissolved gases in the blood.


Diagnostic Medical Equipment may also be used in the home for certain purposes, e.g. for the control of diabetes mellitus
Therapeutic: physical therapy machines like continuous passive range of motion (CPM) machines


...

The success of medicines optimisation depends on an inter-disciplinary collaboration


A) between health professionals

as well as a patient-centred approach. B)Patients and professionals should work together to understand their patients’ experience, choose medicines based on evidence, and make sure medicines are taken properly.

Special medicines for individual needs
Pharmaceutical treatment and clinical care is increasingly focused on a patient’s individual clinical needs.

....



Features

ABC Analysis - A Powerful Tool in Medicine Management
By
Dr Guru Prasad Mohanta, Dr Prabal Kumar Manna, Dr R. Manavalan & S. Madhusudhan

Medicines are part of our lives. They not only save lives and promote health, but prevent epidemics and diseases too.

In our country's public healthcare system about 30-35 per cent of the health budget is spent on medicines.

 Even then, only 35 per cent of the population has access to modern medicines.

A situation jeopardizes the credibility of the public health system. Access to essential medicines is closely linked to health system performance.

In the whole world the lack of access to medicines is particularly concentrated in Africa and India.

Irrational drug use is a common problem in our country. Irrational drug use and poor drug management system are main contributing factors for lack of medicine accessibility to 65 per cent of our population.

Identification of the problem areas is the first step and essential too for initiating corrective measures.

 The World Health Organisation has been advocating many intervention strategies like administrative, educative and regulatory measures for promoting rational drug use and improving drug management system. These strategies have been proved to be successful in improving drug management system leading to better availability of necessary medicines in public health facility benefiting poor patients.

As resources are limited, it is essential that the existing resources be appropriately utilised. With existing drug budget, if rational drug use and improved drug management practices are followed, more number of peoples can be served.

It is impossible and unnecessary too, to monitor every drug used in the health system.


High cost and high volume drugs come in priority whose intervention is likely to cause greatest clinical and economic impact.

 In the whole process it is important first to trace the costliest medicinal products that consume the major portion of the budget and then design a strategy to further study identifying their use pattern.

The study of use pattern will help designing appropriate corrective measure.


 ABC analysis is an important tool used worldwide identifying items, which need greater attention for control.

ABC analysis is also called Pareto analysis, named after a 19th century Italian economist, Vilfredo Pareto. He observed that 80 per cent of Italy's wealth was owned by 20 per cent of the population. Since then this is also known as 80/20 rule.


It is a method of classifying items or activities according to their relative importance. It is also known as "separating the vital few from the trivial many" because for any group of things that contribute to a common effect, a relatively few contributors account for a majority of effects.


The analysis classifies the items into three categories:

The first 20 per cent of the items which accounts for approximately 80 per cent of cumulative value (cost),

40 per cent are category B items that that account for a further 15 per cent of cumulative value and


remaining 40 per cent are C items accounting for mere 5 per cent of total value.

The following logical steps are followed for the analysis:
1. List all items purchased or consumed and enter the unit cost.
2. Enter consumption quantities over a defined period of time.
3. Calculate the value of consumption.
4. Calculate the percentage of total value represented by each item.
5. Rearrange the list. Rank items in descending order by total value, starting at the top with the highest value.
6. Calculate the cumulative percentage of the total value for each item at the top; add the percentage to that of the item below in the list.
7. Choose cut off points for A, B and C categories.
8. Present the result graphically. Plot the percentage of total cumulative value on the Y-axis and the item number in X-axis.

The ABC analysis can be done manually but help of a computer makes work simpler especially when large numbers of items are to be analysed.


Software for ABC analysis of drug consumption is available at Management Sciences for Health website (www.msh.org) for free downloading.

The result of ABC analysis can be applied in the following ways:
1. Identifying the high usage items (A) for which low cost alternative is available. The information can be useful selecting cost effective alternative medicines leading to major cost reduction.
2. Measuring the degree to which actual consumption of A items reflect the public health needs through comparing consumption with morbidity pattern.
3. Reducing inventory levels and cost by arranging for more frequent procurement of small quantities of class A items.
4. Utilising the data for reducing inventory cost by keeping a balance of items in the stock.
5. Analysing the individual therapeutic category where all medicines have equal or similar efficacy, help in selecting alternative cheap item instead of a more expensive ones.

The ABC analysis can be applied to other situations too. In a sales organisation, this analysis identifies the main items or products that contribute the major portion of sales revenue. The management of the organisation may continue concentrating on these items and may develop new strategy to exploit B category to improve sales revenue.

ABC analysis is not one time job; it needs to be performed periodically. Even though ABC analysis offers vital information for further action to improve medicine management, it is neither exploited fully nor pharmacists are trained for performing and interpreting analysis report. This can be kept as an exercise at under graduate level of pharmacy programme especially in hospital pharmacy module for training the students, the future custodians of drug management.

...

Methodology

Do First ABC analysis

Then VED analysis.


ABC analysis was performed. In ABC analysis, annual drug expenditure and unit costs along with names of individual drugs were arranged in ascending order of cost.

The list was divided into A, B and C - three groups based on cumulative costs sequentially.

 Drugs consuming 70.0% of annual drug expenditure were included in group A, those consuming 20.0% were in group B,

 and others in group C.

VED analysis is a system of setting priorities, in which drugs are classified according to their health impact. A panel of clinicians classified the drugs as Vital (V), Essential (E) and Desirable (D)


These were compiled in a table to obtain drugs in the following categories - AV, AE, AD,

BV, BE, BD,

CV, CE and CD.


These were then classified into three categories - X.Y and Z based on the level of manager required to monitor and supervise the drugs.

....

5 Techniques of Inventory Control

Some of the major techniques of inventory control are as follows:

1. Economic Order Quantity

2. Inventory Models

3. ABC Analysis

4. Material Requirements Planning

.5. VED Analysis.

1. Economic Order Quantity:

A problem which always remains in that how much material may be ordered at a time. An industry making bolts will definitely would like to know the length of steel bars to be purchased at any one time.

This length is called “economic order quantity” and an economic order quantity is one which permits lowest cost per unit and is most advantages.

2. Inventory Models:

Concept:

Inventory models determine when and how inventory to carry.

i. Inventory models handle chiefly two decisions:

(a) How much to order at one time.

(b) When to order this quantity to minimize total costs.

ii. Lowest-cost decision rules for inventory management pertain to either buying products from outside or producing then within the company.

iii. Single inventory models assume no delivery delay and that demand is known.

iv. Probabilistic models handle situations of risks and uncertainty.

3. ABC Analysis:

4. Material Requirements Planning:

MRP is a computational technique that converts the master schedule for end products into a detailed schedule for raw material and components used in the end products. The detailed schedule indentifies the quantities of each raw material and component items. It also tells when each item must be ordered and delivered so as to meet the master schedule for the final products.

5. VED Analysis:

Vital essential and desirable analysis is used primarily for the control of spare parts. The spare parts can be divided into three categories:

(i) Vital

(ii) Essential

(iii) Desirable

(i) Vital:

The spares the stock out of which even for a short time will stop production for quite some time and future the cost of stock out is very high are known as vital spares.

(ii) Essential:

The spare stock out of which even for a few hours of days and cost of lost production is high is called essential.

(iii) Desirable:

Spares are those which are needed but their absence for even a week or so will not lead to stoppage of production.

.      .......

Health Care » Patient Care Services » Diagnostic Services
Patient Care Services

Diagnostic Services


Diagnostic Services facilitates the provision of timely, cost-effective, and high quality diagnostic care in safe and secure environments. It includes the clinical services of Pathology and Laboratory Medicine, Radiology, and Nuclear Medicine .

 These services function in the settings of ambulatory care, acute care, mental health, geriatric and rehabilitative care. Facility based diagnostic service employees include physicians, nurses, technicians, technologists, administrators, as well as program assistants and analysts. Combining these diagnostic services and employees into an interdisciplinary group facilitates the sharing of knowledge and permits uniformity of practices and policies.


Nuclear Medicine & Radiation Safety Service

The Nuclear Medicine & Radiation Safety Service Program Office is an integral part of the Diagnostic Imaging Strategic Health Group (SHG) and is proactive in VHA's mission as a leader in quality, safety, clinical informatics, care efficacy and efficiency within a veteran focused and Employer of Choice culture. The Service provides advice and counsel to an array of stakeholders including VA Headquarters, VISNs and local VA medical centers via the dissemination of trends in nuclear services from volume and type of studies performed; to monitoring quality benchmarks including the results of the annual Nuclear Imaging Proficiency Program; to issues concerning professional recruitment and retention, technologist and physician productivity. The Service sponsors ad hoc support groups involving both nuclear medicine and radiation safety issues, and develops productivity models to provide stakeholders with previously unavailable benchmarks to help determine future demands for imaging services and staffing requirements.
Pathology and Laboratory Medicine

The Pathology and Laboratory Medicine (P&LMS) National Program Office has as one of its primary responsibilities, the establishment of Department of Veterans Affairs (VA) national policies applicable to VA clinical laboratories. In addition, the national program office provides P&LMS guidance to the senior leadership in the VA and Veterans Health Administration (VHA) and the VA laboratory community in general, to help ensure that timely, cost effective, and high quality anatomic and clinical pathology services are provided for both VA patients and caregivers. Through its National Enforcement Office, P&LMS has a legislated responsibility to oversee the quality of services provided by VA Clinical Laboratories as well as laboratory compliance with regulatory, accreditation, and policy guidelines. The P&LMS National Program Office accomplishes its mission by the efficient utilization of organizational resources and in collaboration with the Centers for Medicare and Medicaid Services, the Department of Defense, the Food and Drug Administration, the various accrediting organizations, and other federal and civilian external agencies. The P&LMS Program Office is committed to providing support and promoting the delivery of quality laboratory services to eligible veterans.


Radiology

The Radiology Program Office, one of three programs comprising the Diagnostic Services, provides advice and recommends courses of action to VHA Headquarters, VISNs, and facility staff in order to facilitate the provision of timely, cost effective, and highest quality diagnostic care in environments which are safe for patients and caregivers.
The Radiology Program Office provides advice and recommends courses of action to VHA Headquarters, VISNs, and facility staff in order to facilitate the provision of timely, cost effective, and highest quality diagnostic care in environments, which are safe for patients and caregivers. It provides counsel to VA Central Office, VISNs, and facilities regarding trends in imaging statistics in support of effective decision-making. It recommends varied educational opportunities to diagnostic service employees at all levels. It identifies areas of research addressing the needs of our veteran patients. It collaborates with DoD and other government agencies to provide back-up diagnostic services in times of crisis or disaster. The Veterans Health Administration and the Radiology Program Office is committed to provide quality mammography services to our veterans and other patients. The radiographic goal is to generate the best possible reproducible quality image(s) at the minimal radiation dose necessary to give adequate image information.


Teleradiology

The Teleradiology Program provides remote radiologic interpretations. It is the process of sending radiologic images from one point to another through digital, computer-assisted transmission, typically over standard telephone lines, wide area network (WAN), or over a local area network (LAN). Through teleradiology, images can be sent from one from one location to another and even across the country.
VHA Diagnostic Electron Microscopy Program

...

Prescription Drug Side Effects


A A
Dangerous DrugsPrescription Drug Side Effects
Prescription drugs can save lives, but they can also come with unwanted side effects. It's important to remember that not all drugs are safe.
With record numbers of patients suffering or dying as a result of prescription drug side effects, many wonder why medications that are considered dangerous are allowed on the market.

The truth is that nearly all medications, both over-the-counter and prescription, have some kind of undesirable and sometimes dangerous aftereffects, from muscle aches to death. Even with the federal regulations that oversee these drugs, side effects are inevitable. For federal regulators, though, the benefits sometimes outweigh the dangers.

Each year, about 4.5 million Americans visit their doctor’s office or the emergency room because of adverse prescription drug side effects. A startling 2 million other patients who are already hospitalized suffer the ill effects of prescription medications annually, and this when they should be under the watchful eye of medical professionals.Prescription drugs come with serious side effects

All kinds of medications, from those that are considered “all natural” to those that are chemically produced in a laboratory, carry some sort of aftereffect. Even though prescription drugs are supposed to undergo stringent testing and clinical trials, federal drug regulators allow a level of side effects. In addition, most side effects vary from person to person, depending on the dosage, the patient’s disease, age, weight, gender, ethnicity and overall health.

The U.S. Food and Drug Administration (FDA), which oversees all new drug applications, depends on clinical trials conducted by the drug companies to determine the drug’s therapeutic advantages and disadvantages. The FDA is supposed to only approve drugs that have greater benefits than dangers.

Once the drug is on the market, the FDA’s postmarket surveillance program, called MedWatch, comes into play. This voluntary program allows health care professionals to report the adverse effects they see in patients taking the drug. In addition, drug companies are expected to report problems.

Unfortunately, it’s a system that is ripe for abuse.
Are you suffering from injuries related to a prescription drug or medical device?
GET HELP NOW
Serious Side Effects
In addition to common side effects, many drugs cause dangerous side effects. If a drug has numerous problems, the FDA can add warnings to the drug’s label, including its stringent black-box warning. In rare cases, the drug is recalled or removed from the market.

Death
From deadly cancer to fatal heart attacks, some prescription drugs have been known to cause either slow or immediate death. Sometimes prescription drugs such as penicillin stimulate allergic reactions that cause anything from itching to an anaphylactic response, which can lead to death. In other cases, a drug can cause a deadly heart attack or stroke, which has been seen in patients who take the type 2 diabetes drugs Avandia or Actos.

Other drugs may cause patients to do things they wouldn’t ordinarily consider, including suicide. Drugs such as Accutane and some antidepressants have been linked to suicidal thoughts or actions.

Physical Debilitation
Many drugs can be physically and emotionally debilitating, including causing total or partial paralysis or severe pain. This includes headaches, stomachaches, joint and muscle pain and decreased control over bodily functions.

Sometimes these side effects are caused by the drug’s numbing effect on the area of the brain responsible for pain perception. Lipitor, a commonly prescribed cholesterol medication, is linked to unexpected muscle pain and loss of muscle coordination.

Heart Conditions
Problems related to the heart, including heart attacks, congestive heart failure, lifelong heart damage and cardiomyopathy, have been linked to many prescription drugs. Sometimes, the drugs cause an increase in water-weight gain, which causes heart failure or a heart attack. Such is the case with Avandia and its sister drug, Actos. Other drugs, including the painkiller Celebrex, have been proven to be so risky that doctors refuse to prescribe them for long-term use.

In addition to these drugs, studies show that testosterone replacement therapy (TRT) drugs like AndroGel may double the risk of heart attack in men.

Stroke
Described as the rapid loss of brain function due to a blood flow disturbance, strokes have been linked to several kinds of prescription drugs. In some cases, the drugs cause blood clots to form.

When these clots move through the body, they can block the blood flow to the brain. Some antipsychotic drugs, including drugs used in Alzheimer’s treatment such as Risperdal, are linked to strokes. Other drugs, including the painkiller Vioxx, are also linked to stroke.

Cancer
Probably one of the most shocking and overwhelming side effects of prescription drugs is cancer. Perhaps that’s because most people spend their lives avoiding known carcinogens, such as cigarette smoking. When patients learn that their prescription drugs can be carcinogenic, they feel angry and misled.

One of the most shocking medication-cancer connections came when Tamoxifen, a drug used to treat breast cancer, was found to increase the risk of uterine cancer. In addition, Actos, a drug that is supposed to alleviate diabetes symptoms, is linked to an 80 percent increased risk of bladder cancer in those taking the drug two years or longer.

Some drugs have been linked to other significant side effects, including losing the sense of taste, amnesia, sight loss and hallucinations. For all patients, the best way to combat all of these problems is to carefully read the drug’s label and ask the doctor or pharmacist detailed questions.

Common Side Effects
Possibly the most common side effects of any prescription drug are gastrointestinal issues, including nausea, constipation and diarrhea, because most drugs go through the digestive system to be absorbed. Other common aftereffects include drowsiness, pain and skin reactions. Read about side effects specific to women and seniors. Students also face issues involving everyday drugs.

Dizziness
While dizziness may not seem like a serious side effect, it can have grave consequences. For elderly patients or those already unsteady on their feet, random dizziness can cause a fall that could lead to broken bones.

For the elderly, especially those who are already battling other medical problems, a broken hip can take a deadly toll. Because dizziness is a common side effect of most prescription drugs, patients should be acutely aware of any vertigo-like feelings.

Nausea
While nausea and vomiting aren’t considered deadly side effects, they can cause a cascade of medical problems, especially in the elderly or those already weakened by a disease. The resulting dehydration, internal bleeding and esophageal rupture can result in death. Chemotherapy drugs, which are aimed at treating cancer, are known to cause severe nausea and vomiting.

CAG slams Defence Ministry for causing exchequer loss of over Rs 100 crore

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Tue, 22 Dec 2015-09:35pm , New Delhi , PTI

Top government auditor has slammed the Defence Ministry over alleged "irregularities" and "deficiency" in the implementation of the Ex-servicemen Contributory Health Scheme which caused the exchequer a loss of over Rs 100 crore.

The Comptroller and Auditor General of India (CAG) also brought out various shortcomings in the implementation like short supply of medicines to the polyclinics, raising of two claims for the same patients during the overlapping period, irregular payment towards unaccounted bills of empanelled hospitals among others.

The schemes aims to provide health care to around 47 lakh beneficiaries on a cashless basis in line with Central Government health Scheme (CGHS) through a network of 426 polyclinics, service hospitals and private empanelled hospitals spread over the country.

The CAG said availability of medicines, medical equipment, manpower were inadequate in these polyclinics due to which they were forced to function as point of referral of patients to the empanelled hospitals/labs, which consumed about 70% of revenue expenditure of the scheme.

Moreover, funds allotted for the scheme for procurement of medicines/stores were diverted or utilized for treatment of regular service personnel to the extent of Rs 40.78 crore, the report said.

The report highlighted the irregular payment of Rs 23.61 crore made by Station Hqrs (ECHS Cell), Delhi Cantt against the unaccounted bill involving double payments against a particular bill/duplicate bills.

The report also highlighted unethical practices adopted by the empanelled hospitals such as raising of inflated bills for the treatment of indoor patients involving overpayment of Rs 3.51 crore. It said claims amounting to Rs 42.67 lakh were raised simultaneously by two empanelled hospitals for the same patient and for the same time period.

The overpayment/irregular payments to empanelled hospitals could not be detected earlier due to grossly "inadequate post audit of medical bills by internal audit and lack of internal control mechanism for the scheme".

Besides, the CAG also found discrepancies in enrolment of beneficiaries. It said instead of free issue of smart cards, the beneficiaries were being charged, while there were also instances of their multiple enrolment of beneficiaries, raising the possibility of misuse of smart cards. It also pointed out alleged lapses in issue of smart card to ineligible beneficiaries.

Further, the outsourced Bill Processing Agency (BPA) responsible for online processing of medical claims was functioning without Memorandum of agreement (MoA) since its inception in 2012. In the absence of MoA, no performance parameters were enforcible on BPA with the result that 2% discount available on payment made to empanelled hospitals within 10 working days was not obtained.

It said the discount totalling Rs 34.10 crore on payment made to hospitals could not be availed due to delayed processing of bills.

The CAG said an agreement was entered into with SITL (Score Information Technologies Limited), by the Managing Director, ECHS, Delhi Cantonment in January 2004 for supply of smart cards at Rs 89.99 apiece for a period of five years, later extended for one more year.

Audit observed that without adhering to the laid down provisions for the repetition of orders, Central Organisation, ECHS renewed the agreement with the same firm in May 2010 for supply of smart cards at an increased cost of Rs 135 each.

"Further against the spirit of the Government sanction which stipulated that only one-time contribution towards membership fees at the rates prescribed for CGHS pensioners was to be recovered from ECHS subscribers, Central organisation ECHS recovered the cost of smart cards from the ECHS beneficiaries. This recovery of cost was done without the approval of the MoD (Ministry of Defence), thereby putting the ECHS beneficiaries to a disadvantage as against the CGHS beneficiaries," the report said.

CAG said it was found during the audit that ECHS had issued 7,431 cards in excess of the total number produced by SITL. Holding and circulation of excess cards posed a significant risk of possible misuse, it said