Local psychiatrists say time to strengthen mental health research, programmes
THE increasing worry about mental and behavioural health issues has prompted health officials to lobby for the expansion of research to discover more ways to treat with the different challenges.
The experts, consultant psychiatrists Dr Wendel Abel and Dr Clayton Sewell, were addressing the State University of New York and University of the West Indies (UWI), Mona Health Research Consortium Conference held from March 9 to 10.
Abel, who addressed the mental health priorities in Jamaica, said suicide is an area of interest that we should continue to monitor, although the country has one of the lowest suicide rates in comparison to other countries.
"Our [suicide] rate is about 2.1 per 100,000 and when you look at data compared to other areas, we realise that Jamaica has one of the lowest suicide rates in the world and there are several things that would have contributed to it," he said.
According to Abel, there needs to be an "aggressive" programme implemented to detect suicide ideation at the community level, and training of medical practitioners in the primary care setting to treat depression early and effectively.
"This is an area that warrants more interrogation as to why we have been able to achieve a relatively low suicidal rate, although people argue that countries with high murder rate have low suicidal rate," he said.
Meanwhile, Sewell pointed to the link between mental illness and the epidemic of violence in Jamaica.
He said that while a lot of work has been done through the Violence Prevention Alliance at UWI, which focuses on the cost of violence, there are wider effects that violence has on society.
"One of the things we need to look at is the difference in terms of trauma on children, adults, various persons in the community and to see how that will also contribute to the cycle of violence, so when expanding the research agenda, hopefully we can get to the point where we have a violence database that is readily accessible," said Sewell.
"There is the assumption that mental illness is associated with violence and yes, some mental illnesses are. However, its overall contribution to violence is relatively small compared to the general population and so we want to be able to really attach figures to that and to help to guide the discussion as far as the intervention for the mentally ill — and hopefully to be able to prove that there are interventions that work," he added.
2 years 1 month ago
Massive efforts needed to reduce salt intake and protect lives
A first-of-its-kind World Health Organization (WHO) Global report on sodium intake reduction shows that the world is off-track to achieve its global target of reducing sodium intake by 30 per cent by 2025.
Sodium, an essential nutrient, increases the risk of heart disease, stroke and premature death when eaten in excess. The main source of sodium is table salt (sodium chloride), but it is also contained in other condiments such as sodium glutamate. The report shows that only five per cent of WHO member states are protected by mandatory and comprehensive sodium reduction policies and 73 per cent of WHO member states lack full range of implementation of such policies.
Implementing highly cost-effective sodium reduction policies could save an estimated seven million lives globally by 2030. It is an important component of action to achieve the UN Sustainable Development Goal target of reducing deaths from non-communicable diseases (NCDs). But today, only nine countries (Brazil, Chile, Czech Republic, Lithuania, Malaysia, Mexico, Saudi Arabia, Spain, and Uruguay) have a comprehensive package of recommended policies to reduce sodium intake.
"Unhealthy diets are a leading cause of death and disease globally, and excessive sodium intake is one of the main culprits," said Dr Tedros Adhanom Ghebreyesus, WHO director general.
"This report shows that most countries are yet to adopt any mandatory sodium reduction policies, leaving their people at risk of heart attack, stroke, and other health problems. WHO calls on all countries to implement the 'Best Buys' for sodium reduction, and on manufacturers to implement the WHO benchmarks for sodium content in food."
A comprehensive approach to sodium reduction includes adopting mandatory policies and WHO's four "best buy" interventions related with sodium which greatly contribute to preventing NCDs. These include:
Reformulating foods to contain less salt, and setting targets for the amount of sodium in foods and meal;s
Establishing public food procurement policies to limit salt or sodium rich foods in public institutions such as hospitals, schools, workplaces and nursing homes;
Front-of-package labelling that helps consumers select products lower in sodium;
Behaviour change communication and mass media campaigns to reduce salt/sodium consumption.
Countries are encouraged to establish sodium content targets for processed foods in line with the WHO Global Sodium Benchmarks and enforce them though these policies.
Mandatory sodium reduction policies are more effective, as they achieve broader coverage and safeguard against commercial interests, while providing a level playing field for food manufacturers. As part of the report, WHO developed a sodium country score card for member states based on the type and number of sodium reduction policies they have in place.
"This important report demonstrates that countries must work urgently to implement ambitious, mandatory, government-led sodium reduction policies to meet the global target of reducing salt consumption by 2025," said Dr Tom Frieden, president and CEO of Resolve to Save Lives, a not-for-profit organisation working with countries to prevent 100 million deaths from cardiovascular disease over 30 years.
"There are proven measures that governments can implement and important innovations, such as low-sodium salts. The world needs action, and now, or many more people will experience disabling or deadly — but preventable — heart attacks and strokes."
The global average salt intake is estimated to be 10.8 grams per day, more than double the WHO recommendation of less than five grams of salt per day (one teaspoon). Eating too much salt makes it the top risk factor for diet and nutrition-related deaths. More evidence is emerging documenting links between high sodium intake and increased risk of other health conditions such as gastric cancer, obesity, osteoporosis and kidney disease.
WHO calls on member states to implement sodium intake reduction policies without delay and to mitigate the harmful effects of excessive salt consumption. WHO also calls on food manufacturers to set ambitious sodium reduction targets in their products.
2 years 1 month ago
Health Archives - Barbados Today
Greenidge wants improved access to ear care
More needs to be done by Government officials, health-care providers and civil society to help expand the access to primary ear and hearing care in Barbados, the Founder and Chairman of the The Deaf Heart Project said Saturday.
Che’ Greenidge said even though World Hearing Day is an international day celebrated every year, the lack of attention it has received so far in Barbados is worrying, considering the critical need to expand ear and hearing care on the island.
“That to me is just testament of the fact of how much we neglect our ears and neglect our hearing, whatever our varying degree of our hearing ability may be or what hearing loss we may be experiencing,” Greenidge said as she addressed attendees of Saturday’s World Hearing Day Barbados 2023 event, held at Solidarity House.
This morning, our main goal is to channel appropriate ear care, primary health care as well, and understand that the two are closely related,” she said.
Greenidge praised Audiologist at Barbados Speech and Hearing Centre, Dr Mariella Stabler, volunteers from the Barbados Community College and representatives of Rotary Club Of Barbados for joining forces for the worthy cause on the special day, stressing that partnerships in the area are invaluable.
She stated: “These are the types of partnerships that are needed to make sure that we are promoting healthy ears [and] ear care because once we have more persons involved in the community and more persons aware of it, then we would be able to make sure that this is a [continuous] event.
“We understand the fact that our deaf community, our deaf colleagues, their ears need taking care of too, and this is something that persons may not have thought about.”
Meanwhile, John Hollingsworth, Director of the National Disabilities Unit, said the event organised was an important one, stating: “This exercise this morning, apart from addressing the whole issue of hearing treatment, speaks to the need for significant work as it relates to issues affecting persons with disabilities.”
The director also reiterated government’s commitment to assisting members of the deaf community, stating that an expansion of the Deaf Empowerment Project, which is an initiative used to help the deaf and hearing impaired better communicate with persons when conducting business in both the public and private sectors, would soon be expanded into government offices at the beginning of the new financial year.
“We have on the cards a project called the Video Relay project, which basically assists persons who are deaf or hard of hearing to be able to communicate with the essential services in Barbados. This project is set to begin sometime in the new financial year — after April — where a deaf person who wants to access the services of the hospital, police, immigration department, [etc],” Hollingsworth said.
“What they will be able to do is with their cell phone, approach these agencies and the person at the reception or another person within the organisation, who happens to have a government-issued cell phone, will be able to share that with the deaf person, and they will be able to communicate with the organisation via an interpreter [using the phone].”
The post Greenidge wants improved access to ear care appeared first on Barbados Today.
2 years 1 month ago
A Slider, Health, Local News
Health & Wellness | Toronto Caribbean Newspaper
Top five must have vitamins for weight loss
BY RACHEL MARY RILEY Since the pandemic I have gotten into the habit of taking vitamins that will assist me with weight loss. Some people think you can just take your protein shakes, supplements and think that vitamins won’t assist you. My dear, you need vitamins for your body. Magnesium: Magnesium is one of the […]
The post Top five must have vitamins for weight loss first appeared on Toronto Caribbean Newspaper.
2 years 1 month ago
Fitness, #LatestPost
Health & Wellness | Toronto Caribbean Newspaper
Despite the importance of Vitamin D, many people are deficient in this essential nutrient
BY W. GIFFORD- JONES MD & DIANA GIFFORD-JONES Vitamin D is often referred to as the “sunshine vitamin”. This is because it is synthesized in our skin in response to sunlight. The beauty of Vitamin D is that it’s free – a great model for “all things in moderation” too. There are two main forms […]
The post Despite the importance of Vitamin D, many people are deficient in this essential nutrient first appeared on Toronto Caribbean Newspaper.
2 years 1 month ago
Your Health, #LatestPost
News Archives - Healthy Caribbean Coalition
HCC Joins the Caribbean Broadcasting Union as a Theme Sponsor for the 2022 Caribbean Media Awards
As the effort continues to promote healthy food policies, the region’s lead advocacy body in this area, the Healthy Caribbean Coalition (HCC) will be recognising print journalists who are covering this area, and doing so well.
HCC is partnering with the Caribbean Broadcasting Union (CBU) for this year’s Caribbean Media Awards competition.
The August 15, 2023 CBU Caribbean Media Awards Gala event, to be transmitted live from Antigua and Barbuda, for the first time will include an award for print journalism under the theme: Healthy Nutrition Food Policy. The prize will include a trophy as well as a USD 500 bursary for the Award winner to produce additional material under the theme.
The eligible entries for the HCC-supported Award will explore healthy food policies including regulating school food environments, particularly through the restriction or ban on the sale and marketing of ultra-processed foods in schools (including sugar sweetened beverages (SSBs))s; fiscal policies to make healthy foods more affordable while deterring consumption of unhealthy ultra-processed foods through taxation such as the introduction of or increase in SSB taxes of at least 20%; and strengthening food labelling through the adoption of a regional front of pack black octagonal High-In labeling standard using the PAHO nutrient profile model.
This category is open to all print media, whether or not they are CBU members, operating from: Anguilla; Antigua and Barbuda; the Bahamas, Barbados, Belize, the British Virgin Islands; the Commonwealth of Dominica; Grenada; Guyana, Haiti, Jamaica, Montserrat; St. Kitts & Nevis; St. Lucia; St. Vincent & the Grenadines; Trinidad and Tobago; and the Turks & Caicos Islands.
Entries must have been published between January 1 and December 31, of 2022 and can be submitted through to April 12, 2023.
In welcoming this new partnership with the CBU, the HCC Executive Director, Ms Maisha Hutton said she, “looks forward to continued collaboration as we increase media engagement, and build regional support for healthy nutrition food policy, while celebrating the best of content created by media across the Caribbean.”
The post HCC Joins the Caribbean Broadcasting Union as a Theme Sponsor for the 2022 Caribbean Media Awards appeared first on Healthy Caribbean Coalition.
2 years 1 month ago
Latest, News, Slider
Prince Harry says psychedelic drugs helped him — but what about the risks and dangers?
What do Prince Harry, Miley Cyrus, Elon Musk, Harry Styles and Kristen Bell all have in common?
What do Prince Harry, Miley Cyrus, Elon Musk, Harry Styles and Kristen Bell all have in common?
Aside from being rich and famous, these individuals have been open about their use of psychedelic drugs, touting benefits such as spiritual growth, the curbing of grief and reduced stress, anxiety and depression.
During a recent online chat with trauma expert Gabor Maté, Prince Harry admitted that psychedelic drugs helped him acknowledge the death of his mother, Princess Diana, and to move forward from that trauma.
PRINCE HARRY ADMITS PSYCHEDELIC DRUGS HELPED HIM 'DEAL WITH THE TRAUMAS' OF THE PAST
In an interview with Anderson Cooper of "60 Minutes" right after his book, "Spare," came out, the Duke of Sussex also said, "I would never recommend people to do this recreationally. But doing it with the right people if you are suffering from a huge amount of loss, grief or trauma — then these things have a way of working as a medicine," Prince Harry admitted.
"For me, they cleared the windscreen, the windshield, the misery of loss," he also said. "They cleared away this idea that I had in my head that — that my mother, that I needed to cry to prove to my mother that I missed her. When in fact, all she wanted was for me to be happy."
Celebrities are far from the only ones who have embraced psychedelics (also known as hallucinogens).
An estimated 5.5 million U.S. adults use them, according to a 2022 study from Columbia University — despite the fact that these substances are largely illegal.
Why are so many people turning to these drugs, and what should everyone know about the risks and benefits involved? Here's some key information.
Psychedelic drugs are defined as "a class of psychoactive substances that produce changes in perception, mood and cognitive processes," according to the Alcohol and Drug Foundation (ADF).
"Psychedelics affect all the senses, altering a person’s thinking, sense of time and emotions. They can also cause a person to hallucinate — seeing or hearing things that do not exist or are distorted."
Some of the most common types of psychedelics include LSD (lysergic acid diethylamide, also known as acid), psilocybin (magic mushrooms), DMT (dimenthyltryptamine), MDMA (ecstasy), ayahuasca, 2C-B, mesacaline, NBOMe (N-methoxybenzyl) and ketamine, a dissociative anesthetic that has some hallucinogenic effects.
Some psychedelics are found in nature, derived from trees, plants and seeds. Others are synthetically created in laboratories.
Psychedelics aren’t new. For centuries, civilizations around the world have embraced them for medicinal use and for their mystical and spiritual properties.
MILLENNIALS ARE RACKING UP MORE CHRONIC HEALTH CONDITIONS COMPARED TO OTHER GENERATIONS: STUDY
Today, a growing number of people (famous or not) are turning to the drugs for both recreational use and to curb depression, anxiety and other mental health issues — and in many cases, they’re breaking laws along the way.
With so many celebs and high-profile people sharing their psychedelic stories, it begs the question of how they’re getting access to these still-illicit substances.
Dr. Farah Khorassani, associate clinical professor at the School of Pharmacy & Pharmaceutical Sciences at University of California, Irvine, pointed out that most "regular" people don't have access to these drugs, as they are not approved by the FDA for medical use.
US VETERANS WITH PTSD TURN TO PSYCHEDELIC DRUGS OVERSEAS AS FRUSTRATION WITH VA GROWS
The doctor surmises that people using these drugs in the U.S. may be doing so in the rare areas where psychedelic-assisted therapy is being conducted, or they could be enrolled in clinical trials. Or, illegal purchase is also possible.
"If someone decides to buy a psychedelic on the street, it's important to remember that these substances aren't regulated, and they carry the risk of adulteration and contamination with other illicit substances," the associate clinical professor pointed out.
There are also "psychedelic retreats" in places like Mexico, Jamaica and Costa Rica, but these are not generally accessible to the masses, she said.
In 1973, the U.S. federal government classified psychedelics as a schedule 1 substance, which means they have "no currently accepted medical use and a high potential for abuse."
HARVARD TO STUDY PSYCHEDELICS AND THE LAW AS DECRIMINALIZATION GAINS STEAM
Since then, ketamine and esketamine have been the only psychedelic drugs to gain FDA approval for use by medical practitioners across the U.S., although they’re still illegal for recreational use.
Ketamine is widely used as a treatment for depression and pain management.
Some states have been working toward legalizing more psychedelics.
In the state of Oregon, it is now legal for adults to take psilocybin (magic mushrooms) for mental health treatments.
Other states and cities — including some parts of California, Washington, Massachusetts, Michigan and Washington, D.C. — have decriminalized magic mushrooms, which means people can use them recreationally without penalty, though they’re not yet FDA-approved for medical use.
In November 2022, Colorado passed the Natural Medicine Health Act, which legalized the supervised use of five psychedelic substances that come from plants or fungus for people 21 years of age and over.
A handful of other states are also taking steps toward wider legalization.
DOCTORS URGE CAUTION ON DIABETES DRUGS FOR WEIGHT LOSS AFTER STUDY HIGHLIGHTS SIDE EFFECTS
Dr. William Prueitt, a Yale psychiatry resident with Silver Hill Hospital in New Canaan, Connecticut, believes the FDA is starting to recognize the promise of psychedelic therapies for treating mental health conditions.
"Psilocybin- and MDMA-assisted therapies have been granted breakthrough therapy status by the FDA for major depressive disorder and post-traumatic stress disorder (PTSD), respectively," he told Fox News Digital in an email.
"These medicines are both currently undergoing trials for FDA approval, which so far have shown positive results."
While Prince Harry has said he used hallucinogenic drugs to heal from trauma — namely, the death of his mother, Princess Diana — actress Kristen Bell has talked about using magic mushrooms after she heard they could help with depression.
Chelsea Handler said she takes them as a daily mood-booster. Boxer Mike Tyson once told Reuters that magic mushrooms helped him overcome suicidal tendencies.
Numerous studies appear to support the use of psychedelics as a mental health tool. Research by Johns Hopkins Medicine in Baltimore, Maryland, suggests that psychedelic treatment with psilocybin (magic mushrooms), when combined with psychotherapy, can relieve major depressive symptoms for up to a year.
Dr. Alan Davis, director of the Center for Psychedelic Drug Research and Education at The Ohio State University, has done extensive research on the use of psychedelic therapy to treat mental health problems.
This year, his team launched OSU’s first clinical trial on psychedelic therapy for veterans with post-traumatic stress disorder (PTSD).
"These people are going through a pretty intensive psychotherapy process, and psychedelics are just one part of that," Dr. Davis told Fox News Digital in an interview.
"In our clinical trials, we've seen that psychedelics can be effective for treating depression, anxiety and PTSD. We've also seen some evidence that it can help with addiction issues, OCD and social anxiety."
At Numinus Wellness, a psychedelic therapy provider with locations in Utah, Arizona and Canada, doctors prescribe ketamine for mental health therapy.
"It allows patients to get to the root cause of problems faster than with traditional talk therapy or antidepressant medications," Dr. Reid Robison, chief clinical officer at Numinus, told Fox News Digital via email.
"By opening your mind with the help of psychedelics, you are able to feel deeper, listen more intently and speak more freely."
Dr. Robinson claims that patients given a single dose of ketamine experienced a rapid reduction in depressive symptoms during the first 24 hours — with effects lasting up to seven days.
Psychedelics are not for everyone, doctors say — and they carry risks that shouldn’t be overlooked.
Without the right preparation and supervision, psychedelics can create what Dr. Davis calls "challenging experiences." For some people, the drugs could cause them to relive traumatic memories from their past — potentially triggering severe anxiety.
"If that’s not done in a supportive environment, it can lead to panic, paranoia and other challenges," Dr. Davis said. "It's critical that psychedelics are used in a safe, therapeutic setting to minimize those risks."
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In particular, he noted that psychedelics can be dangerous for those who have a genetic predisposition to psychotic disorders — for instance, someone who has a family member with schizophrenia or bipolar disorder.
In those cases, the drugs could trigger a psychotic episode.
There is also the risk of developing hallucinogen-persisting perception disorder.
That's when someone experiences visual flashbacks for anywhere from a few days to over a year after the psychedelic experience.
Dr. Khorassani of the University of California, Irvine, warned that psychedelics have the potential to cause adverse effects in the central and peripheral nervous system.
"Because most psychedelics are classic hallucinogens or dissociative drugs, they can induce unpleasant feelings such as paranoia, psychosis, disorientation and loss of coordination," she told Fox News Digital in an email.
"It is rare for these symptoms to persist. Other physiologic effects such as nausea, numbness, increased heart rate and blood pressure, high body temperatures and increased muscle tension are also possible."
For these reasons, she said people with cardiovascular disorders should steer clear.
At Numinus, Dr. Robinson said his team will not treat individuals who are not candidates for psychedelic treatment. That includes pregnant women, those with a history of epilepsy or another seizure disorder, or patients with severe cardiovascular disease — including uncontrolled blood pressure, heart failure, coronary artery disease or previous heart attack or stroke.
Tracy Wright of Fox News Digital contributed reporting.
2 years 1 month ago
Health, drug-and-substance-abuse, medications, medical-research, wellness, royals, lifestyle, british-royals, mental-health, depression, stress-and-anxiety
Medical News, Health News Latest, Medical News Today - Medical Dialogues |
MCh Plastic and Reconstructive Surgery: Admissions, Medical colleges, fees, eligibility criteria details
MCh Plastic and Reconstructive surgery or Master of Chirurgiae in Plastic
and Reconstructive surgery also known as MCh in Plastic and Reconstructive
surgery 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
MCh Plastic and Reconstructive surgery or Master of Chirurgiae in Plastic
and Reconstructive surgery also known as MCh in Plastic and Reconstructive
surgery 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 the repair, reconstruction, or replacement of physical defects of the form or function of human body parts.
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 All India Institute Of
Medical Sciences, New Delhi, Vardhman Mahavir Medical College And Safdarjung Hospital,
Delhi, and All Institute Of Medical Sciences, Raipur, Chattisgarh.
Admission to this course is done through the NEET-SS Entrance exam
conducted by the National Board of Examinations, followed by counseling based
on the scores of the exam that is conducted by DGHS/MCC/State Authorities.
The fee for pursuing MCh (Plastic and Reconstructive Surgery) varies
from college to college and may range from Rs.7,000 to Rs 23,00,000 per annum.
After completion of their respective course, doctors can either join the
job market or can pursue certificate courses and Fellowship programs recognized
by NMC and NBE. Candidates can take reputed jobs at positions as Senior
residents, Consultants, etc. with an approximate salary range of Rs 15 lakhs to
Rs. 51 lakhs per annum.
What is MCh in Plastic
and Reconstructive Surgery?
Master of Chirurgiae in Plastic and Reconstructive Surgery, also known as MCh (Plastic
and Reconstructive Surgery) or MCh in (Plastic and Reconstructive Surgery) is a
three-year super specialty program that candidates can pursue after completing
a postgraduate degree.
Plastic and Reconstructive surgery is the branch of medical science
dealing with the repair, reconstruction, or replacement of physical defects of the form or function of human body parts. Usually, plastic
surgery comprises different types of surgeries such as Microsurgery and Hand surgery.
National Medical Commission (NMC), the apex medical regulator, has released a Guidelines for Competency-Based Postgraduate Training Programme for MCh in Plastic and Reconstructive Surgery.
The Competency-Based Postgraduate Training Programme governs the education and training of MCh in Plastic and Reconstructive Surgery.
The postgraduate students must gain ample knowledge and experience in
the diagnosis, and treatment of patients with acute, serious, and
life-threatening medical and surgical diseases.
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 Plastic
and Reconstructive surgery would help the specialist recognize the community’s
health needs. The student should be competent to handle medical problems
effectively and should be aware of the recent advances in their specialty.
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 MCh in Plastic and Reconstructive Surgery.
Name of Course
MCh in Plastic and Reconstructive Surgery
Level
Doctorate
Duration of Course
Three years
Course Mode
Full Time
Minimum Academic Requirement
Candidates must have a postgraduate medical Degree in MS/DNB (General Surgery) obtained from any college/university
recognized by the Medical Council of India (Now NMC)/NBE, this feeder
qualification mentioned here is as of 2022. For any further changes to the
prerequisite requirement please refer to the NBE website
Admission Process / Entrance Process / Entrance Modalities
Entrance Exam (NEET-SS)
INI CET for various AIIMS, PGIMER Chandigarh, JIPMER Puducherry,
NIMHANS Bengaluru
Counseling by DGHS/MCC/State Authorities
Course Fees
Rs. 7,000 to Rs. 23,00,000 per annum
Average Salary
Rs 15 lakhs to Rs.51 lakhs per annum
Eligibility Criteria
The eligibility criteria for MCh in Plastic and Reconstructive Surgery are defined as the set of rules or minimum prerequisites that aspirants must
meet to be eligible for admission, which include:
Name of Super Specialty course
Course Type
Prior Eligibility Requirement
Plastic and Reconstructive Surgery
MCh
MS/DNB (General Surgery)
Note:
· The feeder qualification for MCh Plastic and Reconstructive surgery is
defined by the NBE and is subject to changes by the NBE.
· The feeder qualification mentioned here is as of 2022.
· For any changes,
please refer to the NBE website.
- The prior entry qualifications shall be strictly by Post Graduate
Medical Education Regulations, 2000, and its amendments notified by the NMC and
any clarification issued from NMC in this regard. - The candidate must have obtained permanent registration with 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 MCh in Plastic and Reconstructive Surgery.
Candidates can view the complete admission process for MCh in Plastic and
Reconstructive Surgery 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 speciality. - 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 speciality subjects shall be required
to appear in the question paper of the respective group if they are willing to
opt for a super speciality course in any of the super speciality courses covered
in that group. - A candidate can opt for appearing in the question papers of as many
groups for which his/her Postgraduate speciality qualification is an eligible
feeder qualification. - By appearing in the question paper of a group and on qualifying for the
examination, a candidate shall be eligible to exercise his/her choices in the
counselling only for those super speciality subjects covered in the said group
for which his/ her broad speciality is an eligible feeder qualification.
Fees Structure
The fee structure for MCh in Plastic and Reconstructive surgery varies
from college to college. The fee is generally less for Government Institutes
and more for private institutes. The average fee structure for MCh in Plastic
and Reconstructive Surgery is from Rs.7,000 to Rs.23,00,000 per annum.
Colleges offering
MCh in Plastic and Reconstructive Surgery
Various medical colleges across India offer courses for pursuing MCh in
(Plastic and Reconstructive Surgery).
As per National
Medical Commission (NMC) website, the following medical colleges are offering
MCh in (Plastic and Reconstructive Surgery) courses for the academic year
2022-23.
Sl.No.
Course Name
State
Name and Address of
Medical College / Medical Institution
Annual Intake (Seats)
1
M.Ch - Plastic Surgery/Plastic &
Reconstructive Surgery
Andhra Pradesh
Rangaraya Medical College, Kakinada
1
2
M.Ch - Plastic Surgery/Plastic &
Reconstructive Surgery
Andhra Pradesh
Andhra Medical College, Visakhapatnam
2
3
M.Ch - Plastic Surgery/Plastic &
Reconstructive Surgery
Assam
Gauhati Medical College, Guwahati
3
4
M.Ch - Plastic Surgery/Plastic &
Reconstructive Surgery
Bihar
Patna Medical College, Patna
8
5
M.Ch - Plastic Surgery/Plastic &
Reconstructive Surgery
Chandigarh
Postgraduate Institute of Medical Education & Research,
Chandigarh
10
6
M.Ch - Plastic Surgery/Plastic &
Reconstructive Surgery
Chattisgarh
All India Institute of Medical Sciences, Raipur
2
7
M.Ch - Plastic Surgery/Plastic &
Reconstructive Surgery
Delhi
Vardhman Mahavir Medical College & Safdarjung Hospital,
Delhi
10
8
M.Ch - Plastic Surgery/Plastic &
Reconstructive Surgery
Delhi
All India Institute of Medical Sciences, New Delhi
15
9
M.Ch - Plastic Surgery/Plastic &
Reconstructive Surgery
Delhi
Atal Bihari Vajpayee Institute of Medical Sciences and Dr RML
Hospital, New Delhi
4
10
M.Ch - Plastic Surgery/Plastic &
Reconstructive Surgery
Gujarat
Medical College, Baroda
2
11
M.Ch - Plastic Surgery/Plastic &
Reconstructive Surgery
Gujarat
B J Medical College, Ahmedabad
4
12
M.Ch - Plastic Surgery/Plastic &
Reconstructive Surgery
Gujarat
Smt. N.H.L.Municipal Medical College, Ahmedabad
4
13
M.Ch - Plastic Surgery/Plastic &
Reconstructive Surgery
Gujarat
MP Shah Medical College, Jamnagar
1
14
M.Ch - Plastic Surgery/Plastic &
Reconstructive Surgery
Gujarat
SBKS Medical Instt. & Research Centre, Vadodra
1
15
M.Ch - Plastic Surgery/Plastic &
Reconstructive Surgery
Haryana
Pt. B D Sharma Postgraduate Institute of Medical Sciences,
Rohtak (Haryana)
1
16
M.Ch - Plastic Surgery/Plastic &
Reconstructive Surgery
Jammu & Kashmir
Sher-I-Kashmir Instt. Of Medical Sciences, Srinagar
2
17
M.Ch - Plastic Surgery/Plastic &
Reconstructive Surgery
Karnataka
St. Johns Medical College, Bangalore
2
18
M.Ch - Plastic Surgery/Plastic &
Reconstructive Surgery
Karnataka
Bangalore Medical College and Research Institute, Bangalore
4
19
M.Ch - Plastic Surgery/Plastic &
Reconstructive Surgery
Karnataka
S S Institute of Medical Sciences& Research Centre,
Davangere
2
20
M.Ch - Plastic Surgery/Plastic &
Reconstructive Surgery
Karnataka
Rajarajeswari Medical College & Hospital, Bangalore
2
21
M.Ch - Plastic Surgery/Plastic &
Reconstructive Surgery
Karnataka
A J Institute of Medical Sciences & Research Centre,
Mangalore
4
22
M.Ch - Plastic Surgery/Plastic &
Reconstructive Surgery
Karnataka
Vydehi Institute Of Medical Sciences & Research Centre,
Bangalore
2
23
M.Ch - Plastic Surgery/Plastic &
Reconstructive Surgery
Karnataka
Jawaharlal Nehru Medical College, Belgaum
4
24
M.Ch - Plastic Surgery/Plastic &
Reconstructive Surgery
Karnataka
M S Ramaiah Medical College, Bangalore
4
25
M.Ch - Plastic Surgery/Plastic &
Reconstructive Surgery
Kerala
Government Medical College, Kozhikode, Calicut
2
26
M.Ch - Plastic Surgery/Plastic &
Reconstructive Surgery
Kerala
Medical College, Thiruvananthapuram
2
27
M.Ch - Plastic Surgery/Plastic &
Reconstructive Surgery
Kerala
Government Medical College, Kottayam
2
28
M.Ch - Plastic Surgery/Plastic &
Reconstructive Surgery
Kerala
Amrita School of Medicine, Elamkara, Kochi
2
29
M.Ch - Plastic Surgery/Plastic &
Reconstructive Surgery
Madhya Pradesh
All India Institute of Medical Sciences, Bhopal
4
30
M.Ch - Plastic Surgery/Plastic &
Reconstructive Surgery
Maharashtra
Topiwala National Medical College, Mumbai
4
31
M.Ch - Plastic Surgery/Plastic &
Reconstructive Surgery
Maharashtra
Seth GS Medical College, and KEM Hospital, Mumbai
4
32
M.Ch - Plastic Surgery/Plastic &
Reconstructive Surgery
Maharashtra
Lokmanya Tilak Municipal Medical College, Sion, Mumbai
4
33
M.Ch - Plastic Surgery/Plastic &
Reconstructive Surgery
Maharashtra
Government Medical College, Nagpur
2
34
M.Ch - Plastic Surgery/Plastic &
Reconstructive Surgery
Maharashtra
N. K. P. Salve Instt. of Medical Sciences and Research Centre
and Lata Mangeshkar Hospital, Nagpur
1
35
M.Ch - Plastic Surgery/Plastic & Reconstructive
Surgery
Maharashtra
Armed Forces Medical College, Pune
3
36
M.Ch - Plastic Surgery/Plastic &
Reconstructive Surgery
Maharashtra
Padmashree Dr. D.Y.Patil Medical College, Navi Mumbai
2
37
M.Ch - Plastic Surgery/Plastic &
Reconstructive Surgery
Maharashtra
Grant Medical College, Mumbai
4
38
M.Ch - Plastic Surgery/Plastic &
Reconstructive Surgery
Maharashtra
Tata Memorial centre, Mumbai
4
39
M.Ch - Plastic Surgery/Plastic &
Reconstructive Surgery
Maharashtra
Mahatma Gandhi Missions Medical College, Aurangabad
1
40
M.Ch - Plastic Surgery/Plastic &
Reconstructive Surgery
Manipur
Regional Institute of Medical Sciences, Imphal
1
41
M.Ch - Plastic Surgery/Plastic &
Reconstructive Surgery
Orissa
SCB Medical College, Cuttack
3
42
M.Ch - Plastic Surgery/Plastic &
Reconstructive Surgery
Pondicherry
Jawaharlal Institute of Postgraduate Medical Education &
Research, Puducherry
2
43
M.Ch - Plastic Surgery/Plastic &
Reconstructive Surgery
Pondicherry
Pondicherry Institute of Medical Sciences & Research,
Pondicherry
1
44
M.Ch - Plastic Surgery/Plastic & Reconstructive
Surgery
Punjab
Dayanand Medical College & Hospital, Ludhiana
2
45
M.Ch - Plastic Surgery/Plastic &
Reconstructive Surgery
Punjab
Government Medical College, Patiala
46
M.Ch - Plastic Surgery/Plastic &
Reconstructive Surgery
Punjab
Christian Medical College, Ludhiana
2
47
M.Ch - Plastic Surgery/Plastic &
Reconstructive Surgery
Rajasthan
SMS Medical College, Jaipur
8
48
M.Ch - Plastic Surgery/Plastic &
Reconstructive Surgery
Rajasthan
Mahatma Gandhi Medical College and Hospital, Sitapur, Jaipur
4
49
M.Ch - Plastic Surgery/Plastic &
Reconstructive Surgery
Tamil Nadu
Kilpauk Medical College, Chennai
6
50
M.Ch - Plastic Surgery/Plastic &
Reconstructive Surgery
Tamil Nadu
Madurai Medical College, Madurai
4
51
M.Ch - Plastic Surgery/Plastic &
Reconstructive Surgery
Tamil Nadu
Madras Medical College, Chennai
8
52
M.Ch - Plastic Surgery/Plastic &
Reconstructive Surgery
Tamil Nadu
Stanley Medical College, Chennai
6
53
M.Ch - Plastic Surgery/Plastic &
Reconstructive Surgery
Tamil Nadu
Coimbatore Medical College, Coimbatore
2
54
M.Ch - Plastic Surgery/Plastic &
Reconstructive Surgery
Tamil Nadu
Chengalpattu Medical College, Chengalpattu
4
55
M.Ch - Plastic Surgery/Plastic &
Reconstructive Surgery
Tamil Nadu
Sri Ramachandra Medical College & Research Institute,
Chennai
2
56
M.Ch - Plastic Surgery/Plastic &
Reconstructive Surgery
Tamil Nadu
Christian Medical College, Vellore
4
57
M.Ch - Plastic Surgery/Plastic &
Reconstructive Surgery
Tamil Nadu
Thanjavur Medical College,Thanjavur
3
58
M.Ch - Plastic Surgery/Plastic & Reconstructive
Surgery
Tamil Nadu
SRM Medical College Hospital & Research Centre, Chengalpattu
1
59
M.Ch - Plastic Surgery/Plastic &
Reconstructive Surgery
Telangana
Gandhi Medical College, Secunderabad
4
60
M.Ch - Plastic Surgery/Plastic &
Reconstructive Surgery
Telangana
Osmania Medical College, Hyderabad
8
61
M.Ch - Plastic Surgery/Plastic & Reconstructive
Surgery
Telangana
Nizams Institute of Medical Sciences, Hyderabad
4
62
M.Ch - Plastic Surgery/Plastic &
Reconstructive Surgery
Telangana
Deccan College of Medical Sciences, Hyderabad
1
63
M.Ch - Plastic Surgery/Plastic &
Reconstructive Surgery
Uttarakhand
All India Institute of Medical Sciences, Rishikesh
18
64
M.Ch - Plastic Surgery/Plastic &
Reconstructive Surgery
Uttar Pradesh
Institute of Medical Sciences, BHU, Varanasi
4
65
M.Ch - Plastic Surgery/Plastic &
Reconstructive Surgery
Uttar Pradesh
King George Medical University, Lucknow
4
66
M.Ch - Plastic Surgery/Plastic &
Reconstructive Surgery
Uttar Pradesh
Jawaharlal Nehru Medical College, Aligarh
4
67
M.Ch - Plastic Surgery/Plastic &
Reconstructive Surgery
West Bengal
Institute of Postgraduate Medical Education & Research,
Kolkata
8
68
M.Ch - Plastic Surgery/Plastic &
Reconstructive Surgery
West Bengal
Govt. Medical College, Kolkata
4
69
M.Ch - Plastic Surgery/Plastic &
Reconstructive Surgery
West Bengal
Nilratan Sircar Medical College, Kolkata
1
70
M.Ch - Plastic Surgery/Plastic & Reconstructive
Surgery
West Bengal
RG Kar Medical College, Kolkata
4
Syllabus
MCh in Plastic and Reconstructive Surgery is a three years
specialization course that provides training in the stream of Plastic and Reconstructive Surgery.
The course content for MCh in Plastic and Reconstructive Surgery 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 MCh Plastic and Reconstructive Surgery
COURSE CONTENT:
The M.Ch. Plastic and Reconstructive Surgery course will includeAesthetic, Hand Surgery and Burn Care in its syllabus.1. General Plastic Surgery2. Microvascular surgery, Brachial plexus and Peripheral nerve surgery3. Burns and postburn deformity4. Craniofacial, Cleft and Paediatric Plastic Surgery5. Head and Neck Surgery6. Breast7. Hand and Upper Extremity8. Trunk and Lower Extremity9. Aesthetic Surgery and medicine10. Reconstructive Surgery of External Genitalia and intersex disorders 11. Sex reassignment12. Peripheral vascular surgery13. Maxillofacial surgery, trauma and reconstruction1. General Plastic SurgeryA. General Principles1.1 History and development of plastic surgery in India and across the world1.2 The scope of plastic surgery1.3 Evidence Based Medicine and research in plastic surgery1.4 Medico legal issues in plastic surgery practice1.5 Liability issues in plastic surgery, legal & insurance perspective1.6 Documentation, Record keeping and consent.1.7 Patient safety issues in plastic surgery1.8 Psychological aspects of plastic surgery1.9 Ethics in plastic surgery1.10 Photography in plastic surgery. 1.11 Information technology relevant to plastic surgery.B. Basic principles and techniques2.1 Wound: Definition, classification and implications2.2 Wound healing-normal and abnormal.2.3Wound management - Mechanical and pharmacological dressingtechniques. Negative pressure wound therapy & other techniques.2.4 Scar biology and management2.5 Keloid, hypertrophic scars- prevention and management2.6 Unstable scar and scar contracture.2.7 Anatomy and functions of skin2.8 Viscoelastic Properties of Skin2.9 Infective conditions of skin2.10 Benign and malignant skin and soft tissue tumours2.11 Radiation and Radiation Injuries2.12 Principles of tissue reconstruction2.13 Skin grafts 2.14 Blood supply to skin, cutaneous circulation and vascular basis offlaps.2.15 Flaps: Classification, variations and applications2.16 Flap pathophysiology and pharmacology2.15 Grafts – fat, fascia, tendon, nerve, cartilage, bone, composite tissue2.16 Principles of Cancer Management2.17 Lymphedema: Pathophysiology and management2.18 Principles of microvascular surgery and technique2.19 Nosocomial infections2.20 Principles of genetics and general approach to the management ofcongenital malformations.2.21 Vascular anomalies: Pathophysiology and management2.22 Foetal surgery2.23 Local anaesthesia, nerve blocks, regional anaesthesia2.24 Principles of anaesthesia for infants, adults, hypothermia,hypotensive anaesthesia.2.25 Pain management2.26 Plastic Surgical instrumentation: General principles.C. Technology applications3.1 Technological innovations3.2 Laser and energy device applications3.3 Tissue expansion- principles and application3.4 Distraction Histogenesis3.5 Endoscopy in Plastic Surgery
3.6 Robotics
3.7 Simulations
3.8. 3.D printing technology & applications
3.9 Suture materials, Implants and Biomaterials in plastic surgery
3.10 Transplantation biology, techniques and applications
3.11 Regenerative medicine, cell therapy & stem cells
3.12 Tissue Engineering applications in plastic surgery
3.13 Telemedicine in plastic surgery
3.14 Information and Digital Technology for Plastic surgeon
3.15 Teaching tools and methods in plastic surgery
3.16. Training modules for plastic surgery trainees.
2. Microvascular surgery, Brachial plexus and Peripheral nerve surgery
A. Microvascular surgery
1. Instrumentation in Microsurgery
2. Basic Principles of free-flap surgery
3. Fundamental principles
3.1 Fundamental Principles of microvascular surgery
3.2. Pre-operative planning for microsurgery
3.3. Factors affecting outcome of microvascular flap surgery
3.4. Anatomy of angiosomes and perforators
4. Replantation and revascularization
5. Recent advances in microsurgery
6. Terminologies in Microsurgery.
B. Peripheral Nerve surgery
1. Types of Nerve injury
2. Diagnosis and management of peripheral nerve lesions/injuries
3. Compression neuropathies- upper and lower limb
4. Topographic anatomy of various peripheral nerves.
C. Brachial plexus Surgery1. Anatomy of the Brachial Plexus2. Mechanism of Brachial Plexus Injury3. Examination, Investigations and Diagnosis of Brachial Plexus Injury4. Management of neonatal brachial plexus injury5. Management of adult Brachial Plexus injury6. Management of Chronic Brachial Plexus injury.D. Microlymphatic surgery1. Lymphedema pathophysiology2. Assessment of lymphedema3. Medical Management of Lymphedema4. Surgical management of Lymphedema5. Microlymphatic surgery.E. Composite Tissue Allotransplantation1. Principles and regulations of Composite Tissue Allotransplant2. Recent developments in Hand transplant3. Face transplant.F. Video microsurgeryG. Robotic microsurgeryH. Tubal recanalization and Vaso-vasostomyI. Arteriovenous Fistula3. Burns1 History of acute burns injuries & management2 Multidisciplinary burn team3 Prevention of burns4 Burn management in disasters and humanitarian crisis5 Pathophysiology of acute burns246 Systemic Inflammatory Response e Syndrome (SIRS)7 Early burn care8 Fluid management in acute burns9 Inhalation burns10 Management of the burn wound11 Skin and skin substitutes12 Nutrition in Burns13 Burn wound infection and treatment14 Sepsis in burns15 Multiorgan Dysfunction Syndrome (MODS)16 Anaesthesia for a burned patient17 Biomarkers in Burn care18 Electrical burns19 Chemical burns20 Facial burns20 Hand burns21 Feet burns22 Paediatric burns24 Geriatric burns25 Burns in pregnancy26 Management of Pain in burns27 Psychiatric and psychological considerations in burns28 Burn rehabilitation29 Post burns scars29 Post burns contractures30 Post burn facial deformities31 Skin bank32 Role of allografts in burns33. Skin substitutes34. Organizing a burn unit.4. Craniofacial Cleft and Paediatric Plastic Surgery1 General1.1. Embryology and anatomy of craniofacial complex.1.2. Growth and development changes in face, anatomy of facial skeleton.1.3. Structure and development of teeth and Dentofacial anomalies.1.4 Harvesting of bone grafts (including cranial bone).2 Craniofacial anomalies2.1. Principles of craniofacial surgery.2.2. Craniofacial clefts. Tessier’s clefts classification.2.3. Craniosynostosis - syndromic and non-syndromic2.4. Hypertelorism.2.5. Craniofacial microsomia.2.6. Craniofacial distraction.2.7. Hemifacial atrophy.2.8. Treacher-Collins Syndrome.2.9. Pierre Robin sequence.2.10. Other craniofacial syndromes, e.g.- Binders syndrome etc. 2.11 Distraction osteogenesis 2.12 Distractors and craniofacial fixation devices.3 Cleft Lip and Palate3.1. Embryology of head and neck.3.2. Embryogenesis of cleft lip and palate.3.3. History and evolution of techniques in Cleft surgery.3.4. Classification of Clefts3.5. Unilateral Cleft lip3.6. Bilateral Cleft lip3.7. Cleft Palate 3.8. Alveolar Clefts3.9. Secondary deformity correction in clefts3.10. Management of palatal fistula3.11. Flaps in clefts- Abbe flap, Tongue flap, buccal flaps, free flaps etc.3.12. Secondary cleft nose correction3.13. Orthodontics in Cleft lip and Palate.3.14. Midface skeletal evaluation and corrections and Orthognathicsurgery3.15 Distraction in Clefts.3.16. Velopharyngeal incompetence.3.17. Speech therapy in cleft lip and palate. 3.18. Middle ear management in Cleft palate 3.19. Antenatal diagnosis and management.4 Maxillofacial Trauma4.1. Dentofacial anatomy, occlusions, various terminologies.4.2. ATLS protocols.4.3. Management of Airway and acute care.4.4. Evaluation of injuries, imaging, principles of treatment.4.5. General principles of facial soft tissue injury repair.4.6. Management of soft tissue injuries of specific regions of the face.4.7. Facial nerve injuries and management.4.8. Restoration of anatomical subunits of face.4.9. Incisions to access the craniofacial skeleton.4.10. Access osteotomies to the skull base.4.11. Skeletal Fractures –Principles and management4.12. Fracture Mandible and condyle fractures.4.13. Midface fractures: maxilla, nasal bone, NOE complex4.14. Naso-Orbito-Ethmoid injuries.4.15. Nasal bone fractures.4.16. Frontal bone fractures.4.17. Zygomatic complex fractures.4.18. Management of Panfacial injuries.4.19. Management of dento-alveolar injuries.4.20. Fracture reduction and different modalities of skeletal stabilization;AO principles.4.21. Primary and secondary bone grafting of the facial skeleton.4.22. Avulsion injuries of face.4.23. Gunshot injuries of face.4.24. Paediatric Facial fractures.4.25. Management of facial fractures in elderly and edentulous jaw.5 Maxillofacial Disorders5.1. Temporomandibular joint: Ankylosis, Hypermobility, dislocation.5.2. Temporomandibular joint pain, dysfunctions.5.3. T. M Joint Reconstruction.5.4. Obstructive sleep apnoea – Evaluation, planning and management.5.5. Principles of osteointegration and Implantology.5.6. Craniofacial and Maxillofacial Prosthetics.5.7. Craniofacial Implants and retained prosthesis. 5.8. Radiological imaging5. Head and Neck SurgeryA Head and Neck Tumors1 Benign and Malignant tumors of Head and Neck.2 Tumors of oral cavity, oropharynx and Mandible.3 Jaw tumours, lesions and cyst.4 Principles of Reconstruction4.1 Principles of reconstruction of Cancer of upper Aerodigestive system4.2 Reconstruction of the Mandible and Maxilla6 Tumors of skin6.1 Benign skin tumours of the Head and neck6.2 Malignant skin tumours of the Head and Neck7 Paediatric head and neck tumours.B Head and Neck reconstruction by region1 Reconstruction of Scalp and Calvarium2 Reconstruction of the Nose3 Reconstruction of the Eyelids and Orbit4 Reconstruction of external ear5 Reconstruction of the Lip and commissure6 Cheek reconstruction7 Tongue reconstruction8 Reconstruction of pharynx and oesophagusC Principles Skull Base SurgeryD Vascular malformations of head and neckE Infections of the Head & Neck1 Infection of the Cervical spaces 2 Ludwig's angina 3 Post Hansen's deformities of the face 4 Cancrum oris/ Mucor mycosis6. Breast1 Diagnosis of Breast Cancer2 Oncoplastic Surgery3 Management of Carcinoma Breast4 Nipple and Areola Reconstruction 5 Congenital Anomalies of The Breast6 Tuberous Breast7 Poland's Syndrome8 Fat Grafting in The Breast9 Reduction Mammoplasty10 Mastopexy11 Augmentation Mammoplasty and Breast Implants12 Anaplastic Large Cell Lymphoma and Breast Implants (ALCL)13 Gynaecomastia.7. Hand and Upper Extremity1 Regional anatomy and principles1.1 Functional anatomy of hand1.2 Biomechanics of the Hand1.3 Regional anaesthesia in upper limb surgeries1.4 Examination of hand and upper limb1.5 Diagnostic imaging of hand and upper extremity2 Traumatic disorders of the hand2.1 Fingertip and nail injuries2.2 Anatomy of the skeleton of the hand and fractures of the hand and wrist2.3 Flexor tendon injuries of the Upper Limb2.4 Extensor tendon of the Upper Limb2.5 Mutilating injuries of the Upper extremity2.6 Amputation and Prothesis2.7 Thumb reconstruction2.8 Acute nerve injuries and repair2.9 Compartment syndrome of the Upper limb2.10 Paediatric upper extremity trauma and reconstruction.3 Non-traumatic disorders of upper extremities3.1 Infections of hand3.2 Dupytrens disease3.3 Rheumatoid arthritis of the Hand3.4 Compression neuropathies of upper extremity3.5 Hand ischemia and Volkmann’s ischemic contracture3.6 Complex Regional Pain Syndrome3.7 Tumors of the upper limb.4. Congenital disorders of hand and upper extremities4.1 Embryology, classification and principles.4.2 Common congenital hand anomalies.4.3 Vascular anomalies of upper extremity.5 Miscellaneous5.1 Comprehensive management of burned hand.5.2 Occupational hand disorders5.3 Management of the stiff hand5.4 Management of the Spastic hand5.5 Management of upper extremity in tetraplegia.5.6 Hand therapy.8. Trunk and Lower Extremity1 Lower Extremity1.1 Comprehensive Lower Extremity Anatomy1.2 Management of Lower Extremity Trauma1.3 Lower Extremity Sarcoma Reconstruction1.4 Reconstructive Surgery: Lower Extremity Coverage/Composite reconstruction1.5 Diagnosis and Treatment of Painful Neuroma and of nerve compression in the lower extremity 1.6 Lower Extremity Composite Reconstruction1.7 Foot Reconstruction.2 Trunk Reconstruction2.1 Comprehensive Trunk Anatomy2.2 Reconstruction of chest2.3 Reconstruction of the soft Tissues of the back2.4 Abdominal Wall reconstruction.3 Reconstruction of Genitalia3.1 Reconstruction of Male Genitalia3.2 Reconstruction of acquired vaginal defects3.3 Gender identity disorders and disorders of sex development.4 Pressure Sores5 Perineal Reconstruction9. Aesthetic Surgery1. Aesthetic surgery practice1.1. Setting up an aesthetic surgery practice1.2. Preoperative analysis and surgical Planning in aesthetic surgery1.3. Psychological assessment & specialist referrals1.4. Obtaining informed consent and patient counselling1.5. Clinical photography, documentation and record keeping1.6. Dealing with complications and unsatisfied patients1.7. Communication and team building1.8. Ethics and medico-legal aspects of aesthetic surgery1.9. Anaesthesia for aesthetic surgery: general and regional nerve blocks1.10. Care and maintenance of instruments sterilization and infection control practices.2. Age-related changes & rejuvenationA. Facial ageing2.1. Anatomy of the face relevant to aesthetic surgery and injectables(soft tissues and skeletal)2.2. Ageing of the face- skin, soft tissues and skeleton.B. Facial rejuvenation2.3. Non-surgical skin care and rejuvenation topicals and cosmeceuticals2.4. Cutaneous resurfacing - chemical peel, surgical dermabrasion2.5. Regenerative medicine: platelet-rich plasma, mesenchymal stem cells and their aesthetic applications2.6. Laser: physics, tissue interactions and various clinical applications2.7. Other energy-based devices: radio-frequency and ultrasound: their application in skin tightening and body contouring.2.8. Forehead lift: endoscopic and surgical2.9. Brow lift2.10. Blepharoplasty: upper and lower2.11. Oriental blepharoplasty2.12. Secondary blepharoplasty2.13. Thread lifts: science, indications, technique complications2.14. Various facelift techniques: minimal access cranial suspension(macs) subcutaneous lift, Smas-platysma plication, extendedSmas, subperiosteal lift2.15. Secondary deformities from facelift surgery.3. Aesthetic skeletal surgery3.1. Facial skeleton: male and female. Age-related changes in the facial skeleton 3.2. Facial skeletal augmentation: bone graft and implants3.3. Facial masculinisation and feminisation surgeries3.4. Anthropometry, cephalometry, orthognathic surgery.4. Soft tissue fillers4.1. Chemical composition and application of soft tissue fillers4.2. Temporary, semi-permanent, permanent fillers vascular and othercomplications of fillers.5. Botulinum toxin5.1. Botulinum toxin: science, indications, techniques, complications.6. Incisions and scars6.1. Resting skin tension lines and their relation to incision placementand scar revision.6.2. Non-surgical management of incisions and scars6.3. Surgical management of scars of the face and other regions.7. Rhinoplasty7.1. Nasal anatomy, physiology and assessments7.2. Rhinoplasty: aesthetic and functional, open and closed, reductionand augmentation7.3. Structural and preservation rhinoplasty7.4. Tip-plasty7.5. The deviated/ crooked nose and cleft rhinoplasty7.6. The septum in rhinoplasty7.7. Secondary rhinoplasty.8. Lip8.1. Augmentation8.2. Reduction9. Fat grafting9.1. Structural fat grafting: principles, extraction, preparation &injection techniques. Micro, milli & nano fat grafting. indicationsand complications.9.2. Autologous fat grafting: biology, volumetric & non-volumetriceffects of fat grafts9.3. Platelet rich plasma, platelet rich fibrin, nano- fat grafting.10. Liposuction10.1 Principles and composition of various wetting solutions & safety issues10.2 preoperative planning, postoperative care10.3. Lipo-structuring- concept, applications, 7 techniques- power assisted liposuction (PAL), ultrasound assisted liposuction (UAL), laser assisted liposuction, cryo-lipolysis10.4. High definition lipostructuring10.5. Face liposuction and lipolysis10.6. Axillary contouring and axillary breast management10.7. Gynaecomastia correction10.8. Recent techniques- Vaser, radio frequency, j plasma skin tightening10.9. Large volume liposuction.11. Body contouring surgeries11.1 Obesity & massive weight loss (MWL) and post bariatric surgery weight loss11.2 Management of high BMI patients11.3. Body and limb contouring procedures: Brachioplasty, belt lipectomy, lower body lift, upper body lift, thigh plasty, buttock lift: assessment, indications, techniques & complications.12. Abdominoplasty12.1 anatomy and blood supply12.2. Standard abdominoplasty & variants12.3. High tension lateral abdominoplasty, mini abdominoplasty,extended lipo-abdominoplasty12.4. Neo-umbilicoplasty12.5. Correction of divaricated recti, ventral hernia, mesh repair.13. Implants and augmentation13.1. Implant biology13.2. Buttock augmentation, calf augmentation.14. Aesthetic genital surgery: male & female14.1. Anatomy & embryology14.2 Analysis and planning, anatomical and functional corrections14.3 Penile, scrotal, vaginal, vulval, mons pubis surgical procedures.15. Hair restoration15.1 Scalp anatomy and pathology biology of the hair follicle from thesurgical perspective15.2 Patterns of hair loss15.3 Tools for evaluation of hair quality- TrichoScan, densitometry etc.15.4. Management protocols for alopecia. Medical restoration15.5. Various techniques of the restoration including strip harvest (FUT), (FUE)15.6 Body hair transplant (non-scalp donor harvest)15.7 Surgical correction of baldness15.8 Eyebrow, moustache, beard hair transplantation.16. Other aesthetic procedures16.1. Aesthetic jewellery piercing16.2. Cheek dimple creation16.3. Buccal fat pad removal16.4. Ear lobe: repair, augmentation, reduction.
Career Options
After completing an MCh in Plastic and Reconstructive Surgery,
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, Junior Consultant (Plastic and Reconstructive Surgery), Senior Consultant (Plastic and Reconstructive Surgery),
Assistant Professor (Plastic and Reconstructive Surgery), Associate Professor (Plastic and Reconstructive Surgery).
Courses After MCh in
Plastic and Reconstructive Surgery
MCh in Plastic and Reconstructive Surgery is a specialization course
that can be pursued after finishing a Postgraduate medical course. After
pursuing a specialization in MCh in Plastic and Reconstructive Surgery, a
candidate could also pursue certificate courses and Fellowship programs
recognized by NMC and NBE, where MCh in Plastic and Reconstructive Surgery is a
feeder qualification.
These include fellowships in:
· Fellowship in Hand and Reconstructive
Microsurgery
· FNB in Hand and Microsurgery
Frequently Asked Questions (FAQs) –MCh in Plastic and Reconstructive
Surgery
- Question: What is the full form of an MCh?
Answer: The full form of an MCh is Master of Chirurgiae.
- Question: What is an MCh in Plastic and Reconstructive Surgery?
Answer: MCh Plastic and reconstructive surgery or Master of Chirurgiae
in Plastic and Reconstructive surgery also known as MCh in Plastic and Reconstructive surgery is a super speciality 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 an MCh in Plastic and Reconstructive
Surgery?
Answer: MCh in Plastic and Reconstructive surgery is a super specialty
program of three years.
- Question: What is the eligibility of an MCh in Plastic and
Reconstructive Surgery?
Answer: The candidate must have a postgraduate medical Degree in MS/DNB (General Surgery) obtained from any college/university recognized
by the Medical Council of India (Now NMC)/NBE, this feeder qualification
mentioned here is as of 2022. For any further changes to the prerequisite
requirement please refer to the NBE website.
- Question: What is the scope of an MCh in Plastic and Reconstructive
Surgery?
Answer: MCh in Plastic and Reconstructive Surgery offers candidates
various employment opportunities and career prospects.
- Question: What is the average salary for an MCh in Plastic and Reconstructive surgery candidate?
Answer: The MCh in Plastic and Reconstructive surgery candidate’s
average salary is between Rs. 15 lakhs to Rs. 51 lakhs per annum depending
on the experience.
- Question: Can you teach after completing an MCh Course?
Answer: Yes, the
candidate can teach in a medical college/hospital after completing an MCh
course.
2 years 1 month ago
News,Health news,NMC News,Medical Education,Medical Colleges News,Medical Courses News,Medical Universities News,Medical Admission News,Latest Medical Education News,Notifications,Medical Courses
Life after suffering a dangerous heart attack
Dr Batista Herrera is advocating for total lifestyle change for the Grenadian population who are at risk of developing chronic non-communicable diseases due to their unhealthy obsession with fast foods
View the full post Life after suffering a dangerous heart attack on NOW Grenada.
2 years 1 month ago
Community, Health, curlan campbell, elida batista herrera, felix st bernard, four chambers heart of grenada, grenada national patients kidney foundation, ischaemic heart disease
Country’s progress in the field of health is highlighted
Santo Domingo, DR
In the “Great Forum,” a total of 18 speakers and panelists reflected on the approach to the pandemic, with the mistakes and successes experienced by the country, moderated by Eddy Perez Then, director of the Research Center and presidential advisor for COVID-19.
Santo Domingo, DR
In the “Great Forum,” a total of 18 speakers and panelists reflected on the approach to the pandemic, with the mistakes and successes experienced by the country, moderated by Eddy Perez Then, director of the Research Center and presidential advisor for COVID-19.
Chanel Rosa, former director of the National Health Service (SNS), in explaining the context in which the virus struck, pointed out that “the worst thing that happened to us was that the pandemic occurred in the middle of an electoral process, because we all become more petty, more denigrating… and this is transversal to the political class of the Dominican Republic, unfortunately, these are things that happen”.
Rosa emphasized that the good things done in both governments and continuity should be recognized. “It was not easy to manage a pandemic for two governments, however, the fact that a new government took office did not prevent us from continuing with public policies and I feel very proud,” he said.
Among the measures taken, he pointed out the declaration of the State of Emergency and social protection, such as the FASE program, as well as the creation of a national commission for the management of Coronavirus; while among the lessons learned, he listed the strengthening of the Provincial Health Directorates, the Collective Health Programs and the training of health professionals.
Mario Lama, current director of the SNS, said, “we learned that the management of this pandemic was dynamic… we were learning along the way, from the patients themselves and from the panorama we had… we did not take from what was happening in other countries.”
He added as a significant achievement that 18 hospitals were available for the treatment of COVID-19 and, as a lesson, that they had to innovate, creating, for example, daily reports to inform the population about how the hospital occupancy was.
Eladio Pérez, Vice-Minister of Collective Health, indicated that “we all became epidemiologists at that time” when dealing with new medical terms and highlighted the work carried out by the General Public Health Laboratory.
Mr. Perez explained that among the strategies for epidemiological management, the operational structure of the National Laboratory was strengthened and took advantage of his presentation to announce the Forcontact Project, an electronic platform that will allow contact tracing for COVID-19, which will later be used for other diseases.
2 years 1 month ago
Health, Local
Respiratory conditions attack children
Santo Domingo, DR
The director of the San Lorenzo de Los Mina Maternity and Children’s Hospital, Leonardo Aquino, indicated yesterday that between 90 and 100 children are admitted daily to the center, of which 45% are for “respiratory phenomena.”
While the other pediatric ailments are febrile syndromes (high fevers), acute diarrheal diseases, and other pathologies.
Santo Domingo, DR
The director of the San Lorenzo de Los Mina Maternity and Children’s Hospital, Leonardo Aquino, indicated yesterday that between 90 and 100 children are admitted daily to the center, of which 45% are for “respiratory phenomena.”
While the other pediatric ailments are febrile syndromes (high fevers), acute diarrheal diseases, and other pathologies.
Aquino also stated that the cases of respiratory diseases “have always predominated,” mainly in hospitals, because they are located in areas close to neighborhoods and sectors where there is little awareness of “proper health care.”
He also indicated that fewer patients were admitted with respiratory ailments last year because, in previous years, the vestiges of Covid-19 and its variants were still felt.
She also revealed that the health system is taking “adequate” measures to prevent these diseases through the influenza vaccine, one of the leading “producing agents” of these phenomena. In that order, the person in charge of Pediatric Emergency, Marlene Perez, indicated that most respiratory problems are asthma or acute respiratory infections.
Half of the people consulted in the Pediatric Emergency Department of this hospital, located on San Vicente de Paul Street, Santo Domingo East, pointed out that the patients came for flu-like processes and fever, among whom two had severe congestion.
“She woke up with no strength in her body, with no spirit. She has had the flu and fever for several days,” said a mother with her little girl in the emergency room.
“Since last night she has been coughing a lot with a little cough and congestion. She is already on her third nebulization,” explained another mother named Julissa, who had her six-month-old baby with her.
Like them, other parents accompanied by their children occupied the spaces in the emergency room of this health center, seeking attention for their ailments.
At the Reid Cabral
During the tour made by journalists of this media, at least 15 patients waiting for attention at the Robert Reid Cabral Children’s Hospital were consulted. Two presented flu-like processes and congestion, while two others presented fever.
The others came for routine consultations, vomiting, stomach problems, sore throats, and other ailments that afflicted their children.
2 years 1 month ago
Health, Local
Medical News, Health News Latest, Medical News Today - Medical Dialogues |
NMC Guidelines For Competency Based Training Programme For MCh Plastic and Reconstructive Surgery
The National Medical Commission (NMC) has released the Guidelines For Competency-Based Postgraduate Training Programme For MCh In Plastic and Reconstructive Surgery.
1. PREAMBLE
The National Medical Commission (NMC) has released the Guidelines For Competency-Based Postgraduate Training Programme For MCh In Plastic and Reconstructive Surgery.
1. PREAMBLE
Plastic and Reconstructive Surgery is a unique specialty
that defies definition, has no organ
system of its own, is based on principles rather than specific
procedures. It pertains to restoring
form and functions and, in many situations, enhancing it. The scope ranges from the top of the Calvarium to the bottom
of the sole. It has also been defined as a ‘Problem solving specialty’- solving
problems related to many other specialties. The range of Plastic and Reconstructive Surgery
has expanded by leaps and bounds in the past few decades.
Thus, a structured program for a comprehensive training
in the wide range of Plastic and Reconstructive
surgery is the need of the hour as it would lay down the gold standard for training
across all the platforms in the country.
Moreover, it will also help in standardizing the training of future plastic surgeons. This comprehensive
document has been prepared keeping
this need in mind. The core idea all through has been to prepare a curriculum
that is inclusive of theoretical knowledge, practical aspects,
and the desired operative capabilities of the trainee. The document will help the teachers micromanage the nitty gritty
of the daily training and teaching assignments. At the end of the 3-year
training, the candidate would be
equipped with vast knowledge, skills, the right aptitude to function as an independent, knowledgeable consultant, teacher and researcher.
SUBJECT SPECIFIC LEARNING
OBJECTIVES
(Complete details in annexure
II available with Expert Group members)
The aim of course is to produce plastic surgeons capable
of setting standards and demonstrate
commensurate expertise in the field. The training should aim to facilitate the candidate’s acquisition of a judicious
mix of the three domains of learning that will
be practiced ethically: -
- Cognitive (knowledge) domain,
- Affective (communication) domain,
and - Psychomotor (practice)
domain.
i.
COGNITIVE DOMAIN
(KNOWLEDGE DOMAIN)
- Understand the basic sciences
(embryology, anatomy, physiology, biochemistry, pharmaco-therapeutics etc.) and principles of plastic surgical
care as applicable to practice in plastic surgery. - Be conversant with the embryology,
aetiology, pathophysiology, diagnosis and management of common (elective
or emergency) conditions requiring plastic surgical
intervention. - Be
conversant with principles guiding care with reference to plastic surgery,
aesthetic medicine and surgery
and burn management. - Group
approach: Recognize the role of multidisciplinary and
interdisciplinary approach in the management of various conditions requiring plastic surgery so as to obtain
relevant specialist consultation, where appropriate. - Research Methodology: Basic knowledge of research methodology and bio- statistics; familiarity and participation in clinical and experimental research
studies; involvement in scientific presentation and publication.
Recognize the importance of family,
society and socio-cultural environment in the
treatment and rehabilitation of the individual
needing plastic surgery care.
ii.
AFFECTIVE DOMAIN
The trainee should imbibe the following:
- Group /Team approach: function
as a part of a team, co-operate with colleagues, and interact
with the patient
to provide the optimal medical
care. - Ethical
practice: Abide by ethical principles in medical practice,
maintain proper etiquette
in dealings with patients, caretakers and other health
personnel including due attention to the patient’s right to
information, consent and second
opinion. Maintain professional integrity while dealing with patients, colleagues, seniors, pharmaceutical companies and equipment manufacturers. - Teaching
and Communication: Preparation
of oral presentation, medical documents,
professional opinion in interaction with patients, caretakers, peers and paramedical staff – both for clinical
care and medical teaching. Effective communication with the patient/caretakers regarding the nature and extent
of
disease, treatment options available and realistic
outcome following optimal management is essential.
- Provide counselling to the patient and caretakers for the smooth dispensation of medical care.
- During the course of three years, the post graduate student is expected to attend instructive courses that facilitate proficiency relevant to this domain,
for example, communication skills, biomedical ethics,
patient counselling, teaching,
etc.
iii.
PSYCHOMOTOR SKILLS
- Evaluate a patient thoroughly (history, clinical examination), order relevant investigations and interpret them to
reach a diagnosis and plan of management.
- Plan and carry out routine investigations/ procedures (bedside, laboratory, radiology) independently.
- Provide Basic and Advanced Life
Support services in emergency according to ATLS guidelines.
- Acquire Skills to provide critical
care of individuals requiring airway support,
ventilation, central vascular
access etc. during the
course of treatment.
- Prepare a patient for an
elective/emergency surgery and provide specific post- operative care.
- Acquire skills in routine
ward procedures (wound dressings and peripheral vascular
access).
- Acquire proficiency in prescribed
minor and major operative procedures, and provide these,
initially under supervision and later independently.
- Acquire proficiency in managing
emergency and elective referrals and provide
adequate support under supervision and later independently.
- Monitor the post-operative patient
in the routine post-op ward / high dependency
unit / and in the intensive
care setting.
- Provide specific and relevant advice
to the patient and family at discharge time for
proper domiciliary care, reporting to hospital in an emergency and routine follow up.
- Acquire proficiency in teaching
undergraduate students,
nursing and other health care personnel.
SUBJECT SPECIFIC COMPETENCIES
(Complete details in annexure II available with Expert Group members)
At the end of the course, the student should
be able to acquire the following competencies under the three domains, knowledge/skills/ expertise::
1.
Cognitive domain (Knowledge domain)
A.
THEORETICAL KNOWLEDGE:
Should be able to describe
& discuss and synthesize knowledge
of different conditions
needing plastic surgical care and
their diagnosis and management.
B.
CLINICAL/PRACTICAL SKILLS:
Should be able to diagnose,
investigate, perform surgery, manage and follow-up patients
with conditions needing
plastic surgical care using modern therapeutic methods.
C.
TEACHING SKILLS:
Should be able to teach relevant aspects of conditions
needing plastic surgical care to resident doctors,
junior colleagues, nursing
and para-medical staff.
D.
RESEARCH METHODOLOGY:
Should be able to identify and investigate a research
problem in conditions needing plastic
surgical care using appropriate
methodology.
E.
GROUP APPROACH:
Should participate in multi-disciplinary meetings with
radiologists, paediatricians, pathologists,
orthopedic surgeons, rehabilitation specialists, oncologists and experts from allied clinical
disciplines.
2.
Affective domain
(Attitudes including Communication and Professionalism)
The M.Ch. candidate, at the end of training
should demonstrate the ability to:
- communicate in a professional manner the treatment plan with patients,
their family and care givers, - function as
a part of a team in collaboration with other geriatric
mental health care team members
including those from related clinical
disciplines, psychiatric nursing/occupational therapy
staff and nutrition
unit. - Adopt ethical principles and maintain proper etiquette in
dealing with patients, relatives and other
health personnel and to respect the rights of the patient including the right
to information and second opinion. - Develop communication skills to word reports
and professional opinion
and to interact with patients, relatives, peers and paramedical staff, and for effective teaching. - Organize team activities in the
department and community on Plastic Surgery-related conditions including prevention and public awareness. - Plan and implement
group activities with health staff
in the hospital and community.
Leadership skills
Professionalism
- Accept personal responsibility for care of patients with mental health
problems, consistent with good work ethics and empathy. - Demonstrate appropriate truthfulness and honesty with colleagues.
- Recognize personal beliefs, prejudices, and limitations, which should not come in the way of providing
service. - Respect patient confidentiality at all times
in verbal and written communication.
Attitude
- Respect patients' religious, moral, and ethical beliefs and biases, even if
they differ from the
student’s own beliefs. - Present all available options
accurately to the patient and relatives. - Be
aware of the advantages and potential hazards
of referring patients and families to community or to national
resources. - Recognize the limitations of their own skills
and seeks consultation when necessary. - Understand and develop sensitivity to end-of-life care and issues regarding provision
of care. - Acquire an effective system for identifying and addressing ethical,
cultural, and spiritual
issues associated with health care delivery to geriatric mental health patients. - Acquire knowledge or applies an understanding of psychological, social,
and economic factors which are pertinent to the
delivery of health care to geriatric mental health patients. - Effectively engages the patient
and/or family in communications which are non- judgmental and non-coercive.
Interpersonal and Communication Skills
Human Relationships
3.
Psychomotor domain
The list of procedures which a trainee needs to perform
independently, perform under supervision,
assist, and observe are given below. In addition, trainees are encouraged to improve skills by doing procedures on
cadavers, surgical simulators and the surgical
skills laboratory.
Sl. No
Competencies in Psychomotor Domain.
At the end
of the course, the trainee should be able to:
A. Perform
Independently
1.
GENERAL PRINCIPLES
- Create a consent document appropriate to the clinical care sought by a patient
- Perform steps of WHO safety
protocol: surgical patient safety checklist - Obtain standard views
of photographs for different conditions and create a photograph logbook - Select and use appropriate dressing materials for wounds
- Demonstrate wound debridement
- Demonstrate application of Negative pressure wound therapy
- Demonstrate the use of external tissue expansion on
simulation models - Demonstrate the harvest
of split skin
grafts in patients - Harvest and use a full
thickness skin graft - Demonstrate use of the skin
graft Mesher - Identify cutaneous vascular perforators using a vascular
doppler
- Demonstrate with appropriate planning, local skin
flaps, pedicled skin
flaps, muscle flaps,
osseous flaps, free
flaps, perforator flaps - Demonstrate delay procedures
- Demonstrate secondary flap
modification (eg; flap
debulking) - Demonstrate harvest of tendon, bone,
cartilage for grafts - Demonstrate the administration of local anaesthetics, Tumescent anaesthesia, nerve
blocks in patients - Demonstrate Endotracheal intubation on a patient or Simulator
MICROVASCULAR SURGERY, BRACHIAL PLEXUS, PERIPHERAL NERVE SURGERY
- Set up the microscope in the operation theatre or
Laboratory. - Clean and store
the Micro instruments after use. - Use magnifying loupes
and operating microscope during surgery. - Make a pattern of the reconstructive plan with its various components for a given
defect. - Examine, decide the management, implement, operate and rehabilitate cases of brachial plexus injuries.
- Diagnose, investigate, exploration and repair of peripheral nerves under magnification.
BURNS
- Perform escharotomy, escharectomy and fasciotomy on the
limbs and trunk - Place central venous
lines in the Subclavian, Internal Jugular and Femoral
veins in Paediatric and adult patients - Should manage acute
burn patients in intensive care unit including respiratory and critical burn patients. - Set-up Central Venous
pressure measuring systems - Perform burn wound
dressings - Harvest, apply, manage
split skin grafts used to resurface burn
wounds - Procure and apply
allograft skin on wounds - Perform a burn
wound biopsy - Perform dressings for hand burns
- Perform a Z-plasty to lengthen a post burn
contracture band Release and resurface post
burn contractures of various joints
- Make appropriate splints to immobilize hand burns
in the functional position. - Prescribe appropriates splint, pressure garments and
exercises for acute
burns and post burn deformities.
CRANIOFACIAL, CLEFT
AND PEDIATRIC PLASTIC
SURGERY
- Place a Nasopharyngeal Airway to maintain
the upper airway - Demonstrate the various incisions and the anatomy
to approach the Craniofacial skeleton - Demonstrate the
markings for a Unilateral and Bilateral Cleft lip repair - Apply arch bars
and Intermaxillary fixation for fractures of the maxilla and mandible.
HEAD AND NECK
- Obtain biopsies from benign
and malignant lesions of the head and
neck - Incision biopsy
- Excision biopsy
- Core biopsy
- Perform excision biopsy
of Benign lesions of the Head
and neck - Make patterns and plans for partial auricular defects
- Demonstrate the carving
and shaping of a cartilage framework to
reconstruct microtia.
BREAST
- Demonstrate the pre-operative
markings of any one technique of reduction mammoplasty - Perform subcutaneous excision of Gynecomastia.
HAND AND
UPPER EXTREMITY
- Administer the following blocks:
- Axillary
- Wrist,
- Digital
- Demonstrate the various local and cross finger
flaps used in the management of Fingertip injuries - Perform Flexor tendon
repair
- Demonstrate Extensor tendon
repair - Set up the Controlled dynamic mobilization following Flexor tendon repair
- Set up the Controlled dynamic mobilization following Extensor tendon repair
- Perform amputations of the:
- Thumb
- Digits
- Below elbow and Above elbow
infections, Paronychia
of Tenosynovitis.
TRUNK, GENITALIA, LOWER EXTREMITY
- Demonstrate the debridement of a pressure sore.
- Evaluate cases of genital abnormalities.
- Assess and
manage congenital and acquired defects in the trunk.
AESTHETIC SURGERY
- Illustrate the design
of a small Aesthetic surgery
clinic - Mark the important facial Anthropometric points
on a given patient - Measure the important distances and angles
used for facial
deformity analysis - Write a consent
format for common
aesthetic surgical procedures - Record photographs of the face, nose, ears,
peri-orbital region, malar
region, breasts, trunk,
arms, thighs, and calves in
standard views for documentation - Administer regional and local anaesthesia to patients undergoing Aesthetic surgery
- Measure the vertical height of the skull, forehead, midface, and lower
face - Measure the Intercanthal distance, Palpebral fissure
length, Inter-alar distance, Commissure length - Measure the width
of the skull,
forehead, face at the zygoma
and mandibular angle - Measure the nasofrontal & nasolabial angles
- Calculate the Cephalic index
- Draw RSTLs on the Face and other
areas
- Demonstrate the pinch
test to identify RSTLs - Plan incisions on the face and other
parts based on the RSTLs - Perform a Z-plasty and scar revision using the
Z-plasty principle - Prepare tumescent fluid
to be used
to infiltrate the abdomen, thighs and arms - Perform ear
lobe repair for partial and complete tears.
B. Perform under supervision
GENERAL PRINCIPLES
- Demonstrate placement of suitable tissue
expanders in clinical cases.
MICROVASCULAR SURGERY, BRACHIAL PLEXUS, PERIPHERAL NERVE SURGERY
- Demonstrate dissection of recipient and donor vessel
for microvascular anastomosis - Demonstrate the steps
of a microvascular anastomosis and choose the appropriate instruments - Demonstrate tests to assess arterial and venous patency after microvascular transfer
- Demonstrate perforator-based
flap elevation in a cadaver: - Perform Neurorrhaphy
- Harvest a Sural/
Superficial peroneal/ forearm cutaneous nerve graft - Demonstrate the anatomy of common
sites for Compression of the Ulnar, Median, Radial, Sciatic, common
Peroneal and Posterior Tibial nerves.
BURNS
- Plan and participate in a mock drill to manage mass casualties from a major burn
accident - Participate in the
early excision and
resurfacing of burn
wounds - Perform various limb
and digit amputations in deep electric burns - Plan and perform flexion, extension, first web
contracture release, syndactyly release and resurfacing in chronic hand
burns
- Perform release,
resurfacing of a post burn
neck contracture and
make a post-operative splint for immobilization - Perform contracture release and resurfacing of post burn
contractures over various
joints - Resurface Facial
burns according to the Aesthetic units of the face.
CRANIOFACIAL, CLEFT
AND PEDIATRIC PLASTIC
SURGERY
- Dissect the parotid gland and the Facial
Nerve branches in the face - Demonstrate the Bicoronal and subciliary incisions used to expose the skull and orbit
- Take a tongue
stitch to prevent
Glossoptosis - Perform nasal bone reduction and make an external nasal
splint for a patient - Demonstrate the anatomy of the TMJ
•
Mark incision for cleft palate
repair and dissect.
AESTHETIC SURGERY
- Create a digital archiving system for
storing patient data - Perform liposuction and prepare a sample for micro fat
grafting in a patient.
C. AS: Assist,
OB: Observe, CAD: Cadaver, LAB: Laboratory,
SIM: Surgical Simulator
GENERAL PRINCIPLES
- Perform submental intubation in a patient
or cadaver - Perform tracheostomy in a patient
or cadaver - Demonstrate the use of power
tools - Demonstrate perforator-based
flap elevation in a cadaver:
- TDAP and latissimus dorsi
- Scapular and Parascapular
- DIEP
- SGAP and IGAP
- Gracilis
- Fibula and peroneal perforator flap
- Posterior tibial perforator flap.
MICROVASCULAR SURGERY, BRACHIAL PLEXUS, PERIPHERAL NERVE SURGERY
- Demonstrate the anatomy
of the digit - Demonstrate the macro anatomy
of the upper
limb at the arm, forearm and hand - Demonstrate the anatomy
of the lower
limb at the level of the thigh, leg, and foot - Demonstrate the neurovascular anatomy of the scalp
- Demonstrate use
of anastomotic coupler devices in the
Laboratory - Demonstrate the topographic anatomy of the Ulnar, Median,
Radial nerves in the
mid arm, upper, mid and lower forearm - Demonstrate the anatomy
of the Brachial Plexus - Demonstrate the Spinal
accessory to Suprascapular, Triceps branch to
axillary, Ulnar fascicle to Biceps nerve, Median fascicle to Brachialis nerve, and
Intercostal to Musculocutaneous nerve - Demonstrate the anatomy of the Fallopian tubes
- Demonstrate the anatomy of the Vas Deferens
- Perform superificialization of the Brachial artery prior to performing
an AV fistula.
BURNS
- Place naso-gastric and naso-jejunal feeding tubes
- Participate in the respiratory and nursing care
of a patient with MODS, on the ventilator - Participate in the post-operative monitoring and care of a patient with burns after
General anaesthesia - Demonstrate Subclavian and
Femoral artery ligation an electrical burn. - Participate in primary
excision and tangential excision of burns. - Harvest split thickness skin graft.
CRANIOFACIAL, CLEFT
AND PEDIATRIC PLASTIC
SURGERY
- Dissect the various
fat compartments of the
face - Harvest cancellous bone
from the Iliac
bone for alveolar bone grafting
- Perform frontal craniotomy, orbito-frontal advancement, and
occipital advancement - Draw the Facial midline in the 3 Coronal planes
from the Cephalometric tracing, to depict the
asymmetry, as described by Grayson - Assist and perform the
key steps of surgery for unilateral cleft
lip, anterior palate - Assist and perform
the key steps of surgery for bilateral cleft lip, anterior palate - Assist and perform
the key steps
of cleft palate
surgery - Assist in the bone grafting for alveolar clefts
- Demonstrate the
Abbe flap for philtral reconstruction - Demonstrate the open septo-rhinoplasty to correct nasal deformities of the cleft nose
- Demonstrate the
LeForte 1 advancement of the maxilla - Demonstrate the Bilateral Sagittal Split of the Mandible
- Demonstrate arch bar
and Ivy loop
application in a patient or
typhodont - Perform intermaxillary fixation in patients
with fractures of
the mandible - Perform open reduction and Miniplate fixation
in fractures of the Frontal
bones, Orbit, Zygoma, Maxilla,
and Mandible - Perform intercanthal wiring
in a patient - Demonstrate the vascularized auricular cartilage transfer to the Glenoid
fossa - Excise a bony block and perform Costochondral reconstruction of the mandible for Temporomandibular ankylosis
- Plan alloplastic reconstruction of Temporomandibular joint.
- Set-up an external and internal distractor on a Stereolithographic model
of a skull in a child with
Brachycephaly - Perform a Box osteotomy and Facial Bipartition on a model
of a patient with Hypertelorism - Set-up an external and internal distractor on a Stereolithographic model of a
mandible in a child. - Demonstrate a maxillary swing procedure on a model.
HEAD AND NECK
- Demonstrate tongue reconstruction with the following flaps:
- Pectoralis major myocutaneous
- Anterolateral thigh
iii. Radial forearm microvascular flaps
- Demonstrate the Glabella, Paramedian forehead and
Nasolabial flaps for nasal reconstruction - Demonstrate the Radial
forearm microvascular flap
for total nasal
reconstruction - Demonstrate the following flaps for lip reconstruction:
- Abbe
- Estlander
- Fan
- McGregor
- Kerapandzic
lateral canthotomy and Temporal flap
for upper and lower
eyelid repair
of the nasal
chrondromucosal graft
major myocutaneous flap for pharyngeal and oesophageal reconstruction
forearm free flap for
oesophageal reconstruction
I and the maxillary swing
approaches to the skull base
infra-temporal fossa
of the neck.
BREAST
- Display the anatomy
of the breast
and draining lymph
nodes - Demonstrate the steps
of a Simple mastectomy and axillary node
clearance - Demonstrate the
flaps that can be used for Oncoplastic reconstructions:
- Thoracodorsal Artery Perforator
- Lateral Intercostal artery
Perforator - Anterior Intercostal artery
Perforator and Superior epigastric artery Perforator based
flaps
- Demonstrate, in the Breast
glandular flaps that can be used
in the redistribution of
glandular tissue - Demonstrate the Pectoral fascial flap and the lower
pole dermal apron
flap - Demonstrate the Latissimus dorsi muscle transfer to replace the missing Pectoralis major in Poland's syndrome
- Demonstrate any one technique of mastopexy
- Demonstrate augmentation mammoplasty using implants.
HAND AND
UPPER EXTREMITY
- Demonstrate the anatomy
of the Flexor
and Extensor compartments of the Upper
limb - Demonstrate the Vascular anatomy of the Upper
limb - Demonstrate the anatomy of the hand
- Demonstrate the Nerve
supply to the upper
limb - Demonstrate various local and regional flaps that can be used
to resurface the thumb - Demonstrate the anatomy of the Nail
bed - Manage fractures of the Hand
with:
- K-wiring
- Open reduction and internal fixation
- External fixation
and Abdominal flaps
for Hand resurfacing
- Thumb
- Digits
- Below elbow and
- Above elbow
and second toe dissections in preparation for
a toe to the thumb
transfer in a cadaver
finger
muscle slide
- Biceps to Triceps
- Deltoid to Triceps
- Brachioradialis
to Flexor Pollicis Longus - Split FPL to EPL
- FPL tenodesis
- FDS Lasso procedure
- House intrinsic balancing procedure
- EDC and EPL tenodesis
- ECRL to FDP
x. Pronator teres to FPL.
TRUNK, GENITALIA, LOWER EXTREMITY
- Demonstrate the anatomy of the chest
wall, abdominal wall
and back - Demonstrate the anatomy
of the:
- Latissimus dorsi
- Trapezius
- Omentum and
- Gluteal flaps
wall using:
- Pectoralis Major
- Latissimus Dorsi
- Serratus Anterior
- Rectus Abdominis
- Omentum
the component separation techniques
and vascularity of the Penis,
scrotum, and perineum
- Pudendal artery-based flaps
- Gracilis myocutaneous
- Rectus abdominis and
- Colon
excision of the penis and testis along
with creation of flaps for the neo vagina and
vulva in a male to female gender
reassignment surgery
obliteration of the vagina, phalloplasty and scrotoplasty in a patient
for female to male gender reassignment
treatment of pressure sores:
of the perineum
\
- Demonstrate the anatomy
of the lower
limb at the level of the thigh, leg, and foot. - Demonstrate the following Flap anatomy i). Anterolateral thigh
- Anteromedial thigh
- Superior and Inferior
Gluteal Artery iv). Gracilis
v). Posterior
leg Fasciocutaneous vi). Fibula
and fibula perforator vii). Gastrocnemius
- Soleus
- Reverse sural artery
x). Dorsalis pedis - Medial plantar artery
- Perforator and propellor flaps.
AESTHETIC SURGERY
- Assist in the cleaning, packing and sterilization of commonly used surgical instruments
- Dissect the superficial muscles, the Facial
nerve and the blood vessels of the face - Demonstrate the Superficial Muscular Aponeurotic System
(SMAS) - Identify the retaining ligaments of the face
- Identify the Supra-orbital, Infra-orbital and Mental
nerves - Demonstrate/ observe a Glycolic acid
face peel - Demonstrate the forehead lift and expose
the Supra-orbital neurovascular bundle - Demonstrate the anatomy
of the Upper
and Lower eyelid - Dissect to demonstrate the subcutaneous and Sub-SMAS
lifts - Demonstrate the harvest of rib, iliac
crest and cranial
bone grafts in a cadaver or patient - Plan a
simple W-plasty scar revision on a patient - Design a small
Geometric Broken Line
scar revision - Display the Open
approach to the nose and septum - Demonstrate the Open
reduction rhinoplasty - Demonstrate Costochondral graft
for nasal augmentation - Demonstrate high and low septal
preservation rhinoplasty - Demonstrate the various
procedures to modify the nasal tip - Demonstrate the use of septal
and costal cartilage as spreader and septal extension grafts - Demonstrate the anatomy
of the nasal septum
- Demonstrate the muscular and neurovascular anatomy of the Rectus abdominis, External oblique
Internal oblique, Transversus abdominis and Peritoneum - Demonstrate the perforator anatomy of the anterior abdominal wall
- Demonstrate any one
technique of creating a neo-umbilicus - Demonstrate the posterior and anterior component separation procedure for repair of the anterior abdominal wall
- Harvest a strip
of skin and hair from the Occipital region and prepare Follicular units for Transplant - Perform follicular unit
extraction and hair restoration - Perform hair restoration procedures over scalp
and face - Demonstrate the anatomy of the Buccal
fat pad - Use different types
of LASERs for aesthetic procedures - Should use LASER
for the management of scars, pigmented lesions, hair removal, vascular lesion etc. - Use threads, Botox
and Fillers for aesthetic
surgery.
SYLLABUS
COURSE CONTENT:
The M.Ch.
Plastic and Reconstructive Surgery course will include
Aesthetic, Hand Surgery and Burn
Care in its syllabus.
- General Plastic
Surgery - Microvascular surgery,
Brachial plexus and Peripheral nerve
surgery - Burns and postburn deformity
- Craniofacial, Cleft and Paediatric Plastic Surgery
- Head and Neck Surgery
- Breast
- Hand and Upper Extremity
- Trunk and Lower Extremity
9. Aesthetic Surgery
and medicine
- Reconstructive Surgery
of External Genitalia and intersex disorders - Sex reassignment
- Peripheral vascular
surgery - Maxillofacial surgery,
trauma and reconstruction
- General Plastic Surgery
- History and development of plastic surgery
in India and across the world - The scope of plastic surgery
A.
General Principles
1.3 Evidence Based Medicine and research in plastic surgery
- Medico legal issues in plastic surgery
practice
1.5 Liability issues
in plastic surgery,
legal & insurance
perspective
- Documentation, Record
keeping and consent.
1.7 Patient safety
issues in plastic
surgery
- Psychological aspects
of plastic surgery - Ethics in plastic surgery
- Photography in plastic
surgery. - Information technology relevant to plastic
surgery.
B.
Basic principles and techniques
2.1 Wound: Definition, classification and implications
- Wound healing-normal and abnormal.
- Wound management - Mechanical and pharmacological dressing
techniques. Negative pressure
wound therapy & other techniques. - Scar biology
and management
2.5 Keloid, hypertrophic scars- prevention and management
- Unstable scar and scar contracture.
2.7 Anatomy and functions of skin
2.8 Viscoelastic Properties of Skin
2.9 Infective conditions of skin
- Benign and malignant skin and soft tissue tumours
- Radiation and Radiation Injuries
- Principles of tissue reconstruction
- Skin grafts
- Blood supply to skin, cutaneous circulation and vascular basis of flaps.
- Flaps: Classification, variations and applications
- Flap pathophysiology and pharmacology
- Grafts – fat, fascia,
tendon, nerve, cartilage, bone, composite tissue - Principles of Cancer Management
- Lymphedema: Pathophysiology and management
- Principles of microvascular surgery and technique
- Nosocomial infections
- Principles of genetics and general approach
to the management of congenital malformations. - Vascular anomalies: Pathophysiology and management
- Foetal surgery
- Local anaesthesia, nerve blocks, regional
anaesthesia - Principles of anaesthesia for infants, adults,
hypothermia, hypotensive anaesthesia. - Pain management
- Plastic Surgical
instrumentation: General principles.
C.
Technology applications
3.1 Technological innovations
3.2 Laser and energy device
applications
- Tissue expansion- principles and application
3.4 Distraction Histogenesis
3.5 Endoscopy in Plastic Surgery
3.6 Robotics
- Simulations
3.8. 3.D printing
technology & applications
- Suture materials, Implants and Biomaterials in plastic surgery
- Transplantation biology, techniques and applications
- Regenerative
medicine, cell therapy & stem cells - Tissue Engineering applications in plastic
surgery - Telemedicine in plastic
surgery - Information and Digital
Technology for Plastic
surgeon - Teaching tools
and methods in plastic
surgery
3.16. Training modules
for plastic surgery
trainees.
- Microvascular surgery, Brachial
plexus and Peripheral nerve surgery
A.
Microvascular surgery
1. Instrumentation in Microsurgery
2. Basic Principles of free-flap surgery
- Fundamental principles
3.1 Fundamental Principles of microvascular surgery
- Pre-operative planning for microsurgery
- Factors affecting outcome
of microvascular flap surgery
3.4.
Anatomy of angiosomes and perforators
- Replantation and revascularization
5. Recent advances
in microsurgery
6. Terminologies in Microsurgery.
B.
Peripheral Nerve surgery
1. Types of Nerve injury
- Diagnosis and management of peripheral nerve lesions/injuries
- Compression neuropathies- upper and lower limb
4. Topographic anatomy
of various peripheral nerves.
C.
Brachial plexus Surgery
1. Anatomy of the Brachial
Plexus
2. Mechanism of Brachial Plexus
Injury
3. Examination, Investigations and Diagnosis of Brachial Plexus
Injury
- Management of neonatal brachial
plexus injury - Management of adult Brachial
Plexus injury
6. Management of Chronic Brachial
Plexus injury.
D.
Microlymphatic surgery
1. Lymphedema pathophysiology
2. Assessment of lymphedema
3. Medical Management of Lymphedema
- Surgical management of Lymphedema
- Microlymphatic surgery.
E.
Composite Tissue
Allotransplantation
1. Principles and regulations of Composite Tissue Allotransplant
- Recent developments in Hand transplant
3. Face transplant.
F.
Video microsurgery
- Robotic microsurgery
- Arteriovenous Fistula
H.
Tubal recanalization and Vaso-vasostomy
3.
Burns
1
History of acute burns injuries
& management
- Multidisciplinary
burn team - Prevention of burns
- Burn management
in disasters and humanitarian crisis - Pathophysiology of acute burns
6
Systemic Inflammatory Response
Syndrome (SIRS)
- Early burn care
- Fluid management in
acute burns - Inhalation burns
- Management of the burn wound
- Skin and
skin substitutes - Nutrition in Burns
13
Burn wound infection and treatment
- Sepsis in burns
- Multiorgan Dysfunction Syndrome
(MODS) - Anaesthesia for a burned patient
- Biomarkers in Burn care
- Electrical burns
- Chemical burns
- Facial burns
- Hand burns
- Feet burns
- Paediatric burns
- Geriatric burns
- Burns in pregnancy
- Management of Pain in burns
- Psychiatric and psychological considerations in burns
- Burn rehabilitation
- Post burns scars
- Post burns contractures
- Post burn facial
deformities - Skin bank
- Role of allografts in burns
- Skin substitutes
34. Organizing a burn unit.
4.
Craniofacial Cleft and Paediatric Plastic
Surgery
1
General
- Embryology and anatomy
of craniofacial complex. - Growth and development changes
in face, anatomy
of facial skeleton. - Structure and development of teeth and Dentofacial anomalies.
1.4 Harvesting of bone
grafts (including cranial
bone).
2
Craniofacial anomalies
- Principles of craniofacial surgery.
- Craniofacial clefts.
Tessier’s clefts classification. - Craniosynostosis - syndromic
and non-syndromic - Hypertelorism.
- Craniofacial microsomia.
- Craniofacial distraction.
- Hemifacial atrophy.
- Treacher-Collins Syndrome.
- Pierre Robin sequence.
- Other craniofacial syndromes, e.g.- Binders
syndrome etc.
2.11 Distraction osteogenesis
- Distractors and craniofacial fixation
devices. - Embryology of head and neck.
- Embryogenesis of cleft
lip and palate. - History and evolution of techniques in Cleft surgery.
- Classification of Clefts
- Unilateral Cleft lip
- Bilateral Cleft lip
- Cleft Palate
- Alveolar Clefts
- Secondary deformity
correction in clefts - Management of palatal
fistula - Flaps in clefts- Abbe flap, Tongue flap, buccal flaps, free flaps etc.
- Secondary cleft nose correction
- Orthodontics in Cleft lip and Palate.
- Midface skeletal evaluation and corrections and Orthognathic surgery
3
Cleft Lip and Palate
3.15 Distraction in Clefts.
- Velopharyngeal incompetence.
- Speech therapy in cleft lip and palate.
- Middle ear management in Cleft palate
3.19. Antenatal diagnosis
and management.
4
Maxillofacial Trauma
- Dentofacial anatomy, occlusions, various terminologies.
- ATLS protocols.
- Management of Airway and acute care.
- Evaluation of injuries,
imaging, principles of treatment. - General principles of facial soft tissue injury repair.
- Management of soft tissue injuries of specific regions
of the face. - Facial nerve injuries
and management. - Restoration of anatomical subunits
of face. - Incisions to access the craniofacial skeleton.
- Access osteotomies to the skull base.
- Skeletal Fractures
–Principles and management - Fracture Mandible and condyle fractures.
- Midface fractures: maxilla, nasal bone,
NOE complex - Naso-Orbito-Ethmoid injuries.
- Nasal bone
fractures. - Frontal bone
fractures. - Zygomatic complex fractures.
- Management of Panfacial
injuries. - Management of dento-alveolar injuries.
- Fracture reduction and different modalities of skeletal
stabilization; AO principles. - Primary and secondary bone grafting of the facial
skeleton. - Avulsion injuries of face.
- Gunshot injuries
of face. - Paediatric Facial fractures.
4.25. Management of facial fractures in elderly and edentulous jaw.
5
Maxillofacial Disorders
- Temporomandibular
joint: Ankylosis, Hypermobility, dislocation. - Temporomandibular joint
pain, dysfunctions. - T. M Joint Reconstruction.
- Obstructive sleep apnoea –
Evaluation, planning and management. - Principles of osteointegration and Implantology.
- Craniofacial and Maxillofacial Prosthetics.
- Craniofacial Implants and retained prosthesis.
- Radiological imaging
5. Head and Neck
Surgery A Head and Neck Tumors
- Benign and Malignant
tumors of Head and Neck. - Tumors of oral cavity, oropharynx and Mandible.
- Jaw tumours, lesions
and cyst. - Principles of Reconstruction
4.1 Principles of reconstruction of Cancer of upper Aerodigestive system
4.2 Reconstruction of the Mandible
and Maxilla
- Tumors of skin
- Benign skin tumors of the Head and neck
6.2 Malignant skin tumors
of the Head and Neck
- Paediatric head and neck tumours.
B
Head and Neck reconstruction by region
- Reconstruction of Scalp and Calvarium
- Reconstruction of the Nose
- Reconstruction of the Eyelids and Orbit
- Reconstruction of external
ear - Reconstruction of the Lip and commissure
- Cheek reconstruction
- Tongue reconstruction
- Reconstruction of pharynx
and oesophagus
C
Principles Skull Base Surgery
- Vascular malformations of head and neck E Infections
of the Head & Neck - Infection of the Cervical spaces
- Ludwig's angina
- Post Hansen's deformities of the face
- Cancrum oris/ Mucor mycosis
6.
Breast
- Diagnosis of Breast Cancer
2
Oncoplastic Surgery
3
Management of Carcinoma Breast
- Nipple and Areola
Reconstruction - Congenital Anomalies of The Breast
6
Tuberous Breast
- Poland's Syndrome
8
Fat Grafting in The Breast
- Reduction Mammoplasty 10 Mastopexy
- Augmentation Mammoplasty and Breast Implants
- Anaplastic Large Cell Lymphoma
and Breast Implants
(ALCL) 13 Gynaecomastia.
7.
Hand and Upper Extremity
1
Regional anatomy
and principles
1.1 Functional anatomy
of hand
- Biomechanics of the Hand
1.3 Regional anaesthesia in upper limb surgeries
- Examination of hand and upper limb
1.5 Diagnostic
imaging of hand and upper
extremity
2
Traumatic disorders
of hand
2.1 Fingertip and nail injuries
- Anatomy of the skeleton
of the hand and fractures of the hand and wrist - Flexor tendon injuries of the Upper Limb
2.4 Extensor tendon
of the Upper Limb
2.5 Mutilating injuries
of the Upper extremity
2.6 Amputation and Prothesis
2.7 Thumb reconstruction
- Acute nerve injuries and repair
2.9 Compartment syndrome
of the Upper limb
- Paediatric upper extremity trauma and reconstruction.
3
Non-traumatic disorders of upper extremities
3.1 Infections of hand
3.2 Dupytrens disease
- Rheumatoid arthritis of the Hand
3.4 Compression neuropathies of upper extremity
- Hand ischemia
and Volkmann’s ischemic
contracture - Complex Regional
Pain Syndrome
3.7 Tumors of the upper limb.
4.
Congenital disorders of hand and upper extremities
4.1 Embryology, classification and principles.
4.2 Common congenital hand anomalies.
- Vascular anomalies of upper extremity.
5
Miscellaneous
5.1 Comprehensive management of burned hand.
- Occupational hand disorders
5.3 Management of the stiff
hand
5.4 Management of the Spastic
hand
- Management of upper extremity in tetraplegia.
5.6 Hand therapy.
8.
Trunk and Lower Extremity
1
Lower Extremity
1.1 Comprehensive Lower
Extremity Anatomy
- Management of Lower Extremity Trauma
1.3 Lower Extremity Sarcoma Reconstruction
- Reconstructive Surgery:
Lower Extremity Coverage/Composite reconstruction
1.5 Diagnosis and Treatment of Painful Neuroma
and of nerve
compression in the lower extremity
1.6 Lower Extremity
Composite Reconstruction
- Foot Reconstruction.
2
Trunk Reconstruction
2.1 Comprehensive Trunk
Anatomy
2.2 Reconstruction of chest
- Reconstruction of the soft Tissues
of the back - Abdominal Wall reconstruction.
3
Reconstruction of Genitalia
3.1 Reconstruction of Male Genitalia
- Reconstruction of acquired vaginal
defects
3.3 Gender identity
disorders and disorders of sex development.
4
Pressure Sores
- Perineal Reconstruction
9.
Aesthetic Surgery
1. Aesthetic surgery practice
1.1. Setting up an aesthetic
surgery practice
- Preoperative analysis and surgical Planning
in aesthetic surgery - Psychological assessment &
specialist referrals
1.4. Obtaining informed
consent and patient
counselling
1.5. Clinical photography, documentation and record keeping
- Dealing with complications and unsatisfied patients
1.7. Communication and team
building
- Ethics and medico-legal aspects of aesthetic
surgery - Anaesthesia for aesthetic surgery:
general and regional
nerve blocks - Care and maintenance of instruments sterilization and infection control
practices.
2.
Age related changes & rejuvenation
A. Facial ageing
- Anatomy of the face relevant
to aesthetic surgery
and injectables (soft tissues and skeletal)
2.2. Ageing of the face- skin, soft tissues and skeleton.
B. Facial rejuvenation
- Non-surgical skin care and rejuvenation topicals
and cosmeceuticals
2.4. Cutaneous resurfacing - chemical peel, surgical dermabrasion
- Regenerative medicine: platelet rich plasma,
mesenchymal stem cells and
their aesthetic applications
2.6. Laser: physics,
tissue interactions and various clinical
applications
- Other
energy based devices: radio-frequency and ultrasound: their application in skin tightening and
body contouring. - Forehead lift:
endoscopic and surgical
2.9. Brow lift
- Blepharoplasty: upper and lower
2.11. Oriental blepharoplasty
2.12. Secondary blepharoplasty
2.13. Thread lifts:
science, indications, technique
complications
- Various facelift techniques: minimal access cranial
suspension (macs)
subcutaneous lift, Smas-platysma plication, extended Smas, subperiosteal lift - Secondary deformities from facelift surgery.
3.
Aesthetic skeletal
surgery
- Facial skeleton: male and female.
Age related changes in the facial skeleton
3.2. Facial skeletal
augmentation: bone graft and
implants
- Facial masculinisation and feminisation surgeries
3.4. Anthropometry, cephalometry, orthognathic surgery.
4.
Soft tissue fillers
4.1. Chemical composition and application of soft tissue fillers
- Temporary, semi-permanent, permanent fillers
vascular and other
complications of fillers.
5.
Botulinum toxin
5.1. Botulinum toxin:
science, indications, techniques, complications.
6.
Incisions and scars
- Resting skin tension lines
and their relation
to incision placement and scar revision.
6.2. Non-surgical management of incisions and scars
6.3. Surgical management of scars of the face and other
regions.
7.
Rhinoplasty
7.1. Nasal anatomy,
physiology and assessments
- Rhinoplasty: aesthetic and functional, open and closed,
reduction and augmentation
7.3. Structural and preservation rhinoplasty
7.4. Tip-plasty
- The deviated/
crooked nose and cleft rhinoplasty - The septum in rhinoplasty
7.7. Secondary rhinoplasty.
8.
Lip
8.1. Augmentation
8.2. Reduction
9.
Fat grafting
- Structural fat grafting:
principles, extraction, preparation & injection techniques. Micro, milli & nano fat grafting. indications and complications. - Autologous fat grafting: biology,
volumetric & non-volumetric effects of fat grafts - Platelet rich plasma, platelet
rich fibrin, nano-
fat grafting.
10.
Liposuction
- Principles and composition of various wetting
solutions & safety
issues - preoperative planning,
postoperative care - Lipo-structuring- concept,
applications, 7 techniques- power assisted
liposuction (PAL), ultrasound assisted liposuction (UAL), laser assisted
liposuction, cryo-lipolysis
10.4. High definition lipostructuring
10.5. Face liposuction and lipolysis
- Axillary contouring and axillary breast
management - Gynaecomastia correction
- Recent techniques- Vaser, radio
frequency, j plasma skin tightening - Large volume
liposuction.
11.
Body contouring surgeries
- Obesity & massive weight
loss (MWL) and post bariatric
surgery weight loss - Management of high BMI patients
11.3. Body and limb contouring procedures: brachioplasty,
belt lipectomy, lower body lift,
upper body lift,
thigh plasty, buttock
lift: assessment, indications, techniques & complications.
12.
Abdominoplasty
12.1 anatomy and blood
supply
- Standard abdominoplasty & variants
- High tension lateral abdominoplasty, mini abdominoplasty, extended lipo-abdominoplasty
12.4. Neo-umbilicoplasty
12.5. Correction of divaricated recti, ventral hernia,
mesh repair.
13.
Implants and augmentation
13.1. Implant biology
13.2. Buttock augmentation, calf augmentation.
14.
Aesthetic genital
surgery: male & female
14.1. Anatomy & embryology
- Analysis and planning, anatomical and functional corrections
- Penile, scrotal,
vaginal, vulval, mons pubis surgical
procedures.
15.
Hair restoration
- Scalp anatomy
and pathology biology
of the hair follicle from the surgical perspective
15.2 Patterns of hair loss
15.3 Tools for evaluation of hair quality-
TrichoScan, densitometry etc.
- Management protocols for alopecia. Medical restoration
- Various techniques of restoration including strip
harvest (FUT), (FUE)
15.6 Body hair transplant (non-scalp donor harvest)
15.7 Surgical correction of baldness
15.8 Eyebrow, moustache, beard hair transplantation.
16.
Other aesthetic procedures
16.1. Aesthetic jewellery
piercing
- Cheek dimple
creation
16.3. Buccal fat pad removal
- Ear lobe: repair, augmentation, reduction.
TEACHING AND LEARNING METHODS
GENERAL PRINCIPLES:
The syllabus has been designed to ensure
competency-based training of the student during the 3 years. This will cover the Cognitive, Psychomotor and Affective domains.
The training will essentially be self-directed and
revolve around practical skills acquired from
graded patient care responsibilities and formal academic sessions.
Trainees are expected to be fully
conversant with the use of computers (documentation, editing and presentation
software (word, power point, excel etc.)) and be
able to use databases like the Medline,
PubMed etc.
PATIENT CARE RESPONSIBILITIES:
The student will be posted
in the OPD, Wards, Operation theatres
and the Emergency
medicine where he will participate in patient care responsibilities
- History taking,
- Clinical Examination,
- Documentation : Clinical
notes, Clinical photographs, - Progress notes,
- Order and interpret relevant investigations,
- Treatment planning,
- Make a
pattern of the treatment plan where indicated, - Counsel the patient or relatives regarding the procedure to be undertaken,
- Take informed consent,
- Assist or perform
the surgical treatment, - Coordinate care and
rehabilitation with other ancillary departments.
FORMAL ACADEMIC
SESSIONS:
Below is a suggested Academic
schedule that could be
followed:
Sr. No.
Description
Frequency
1
Subject seminars
Once a week
2
Journal club
Once in two weeks
3
Didactic lectures by faculty
Once a month
4
Bedside teaching
As and when
feasible
5
Clinical rounds
Once a week
6
Structured interactive group
discussions (Including buzz sessions, debates,
problem-based learning
etc)
Once a week
7
Case Presentation and Treatment Planning
Once a week
8
File Audit/Statistic Meet/Mortality and
Morbidity Audit
Once month
9
Cadaver dissections
As and when
possible/
Once a week
10
Skills Laboratory
- Microvascular laboratory
- Craniofacial
techniques/ fracture fixation iii). Simulator based
Daily/ Weekly/ Once a month (as per requirement)
11
Grand Round/Interdepartmental Meet
Once a month
The following
things have to be considered in the formal teaching program
- PG
students shall be required to participate in the teaching and training
programme of Undergraduate students and interns. - The department should
encourage e-learning activities.
EXTERNAL POSTINGS:
As it is not possible for all departments to expose the
student to all aspects of Plastic and reconstructive surgery, it is recommended (if permissible) that the student be permitted external
postings to departments of excellence in various subspecialties for a
period of 2 weeks to a month at a
time, a total of three months being permitted during a period of 3 years. This
is provided that the student has shown the required
progress and worked to the satisfaction of the
faculty members and head of the department, availability
of permissible leave of absence as per the concerned University
Rules & Regulations.
The sub-speciality where posting may be done would include:
- Burns
- Hand surgery
- Microvascular surgery
- Aesthetic surgery
- Cleft and craniofacial surgery
- Others as deemed useful by the HOD and student
i.
Orthopaedics
ii.
Anaesthesia
iii.
Oncosurgery
iv.
Radiodiagnosis
PAPER PRESENTATION AND PUBLICATION (Compulsory)
A postgraduate student
would be required
to present one poster, read one paper at a national/state conference and to present one research paper which should be published/accepted for publication/sent for publication during the period
of his postgraduate studies so as to make him eligible to appear at the
postgraduate degree examination.
RESEARCH METHODOLOGY/ THESIS: (Optional)
It is desirable for the trainee to take up a thesis during their
posting and complete
it before their
training ends.
During the training
programme, patient safety is of paramount importance; therefore, skills are to be learnt initially on the
models, later to be performed under supervision followed by performing independently. For this purpose, provision of skills laboratories in medical colleges is mandatory.
ASSESSMENT
GENERAL PRINCIPLES
Internal Assessment should be frequent, cover all
domains of learning and used to provide feedback
to improve learning; it should also cover professionalism and communication
skills. The Internal Assessment should be conducted in theory and practical/clinical examination.
FORMATIVE ASSESSMENT
Formative assessment should be continual
and should assess
medical knowledge, patient
care, procedural &
academic skills, interpersonal skills, professionalism, self-directed learning
and ability to practice in the system.
INTERNAL ASSESSMENT
The student to be assessed periodically as per categories listed in postgraduate student appraisal form (Annexure I).
QUARTERLY ASSESSMENT
1.
Patient based:
- Documentation of case records
- Progress notes
iii.
Clinical photographs
- Laboratory or Skill
based learning: - Cadaver dissection
- Microvascular laboratory
- Learning on simulation models
3.
Self-directed learning and teaching:
- Seminar: departmental
- Journal based / recent advances
learning
iii.
Case presentation and treatment planning.
The department could also conduct an annual assessment
on the lines of the final Summative assessment.
SUMMATIVE ASSESSMENT: Assessment at the end of training.
The summative examination would be carried
out as per the Rules given in POSTGRADUATE MEDICAL
EDUCATION REGULATIONS, 2000.
The Post graduate examination shall be in two parts:
The examinations shall be organised based on ‘Grading’
or ‘Marking system’ to evaluate and to
certify post graduate student's level of knowledge, skill and competence at the
end of the training.
- Log book of work done during the training period including rotation postings, departmental presentations, and internal
assessment reports should
be submitted.
- At least
two presentations at national
level conference. At least one research paper
should be published/ accepted in an indexed journal. (It is suggested that the local or University Review committee assess
the work sent for publication).
There will be four theory papers
based on broad distribution, as below:
Paper I: General principles and basic sciences relevant to plastic and
reconstructive surgery.
Paper II: Clinical part I- Burns, Cleft and Craniofacial, Micro neurovascular and Brachial plexus, Hand and upper extremity
surgery
Paper III: Clinical part II- Aesthetic surgery,
Head and neck, Breast, Trunk,
Genitalia, Lower limb surgery
Paper IV: Recent Advances in Plastic and Reconstructive Surgery
- Clinical Examination
- Long
case: Should assess the students’ ability to diagnose a
complex condition, order and interpret
relevant investigations and plan the reconstruction of a composite defect. - Short
cases: 2 or 3: Each case would assess one or more aspects of one of
areas of reconstruction. - Ward
rounds: 4 cases: Assess the students’ ability to counsel a patient or
relatives about a procedure, possible
complications, expected results
and post-operative management. It could also assess his
ability to anticipate complications, prevent them and manage them should they occur.
2.
Viva voce
- Surgical planning
- Operative procedures
- Instruments
- Radiology: X-rays, CT scan,
- Osteology (Skull, Mandible,
Hand, Fibula) - Photographs based
viva.
LOG BOOK:
The student will maintain
a comprehensive log of:
- Cases operated- observed, assisted, performed
independently, - Seminars presented/ attended,
- Faculty lectures attended,
- Journal presentations
made and attended, - Conferences/webinars attended, and presentations made.
WORK RECORD: PHOTO ALBUM:
The student will maintain photographic documentation of the important
cases operated or assisted including
relevant post-operative follow up.
Recommended reading:
Books (latest
edition)
- Neligan, Peter C. Textbook of Plastic surgery.
Elsevier.
2.
Karoon Agrawal. Text book
of Plastic, Reconstructive and Aesthetic surgery
(6 volumes): Thieme
3. Kevin C. Chung, Grabb & Smith’s:
Plastic Surgery. Lippincott, Williams and Wilkins,
New York.
4.
Mathes, Stephen J.
Plastic Surgery (Vol. 1-8). London. W.B. Saunders.
5.
Mimis Cohen. Mastery of Plastic & Reconstructive Surgery
(Vol.1-3). Little, Brown & Co.
6. Alan D. McGregor, Ian A. McGregor.
Fundamental Techniques of Plastic Surgery.
Elsevier.
7. Berish Strauch,
Luis Vasconez, Charles
K. Herman, Bernard
T. Lee. Grabb’s
Encyclopaedia of flaps (2 Vol) .
8.
Fu-Chan Wei, Samir Mardini. Flaps and Reconstructive Surgery. Elsevier.
9. Scott W. Wolfe, William
C. Pederson, Scott H. Kozin,
Mark S. Cohen. Green’s Operative Hand Surgery (2 Vol.).
10. David N. Herndon,
Total Burn Care. Elsevier.
11. Sujatha Sarabhai. Principles & Practice
of Burn care. JP
Brothers.
12. Rajiv Sood, Bruce M. Achauer. Burn surgery- Reconstruction and Rehabilitation. Saunders Elsevier.
13. Raymond Fonseca.
Oral and Maxillofacial Surgery. Elsevier.
14. Robert Acland, S. Raja Sabapathy. Acland‘s
Practice manual for Microvascular Surgery. The Indian Society
for Surgery of The
Hand.
15. Prabha Yadav, Vinay Shankhdhar, Dushyant Jaiswal. Mastering Cancer Reconstructive Surgery with Free Flaps. JP Brothers.
Journals
03-05 international Journals and 02 national (all indexed) journals.
Student
appraisal form for M.Ch. in Plastic and Reconstructive Surgery
Element
Less than Satisfactory
Satisfactory
More
than satisfactory
Comments
1
2
3
4
5
6
7
8
9
1
Scholastic
Aptitude and Learning
1.1
Knowledge appropriate
for level of training
1.2
Participation and contribution
to learning activity e.g.,
Journal Club, Seminars, CME
etc)
1.3
Conduct of research and other
scholarly activity
assigned (e.g
Posters, publications etc)
1.4
Documentation of acquisition of competence
(eg Log
book)
1.5
Performance in
work
based assessments
1.6
Self Directed Learning
2
Care of the patient
2.1
Ability to provide patient care appropriate to level
of training
2.2
Ability to work with
other members of the health
care team
2.3
Ability to communicate appropriately and empathetically with
patients
families and care givers
2.4
Ability to do procedures appropriate for the level
of training and assigned role
2.5
Ability to record and document work accurately and
appropriate for level of
training
2.6
Participation and contribution
to health care quality improvement
3
Professional attributes
3.1
Responsibility
and
accountability
3.2
Contribution
to growth of learning of the team
3.3
Conduct that is ethical
appropriate and respectful at all times
4
Scholarship
4.1
Teaching and mentoring skills
appropriate to level
of training
4.2
Ability to formulate research questions, initiate conduct and
complete
research projects
4.3
Ability to review and use the published literature appropriately in care of
the patient lab or workspace
4.4
Ability to provide consultations to other specialties as may be
required
5
Space for additional comments
6
Disposition
Has this assessment been
discussed with
the trainee?
Yes
No
If not explain
Name and Signature of
the assesse
Name and Signature of
the assessor
Date
2 years 1 month ago
News,Health news,NMC News,Medical Education,Medical Colleges News,Medical Courses News,Medical Universities News,Medical Admission News,Latest Medical Education News,Medical Courses,Medical Courses Curriculum
Renal patients urged to be responsible to avoid complications
PEOPLE who need care related to renal challenges are being urged to do what is recommended by health-care professionals in a bid to not worsen the issues they face.
The plea was made on Thursday by Michelle-Ann Blake-Rodney, a certified nephrology nurse at Cornwall Regional Hospital in St James.
PEOPLE who need care related to renal challenges are being urged to do what is recommended by health-care professionals in a bid to not worsen the issues they face.
The plea was made on Thursday by Michelle-Ann Blake-Rodney, a certified nephrology nurse at Cornwall Regional Hospital in St James.
Thursday was designated World Kidney Day, and Blake-Rodney used the opportunity to call on Jamaicans facing renal challenges to be responsible with their actions in relation to their health.
"They have their responsibilities when they go home. When they come here we are removing fluid, we are removing toxins, and so when they go home they have to remember to not exceed the fluid amounts recommended, among other things," said Blake-Rodney.
"When they exceed the fluid amounts they are unable to clear the excess amount through urination and [so] it backs up on them, leading to swollen parts of the body because of what they drinking," added Blake-Rodney.
She noted that the renal department at Cornwall Regional Hospital currently provides dialysis care for some 50 to 55 patients each day but that this is still not enough, and so people need to realise that they have a very important role to play in protecting their own interests.
"Sometimes the time that we give on the machine is not always enough to remove everything and so when they go back they have a responsibility to control what they drink, what they eat," explained Blake-Rodney.
She lamented that some individuals, despite knowing the consequences of their actions, still act contrary to the recommendations. She warned that when they do this it will have a negative impact.
"We try to give them tips: Yes, the time is hot now but instead of drinking so much, eat some ice. Freeze the things that you have so at least you know the water content is not so much but at least you're still taking in fluid," she explained.
"We try to tell them watch the foods that are high in potassium — the banana, the coconut water. Sometimes, unfortunately, they die, not because of renal failure but because of their diet," Blake-Rodney added.
Medication is also a big part of the responsibility for people facing renal challenges and Blake-Rodney argued that they need to ensure they follow the requirements to protect their well-being.
"I know that it is hard but they have to remember: We can do so much and no more with what we have, such as the machines," highlighted Blake-Rodney.
The Cornwall Regional Hospital is the only facility in the western end of Jamaica that provides renal care at no cost to patients, and Blake-Rodney pointed out that the facility now has more than 100 patients being treated but the waiting list is more than that, with just under 500 people waiting to get access to those facilities.
She, however, explained that the facility works as best as possible to accommodate different patients, especially those with emergency issues, with some coming from outside the region as well.
Dialysis is a treatment that helps the body remove extra fluid and waste products from the blood when the kidneys are not able to.
Blake-Rodney noted that the medical team at the hospital has been working to educate patients as part of the programme. On Thursday patients were treated to a lecture on renal osteodystrophy (a complication of chronic kidney disease that weakens bones), and the steps they can take to address it.
Today there will be a blood drive in Sam Sharpe Square, St James, as the hospital moves to increase its supply of blood, which is sometimes used to treat people with renal issues.
2 years 1 month ago
PAHO says COVID-19 not yet over in region
WASHINGTON, DC, United States (CMC) — The Pan American Health Organization (PAHO) is calling on countries in the Americas, including the Caribbean, to strengthen surveillance and bridge gaps in COVID-19 vaccination coverage so as to end the emergency and better prepare for future health crises.
PAHO Director Dr Jarbas Barbosa made the call as the novel coronavirus pandemic, linked to millions of deaths and infections worldwide, entered its third year.
Over the past three years the Americas had more than 190.3 million COVID-19 cases and over 2.9 million deaths, accounting for 25 and 43 per cent of the global total, respectively.
"The pandemic underscored that no country or organisation in the world was fully prepared for the impact of this pandemic," Dr Barbosa told a news conference, adding this includes the Americas which is a region "marked by inequities".
The PAHO director said currently, incidence rates are 20-30 times lower than a year ago and so "while we are not totally out of the woods, we are in a much better place".
He highlighted the key role PAHO played in helping countries, including building and strengthening the COVID-19 Genomic Surveillance Regional Network which is key to tracking the evolution of the virus, as well as monitoring for other pathogens with pandemic potential, including avian flu.
Over the past three years the network has facilitated the uploading of more than 580,000 sequences from Latin America and the Caribbean into global databases.
Dr Barbosa also spoke of the role PAHO played in acquiring COVID-19 vaccines and "mobilising more than 160 million doses through COVAX, and helping the countries of Latin America and the Caribbean roll out more than 1.3 billion vaccine doses in less than two years".
But he acknowledged that, despite these achievements, "COVID-19 is still with us and the virus has yet to settle into a predictable pattern".
"Throughout the last month we have seen more than 1.5 million new cases and 17,000 deaths. We cannot be complacent," he warned, adding that while testing rates have dropped it is crucial that countries maintain and continue to strengthen surveillance as the SARS-CoV-2 virus "can evolve and adapt quickly".
Reaching the 30 per cent of people who have yet to receive their primary series of the COVID-19 vaccine is also key to "preparing ourselves for any new wave of infection or new variant of concern".
He said while the region has experienced a variety of setbacks throughout the pandemic that have "revealed or exacerbated weaknesses in our health systems" — including in the detection and treatment of diseases such as tuberculosis and HIV, in the testing and treatment of noncommunicable diseases, and in declining rates for routine vaccination — we now have a unique opportunity to "place health at the centre of the Sustainable Development Agenda.
"We must focus on recovering losses and on rebuilding resilient health systems that work for everyone, as well as being better prepared for future health threats," the PAHO director said, noting "as I begin my tenure, a primary focus is to help countries of the Americas move past the COVID-19 pandemic".
"PAHO stands ready to support our countries in the Americas to learn from and apply the lessons we have learned from the COVID-19 pandemic," he said.
2 years 1 month ago
Experts hold a Forum to discuss COVID-19 in the Dominican Republic
This Friday the “COVID-19 Forum, lessons learned in the pandemic” began, which aims to generate a proactive national reflection on the management carried out by the country.
In Event Hall A of the Pontificia Universidad Católica Madre y Maestras (Pucmm), the venue of the event, its rector, Presbítero Secilio Espinal, highlighted prior to the invocation the role played by higher education institutions, schools, and colleges in a moment of “uncertainty”, as the one experienced in the Covid-19 pandemic. “Higher Education institutions saw the need to design policies and procedures, as well as organize the different environments for the development of academic, administrative, research, and extension activities with the highest possible quality, preserving physical and emotional health of those involved,” Espinal said.
Secilio Espinal added that a great innovation in the educational field was the implementation of the Flipped Classroom teaching-learning Methodology, aimed at guaranteeing a competency-based approach and meaningful learning, ensuring that the student uses time outside the classroom to learn theory and concepts independently, and time within class sessions to apply, analyze, evaluate, and create knowledge. He also called for a minute of silence for all those who have died from the virus. Immediately afterward, the director of the newspaper Listín Diario, Miguel Franjul, gave some introductory words for reflection in which he reaffirmed the commitment assumed by the authorities and citizens of the nation at that moment of crisis, taking the case of the same medium.
“The Listín Diario sighted what could come here and since February 5 it has focused on this threat. In this forum, it is necessary for the population to know how we accepted it, how we reacted, to what extent we were resilient… which gave rise to the idea of holding this forum last December,” said Franjul. Franjul took advantage of the moment of his address to thank the Minister of Public Health, Dr. Daniel Rivera, for making an appointment and collaborating so that many health specialists and experts could come to explain his ideas; in addition, to the scientists, academics, and authorities who decided to participate. He also paid tribute to the doctors and nurses for their hard work.
Then Dr. Daniel Rivera, in his opening remarks, stated that the Dominican Republic has been a benchmark for management in all areas of the COVID-19 pandemic for other countries, a feat that has even been recognized internationally. At least five exhibitors and 11 panelists will present the experiences and actions adopted by the country in the face of the pandemic. The first speakers will be Dr. Mario Lama and Chanel Rosa, director, and deputy director of the National Health Service (SNS), respectively, under the moderation of Eddy Pérez Then, director of the Research Center and presidential adviser for COVID-19.
2 years 1 month ago
Health, Local
Biden Budget Touches All the Bases
The Host
Julie Rovner
KHN
Julie Rovner is chief Washington correspondent and host of KHN’s weekly health policy news podcast, “What the Health?” A noted expert on health policy issues, Julie is the author of the critically praised reference book “Health Care Politics and Policy A to Z,” now in its third edition.
President Joe Biden’s fiscal 2024 budget proposal includes new policies and funding boosts for many of the Democratic Party’s important constituencies, including advocates for people with disabilities and reproductive rights. It also proposes ways to shore up Medicare’s dwindling Hospital Insurance Trust Fund without cutting benefits, basically daring Republicans to match him on the politically potent issue.
Meanwhile, five women in Texas who were denied abortions when their pregnancies threatened their lives or the viability of the fetuses they were carrying are suing the state. They charge that the language of Texas’ abortion ban makes it impossible for doctors to provide needed care without fear of enormous fines or prison sentences.
This week’s panelists are Julie Rovner of KHN, Shefali Luthra of The 19th, Victoria Knight of Axios, and Margot Sanger-Katz of The New York Times.
Panelists
Victoria Knight
Axios
Shefali Luthra
The 19th
Margot Sanger-Katz
The New York Times
Among the takeaways from this week’s episode:
- Biden’s budget manages to toe the line between preserving Medicare and keeping the Medicare trust fund solvent while advancing progressive policies. Republicans have yet to propose a budget, but it seems likely any GOP plan would lean heavily on cuts to Medicaid and subsidies provided under the Affordable Care Act. Democrats will fight both of those.
- Even though the president’s budget includes something of a Democratic “wish list” of social policy priorities, the proposals are less sweeping than those made last year. Rather, many — such as extending to private insurance the $35 monthly Medicare cost cap for insulin — build on achievements already realized. That puts new focus on things the president has accomplished.
- Walgreens, the nation’s second-largest pharmacy chain, is caught up in the abortion wars. In January, the chain said it would apply for certification from the FDA to sell the abortion pill mifepristone in states where abortion is legal. However, last week, under threats from Republican attorneys general in states where abortion is still legal, the chain wavered on whether it would seek to sell the pill there or not, which caused a backlash from both abortion rights proponents and opponents.
- The five women suing Texas after being denied abortions amid dangerous pregnancy complications are not asking for the state’s ban to be lifted. Rather, they’re seeking clarification about who qualifies for exceptions to the ban, so doctors and hospitals can provide needed care without fear of prosecution.
- Although anti-abortion groups have for decades insisted that those who have abortions should not be prosecuted, bills introduced in several state legislatures would do exactly that. In South Carolina, those who have abortions could even be subject to the death penalty. So far none of these bills have passed, but the wave of measures could herald a major policy change.
Also this week, Rovner interviews Harris Meyer, who reported and wrote the two latest KHN-NPR “Bill of the Month” features. Both were about families facing unexpected bills after childbirth. If you have an outrageous or exorbitant medical bill you want to share with us, you can do that here.
Plus, for “extra credit,” the panelists suggest health policy stories they read this week that they think you should read, too:
Julie Rovner: KHN’s “Girls in Texas Could Get Birth Control at Federal Clinics, Until a Christian Father Objected,” by Sarah Varney
Shefali Luthra: The 19th’s “Language for Treating Childhood Obesity Carries Its Own Health Risks to Kids, Experts Say,” by Jennifer Gerson
Victoria Knight: KHN’s “After People on Medicaid Die, Some States Aggressively Seek Repayment From Their Estates,” by Tony Leys
Margot Sanger-Katz: ProPublica’s “How Obamacare Enabled a Multibillion-Dollar Christian Health Care Cash Grab,” by J. David McSwane and Ryan Gabrielson
Also mentioned in this week’s podcast:
- The New York Times’ “The Programs You’d Have to Cut to Balance the Budget,” by Alicia Parlapiano, Margot Sanger-Katz, and Josh Katz
Click to open the transcript
Transcript: Biden Budget Touches All the Bases
KHN’s “What the Health?”Episode Title: Biden Budget Touches All the BasesEpisode Number: 288Published: March 10, 2023
[Editor’s note: This transcript, generated using transcription software, has been lightly edited for style and clarity.]
Julie Rovner: Hello and welcome back to KHN’s “What the Health?” I’m Julie Rovner, chief Washington correspondent at Kaiser Health News. And I’m joined by some of the best and smartest health reporters in Washington. We are taping this week on Friday, March 10, at 10 a.m. As always, news happens fast, and things might have changed by the time you hear this. So here we go. Today we are joined via video conference by Shefali Luthra of The 19th.
Shefali Luthra: Hello.
Rovner: Victoria Knight of Axios News.
Victoria Knight: Hi. Good morning.
Rovner: And Margot Sanger Katz of The New York Times.
Margot Sanger Katz: Hello, everybody.
Rovner: Later in this episode we’ll have my “Bill of the Month” interview with Harris Meyer. It’s a twofer this time: two successive bills from two different families related to having a baby. But first, this week’s news. We are taping on Friday this week because President [Joe] Biden released his budget Thursday afternoon, and it felt weird to have a news podcast without talking about the budget. And yes, like most presidential budgets since the 1980s, this one is, quote-unquote, “dead on arrival” on Capitol Hill. But one thing the president’s budget does is provide a pretty-detailed look at the administration’s priorities and policy initiatives. Which health program stuck out to you as getting a publicity, if not an actual funding, boost in this document? Victoria, you were looking at the budget.
Knight: Yeah. My colleagues at Axios and I spent several hours yesterday morning going through the budget. I think it was really interesting because I think he was trying to toe the line between “we want to save Medicare, make sure it stays solvent,” but also “we want to push some more progressive ideas as well.” So there’s kind of both things in there. Some obvious things: He wants to permanently extend the enhanced tax credits for the ACA [Affordable Care Act] — so, make permanent those subsidies. Those expire, currently, at the end of 2025. He also wanted to do something called Medicaid-like coverage for eligible people in states that haven’t expanded Medicaid. And then he also wants to expand the number of drugs to be negotiated under the IRA [Inflation Reduction Act] and also move up the timeline a little bit. So, just an example: It’s supposed to be 10 drugs to be negotiated in 2026. And now he wants to do 20. Something also really interesting: [He] wants to do like a Netflix-like subscription service for hepatitis C to basically eradicate hepatitis C within the U.S.
Rovner: I thought that was maybe the most interesting thing in this budget because it’s something that we just hadn’t heard of before.
Knight: Yeah.
Rovner: That, basically, I mean, these hepatitis C drugs were really expensive when they first came out and there was concern that Medicaid programs, in particular, were going to have trouble paying for them because many of the people who have hepatitis C are intravenous drug users, and they’re more likely to get hepatitis C — or people in prison. Lots of people on Medicaid who have hepatitis C. And this would basically be a way to pay in advance for the drugs. Is that essentially what they would do?
Knight: Yeah. And I think it’s also interesting that it at least has one Republican senator — Bill Cassidy is super into this idea. He did something similar in Louisiana. I’m not sure there’s other Republicans that are on board for that, but I thought that was really interesting. You know, of course, he was talking about extending the $35 insulin cap to the commercial market. There’s some other stuff about behavioral health, pandemic preparedness. One other thing Shefali will appreciate also, he proposed increasing Title X family planning funding by almost 80% from 2023 levels, which I think — Shefali, maybe you know — [is] one of the highest increases they’ve ever proposed, in a while at least.
Luthra: Yeah, the family planning clinics, interest groups, etc., were very, very happy about this proposal, even if they know it will not become reality. I think their sense was this was a commitment that would be really transformative for them, especially now, when they are so tightly funded.
Rovner: I did notice that for a president who has not technically said that he’s running again, some of these targeted increases were for some of the very important interest groups who have been kind of, I won’t say whining, but complaining. You know, Title X had not gotten big increases since Biden became president. There’s an initiative for more money for home- and community-based care in Medicaid, which is something, again, there’s an active constituency for in the Democratic Party; the “Cancer Moonshot,” you know, which has obviously been something near and dear to President Biden’s heart; also more money … also, the [American] Cancer Society sent out a lot of emails yesterday saying, yay, thanks for proposing this big budget increase. So there does certainly seem to be a lot of touching of the important constituencies, perhaps in anticipation of reelection campaign?
[Three panelists chime in at once.]
Luthra: Julie, you forgot …
Sanger-Katz: I would say …
Knight: And I think he did … Go, Margot!
Rovner: One at a time! [laughing all around] Margot, you go first.
Sanger-Katz: I would say so. And I would also just point out that the Medicare policies in the bill were previewed by the White House a couple of days before the budget release, and they were, like, the main thing. This is what they were leading with. The president had an op-ed in The New York Times describing his Medicare policies, and they put out a fact sheet with a lot of the Medicare policies. And I think it really reflects this notion that improving the solvency of Medicare and also committing to not really cutting the core services of Medicare, that this is a very key political message that the president cares about, that the president wants to run on, and that he thinks is a very useful contrast with what some Republicans have proposed in the past and what he imagines they might want to propose as House Republicans get ready to release their own budget, which faces some difficult constraints because Speaker [Kevin] McCarthy has promised certain members that the budget that they will pass will be a balanced budget. And that’s quite hard to do without touching the big health care programs.
Rovner: Yeah. Republicans have not promised not to touch Medicaid, which now the president has been very careful to say, “It’s not just Medicare and Social Security. I’m not going to let you cut Medicare, the Affordable Care Act either.” All right, Victoria, you wanted to say something?
Knight: I think — it was also interesting that, I do think, the president did want to push forward some of the more progressive policies that … the progressive base care about, such as doing more negotiating of drugs; something Sen. Bernie Sanders (I-Vt.) has talked a lot about is the community health centers program; expanding Medicaid, home- and community-based services; … and the insulin price cap — things that I think the progressive base cares about as well. So I feel like, as you’re saying, that interest groups, but also the different bases and also the groups that care about reproductive health care, they want him to do something after Roe v. Wade. So it definitely was, like, this huge list of trying to cater to everyone.
Rovner: It’s kind of a Democratic wish list.
Sanger-Katz: At the same time, though, I think he did leave out some of the things that were part of the Build Back Better package. In the previous budgets, the president had gone even bigger on things that the progressive base wanted. And you can see a lot of things in this budget where he’s ticking those boxes, as you say. And I think a lot of policies that he has proposed in the past that he wasn’t able to get through the last Congress — but not all. It does seem like this budget is a little more focused on being able to reduce the deficit a little bit less on this very expansive notion of a robust federal government that is spending money to improve people’s lives in quite as many ways as the message that he has been proposing in his previous budgets. You can see, again, I think this is a pivot towards campaign mode, towards his assessment of the current political moment, growing concerns about the deficit and about inflation.
Rovner: But also, as you mentioned, Margot, they put out the Medicare part of this in advance, mainly because I feel like the Medicare part of the budget is not so much a part of, you know, the statement of the budget as it is a negotiating position for this whole fight we’re going to have over the debt ceiling in a couple of months, where the Republicans are going to want to demand cuts to programs basically in exchange for not letting the U.S. default on its debts. And what the president has managed to do here is say, “We’re going to lower the price of prescription drugs more, we’re going to tax the rich more. And those two things are going to a) reduce the deficit some and b) shore up the Medicare trust fund. So you can’t accuse me of not dealing with the impending problem of Medicare.” How much of a box does that actually put Republicans in when we start to get to these negotiations?
Sanger-Katz: I don’t know how much of a box it really puts them in for a couple of reasons. One is that some of what he’s proposing is really kind of an accounting gimmick. He’s taking money that is already flowing into the federal budget, that is already part of the dollars and cents of our deficit, and he’s just redirecting them from the general fund into the Medicare trust fund. So it is true that these proposals would extend the solvency of the Medicare Hospital Insurance Trust Fund, which is projected to run into some financial trouble in the coming decade. But it is not true that, like, all of the things that he’s proposing are actually new money. Some of it just comes out of other parts of the budget. It doesn’t change the deficit.
Rovner: So I will point out that that is a time honored way of extending the solvency of trusts.
Sanger-Katz: Oh, sure. I’m not saying that Biden is alone in doing that. But I just think there’s kind of three things he’s doing in this proposal. One of them is not deficit reduction. It’s just kind of moving money around. One is this drug price reduction proposal where he’s trying to get more savings by going more aggressively after more drugs. I think that is a place where he can put Republicans in a box a little bit. They’ve come out in opposition to the drug price negotiation provisions that were part of the Inflation Reduction Act that they passed last year. But those policies are super popular. The public really supports them. They feel like the pharmaceutical companies make too much money. They think that Medicare should be able to negotiate. So I think that’s a very politically shrewd decision that I think does demand potentially a response from Republicans as a possibility for deficit reduction. But then the third thing that he did is he really just raised taxes. You know, these are taxes on the rich; as Biden has been promising all along, he’s not going to raise taxes for people earning under $400,000 a year. So they’ve increased these payroll taxes, they’ve increased some investment taxes. There was kind of a loophole, a category of businesses that were not subject to that tax in the past. And, you know, I think those are basically nonstarters with Republicans. And when Republicans talk about deficit reduction, they often are very, very focused on cutting spending that the federal government does. They are much less interested in increasing taxes. And I do think that the fact that Biden led with this proposal, that he’s so comfortable talking about raising taxes as a core part of his platform, is a sign that the politics of tax cuts have changed a little bit, that that is … if you’re just taxing the rich, it seems like the public will accept that. Democrats seem actually excited about that in certain cases. But I still think tax increases are a hard political row to hoe. I think that it is not something that probably appeals to many Republican politicians. And I also think it’s probably not something that appeals to many Republican voters, either. So I don’t know that it really puts Republicans in a box in a meaningful way because they don’t feel any tension where their supporters will want them to do this thing.
Rovner: Obviously, this is a big fight yet to come. Victoria, you wanted to say something.
Knight: Yeah. I just want to add one thing. We did have, like, the first indicator: The House Freedom Caucus had a press conference this morning, and they didn’t give a lot of details, but they did say they want to restore Clinton-era work requirements for welfare programs. So they didn’t specify Medicaid, but it seems pretty likely that’s probably what they’re talking about. My colleagues and I did talk to some Republicans last week that were indicating they did want work requirements for Medicaid. So I think that seems like the very first. There’s going to be three different groups within the House Republican caucus that are going to release budgets: the Budget Committee, the House Freedom Caucus, the Republican Study Committee. So I think we are going to start seeing the outlines of what they want to do very soon. But that was kind of the first one coming out this morning, so …
Rovner: Yes, underscoring the fact that the Republicans don’t agree on what they want to do …
Knight: No.
Rovner: … which is why we haven’t seen their budget yet.
Knight: Exactly.
Rovner: Although I will point out President Biden’s budget was a month late, too.
Sanger-Katz: Can I just say one thing about the Republican budget? Because I actually spent a lot of time looking at various budget proposals and trying to examine this goal that the Republicans have of balancing the budget. Just like: How hard is it to balance the budget? And it turns out that it’s extremely hard. It’s sort of hard in a normal year. But in this post-covid era, when spending has been so elevated for so long, balancing the budget within a decade is just really, really, really hard. If you do it without raising taxes, which Republicans say they don’t want to raise taxes; if you do it without cutting defense spending, which Republicans say they don’t want to cut defense spending; if you do it without cutting Medicare or Social Security, which recently McCarthy has said he does not want to do — you end up just … this is just the basic math … having to cut everything else by 70%. That’s 7-0%. That is not the kind of cut that you can achieve even by imposing a work requirement on Medicaid, a work requirement on food stamps, and other kinds of policies that Republicans have proposed in the past. That is like deeply, deeply reducing the role of the federal government, you know, cutting Medicaid in more than half. Larry Levitt [KFF’s executive vice president for health policy] pointed out earlier this week reducing Medicaid spending by 70% probably means 50 million fewer people would have Medicaid coverage. And that’s just Medicaid. You’re talking about basically everything that the government does — environmental protection, law enforcement, military pensions, just about any program that you can think about in the government that’s not Medicare, Social Security, or direct defense spending. Seventy percent cut is quite hard to do. And so I am very curious to see what these budgets look like. I can tell you, having looked at some of the previous Republican proposals, that those all relied on some reductions to Medicare and Social Security because those programs represent such a large percentage of federal spending that if you don’t cut those at all, there’s just not a lot of dollars left. And in my reporting on this question, it does seem like one thing that the Republican Budget Committee is very likely to do is to use very aggressive assumptions about the economic growth that their policies will unleash. And so the idea is that if the economy grows by so much, then tax revenue, what increase all by itself, because people will be earning more money, and so that will enable them to balance the budget in 10 years without having to actually reduce the deficit by as much as independent scorekeepers like the Congressional Budget Office think would be necessary.
Rovner: Although I would point out that every time we’ve had one of these big tax cuts that Republicans say it’s going to grow the economy enough to pay for it, it has not grown the economy enough to pay for it.
Sanger-Katz: Indeed! You know, cutting everything that the government does by 70% probably actually would have a negative impact on the economy. People would be losing money. They would be losing their government jobs. These would be very large economic impacts that probably most economists do not think would lead to economic growth.
Rovner: Yeah, well, we will see. I will put, Margot, the nice story you did with your colleagues demonstrating all of this in chart form in the show notes. OK. Let us turn to abortion. We will start with Walgreens, poor Walgreens, caught in the maw of the abortion wars. In January, the FDA said that brick-and-mortar pharmacies for the first time could start dispensing the abortion pill, mifepristone, whose distribution had been tightly regulated since it was first approved more than 20 years ago. Almost immediately, both CVS and Walgreens, the country’s largest and second-largest pharmacy chains, announced they would apply for FDA certification to distribute the pills in states where abortion is still legal. Then, last month, 20 Republican state attorneys general, including at least four in states where abortion is still legal, warned CVS and Walgreens that if they send the pills by mail, they could be in violation of the 1873 Comstock Act, which we have talked about here before, which prohibited the mailing of items considered, air quotes, “obscene,” which at the time included information about birth control. Cut to last week when Walgreens appeared to cave to the pressure and the threat of legal action, saying it would not sell the pill in states where it’s illegal, not actually naming those states. Then, after a huge backlash, it tried to walk back its position a little, mostly leaving lots of questions. Shefali, what is your take on what Walgreens is and isn’t going to do now vis-a-vis mifepristone? They’ve kind of said both things.
Luthra: I think there’s a lot of layers here, but I want to go back to January for a moment, when we got that news from Walgreens and CVS so quickly that they would participate in providing mifepristone. Frankly, a lot of these folks that I spoke to were very surprised that [the pharmacies] reacted so quickly because carrying mifepristone in stock opens you up to really intense harassment, boycotts, protests from the anti-abortion movement. And we did see right away many of the premier anti-abortion movements calling for boycotts of Walgreens and CVS, for protests, etc. They have been organizing protests outside pharmacies right now. And there has been pressure from the beginning from governors like [Florida] Gov. Ron DeSantis instructing pharmacies not to stock the press down. The fact that Walgreens ultimately has caved in these states with hostile governments wasn’t surprising. If anything, it was surprising that it took quite so long. I am incredibly curious to see what happens with CVS and Rite Aid, the other two pharmacies that are now getting caught in the crosshairs, facing really intense pressure from lawmakers and politicians who support abortion access and also those who don’t. We saw in New York this week, the governor and the attorney general called on pharmacies to continue carrying mifepristone. Frankly, I’m skeptical that that really matters because there is no reason not to carry mifepristone in New York, a state where the government is very friendly to abortion.
Rovner: And we should point out, because this is my biggest frustration: Nobody’s actually doing it yet because nobody’s gotten certified yet.
Luthra: Correct.
Rovner: They’re not — all these headlines that said, “Walgreens is going to stop doing this.” It’s like, no, they’re going to not start doing this. Sorry.
Luthra: And we have no idea when they will get certified how long it would take. We have no idea, frankly, if mifepristone will still be able to be distributed in the country at that point, because we are still waiting on the ruling from this judge in Texas. We simply have so many open questions. And at this point, this really is more of an avenue for people to make statements about how they feel about abortion access, than it is actually affecting people’s ability to get care. The other statement grandstanding that I have been really struck by is what we’ve seen from the California governor, Gavin Newsom, who really does love to talk a lot about his pro-abortion rights bona fides, even if those statements don’t translate much into actual impact or policy. And what we saw this week was his promise that California wouldn’t do business with Walgreens if they wouldn’t stock mifepristone.
Rovner: And this is not just an idle threat in California, right? There’s a huge contract that he now says he’s not going to renew.
Luthra: So there is a contract. But friend of the podcast and former KHNer Sydney Lumpkin found the contract that Newsom was referring to. You would think it would be a significant amount of money, given how much attention it has gotten. It is a $54 million contract over five years. When you look at the overall market cap of Walgreens, a $30 billion company, it’s not clear exactly how meaningful that actually is compared to the pressure they are facing from lawsuits and the very powerful anti-abortion movement.
Rovner: So, and what … I mean, you referred to this, but what are we thinking that CVS and Rite Aid are going to do — having seen Walgreens literally put through the wringer here on this issue?
Luthra: I think that’s a really good question. I — I mean, coming into this week — had assumed that they would follow the path of Walgreens and do the exact same thing, right? Stock mifepristone, provide it with a doctor’s prescription in states where they are protected and face no legal risks, but perhaps not do so in those states where a) mifepristone is banned, as they have said they would not do. And also in states where, like Kansas, for instance, abortion is legal, but you have a very anti-abortion attorney general. It is quite interesting that they have not said either way what they will do beyond just, well we won’t do it in states where it’s illegal.
Rovner: Yeah, if I was advising CVS at this point, I would tell them to not say a word to anybody until some of this shakes out.
Luthra: Exactly.
Rovner: All right. Well, let us move on to Texas, where there is always abortion news. As Shefali mentioned, we have not had the decision yet on that abortion pill case out of Amarillo, but both sides are still going at it on other issues. Remember all those stories we’ve been chronicling about women with wanted pregnancies gone wrong who couldn’t get medical care until they were literally at death’s door or they went to another state? Well, five of them are suing the state of Texas, saying they should have been allowed to terminate their pregnancies under existing exceptions to the abortion bans, except that doctors and hospitals have been unwilling to risk giant fines and even jail time. The five women — some of whom are still pregnant, some of whom are not — want the state, whose officials continue to claim that these women were eligible for abortions in Texas if their lives were truly at risk, they want the state to clarify those exceptions even more. Is there any chance this happens? They’re not asking for the bans to be lifted. I mean, this is a kind of a unique lawsuit that we’ve not seen before because we’ve not seen that many women in this situation before.
Luthra: I think this is a pretty smart approach. I wouldn’t be surprised if it has better odds of success than, as you mentioned, a request to fully overturn Texas’ abortion bans because the exceptions are really unclear. Doctors do not feel safe talking about abortion, even in cases where it is likely that it would be very beneficial for the pregnant person, for a fetus that has really minimal chance of survival upon birth. One thing that Nancy Northup, the head of CRR [the Center for Reproductive Rights], said to me when I asked her is, depending on how this case goes, it is not at all unlikely that we see similar lawsuits filed in other states with abortion bans with similarly vague “life of the parent” exceptions that are, in reality, impossible to enforce. I think this is going to be the beginning of a very robust series of legal challenges to state abortion bans. And we’ll see better success for abortion rights lawyers in some states than in others — really depending on the makeup of these different states’ supreme courts.
Rovner: Yeah, I mean, it’s funny because over the years I’ve heard obviously lots of warning about this possibility, both from the Center for Reproductive Rights, which, as you say, is pushing this case, and other groups. But nobody could sue because nobody had standing, because it hadn’t happened. It was all theoretical. Well, now it’s happened and we have people to whom it is not theoretical, who are able to go to court and say, hey, this happened to us and it violated our rights and you need to do something about it.
Luthra: And I do want to add just one thing. I mean, it’s — I think we can’t understate just what these people have been through, the women who are suing Texas. I was just really struck by one woman who flew from Texas to Colorado for an abortion that she couldn’t get in state, paid extra for a seat by the airplane in case she went into labor on the flight, and said that she still has PTSD to this day from having to travel while afraid that she might go into labor and could die from it. Like, what these people are going through right now is just … it’s really difficult for us to imagine. And I think we’re just going to hear so many more stories that are really troubling about people whose lives have been so deeply put at risk, and they’re unable to get the care their doctors want to provide.
Rovner: Right. And I say for the 11th time, these are not women who got pregnant by accident and don’t wish to be pregnant. Many of these are women who’ve been through infertility treatment and were desperately anxious to be pregnant, were thrilled when they got pregnant, but whose pregnancy took a bad turn either for the fetus or, in some cases, one of the fetuses of twins, or in some cases the pregnant person themselves. Well, meanwhile, the Texas Republican legislature has been busy proposing even more abortion restrictions. Last week, we talked about a bill that would ban websites that include information about how to get abortion pills and punish internet providers who don’t block those sites. This week, we have a bill giving state officials the upper hand in prosecuting abortion cases in parts of the state where local Democratic prosecutors have suggested they don’t plan to zealously pursue such cases. Another bill would create a special prosecutor whose job would be, among other things, to pursue violations of the state’s abortion bans. Why is Texas such a hotbed of this?
Luthra: It’s always Texas. Texas is the biggest state in the country to have banned abortion, right? Most of the people who are traveling out of state — well, maybe not most, but the plurality — are Texans, because just so many people live there. And if we think about it, Roe v. Wade, as a case, it came from Texas. SB 8, the first law that allowed a state to circumvent Roe and ban abortions [at] anything after six weeks, that was a Texas law. This is a place where lawmakers really believe that they can be a fertile testing ground for the future of abortion restrictions. Between them and Missouri, I think, that is where we will see the bulk of innovative new ways to further restrict access.
Rovner: Well, speaking of big states that are banning or thinking about banning abortion, you wrote about Florida this week, which already has a ban on abortions after 15 weeks [and is] now considering a ban after six weeks. Florida is kind of a pivotal state in all this, right?
Luthra: Florida, third-biggest state in the country. And if we look at the map of the U.S. South and particularly the Southeast, Florida is just critical. Between Florida and North Carolina, that is where people across the region are going for abortions. And Florida has more than 60 clinics compared to, you know, around a dozen in North Carolina. If abortion there is banned after six weeks, there will be thousands of people who are displaced. They will probably have to go to North Carolina, while abortion is legal there, to Virginia and then to Illinois. And that is just really too far for so many people to travel. There just aren’t realistic options once you take Florida off the map.
Rovner: Well, finally, a bill has been introduced in the South Carolina legislature that could potentially subject patients who get abortions to the death penalty. Now, I am old enough to remember last year, when anti-abortion groups insisted they didn’t want to punish women who had abortions, just those who provide or facilitate them. I guess that’s not the case anymore.
Luthra: And I think we need to see where this bill goes. It is not the only state, either, where we are seeing legislation proposed that would treat abortion as murder or as homicide. There was a bill in Louisiana just last summer that failed on that front. But we have seen bills introduced in Tennessee, in Georgia, in so many others that I cannot remember now. But it’s a long list. I think what’s interesting is, so far, none of these bills have actually moved forward. And it’s still obviously early in the session. But what I’m curious about is, is this chipping away at the resistance toward these kinds of really strict abortion bans? And is this the first step in a multiyear effort to redirect who is punished for getting an abortion to switch from the doctors, the health care providers, to the pregnant people themselves, which has always been sort of this Rubicon the movement has been afraid to cross.
Rovner: Yeah, I remember in 2016 Chris Matthews was interviewing then-candidate Donald Trump and sort of got Donald Trump to say, you know, yes, the woman should be punished. And the anti-abortion movement came at him, like, no, no, no, that’s not what we say. That’s not what we want. And now it’s, you know, seven, eight years later and that’s not necessarily what people are saying. So, we will see how that goes. OK. That’s the news for this week. Now, we will play my “Bill of the Month” interview with Harris Meyer and then we’ll come back and do her extra credits.
We are pleased to welcome to the podcast Harris Meyer, who reported and wrote the last two KHN-NPR “Bill of the Month” stories, which are kind of related. Harris, welcome to “What the Health?”
Harris Meyer: Thanks very much, Julie.
Rovner: So, both of these bills have to do with something very common and very treacherous to your financial health: having a baby. Let’s start with baby No. 1, a now-3-year-old named Joey Trumble. Where is she from? Why was she in the hospital for 36 days?
Meyer: Joey was born prematurely in December 2019. Her mother, Brenna Kearney, is a writer in Chicago, and she was diagnosed with preeclampsia, and her doctors ordered her hospitalized at Northwestern. And then she developed a worse form of preeclampsia called HELLP syndrome. But anyway, the baby was born healthy but premature. And the baby, Joey, was treated at Northwestern Prentice, but without the knowledge of the parents the doctors who were treating her came over from next door from Lurie Children’s, and her hospital, Northwestern, was in network for her health plan. But Lurie Children’s doctors were out of network. They did not know that. So after her baby was sent home — it had about a month, 36 days, of hospitalization — the family got a bill of about $12,000, which was unexpected.
Rovner: That’s right. And we should point out that the baby was covered, right, under the mother’s health insurance.
Meyer: Correct.
Rovner: And yet they still got a bill for $12,000.
Meyer: That’s right. The hospitalization was covered. And, to their surprise, the doctors, the neonatologist from Lurie who treated the baby, were not covered in network. And so Brenna spent the next year contesting these charges. And they were never told that the doctors were out of the network. But she had found out that there was a 2011 Illinois law, which was in effect, which prohibited this kind of out-of-network billing for neonatology services.
Rovner: That’s right. And we should point out that this was before the federal No Surprises Act took effect, because this was late 2019.
Meyer: Correct.
Rovner: But there was a state law that should have applied.
Meyer: There was a state law. Illinois was a pioneer in this. So she cited that law to Blue Cross Blue Shield Illinois and to Lurie Children’s, and they said they knew nothing about it. So the bill was sent to collections about a year later, and she was able to get Blue Cross, finally, and, a year after the birth, to cover the Lurie doctor charges fully. However, in December, three years after she gave birth, she finds out she’s being billed again, after she thought the whole ordeal was over — many years after. And she finds out that Blue Cross of Illinois had taken the money back and now Lurie was coming after her and her husband again for the out-of-network charges. And that’s when she came to Kaiser Health News, and I made calls to Lurie, to Blue Cross of Illinois, and to Northwestern. And after my calls, Lurie agreed to drop the charges. But now a state senator, the Illinois Department of Insurance, and the Illinois attorney general are looking into this to see if there was a long pattern of violations by Lurie of this 2011 state law. And Brenna actually has been contacted now by three other women who experienced similar out-of-network bills from Lurie. So we’ll see what happens with that.
Rovner: So sort of a happy ending to that one. Let’s move to baby No. 2, or, more accurately, his mother. Who is she and what happened to her?
Meyer: OK. This was last June. Danielle Laskey is a school nurse, an RN, in Seattle. She was on vacation with the family. And at 26 weeks pregnant she felt that her water broke. Her doctors in Seattle ordered her to come back and said, you’d better come in. And her doctors were at Swedish Maternal & Fetal Specialty Center in Seattle, which was in network for her Blue Shield health plan. And when she got there, they said, yes, your water broke. You were at risk for the same complication from your first pregnancy three years ago. We want you to go to Swedish Medical Center across the street immediately, and we want you to stay there until you give birth, and we’ll monitor you. So she was in the hospital for seven weeks until she gave birth in August of last year.
Rovner: Oh, so just for context, Swedish is one of the big hospitals in Seattle, right?
Meyer: Yes, absolutely. And it’s one of the specialty facilities for this particular uncommon complication, which is called placenta accreta. Anyway, she was there for seven weeks. And again, she and her husband were not told that the hospital was out of network. But it turns out that Swedish, even though her doctors were — her Swedish doctors were in network for her health plan, it turns out that Swedish Medical Center was out of network, and she found out. Then the baby was born. The baby was in the hospital, the baby boy, for about a month. And then, meanwhile, after the baby was born, she experienced symptoms again, and she was rehospitalized for a day to have this placenta condition treated. Both those hospitalizations — you know, she and her husband, who’s a psychiatrist, thought they were emergencies. The doctors regarded them as emergencies. But yet afterward, the Regence Blue Shield and Swedish decided they were not emergencies. And so, guess what? The family was hit with over $100,000 in out-of-network bills for the two Swedish hospitalizations.
Rovner: And this was after the federal law took effect, right? This was last year.
Meyer: The federal law and a Washington state law were both in effect at that point, which say that you cannot apply out-of-network charges in an emergency situation. So, at first, Blue Shield said that it was not an emergency and it didn’t come under the law. And Swedish Medical Center was going to take the family to collections. The family appealed to Regence Blue Shield. Regence in January granted the appeal for the first hospitalization, erasing $100,000 or so of the charges. But the second hospitalization, $15,000 bill, was still in effect. And then they contacted Kaiser Health News. I contacted Regence Blue Shield and Swedish, and then the charges were dropped for the second hospitalization.
Rovner: Amazing how that happens.
Meyer: Yeah, well, it’s not a solution. So the twist on this one is that Regence Blue Shield said we decided it was an emergency and that it wasn’t proper that the doctors were in network but the hospital wasn’t, so we’re going to consider this an in network and erase the charges. But they said Regence Blue Shield had a contract with Swedish, which made Swedish a quote-unquote “participating provider”; therefore, the federal and state laws do not apply to that situation, and the hospital was allowed to charge the out-of-network charge. We’re going to erase it for this case, but the law does not apply to that situation.
Rovner: I confess, if I’m in a hospital and they say they’re a participating provider, I’m going to assume that means they’re in network. And in this case, it doesn’t, right?
Meyer: Right. It’s a very strange twist that my experts had never encountered before. I took the issue to the federal agency CMS, which administers the No Surprises Act, and they said that they’re going to look into this and HHS, Treasury Department, and Department of Labor are all going to have to look into this to see if this could be fixed through an agency guidance or whether this would require a congressional action to fix this apparent loophole in the law.
Rovner: Creativity. So what’s the takeaway here for both women and particularly for pregnant women who know at some point they’re likely to be in the hospital? You can’t ask every single person who touches you whether they’re in your network. And isn’t that what state and the federal law are supposed to guard against? These are the exact things that we assumed would be taken care of. Right?
Meyer: Right. Well, first of all, the family, the patient, and their loved ones need to ask the hospital and the insurer to tell them their rights under the No Surprises Act and make sure that both the insurer and the provider are following the letter of those federal and state laws. Second, if they do get, God forbid, a out-of-network bill, they need to immediately appeal that to the insurance company, and there’s a two-level appeal process. The second level, they get an independent review. And then, at the same time, they need to file a report or a complaint with the state attorney general’s office, the state department of insurance, and maybe even contact state legislators. There also are private agencies or private companies with nurses and lawyers, etc., that will help families, for a fee, address issues like this. Hopefully it shouldn’t require that, but sometimes it may. And of course, then there’s Kaiser Health News. You can file your “Bill of the Month” complaint through the portal, which we can’t deal with hundreds of thousands of cases, obviously.
Rovner: But we can help at least a few. And Harris Meyer, you helped two. So thank you very much. And thank you for joining us.
Meyer: Thank you, Julie.
Rovner: OK, we’re back. And now it’s time for our extra-credit segment. That’s when we each recommend a story we read this week we think you should read, too. As always, don’t worry if you miss it. We will post the links on the podcast page at khn.org and in our show notes on your phone or other mobile device. Victoria, why don’t you go first this week? You got one of my favorites.
Knight: My extra credit is called “They Could Lose the House — to Medicaid,” by Tony Leys, and it is published on NPR but is a KHN story. It’s about a family in Iowa who found out, after the mother in the family died, that they could lose their house because she was getting services through Medicaid. She had dementia, and so she needed really intensive at-home family care. Then after she died, they got a letter from the Iowa Department of Human Services — just a month after she died, so not long after — saying that the state was trying to recoup the money that they had spent on her care. So it was almost over $200,000 that they were asking for. And what was really upsetting is this family home was going to be the inheritance for the daughter. And so now they’re kind of like, what are we going to do? Thankfully, they don’t have to do anything with the house until something happens to the father. So it’s not gone immediately. But this is basically something that some states do. It’s called estate recovery programs. And if people use Medicaid in those states, the states have the ability to come back later … whether it’s, like, a house or they can ask for funds that these families used for Medicaid. So it’s really illuminating. I had no idea this was something that happened, and it varies by state to state. But in Iowa, this is something that they kind of pursue very aggressively.
Rovner: I remember when Congress made this a possibility, I think it was back in 1995. It’s been around, the possibility of states recouping Medicaid money for a long time. But as you point out, not all states do it. And it’s usually a surprise when states do do it. People still really don’t know about it. Shefali.
Luthra: So my story is from my 19th colleague, Jennifer Gerson. The headline is “Language for Treating Childhood Obesity Carries Its Own Health Risks to Kids, Experts Say.” And what Jen did, which I think is really smart and important, is she looked at the new clinical guidelines we got from the American Academy of Pediatrics. And those were meant to improve how we evaluate and treat obesity in children. And what she gets into is that there are a lot of children’s health experts, especially mental health experts, who are deeply concerned about what the impacts of these new guidelines could be, how they might exacerbate weight stigma, and how the long-term ramifications of some of the treatment guidelines could actually have worse outcomes for young people as a result, by building on weight stigma, which could lead to different kinds of unhealthy behaviors, could lead to mental health harms that could have much longer term repercussions, possibly more, in fact, dangerous than the actual problems that these guidelines are trying to treat. And one thing that Jen notes I think is really important is that the implications of weight stigma, in particular, are especially harmful for young girls who, as we know, are already facing so many mental health crises in general right now. I thought this was a really important look at a potentially really troubling unintended consequence, and I’m really glad Jen wrote about it.
Rovner: Yeah, I had no idea. It was a very counterintuitive but really interesting piece. Margot, what do you have this week?
Sanger-Katz: I wanted to suggest an article in ProPublica called “How Obamacare Enabled a Multibillion-Dollar Christian Health Care Cash Grab,” by J. David McSwane and Ryan Gabrielson which is just this wonderful historic dive into how the Affordable Care Act ended up allowing something called Christian health ministries to provide an alternative to health insurance. As we all know, the Affordable Care Act basically said, if you’re going to offer health insurance, it has to meet certain minimum guidelines in terms of what it covers and how it works. And these Christian health sharing ministries are just this huge, huge exception where basically it’s just, you know, groups of religiously affiliated people can get together and just pay for each other’s health care or not, depending on what they want to do. There has been a lot of reporting over the years about the degree to which these plans are kind of scammy or poorly run or are not paying for needed health care for their members who think that they are an alternative to insurance. And so this piece is just fun because it looked at the lobbying that generated this strange policy.
Rovner: Yeah. You know, I remember when they got the Christian sharing ministries exception into the ACA and not really knowing where it came from. Well, this story explains exactly where it came from. So it is quite an eye-popping read. Mine is from my KHN colleague Sarah Varney, and it’s called “Girls in Texas Could Get Birth Control at Federal Clinics, Until a Christian Father Objected. Now, for decades, underage girls have been able to get contraception from federally funded Title X family planning clinics without parental permission. An effort by the Reagan administration in the early 1980s, dubbed the “Squeal Rule,” which would have required that parents be notified after the fact, was struck down in federal court and the Reagan administration did not appeal it. And no, I was not there to cover that at that time. I did look it up. A couple of months ago, Judge Matthew Kacsmaryk — yes, that Judge Kacsmaryk, who will any day now rule on whether the FDA approval of the abortion pill should be revoked — ruled in favor of a father in Texas, not a father whose daughters did or said they wanted to obtain contraception from a Title X clinic. But the father complained that the very possibility that his daughters could get birth control without his consent rendered that portion of the law — which has been in effect since Title X, was signed by Richard Nixon in 1970 — unconstitutional. And of course, the judge agreed with him. So for now, the ruling only applies in Texas. But lest you think they’re not coming for your birth control, think again.
OK. That is our show for this week. As always, if you enjoy the podcast, you can subscribe wherever you get your podcasts. We’d appreciate it if you left us a review — that helps other people find us, too. Special thanks, as always, to our ever-patient producer, Francis Ying. Also, as always, you can email us your comments or questions. We’re at whatthehealth — all one word — @kff.org. Or you can tweet me. I’m @jrovner. Shefali?
Luthra: I’m @shefalil
Rovner: Victoria.
Knight: @victoriaregisk
Rovner: Margot.
Sanger-Katz: @sangerkatz
Rovner: We will be back in your feed next week. Until then, be healthy.
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VIDEO: Facility Guidelines Institute is accepting proposals for home dialysis training
KANSAS CITY, Mo. — In this interview from the Annual Dialysis Conference, Michael A.
Kraus, MD, discussed the 2026 home dialysis training guidelines being developed by the Facility Guidelines Institute.The guidelines for 2022 were recently published and, according to Kraus, about half of the United States follow these guidelines for home dialysis training.“As they open the proposals for 2026, it’s a good time to think about, ‘Is that something that interests you? Can you fill in their proposal [and] send in your thoughts about how home dialysis training might change?”
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Seniors With Anxiety Frequently Don’t Get Help. Here’s Why.
Anxiety is the most common psychological disorder affecting adults in the U.S. In older people, it’s associated with considerable distress as well as ill health, diminished quality of life, and elevated rates of disability.
Yet, when the U.S. Preventive Services Task Force, an independent, influential panel of experts, suggested last year that adults be screened for anxiety, it left out one group — people 65 and older.
The major reason the task force cited in draft recommendations issued in September: “the current evidence is insufficient to assess the balance of benefits and harms of screening for anxiety” in all older adults. (Final recommendations are expected later this year.)
The task force noted that questionnaires used to screen for anxiety may be unreliable for older adults. Screening entails evaluating people who don’t have obvious symptoms of worrisome medical or psychological conditions.
“We recognize that many older adults experience mental health conditions like anxiety” and “we are calling urgently for more research,” said Lori Pbert, associate chief of the preventive and behavioral medicine division at the University of Massachusetts Chan Medical School and a former task force member who worked on the anxiety recommendations.
This “we don’t know enough yet” stance doesn’t sit well with some experts who study and treat seniors with anxiety. Dr. Carmen Andreescu, an associate professor of psychiatry at the University of Pittsburgh, called the task force’s position “baffling” because “it’s well established that anxiety isn’t uncommon in older adults and effective treatments exist.”
“I cannot think of any danger in identifying anxiety in older adults, especially because doing so has no harm and we can do things to reduce it,” said Dr. Helen Lavretsky, a psychology professor at UCLA.
In a recent editorial in JAMA Psychiatry, Andreescu and Lavretsky noted that only about one-third of seniors with generalized anxiety disorder — intense, persistent worry about everyday matters — receive treatment. That’s concerning, they said, considering evidence of links between anxiety and stroke, heart failure, coronary artery disease, autoimmune illness, and neurodegenerative disorders such as dementia.
Other forms of anxiety commonly undetected and untreated in seniors include phobias (like a fear of dogs), obsessive-compulsive disorder, panic disorder, social anxiety disorder (a fear of being assessed and judged by others), and post-traumatic stress disorder.
The smoldering disagreement over screening calls attention to the significance of anxiety in later life — a concern heightened during the covid-19 pandemic, which magnified stress and worry among seniors. Here’s what you should know.
Anxiety is common. According to a book chapter published in 2020, authored by Andreescu and a colleague, up to 15% of people 65 and older who live outside nursing homes or other facilities have a diagnosable anxiety condition.
As many as half have symptoms of anxiety — irritability, worry, restlessness, decreased concentration, sleep changes, fatigue, avoidant behaviors — that can be distressing but don’t justify a diagnosis, the study noted.
Most seniors with anxiety have struggled with this condition since earlier in life, but the way it manifests may change over time. Specifically, older adults tend to be more anxious about issues such as illness, the loss of family and friends, retirement, and cognitive declines, experts said. Only a small fraction develop anxiety after turning 65.
Anxiety can be difficult to identify in older adults. Older adults often minimize symptoms of anxiety, thinking “this is what getting older is like” rather than “this is a problem that I should do something about,” Andreescu said.
Also, seniors are more likely than younger adults to report “somatic” complaints — physical symptoms such as dizziness, fatigue, headaches, chest pain, shortness of breath, and gastrointestinal problems — that can be difficult to distinguish from underlying medical conditions, according to Gretchen Brenes, a professor of gerontology and geriatric medicine at Wake Forest University School of Medicine.
Some types of anxiety or anxious behaviors — notably, hoarding and fear of falling — are much more common in older adults, but questionnaires meant to identify anxiety don’t typically ask about those issues, said Dr. Jordan Karp, chair of psychiatry at the University of Arizona College of Medicine in Tucson.
When older adults voice concerns, medical providers too often dismiss them as normal, given the challenges of aging, said Dr. Eric Lenze, head of psychiatry at Washington University School of Medicine in St. Louis and the third author of the recent JAMA Psychiatry editorial.
Simple questions can help identify whether an older adult needs to be evaluated for anxiety, he and other experts suggested: Do you have recurrent worries that are hard to control? Are you having trouble sleeping? Have you been feeling more irritable, stressed, or nervous? Are you having trouble with concentration or thinking? Are you avoiding things you normally like to do because you’re wrapped up in your worries?
Stephen Snyder, 67, who lives in Zelienople, Pennsylvania, and was diagnosed with generalized anxiety disorder in March 2019, would answer “yes” to many of these queries. “I’m a Type A personality and I worry a lot about a lot of things — my family, my finances, the future,” he told me. “Also, I’ve tended to dwell on things that happened in the past and get all worked up.”
Treatments are effective. Psychotherapy — particularly cognitive behavioral therapy, which helps people address persistent negative thoughts — is generally considered the first line of anxiety treatment in older adults. In an evidence review for the task force, researchers noted that this type of therapy helps reduce anxiety in seniors seen in primary care settings.
Also recommended, Lenze noted, is relaxation therapy, which can involve deep breathing exercises, massage or music therapy, yoga, and progressive muscle relaxation.
Because mental health practitioners, especially those who specialize in seniors’ mental health, are extremely difficult to find, primary care physicians often recommend medications to ease anxiety. Two categories of drugs — antidepressants known as SSRIs (selective serotonin reuptake inhibitors) and SNRIs (serotonin-norepinephrine reuptake inhibitors) — are typically prescribed, and both appear to help to older adults, experts said.
Frequently prescribed to older adults, but to be avoided by them, are benzodiazepines, a class of sedating medications such as Valium, Ativan, Xanax, and Klonopin. The American Geriatrics Society has warned medical providers not to use these in older adults, except when other therapies have failed, because they are addictive and significantly increase the risk of hip fractures, falls and other accidents, and short-term cognitive impairments.
We’re eager to hear from readers about questions you’d like answered, problems you’ve been having with your care, and advice you need in dealing with the health care system. Visit khn.org/columnists to submit your requests or tips.
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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2 years 1 month ago
Aging, Health Industry, Mental Health, Navigating Aging, Pennsylvania
Opinion: STAT+: Clearing the patent thicket: A pathway to faster generic drug approvals
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