According to the same Global Health report, 58% of the global population says they think “often” about their mental well-being.

According to the World Health Organization (WHO), 15% of adults of working age have a mental disorder, resulting in global economic losses of more than $1 trillion. As a result, this issue is presented as a priority for the international community’s socioeconomic mobility. With these statistics, it is clear that mental health is a topic that is extremely important today and will become even more so in the future. As a result, in a society where consumers expect brands to be agents of change and contribute to people’s well-being, communication strategies that focus on their attention have begun to gain prominence, and many brands have made it their purpose.

The global Communication, Public Affairs, and Marketing consultancy, LLYC, presents the Report “Mental health as a brand purpose” to provide communication strategies that allow brands to relate to their communities of interest. Considering the context in which the definition of a brand’s purpose is critical, mental health presents a great opportunity for companies to play an active, legitimate role in raising awareness and having a positive impact on people.

 

Earlier this year, Grace Elizabeth Elliott got a mysterious hospital bill for medical care she had never received.

She soon discovered how far a clerical error can reach — even across a continent — and how frustrating it can be to fix.

During a college break in 2013, Elliott, then 22, began to feel faint and feverish while visiting her parents in Venice, Florida, about an hour south of Tampa. Her mother, a nurse, drove her to a facility that locals knew simply as Venice Hospital.

In the emergency department, Elliott was diagnosed with a kidney infection and held overnight before being discharged with a prescription for antibiotics, a common treatment for the illness.

“My hospital bill was about $100, which I remember because that was a lot of money for me as an undergrad,” said Elliott, now 31.

She recovered and eventually moved to California to teach preschool. Venice Regional Medical Center was bought by Community Health Systems, based in Franklin, Tennessee, in 2014 and eventually renamed ShorePoint Health Venice.

The kidney infection and overnight stay in the ER would have been little more than a memory for Elliott.

Then another bill came.

The Patients: Grace E. Elliott, 31, a preschool teacher living with her husband in San Francisco, and Grace A. Elliott, 81, a retiree in Venice, Florida.

Medical Services: For Grace E., an emergency department visit and overnight stay, plus antibiotics to treat a kidney infection in 2013. For Grace A., a shoulder replacement and rehabilitation services in 2021.

Service Provider: Venice Regional Medical Center, later renamed ShorePoint Health Venice.

Total Bill: $1,170, the patient’s responsibility for shoulder replacement services, after adjustments and payments of $13,210.21 by a health plan with no connection to Elliott. The initial charges were $123,854.14.

What Gives: This is a case of mistaken identity, a billing mystery that started at a hospital registration desk and didn’t end until months after the file had been handed over to a collection agency.

Early this year, Grace E. Elliott’s mother opened a bill from ShorePoint Health Venice that was addressed to her daughter and sought more than $1,000 for recent hospital services, Elliott said. She “immediately knew something was wrong.”

Months of sleuthing eventually revealed that the bill was meant for Grace Ann Elliott, a much older woman who underwent a shoulder replacement procedure and rehabilitation services at the Venice hospital last year.

Experts said that accessing the wrong patient’s file because of a name mix-up is a common error — but one for which safeguards, like checking a patient’s photo identification, usually exist.

The hospital had treated at least two Grace Elliotts. When Grace A. Elliott showed up for her shoulder replacement, a hospital employee pulled up Grace E. Elliott’s account by mistake.

“This is the kind of thing that can definitely happen,” said Shannon Hartsfield, a Florida attorney who specializes in health care privacy violations. (Hartsfield does not represent anyone involved in this case.) “All kinds of human errors happen. A worker can pull up the names, click the wrong button, and then not check [the current patient’s] date of birth to confirm.”

It was a seemingly obvious error: The younger Elliott was billed for a procedure she didn’t have by a hospital she had not visited in years. But it took her nearly a year of hours-long phone calls to undo the damage.

At first, worried that she had been the victim of identity theft, Grace E. Elliott contacted ShorePoint Health Venice and was bounced from one department to another. At one point, a billing employee disclosed to Elliott the birthdate the hospital had on file for the patient who had the shoulder replacement — it was not hers. Elliott then sent the hospital a copy of her ID.

It took weeks for an administrator at ShorePoint’s corporate office in Florida to admit the hospital’s error and promise to correct it.

In August, though, Grace E. Elliott received a notice that the corporate office had sold the debt to a collection agency called Medical Data Systems. Even though the hospital had acknowledged its error, the agency was coming after Grace E. Elliott for the balance due for Grace A. Elliott’s shoulder surgery.

“I thought, ‘Well, I’ll just work with them directly,’” Grace E. Elliott said.

Her appeal was denied. Medical Data Systems said in its denial letter that it had contacted the hospital and confirmed the name and address on file. The agency also included a copy of Grace A. Elliott’s expired driver license to Grace E. — along with several pages of the older woman’s medical information — in support of its conclusion.

“A collection agency, as a business associate of a hospital, has an obligation to ensure that the wrong patient’s information is not shared,” Hartsfield said.

In an email to KHN, Cheryl Spanier, a vice president of the collection agency, wrote that “MDS follows all state and federal rules and regulations.” Spanier declined to comment on Elliott’s case, saying she needed the written consent of both the health system and the patient to do so.

Elliott’s second appeal was also denied. She was told to contact the hospital to clear up the issue. But because the health system had long since sold the debt, Elliott said, she got no traction in trying to get ShorePoint Health Venice to help her. The hospital closed in September.

Resolution: In mid-November, shortly after a reporter contacted ShorePoint Health, which operates other hospitals and facilities in Florida, Grace E. Elliott received a call from Stanley Padfield, the Venice hospital’s outgoing privacy officer and director of health information management. “He said, ‘It’s taken care of,’” Elliott said, adding that she was relieved but skeptical. “I’ve heard that over and over.”

Elliott said Padfield told her that she had become listed as Grace A. Elliott’s guarantor, meaning she was legally responsible for the debt of a woman she had never met.

Elliott soon received a letter from Padfield stating that ShorePoint Health had removed her information from Grace A. Elliott’s account and confirmed that she had not been reported to any credit agencies. The letter said her information had been removed from the collection agency’s database and acknowledged that the hospital’s fix initially “was not appropriately communicated” to collections.

Padfield said the error started with a “registration clerk,” who he said had “received additional privacy education as a result of this incident.”

Devyn Brazelton, marketing coordinator for ShorePoint Health, told KHN the hospital believes the error was “an isolated incident.”

Using the date of birth provided by a hospital worker, Elliott was able to contact Grace A. Elliott and explain the mix-up.

“I’m a little upset right now,” Grace A. Elliott told KHN on the day she learned about the billing error and disclosure of her medical information.

The Takeaway: Grace E. Elliott said that when she asked Padfield, the Venice hospital’s outgoing privacy officer, whether she could have done something to fight such an obvious case of mistaken identity, he replied, “Probably not.”

This, experts said, is the dark secret of identity issues: Once a mistake has been entered into a database, it can be remarkably difficult to fix. And such incorrect information can live for generations.

For patients, that means it’s crucial to review the information on patient portals — the online medical profiles many providers use to manage things like scheduling appointments, organizing medical records, and answering patient questions.

One downside of electronic medical records is that errors spread easily and repeat frequently. It is important to challenge and correct errors in medical records early and forcefully, with every bit of documentation available. That is true whether the problem is an incorrect name, a medication no longer (or never) taken, or an inaccurate diagnosis.

The process of amending a record can be “very involved,” Hartsfield said. “But with patients able now to see more and more of their medical records, they are going to want those amendments, and health systems and their related entities need to get prepared for that.”

Grace A. Elliott told KHN that she had received a call from ShorePoint Health in the previous few months indicating that she owed money for her shoulder replacement.

She asked for a copy of the bill, she told KHN. Months after she asked, it still hadn’t arrived.

Bill of the Month is a crowdsourced investigation by KHN and NPR that dissects and explains medical bills. Do you have an interesting medical bill you want to share with us? Tell us about it!

This story was produced by KHN, which publishes California Healthline, an editorially independent service of the California Health Care Foundation.

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.

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DM Critical Care Medicine or Doctorate
of Medicine in Critical Care Medicine also
known as DM in Critical Care Medicine is a super specialty level course for doctors in India that is done by
them after completion of their postgraduate medical degree course. The duration
of this super specialty course is 3 years and it deals with critically ill patients who are battling with something life-threatening. This includes providing life support, invasive medical techniques, and end-of-life procedures.

The course is a
full-time course pursued at various recognized medical colleges across the
country. Some of the top medical colleges offering this course include- NRI Medical College- Guntur, Indira
Gandhi Institute of Medical Sciences, Sheikhpura- Patna, Rajendra Institute of Medical
Sciences- Ranchi, and more.

Admission to this
course is done through the NEET-SS Entrance exam conducted by the National
Board of Examinations, followed by counselling based on the scores of the exam
that is conducted by DGHS/MCC/State
Authorities.

The fee for
pursuing DM (Critical Care Medicine) varies from college to college and may
range from Rs. 7000 to Rs.
25,00,000 per year.

After completion of their respective course,
doctors can either join the job market or can pursue certificate courses and Fellowship programmes recognised by
NMC and NBE. Candidates can take
reputed jobs at positions as Senior residents, Consultants etc. with an
approximate salary range of Rs. 11,00,000 to Rs. 26,00,000 per year.

What is DM in Critical Care
Medicine?

Doctorate of
Medicine in Critical Care Medicine, also known as DM (Critical Care Medicine) or
DM in (Critical Care Medicine) is a three-year super specialty
programme that candidates can pursue after completing a postgraduate degree.

Critical Care Medicine is the branch of medical science dealing with critically ill patients who are battling with something life-threatening. This includes providing life support, invasive medical techniques, and end-of-life procedures.

with patients who have sustained or are at risk of sustaining
acutely life-threatening single or multiple organ failure due to disease or
injury.

National Medical Commission (NMC), the apex
medical regulator, has released a Guidelines for Competency-Based
Postgraduate Training Programme for DM
in Critical Care Medicine.

The Competency-Based Postgraduate
Training Programme governs the education and training of DMs in Critical Care Medicine.

The postgraduate
students must gain ample of knowledge and experience in the diagnosis,
treatment of patients with acute, serious, and life-threatening medical and
surgical diseases.

The PG education
intends to create specialists who can contribute to high-quality health care
and advances in science through research and training.

The required
training done by a postgraduate specialist in the field of Critical Care Medicine would help the specialist to recognize the
health needs of the community. The student should be competent to handle
medical problems effectively and should be aware of the recent advances in
their speciality.

The candidate is
also expected to know the principles of research methodology and modes of the
consulting library. The candidate should regularly attend conferences,
workshops and CMEs to upgrade her/ his knowledge.

Course Highlights

Here
are some of the course highlights of DM
in Critical Care Medicine

Name of Course

DM in Critical
Care Medicine

Level

Doctorate

Duration of Course

Three years

Course Mode

Full Time

Minimum Academic Requirement

Postgraduate medical degree obtained from any
college/university recognized by the MCI (Now NMC)/NBE

Admission Process / Entrance Process / Entrance
Modalities

Entrance Exam (NEET-SS)

INI CET for various AIIMS, PGIMER Chandigarh, JIPMER Puducherry, NIMHANS Bengaluru

Counselling
by DGHS/MCC/State Authorities

Course Fees

Rs. 7000 to Rs. 25,00,000 per year

Average Salary

Rs. 11,00,000 to Rs. 26,00,000 per year

Eligibility Criteria

The eligibility criteria for DM in Critical Care Medicine are defined as the set of rules or
minimum prerequisites that aspirants must meet in order to be eligible for
admission, which include:

• Candidates must
  be in possession of a postgraduate medical Degree (MD/MS/DNB) from any
  college/university recognized by the Medical Council of India (MCI).
• The candidate must have obtained permanent
  registration of any State Medical Council to be eligible for admission.
• The medical college's recognition cut-off
  dates for the Postgraduate Degree courses shall be as prescribed by the Medical
  Council of India (now NMC).

Admission
Process

• The admission process contains a few steps to be followed in
  order by the candidates for admission to DM
  in Critical Care Medicine. Candidates can view the complete admission
  process for DM in Critical Care Medicine
  mentioned below:

• The NEET-SS or National Eligibility Entrance Test for Super
  specialty courses is a national-level master's level examination conducted by
  the NBE for admission to DM/MCh/DrNB Courses.

• Qualifying
  Criteria-Candidates placed at the 50th percentile or above shall be declared as
  qualified in the NEET-SS in their respective specialty.

• The
  following medical institutions are not covered under centralized admissions for
  DM/MCh courses through NEET-SS:

1. AIIMS, New
   Delhi and other AIIMS
2. PGIMER,
   Chandigarh
3. JIPMER,
   Puducherry
4. NIMHANS, Bengaluru

• Candidates
  from all eligible feeder specialty subjects shall be required to appear in the
  question paper of respective group, if they are willing to opt for a
  superspecialty course in any of the super specialty courses covered in that group.

• A
  candidate can opt for appearing in the question papers of as many groups for
  which his/her Postgraduate specialty qualification is an eligible feeder
  qualification.

• By
  appearing in the question paper of a group and on qualifying the examination, a
  candidate shall be eligible to exercise his/her choices in the counseling only
  for those superspecialty subjects covered in said group for which his/ her
  broad specialty is an eligible feeder qualification.

Fees Structure

The fee structure for DM in Critical
Care Medicine varies from college to college. The fee is generally less for
Government Institutes and more for private institutes. The average
fee structure for DM in Critical
Care Medicine is around Rs. 7000 to Rs. 25,00,000 per year.

Colleges offering DM in Critical Care Medicine

There are
various medical colleges across India that offer courses for pursuing DM in (Critical Care Medicine).

As per
National Medical Commission (NMC) website, the following medical colleges are
offering DM in (Critical
Care Medicine)
courses for the academic year 2022-23.

Sl.No.

Course Name

Name and Address of
Medical College / Medical Institution

Annual Intake (Seats)

1

DM - Critical Care Medicine

NRI Medical College, Guntur

2

2

DM - Critical Care Medicine

Indira Gandhi Institute of Medical Sciences,Sheikhpura, Patna

3

3

DM - Critical Care Medicine

Rajendra Institute of Medical Sciences, Ranchi

2

4

DM - Critical Care Medicine

St. Johns Medical College, Bangalore

4

5

DM - Critical Care Medicine

Kasturba Medical College, Manipal

2

6

DM - Critical Care Medicine

All India Institute of Medical Sciences, Bhopal

3

7

DM - Critical Care Medicine

Dr. D Y Patil Medical College, Hospital and Research Centre,
Pimpri, Pune

2

8

DM - Critical Care Medicine

Jawaharlal Nehru Medical College, Sawangi (Meghe), Wardha

2

9

DM - Critical Care Medicine

Bharati Vidyapeeth University Medical College, Pune

6

10

DM - Critical Care Medicine

Tata Memorial centre, Mumbai

6

11

DM - Critical Care Medicine

Instt. Of Medical Sciences & SUM Hospital, Bhubaneswar

2

12

DM - Critical Care Medicine

Jawaharlal Institute of Postgraduate Medical Education &
Research, Puducherry

2

13

DM - Critical Care Medicine

Dayanand Medical College & Hospital, Ludhiana

2

14

DM - Critical Care Medicine

All India Institute of Medical Sciences, Jodhpur

6

15

DM - Critical Care Medicine

National Institute of Medical Science & Research, Jaipur

3

16

DM - Critical Care Medicine

Mahatma Gandhi Medical College and Hospital, Sitapur, Jaipur

4

17

DM - Critical Care Medicine

Saveetha Medical College and Hospital, Kanchipuram

2

18

DM - Critical Care Medicine

Madras Medical College, Chennai

2

19

DM - Critical Care Medicine

Christian Medical College, Vellore

5

20

DM - Critical Care Medicine

Sri Ramachandra Medical College & Research Institute,
Chennai

2

21

DM - Critical Care Medicine

All India Institute of Medical Sciences, Rishikesh

10

22

DM - Critical Care Medicine

King George Medical University, Lucknow

5

23

DM - Critical Care Medicine

Sanjay Gandhi Postgraduate Institute of Medical Sciences,
Lucknow

5

24

DM - Critical Care Medicine

Institute of Postgraduate Medical Education & Research,
Kolkata

2

Syllabus

A DM in Critical Care Medicine is a three years specialization
course which provides training in the stream of Critical Care Medicine.

The course
content for DM in Critical Care Medicine
is given in the Competency-Based Postgraduate Training Programme
released by National Medical Commission, which can be assessed through the link
mentioned below:

NMC Guidelines for Competency-Based Training Programme For DM Critical Care Medicine

1. Resuscitation and Initial Management of the Acutely Ill Patients

1.1 Timely approach to the recognition, assessment and stabilization of the acutely ill patients with disordered physiology

1.2 Cardiopulmonary resuscitation

1.3 Post-resuscitation management

1.4 Triage and prioritization of patients for ICU admission

1.5 Assessment and initial management of the trauma patient

1.6 Assessment and initial management of the patient with burns

1.7 Fundamentals of the management of mass casualties

2. Diagnosis: Assessment, Investigation, Monitoring and Data: Interpretation of the acutely ill patients

2.1 History taking and clinical examination

2.2 Timely and appropriate investigations

2.3 Understanding of echocardiography (trans-thoracic/trans-oesophageal), Indications and interpretation of results

2.4 Understanding of Electrocardiography (ECG/EKG), Indications and interpretation of the results

2.5 Appropriate microbiological sampling and interpretation of results

2.6 Interpretation of results from blood gas samples

2.7 Organization and interpretation of wide range of clinical imaging including bed-side chest x- rays, ultrasound, CT scan, MRI and nuclear imaging relevant for the diagnosis and management of critically ill and injured patients.

2.8 Understanding and interpretation of physiological variables

2.9 Integration of clinical findings with laboratory, radiology, microbiology and other investigations to form appropriate differential diagnosis and management strategy

3. Disease Management Acute disease

3.1 Management of the care of the critically ill patient with following specific acute medical conditions

• Acute Myocardial Infarction

• Pulmonary Embolism

• Cardiogenic Shock

• Life Threatening Arrhythmias

• Pericardial Tamponade

• Acute Ischemic Stroke

• Intracranial Hemorrhage

• Status Epilepticus

• Head & Spine Trauma

• Acute neuromuscular failure (OPP/GBS/MG/Snakebite, etc)

• Acute severe Asthma

• Acute Exacerbation of COPD

• Severe Community acquired pneumonia

• Chest Trauma

• Acute hypoxemia Respiratory Failure including ARDS

• Acute GI Bleed

• Acute Liver Failure

• Acute Pancreatitis

• Acute Abdomen

• Acute coagulation disorders

• Sepsis and Septicemic Shock

• Meningitis

• Acute Hemorrhagic Fevers

• Severe forms of tropical infections like Malaria, Typhoid etc.

• Acute Renal Failure

• Eclampsia

• Bone marrow suppression

• Critical care of mother and child including pre-eclampsia, eclampsia, acute fatty liver of pregnancy, HELLP syndrome, meconium aspiration syndrome, respiratory distress syndrome, transient tachypnoea of the newborn etc.

• Acute poisoning

Chronic Disease

3.2 Identifications of the implications of chronic and co morbid disease in the acutely ill patients

Organ System Failure

3.3 Management of patients with or at risk of circulatory failure

3.4 Management of patients with or at risk of acute renal failure

3.5 Management of patients with or at risk of acute liver failure

3.6 Management of patients with or at risk of neurological impairment

3.7 Management of patients with or at risk of acute gastrointestinal failure

3.8 Management of patients with or at risk of acute lung injury syndromes (ALI/ARDS)

3.9 Management of patients with or at risk of septic shock

3.10 Management of patients with or at risk of severe sepsis/septic shock with multi-organ dysfunction/failure

3.11 Management of patients following intoxication with drugs or environmental toxins

3.12 Early recognition and treatment of life-threatening complications, in mother and child, including but not limited to like eclampsia, preeclampsia, acute fatty liver of pregnancy, HELLP in mother and respiratory distress in child.

4. Therapeutic Interventions/Organ System Support in Single or Multiple Organ Failure

4.1 Principles of safe prescription

4.2 Principles of safe delivery of life-support therapies

4.3 Antimicrobial drug therapy – Fundamental principles and ICU specific issues

4.4 Transfusion therapy - Fundamental principles and ICU specific issues

4.5 Circulatory therapies - Fundamental principles and ICU specific issues pertaining to Fluid therapy including dynamic variables of fluid responsiveness and vasoactive/inotropic drugs

4.6 Mechanical circulatory assist devices

4.7 Initiation, management and weaning of the patients from invasive and non-invasive ventilatory support

4.8 Initiation, management and weaning of the patients from renal replacement therapy

4.9 Management of electrolyte, glucose and acid-base disturbances

4.10 Nutritional assessment and support

5. Peri-operative Care

5.1 Management of the pre-& post-operative care of the high risk surgical patients

5.2 Fundamentals of the management of the care of patients following cardiac surgery

5.3 Fundamentals of the management of the patients following craniotomy

5.4 Fundamentals of the management of the patients following solid organ transplantation

5.5 Fundamentals of the management of the pre and post-operative trauma care of the trauma patients

6. Critical Care of Children

6.1 Understanding of the critical care of children including but not limited to early diagnosis, initial management and life support therapies related to pediatric and neonatal emergencies

7. Transportation

7.1 Transportation of the mechanically ventilated critically ill patient outside the ICU

7.2 Understanding of the special considerations required during patient transport by air

8. Physical& Clinical Measurement Mathematical Concepts:

8.1 Relationships and graphs

8.2 Concepts of exponential functions and logarithms: wash-in and washout

8.3 Basic measurement concepts: linearity, drift, hysteresis, signal: noise ratio, static and dynamic response

8.4 SI units: fundamental and derived units

8.5 Other systems of units where relevant to ICM (e.g. mmHg, bar, atmospheres)

8.6 Simple mechanics: Mass, Force, Work and Power

Gases &Vapours:

8.7 Absolute and relative pressure.

8.8 The gas laws; triple point; critical temperature and pressure

8.9 Density and viscosity of gases.

8.10 Laminar and turbulent flow; Poiseuille's equation, the Bernoulli principle

8.11 Vapour pressure: saturated vapour pressure

8.12 Measurement of volume and flow in gases and liquids.

8.13 The pneumotachograph and other respirometers.

8.14 Principles of surface tension

Electricity & Magnetism:

8.15 Basic concepts of electricity, magnetism and Bridge circuits

8.16 Capacitance, inductance and impedance

8.17 Amplifiers: bandwidth, filters

8.18 Amplification of biological potentials: ECG, EMG, EEG.

8.19 Sources of electrical interference

8.20 Processing, storage and display of physiological measurements

Electrical Safety:

8.21 Principles of cardiac pacemakers and defibrillators

8.22 Electrical hazards: causes and prevention.

8.23 Electrocution, fires and explosions.

8.24 Diathermy and its safe use

8.25 Basic principles and safety of lasers

8.26 Basic principles of ultrasound and the Doppler effect

Pressure & Flow Monitoring:

8.27 Principles of pressure transducers

8.28 Resonance and damping, frequency response

8.29 Measurement and units of pressure.

8.30 Direct and indirect methods of blood pressure measurement; arterial curve analysis

8.31 Principles of pulmonary artery and wedge pressure measurement

8.32 Cardiac output: Fick principle, thermodilution

Clinical Measurement:

8.33 Measurement of gas and vapour concentrations, (oxygen, carbon dioxide, nitrous oxide, and volatile anaesthetic agents) using infrared, paramagnetic, fuel cell, oxygen electrode and mass spectrometry methods

8.34 Measurement of H+, pH, pCO2, pO2

8.35 Measurement CO2 production/ oxygen consumption/ respiratory quotient

8.36 Colligative properties: osmometry

8.37 Simple tests of pulmonary function e.g. peak flow measurement, spirometry.

8.38 Capnography

8.39 Pulse oximetry

8.40 Measurement of neuromuscular blockade

8.41 Measurement of pain

9. Research Methods Data Collection:

9.1 Simple aspects of study design (research question, selection of the method of investigation, population, intervention, outcome measures)

9.2 Power analysis

9.3 Defining the outcome measures and the uncertainty of measuring them

9.4 The basic concept of meta-analysis and evidence-based medicine

Descriptive Statistics:

9.5 Types of data and their representation

9.6 The normal distribution as an example of parametric distribution

9.7 Indices of central tendency and variability

Deductive & Inferential Statistics:

9.8 Simple probability theory and the relation to confidence intervals

9.9 The null hypothesis.

9.10 Choice of simple statistical tests for different data types

9.11 Type I and type II errors

9.12 Inappropriate use of statistics

10. Applied Anatomy Respiratory System:

10.1 Mouth, nose, pharynx, larynx, trachea, main bronchi, segmental bronchi, structure of bronchial tree and differences in the children's airway

10.2 Airway and respiratory tract, blood supply, innervation and lymphatic drainage

10.3 Pleura, mediastinum and its contents

10.4 Lungs, lobes, microstructure of lungs

10.5 Diaphragm, other muscles of respiration, innervation

10.6 The thoracic inlet and 1st rib

10.7 Interpretation of a chest x-ray

Cardiovascular System:

10.8 Heart, chambers, conducting system, blood and nerve supply

10.9 Congenital deviations from normal anatomy

10.10 Pericardium

10.11 Great vessels, main peripheral arteries and veins

10.12 Foetal and maternal-foetal circulation

Nervous System:

10.13 Brain and its subdivisions

10.14 Spinal cord, structure of spinal cord, major ascending & descending pathways

10.15 Spinal meninges, subarachnoid & extradural space, extradural space-contents

10.16 Cerebral blood supply

10.17 CSF and its circulation

10.18 Spinal nerves, dermatomes

10.19 Brachial plexus, nerves of arm

10.20 Intercostal nerves

10.21 Nerves of abdominal wall

10.22 Nerves of leg and foot

10.23 Autonomic nervous system

10.24 Sympathetic innervation, sympathetic chain, ganglia and plexuses

10.25 Parasympathetic innervation.

10.26 Stellate ganglion

10.27 Cranial nerves: base of skull: trigeminal ganglion

10.28 Innervation of the larynx

10.29 Eye and orbit

Vertebral Column:

10.30 Cervical, thoracic, and lumbar vertebrae

10.31 Interpretation of cervical spinal imaging in trauma

10.32 Sacrum, sacral hiatus

10.33 Ligaments of vertebral column

10.34 Surface anatomy of vertebral spaces, length of cord in child and adult

Surface Anatomy:

10.35 Structures in antecubital fossa

10.36 Structures in axilla: identifying the brachial plexus

10.37 Large veins and anterior triangle of neck

10.38 Large veins of leg and femoral triangle

10.39 Arteries of arm and leg

10.40 Landmarks for tracheostomy, cricothyrotomy

10.41 Abdominal wall (including the inguinal region): landmarks for suprapubic urinary and peritoneal lavage catheters

10.42 Landmarks for intrapleural drains and emergency pleurocentesis

10.43 Landmarks for pericardiocentesis

Abdomen:

10.44 Gross anatomy of intra-abdominal organs

10.45 Blood supply to abdominal organs and lower body

11. Physiology & Biochemistry General:

11.1 Organisation of the human body and homeostasis

11.2 Variations with age

11.3 Function of cells; genes and their expression

11.4 Mechanisms of cellular and humoral defense

11.5 Cell membrane characteristics; receptors

11.6 Protective mechanisms of the body

11.7 Genetics & disease processes

Biochemistry:

11.8 Acid base balance and buffers, Ions e.g. Na, K, Ca, Cl, HCO3, Mg, PO4,

11.9 Enzymes and Cellular and intermediary metabolism

Body Fluids:

11.10 Capillary dynamics and interstitial fluid

11.11 Oncotic pressure

11.12 Osmolarity: osmolality, partition of fluids across membranes

11.13 Lymphatic system

11.14 Special fluids: cerebrospinal, pleural, pericardial and peritoneal fluids

Haematology & Immunology:

11.15 Red blood cells: haemoglobin and its variants

11.16 Blood groups

11.17 Haemostasis and coagulation; pathological variations

11.18 White blood cells

11.19 Inflammation and its disorders

11.20 Immunity and allergy

Muscle:

11.21 Action potential generation and its transmission

11.22 Neuromuscular junction and transmission

11.23 Muscle types

11.24 Skeletal muscle contraction

11.25 Motor unit

11.26 Muscle wasting

11.27 Smooth muscle contraction: sphincters

Heart & Circulation:

11.28 Cardiac muscle contraction

11.29 The cardiac cycle: pressure and volume relationships

11.30 Rhythmicity of the heart

11.31 Regulation of cardiac function; general and cellular

11.32 Control of cardiac output (including the Starling relationship)

11.33 Fluid challenge and heart failure

11.34 Electrocardiogram and arrhythmias

11.35 Neurological and humoral control of systemic blood pressures, blood volume and blood flow (at rest and during physiological disturbances e.g. exercise, haemorrhage and Valsalva manoeuvre)

11.36 Peripheral circulation: capillaries, vascular endothelium and arteriolar smooth muscle, autoregulation and the effects of sepsis and the inflammatory response on the peripheral vasculature

11.37 Characteristics of special circulations including: pulmonary, coronary, cerebral, renal, portal and foetal

Renal Tract:

11.38 Blood flow, glomerular filtration and plasma clearance

11.39 Tubular function and urine formation

11.40 Endocrine functions of kidney

11.41 Assessment of renal function

11.42 Regulation of fluid and electrolyte balance

11.43 Regulation of acid-base balance

11.44 Micturition

11.45 Pathophysiology of acute renal failure

Respiration:

11.46 Gaseous exchange: O2 and CO2 transport, hypoxia and hyper- and hypocapnia, hyperandhypobaric pressures

11.47 Functions of haemoglobin in oxygen carriage and acid-base equilibrium

11.48 Pulmonary ventilation: volumes, flows, dead space.

11.49 Effect of IPPV and PEEP on lungs and circulation

11.50 Mechanics of ventilation: ventilation/perfusion abnormalities

11.51 Control of breathing, acute and chronic ventilatory failure, effect of oxygen therapy

11.52 Non-respiratory functions of the lungs

11.53 Cardio-respiratory interactions in health & disease

Nervous System:

11.54 Functions of nerve cells: action potentials, conduction, synaptic mechanisms and transmitters

11.55 The brain: functional divisions

11.56 Intracranial pressure: cerebrospinal fluid, blood flow

11.57 Maintenance of posture

11.58 Autonomic nervous system: functions

11.59 Neurological reflexes Motor function: spinal and peripheral

11.60 Senses: receptors, nociception, special senses

11.61 Pain: afferent nociceptive pathways, dorsal horn, peripheral and central mechanisms, neuromodulatory systems, supraspinal mechanisms, visceral pain, neuropathic pain, influence of therapy on nociceptive mechanisms

11.62 Spinal cord: anatomy and blood supply, effects of spinal cord section

Liver:

11.63 Functional anatomy and blood supply

11.64 Metabolic functions

11.65 Tests of function

Gastrointestinal:

11.66 Gastric function; secretions, nausea and vomiting

11.67 Gut motility, sphincters and reflex control

11.68 Digestive functions and enzymes

11.69 Nutrition: calories, nutritional fuels and sources, trace elements, growth factors

Metabolism and Nutrition:

11.70 Nutrients: carbohydrates, fats, proteins, vitamins, minerals and trace elements

11.71 Metabolic pathways, energy production and enzymes; metabolic rate

11.72 Hormonal control of metabolism: regulation of plasma glucose, response to trauma

11.73 Physiological alterations in starvation, obesity, exercise and the stress response

11.74 Body temperature and its regulation

Endocrinology:

11.75 Mechanisms of hormonal control: feedback mechanisms, effect on membrane and intracellular receptors

11.76 Central neuro-endocrine interactions

11.77 Adrenocortical hormones

11.78 Adrenal medulla: adrenaline (epinephrine) and noradrenaline (norepinephrine)

11.79 Pancreas: insulin, glucagon and exocrine function

11.80 Thyroid and parathyroid hormones and calcium homeostasis

Physiology and Metabolism Unique to Pregnancy, Child Birth and Neonates:

11.81 Physiological changes associated with a normal pregnancy and delivery

11.82 Materno-foetal, foetal and neonatal circulation

11.83 Functions of the placenta: placental transfer

11.84 Foetus: changes at birth

11.85 Metabolism unique to pregnant mother and neonates

12. Pharmacology

Principles of Pharmacology:

12.1 Dynamics of drug-receptor interaction

12.2 Agonists, antagonists, partial agonists, inverse agonists

12.3 Efficacy and potency

12.4 Tolerance

12.5 Receptor function and regulation

12.6 Metabolic pathways; enzymes; drug: enzyme interactions; Michaelis-Menten equation

12.7 Enzyme inducers and inhibitors.

12.8 Mechanisms of drug action Ion channels: types: relation to receptors.

12.9 Gating mechanisms.

12.10 Signal transduction: cell membrane/receptors/ion channels to intracellular molecular targets, second messengers

12.11 Action of gases and vapours

12.12 Osmotic effects 12.13pH effects

12.14 Adsorption and chelation

12.15 Mechanisms of drug interactions:

12.16 Inhibition and promotion of drug uptake.

12.17 Competitive protein binding.

12.18 Receptor inter-actions.

12.19 Effects of metabolites and other degradation products.

Pharmacokinetics & Pharmacodynamics

12.20 Drug uptake from: gastrointestinal tract, lungs, nasal, transdermal, subcutaneous, IM, IV, epidural and intrathecal routes

12.21 Bioavailability

12.22 Factors determining the distribution of drugs: perfusion, molecular size, solubility, protein binding.

12.23 The influence of drug formulation on disposition

12.24 Distribution of drugs to organs and tissues:

12.25 Body compartments Influence of specialised membranes: tissue binding and solubility

12.26 Materno-foetal distribution

12.27 Distribution in CSF and extradural space

12.28 Modes of drug elimination:

12.29 Direct excretion

12.30 Metabolism in organs of excretion: phase I & II mechanisms

12.31 Renal excretion and urinary H

12.32 Non-organ breakdown of Drugs

12.33 Pharmacokinetic analysis:

12.34 Concept of a pharmacokinetic compartment

12.35 Apparent volume of distribution

12.36 Orders of kinetics

12.37 Clearance concepts applied to whole body and individual organs

12.38 Simple 1 and 2 compartmental models:

12.39 Concepts of wash-in and washout curves

12.40 Physiological models based on perfusion and partition coefficients

12.41 Effect of organ blood flow: Fick principle

12.42 Pharmacokinetic variation: influence of body size, sex, age, disease, pregnancy, anaesthesia, trauma, surgery, smoking, alcohol and other drugs

12.43 Effects of acute organ failure (liver, kidney) on drug elimination Influence of renal replacement therapies on clearance of commonly used drugs

12.44 Pharmacodynamics: concentration-effect relationships: hysteresis

12.45 Pharmacogenetics: familial variation in drug response

12.46 Adverse reactions to drugs: hypersensitivity, allergy, anaphylaxis, anaphylactoid reactions

Systemic Pharmacology

12.47 Hypnotics, sedatives and intravenous anaesthetic agents

12.48 Simple analgesics

12.49 Opioids and other analgesics; Opioid antagonists

12.50 Non-steroidal anti-inflammatory drugs

12.51 Neuromuscular blocking agents (depolarising and non-depolarising) and anti cholinesterases

12.52 Drugs acting on the autonomic nervous system (including inotropes, vasodilators vasoconstrictors, antiarrhythmics, diuretics)

12.53 Drugs acting on the respiratory system (including respiratory stimulants and bronchodilators)

12.54 Antihypertensives

12.55 Anticonvulsants

12.56 Anti-diabetic agents

12.57 Diuretics

12.58 Antibiotics

12.59 Corticosteroids and other hormone preparations

12.60 Antacids. Drugs influencing gastric secretion and motility

12.61 Antiemetic agents

12.62 Local anaesthetic agents

12.63 Immunosuppressants

12.64 Principles of therapy based on modulation of inflammatory mediators, indications, actions and limitations

12.65 Plasma volume expanders

12.66 Antihistamines

12.67 Antidepressants

12.68 Anticoagulants

12.69 Vitamins and trace elements

Career Options

After
completing a DM in Critical Care Medicine,
candidates will get employment opportunities in Government as well as in the
Private sector.

In the Government sector, candidates have various options to
choose from which include Registrar, Senior Resident, Demonstrator, Tutor etc.

While in the Private sector the
options include Resident Doctor, Consultant, Visiting Consultant (Critical Care Medicine), Junior Consultant, Senior
Consultant (Critical Care Medicine), Critical Care
Medicine Specialist.

Courses After DM
in Critical Care Medicine Course

DM
in Critical Care Medicine is a specialisation course which
can be pursued after finishing a Postgraduate medical course. After pursuing
specialisation in DM in Critical Care Medicine, a candidate could also
pursue certificate courses and Fellowship programmes recognised by NMC and NBE,
where DM in Critical Care Medicine is a feeder
qualification.

Frequently Asked Question (FAQs) –DM in Critical Care Medicine Course

Question: What is the
full form of DM?

Answer: The full form of
DM is a Doctorate of Medicine.

Question: What is a DM in Critical Care Medicine?

Answer: DM Critical Care Medicine or Doctorate of Medicine in Critical Care Medicine
also known as DM in Critical Care Medicine is
a super specialty level course for doctors in India that is done by them after
completion of their postgraduate medical degree course.

Question: What is the
duration of a DM in Critical
Care Medicine?

Answer: DM in Critical Care Medicine is a super
specialty programme of three years.

Question: What
is the eligibility of a DM in Critical
Care Medicine?

Answer:
Candidates must be in possession of a postgraduate medical Degree (MD/MS/DNB)
from any college/university recognized by the Medical Council of India (now
NMC)/NBE.

Question: What is the scope of a DM in Critical Care Medicine?

Answer: DM in Critical
Care Medicine offers candidates various employment opportunities and career
prospects.

Question: What is the average salary for a DM in Critical Care Medicine candidate?

Answer: The DM in
Critical Care Medicine candidate's average salary is between Rs. 11,00,000 to Rs. 26,00,000 per year depending on the experience.

Question: Can you teach after
completing DM Course?

Answer: Yes, candidate can teach in
a medical college/hospital after completing DM course.

Gastritis
is a common condition
encountered in pediatric practice presenting with symptoms of abdominal
pain, nausea, and vomiting. (1) While there are different aetiologies for
gastritis in children, drug-induced gastritis is identified as one of the most
common cause. It generally results from commonly used drugs such as
non-steroidal anti-inflammatory drugs (NSAIDs), antibiotics, steroids, zinc,
iron preparations etc. (1,2) Antibiotics are prescribed to more than one-third
of pediatric patients in Indian outpatient settings. (3)

There is an urgent need for prompt
intervention to ensure rapid symptomatic relief in the pediatric population.
However, there is a gap in recommendations for drug-induced gastritis,
especially in pediatric patients.

In order to bridge this gap, a panel of
thirteen Indian pediatricians and pediatric gastroenterologists formed clinical
practice-based recommendations on Ranitidine, a histamine H2 receptor
antagonist in drug-induced gastritis for pediatric patients. The consensus
statements were formulated with respect to clinical applicability, benefits,
efficacy, and safety of Ranitidine in pediatric patients. (1)

Published in the 10th issue of the International
Journal of Contemporary Paediatrics this year, the consensus was achieved using
the Delphi method. (1)

The experts recommend the use of
Ranitidine in drug-induced gastritis in pediatric settings and the noteworthy
highlights are as follows: (1)

1. Commonly
   used drugs in pediatric practice like antibiotics, NSAIDs, steroids, iron, and
   zinc preparations can cause gastritis.
2. Ranitidine
   has a rapid onset of action compared to proton pump inhibitors (PPIs) and can
   be helpful for immediate relief of symptoms of gastritis.
3. Ranitidine
   is preferred for on-demand use to relieve the symptoms of gastritis.

Causes
of Drug-Induced Gastritis

One of the recommendations stated
that antibiotics, NSAIDs, steroids, and iron and zinc preparations, are the
major causes of drug-induced gastritis in children. (1) This recommendation
finds its basis in evidence from various descriptive studies.

Speaking
to Medical Dialogues, Dr. Lalit Bharadia, Consultant Pediatric
Gastroenterologist, Santokba Durlabhji Memorial Hospital (SDMH), Jaipur, an
expert on the panel of consensus paper, said-

"There are numerous drugs like
NSAIDs, steroids, and anti-tuberculous drugs which are known to cause gastritis
or gastritis-like symptoms such as abdominal pain, nausea, and vomiting in
children. In cases where the administration of these drugs is essential,
simultaneous acid suppression therapy becomes a necessity. Ranitidine scores
higher over PPIs because of rapid onset of action and relatively fewer drug
interactions".

"Ranitidine
can be easily used in all cases irrespective of whether acid suppression is
required as preventive or curative therapy", he added.

Rapid Onset of Action of Ranitidine

The
consensus statement also noted Ranitidine is a better alternative to PPIs in
drug-induced gastritis in children for prompt relief, citing Ranitidine's rapid
onset of action, compared to PPIs. (1)

Dr. Raju C. Shah, Medical Director,
Ankur Institute of Child Health, Ahmedabad, another expert said, "Rapid onset
of action of Ranitidine makes it extremely useful in pediatric cases.

Ranitidine starts working within 30 minutes. However, PPIs have a relatively slower onset of action and take around 3 days to show its optimum effect. 

Dr. Shah also highlighted pediatric
conditions where Ranitidine is preferred over PPIs in children.

"PPIs should be avoided in cases where the
child has pre-existing clinical conditions like diarrhea, renal insufficiency,
or liver damage. Ranitidine is a much safer option in such cases", he
commented.

The On-demand Edge of Ranitidine

Dr. Somashekara H R, Consultant
Pediatric Hepatologist & Gastroenterologist Gleneagles Global Health City
Perumbakkam, Chennai, stressed on pediatricians' preference towards Ranitidine
for on-demand use in gastritis.

"On-demand use generally requires a drug that can act fast to impart
symptomatic relief to the patient. In this regard, Ranitidine proves better
than PPIs because of difference in their mode of action," he elaborated.

"Proton pumps are stimulated by mere smell or
taste of food. But PPIs do not inhibit all proton pumps immediately and are
therefore slow to act. Owing to a
different site of action, this is not the case with Ranitidine. Ranitidine is
thus preferred for on-demand use drug-induced gastritis in children is
permissible independent of meals which is not fixed in infants and children for
obvious reasons", Dr. Somashekara added.

Dr. Somashekara H. R. reiterated
that Ranitidine has the potential to raise intragastric pH to above 4 within
minutes. With this, it becomes the preferred treatment option in complicated
cases as well.

References:

1. Pai UA, Kesavelu D, Shah
AK, Manglik AK, Wadhwa A, Acharya B, et al. Ranitidine use in pediatrics:
current evidence-based review and recommendations. Int J Contemp Pediatr
2022;9:987-97.https://dx.doi.org/10.18203/2349-3291.ijcp20222434

2. Mohsen S, Dickinson
JA, Somayaji R. Update on the adverse effects of antimicrobial therapies in
community practice. Can Fam
Physician. 2020;66(9):651-659.

3. Gedam, D. & Patel,
Utsav & Verma, Mamta & Gedam, Swapnil & Chourishi, A.. (2012). Drug
prescription pattern in pediatric out patient department in a teaching hospital
in central India. International Journal of Pharmaceutical Sciences Review and
Research. 17. 42-45.

Health facilities in Guyana’s interior regions are to be upgraded over the next three years to the value of GY$125 billion, President Irfaan Ali announced during Monday’s commissioning of the upgraded Mabaruma Smart Hospital. He said that upgrades would give the “best possible working conditions” and provide the areas, which include Lethem, Kato, Mahdia, Kamarang, ...

The health center, when applying for the National Quality Award, organized by the Ministry of Public Administration, obtained a silver medal in 2015, a gold medal in 2016, and the Grand National Quality Award in 2017, as well as Gold in its first application for the Ibero-American Quality Award in its 2019 version and was received in Madrid in February 2020.

In July of this year, the HPHM led in the No.1 position in the ranking of the best hospitals nationwide according to the Public Administration Monitoring System (SISMAP) for the health sector. On that occasion, it was also recognized by the National Health Service (SNS), for achieving the best hospital performance in the country. When offering the information, Dr. Dhamelisse Then, Director of the Hugo Mendoza Pediatric Hospital, highlighted the full support of the National Health Service, for what was a country application and revealed the passion, dedication, and great sense of humanization of the medical and administrative staff that make this health center a national and Ibero-American reference model.

The Ibero-American Quality Award is organized by the Ibero-American Quality Foundation (FUNDIBEQ) and the Ibero-American General Secretariat (SEGIB), an organization attached to the Ibero-American Summit of Heads of State and Government.