View the full post Canada supports Grenada Planned Parenthood Association’s SRHR clinics on NOW Grenada.

“Honestamente, no quería pasar 10 días solo en una habitación, lo llaman el agujero”, dijo Ramírez-Cecena, quien espera que decidan si es deportado a México o puede permanecer en los Estados Unidos, en donde ha vivido por más de dos décadas.

Poco antes de que Ramírez-Cecena se enfermara, los funcionarios del Servicio de Inmigración y Control de Aduanas (ICE) de la instalación le negaron su solicitud de alta médica. Es VIH positivo, que según la lista de los Centros para el Control y la Prevención de Enfermedades es una afección que puede aumentar el riesgo de enfermar gravemente por covid.

Ahora, frente al tercer invierno pandémico, reza para no contraer covid mientras está detenido. “Todavía da miedo”, dijo.

En todo el país, la posibilidad de desarrollar una enfermedad grave o morir por covid ha bajado, por las vacunas de refuerzo actualizadas, las pruebas en el hogar y las terapias. La mayoría de las personas pueden sopesar los riesgos de asistir a reuniones o viajar.

Pero para las aproximadamente 30,000 personas que viven en espacios cerrados en la red de instalaciones de inmigración del país, covid sigue siendo una amenaza constante.

El ICE actualizó su guía de pandemia en noviembre. Pero las instalaciones han ignorado las recomendaciones anteriores de usar máscaras y equipo de protección, tener pruebas y vacunas disponibles, y evitar el uso del confinamiento solitario como cuarentena, según detenidos, grupos de defensa e informes internos del gobierno federal.

Según los protocolos de ICE, el aislamiento por covid, utilizado para evitar que otros detenidos se enfermen, debe estar separado de la segregación disciplinaria.

La agencia no abordó este punto, pero dijo en un comunicado a KHN que a los detenidos se los coloca en una “sala de alojamiento médico individual” o en un “una habitación de aislamiento médico de infecciones transmitidas por el aire”, cuando esté disponible.

La atención médica en los centros de detención de inmigrantes ya era deficiente antes de la pandemia. Y en septiembre, las personas médicamente vulnerables en los centros de detención de ICE perdieron una protección, con la expiración de una orden judicial que requería que los funcionarios federales de inmigración consideraran la liberación de los detenidos con riesgo de covid.

La agencia “ha renunciado por completo a proteger a las personas detenidas de covid”, dijo Zoe Bowman, abogada supervisora ​​de Las Américas Immigrant Advocacy Center en El Paso, Texas.

El uso de la detención de inmigrantes en el país se disparó a fines de la década de 1990 y creció después de la creación de ICE en 2003. Los centros de detención —unos 200 complejos privados, instalaciones administradas por ICE, cárceles locales y prisiones repartidas por todo el país— retienen a adultos que no son ciudadanos estadounidenses mientras disputan o esperan la deportación.

La duración promedio de la estadía en el año fiscal federal 2022 fue de aproximadamente 22 días, según la agencia. Los defensores de los inmigrantes han argumentado durante mucho tiempo que las personas no deberían ser detenidas y, en cambio, se les debería permitir vivir en comunidades.

El Centro de Detención de Stewart, un vasto complejo rodeado de cercas con alambre de púas en los bosques de Lumpkin, tiene una de las poblaciones de detenidos más grande del país. Cuatro personas bajo la custodia del centro han muerto por covid desde el comienzo de la pandemia, el mayor número de muertes por covid registradas en estos centros.

Cuando funcionarios de inmigración transfirieron a Cipriano Álvarez-Chávez al centro de Stewart en agosto de 2020, todavía confiaba en la máscara que tenía después de ser liberado de la prisión federal en julio, según su hija, Martha Chavez.

Diez días después, el sobreviviente de linfoma de 63 años fue llevado a un hospital en Columbus, a 40 millas de distancia donde dio positivo para covid, según su informe de defunción. Murió después de pasar más de un mes conectado a un ventilador.

“Fue pura negligencia”, dijo su hija.

Dos años después de la muerte de Álvarez-Chávez, grupos de defensa y detenidos dijeron que el ICE no ha hecho lo suficiente para proteger de covid a los detenidos, una situación consistente con el historial de atención médica deficiente y falta de higiene de las instalaciones.

“Es desalentador ver que no importa cuánto empeoran las cosas, nada cambia”, dijo la doctora Amy Zeidan, profesora asistente en la Facultad de Medicina de la Universidad de Emory, quien revisa los registros de salud de los detenidos y realiza evaluaciones médicas para las personas que buscan asilo.

Una investigación bipartidista del Senado reveló en noviembre que las mujeres en el Centro de Detención del Condado de Irwin en Georgia “parecen haber sido sometidas a procedimientos ginecológicos excesivos, invasivos y, a menudo, innecesarios”.

En el Centro de Procesamiento de Folkston, también en Georgia, el ICE no respondió a las solicitudes médicas de manera oportuna, tuvo una atención de salud mental inadecuada y no cumplió con los estándares básicos de higiene, incluidos baños funcionales, según un informe de junio de la Oficina del Inspector General de Seguridad del Departamento de Asuntos Internos. Y una denuncia presentada en julio por un grupo de organizaciones de defensa alegó que una enfermera del centro Stewart agredió sexualmente a cuatro mujeres.

El ICE defendió su atención médica en un comunicado enviado por correo electrónico, diciendo que gasta más de $315 millones anualmente en atención médica, y que garantiza la prestación de los servicios médicos necesarios e integrales.

Aún así, muchas instalaciones carecen de personal y están mal equipadas para manejar las necesidades médicas a largo plazo de la gran población de detenidos, dijo Zeidan. La atención tardía es común, la atención especializada es casi inexistente y el acceso a la terapia es limitado, dijo. El cuidado de covid no es diferente.

En sus protocolos para covid, el ICE recomienda el uso de anticuerpos monoclonales, que ayudan al sistema inmunológico a responder de manera más efectiva a covid, para el tratamiento. Pero no reconoce ninguno de los otros tratamientos recomendados por los CDC, incluidos los antivirales como Paxlovid, que pueden reducir las hospitalizaciones y las muertes entre los pacientes con covid.

“Durante décadas, el ICE ha demostrado ser incapaz y no estar dispuesto a garantizar la salud y la seguridad de las personas bajo su custodia”, dijo Sofia Casini, directora de monitoreo y defensa comunitaria de Freedom for Immigrants, un grupo de defensa. “Covid-19 solo ha empeorado esta horrible realidad”.

Once personas han muerto por covid bajo custodia de ICE. Pero ese número puede ser una subestimación; defensores de los detenidos han acusado a la agencia de liberar a las personas o deportarlas cuando están gravemente enfermas como una forma de evadir las estadísticas de muertes.

Antes de la pandemia, Johana Medina León fue liberada de la custodia de ICE cuatro días antes de su muerte, según un artículo de mayo en Los Angeles Times. Vio a un médico unas seis semanas después de su primera solicitud, decía el artículo, pero ICE aceleró su liberación solo unas horas después de que su condición empeorara.

Este otoño, los detenidos recluidos en instalaciones de todo el país llamaron a la línea directa de detención de Freedom for Immigrants para quejarse de las condiciones de covid, que varían de una instalación a otra, dijo Casini. “Incluso en la misma instalación, puede cambiar de semana a semana”, dijo.

Según Casini, muchas personas que habían dado positivo para covid estaban recluidas en las mismas celdas que las personas que habían dado negativo, incluidas las personas médicamente vulnerables. Este verano, el grupo encuestó a 89 personas a través de su línea directa y descubrió que alrededor del 30% de los encuestados tuvieron problemas para acceder a las vacunas mientras estuvieron detenidos.

Ramírez-Cecena dijo que le dijeron que es elegible para una segunda vacuna de refuerzo de covid, pero que, a diciembre, aún no la había recibido. Un detenido en el Centro de Procesamiento de Moshannon Valley en Pennsylvania dijo que a un guardia se le permitió interactuar con los detenidos mientras estaba visiblemente enfermo, dijo Brittney Bringuez, coordinadora del programa de asilo de Physicians for Human Rights, quien visitó las instalaciones este otoño.

La orden judicial que requería que ICE considerara la liberación de personas con alto riesgo de covid ha ayudado a los detenidos con afecciones médicas graves, dijeron los defensores. Según la orden, ICE liberó a unos 60,000 detenidos médicamente vulnerables en dos años, dijo Susan Meyers, abogada sénior del Southern Poverty Law Center, uno de los grupos de defensa que ayudó a presentar la demanda que resultó en la orden judicial.

El ICE dijo en un comunicado que aún considerará los factores de riesgo de covid como una razón para la liberación. Pero los abogados dijeron que las instalaciones de ICE a menudo no cumplían con la orden judicial cuando estaba vigente.

El año pasado, el ICE negó la solicitud de liberación de Ricardo Chambers del Centro de Detención de Stewart. Chambers, de 40 años, tiene enfermedades psiquiátricas graves, consideradas un factor de riesgo según la orden judicial. También tiene problemas para respirar y se ahoga mientras duerme, como resultado de una lesión nasal que sufrió en un ataque antes de ser detenido. A dos años de estar detenido, todavía no recibió atención para esa lesión.

Ha presentado quejas sobre los protocolos para covid de Stewart, incluidas las condiciones de hacinamiento y la falta de uso de máscaras u otro equipo de protección por parte del personal.

Al negar su liberación, el ICE dijo que Chambers era una amenaza para la seguridad pública debido a sus antecedentes penales, según su abogada Erin Argueta, abogada principal de la oficina de la Iniciativa de Libertad de Inmigrantes del Sureste del Southern Poverty Law Center en Lumpkin. Chambers ya cumplió sus condenas, dijo, y hay una familia en Nueva York que lo acogería.

A principios de este año, fue enviado a confinamiento solitario durante unos 10 días después de dar positivo para covid, dijo. Pero Chambers, quien está luchando contra una orden de deportación a Jamaica, dijo que su experiencia con covid no fue diferente de las otras veces que estuvo en aislamiento.

“Serás tratado como un animal, enjaulado y sin tener culpa de nada”, dijo Chambers.

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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The National Board of Examinations (NBE) has released the Curriculum for DrNB Plastic Surgery (Direct 6 Year) course.

I. PROGRAMME GOAL & OBJECTIVES

A. Programme Goal

The goal of DNB in Plastic Surgery (Direct 6 years course) course is to produce a competent

surgeon who:

• Recognizes the health needs of adults and carries out professional obligations in keeping with principles of National Health Policy and professional ethics;

• Has acquired the competencies pertaining to Plastic Surgery (Direct 6 years course) that are required to be practiced in the community and at all levels of health care system;

• Has acquired skills in effectively communicating with the patients, family and the

• community;

• Is aware of the contemporary advances and developments in medical sciences.

• Acquires a spirit of scientific enquiry and is oriented to principles of research

• methodology; and

• Has acquired skills in educating medical and paramedical professionals.

B. Programme Objectives

At the end of the DNB Plastic Surgery (Direct 6 years course), the student should be able to:

• Recognize the key importance of medical problems in the context of the health priority of the country

• Practice the specialty of Plastic Surgery in keeping with the principles of professional ethics;

• Identify social, economic, environmental, biological and emotional determinants of Plastic Surgery and know the therapeutic, rehabilitative, preventive and promotion

• Measures to provide holistic care to all patients;

• Take detailed history, perform full physical examination and make a clinical diagnosis;

• Perform and interpret relevant investigations (Imaging and Laboratory); Perform and interpret important diagnostic procedures;

• Diagnose illnesses in adults based on the analysis of history, physical examination and investigative work up;

• Plan and deliver comprehensive treatment for illness in adults using principles of rational drug therapy;

• Plan and advise measures for the prevention of diseases;

• Plan rehabilitation of adults suffering from chronic illness, and those with special needs;

• Manage emergencies efficiently;

• Demonstrate skills in documentation of case details, and of morbidity and mortality data

• Relevant to the assigned situation;

• Demonstrate empathy and humane approach towards patients and their families and respect their sensibilities;

• Demonstrate communication skills of a high order in explaining management and prognosis, providing counseling and giving health education messages to patients, families and communities.

• Develop skills as a self-directed learner, recognize continuing educational needs; use appropriate learning resources, and critically analyze relevant published literature in order to practice evidence-based medicine;

• Demonstrate competence in basic concepts of research methodology and epidemiology;

• Facilitate learning of medical/nursing students, practicing surgeons , paramedical health workers and other providers as a teacher-trainer;

• Play the assigned role in the implementation of national health programs, effectively and responsibly;

• Organize and supervise the desired managerial and leadership skills;

• Function as a productive member of a team engaged in health care, research and education.

II. TEACHING AND TRAINING ACTIVITIES

The fundamental components of the teaching programme should include:

• Case presentations & discussion- once a week

• Seminar – Once a week

• Journal club- Once a week

• Grand round presentation (by rotation departments and subspecialties)- once a week

• Faculty lecture teaching- once a month

• Clinical Audit-Once a Month

• A poster and have one oral presentation at least once during their training period in a recognized conference.

• Attendance of one National conference of Association of Plastic Surgeons of India and one speciality conference / regional conference is a must (specialty conference means Cleft lip and palate conference, Hand, Microsurgery, Burns or Aesthetic surgery. Regional means State or Zonal meetings)

• One paper publication – preferably peer reviewed.

Microsurgery Lab Course: All trainees must undergo a week long microsurgery lab course. Trainees must become proficient in using loupes and microscope. This is mandatory as trainees who are not proficient in microsurgery when they pass out are at a disadvantage.

Fracture Fixation Course: Recommended to attend the AO course on fracture fixation for Cranio Maxilla Facial and Hand. The rounds should include bedside sessions, file rounds & documentation of case history and examination, progress notes, round discussions, investigations and management plan) interesting and difficult case unit discussions.

The training program would focus on knowledge, skills and attitudes (behavior), all essential components of education. It is being divided into theoretical, clinical and practical in all aspects of the delivery of the rehabilitative care, including methodology of research and teaching.

Theoretical: The theoretical knowledge would be imparted to the candidates through discussions, journal clubs, symposia and seminars. The students are exposed to recent advances through discussions in journal clubs. These are considered necessary in view of an inadequate exposure to the subject in the undergraduate curriculum.

Symposia: Trainees would be required to present a minimum of 30 topics based on the curriculum in a period of six years to the combined class of teachers and students. A free discussion would be encouraged in these symposia. The topics of the symposia would begiven to the trainees with the dates for presentation.

Clinical: The trainee would be attached to a faculty member to be able to pick up methods of history taking, examination, prescription writing and management in rehabilitation practice.

Bedside: The trainee would work up cases, learn management of cases by discussion with faculty of the department.

Journal Clubs: This would be a weekly academic exercise. A list of suggested Journals is given towards the end of this document. The candidate would summarize and discuss the scientific article critically. A faculty member will suggest the article and moderate the discussion, with participation by other faculty members and resident doctors. The contributions made by the article in furtherance of the scientific knowledge and limitations, if any, will be highlighted.

Research: The student would carry out the research project and write a thesis/ dissertation in accordance with NBE guidelines. The trainee would also be given exposure to partake in the research projects going on in the departments to learn their planning, methodology and execution so as to learn various aspects of research.

III. SYLLABUS

Theory

Principles, Techniques, and Basic Sciences

• Techniques and principles in Plastic Surgery

• Wound Healing: Normal and Abnormal

• Wound care

• The Blood Supply of the Skin

• Muscle flaps and their Blood supply

• Transplant Biology and Applications to Plastic Surgery (Direct 6 years course)

• Implant Materials and biomaterials

• Principles of Microsurgery

• Microsurgical Repair of Peripheral Nerves and Nerve Grafts

• Tissue Expansion

Plastic Surgery and innovation in medicine

• History of reconstructive and aesthetic surgery

• Psychological aspects of Plastic Surgery

• The role of ethics in Plastic Surgery

• Business principles for plastic surgeons

• Medico-legal issues in Plastic Surgery

• Photography in Plastic Surgery

• Patient safety in Plastic Surgery

• Local anesthetics in Plastic Surgery

• Evidence-based medicine and health services research in Plastic Surgery

• Genetics and prenatal diagnosis

• Principles of cancer management

• Stem cells and regenerative medicine

Aesthetic

• Managing the cosmetic patient

• Aesthetic Surgery of the Face

• Nonsurgical skin care and rejuvenation

• Botulinum toxin (BoNT-A)

• Soft-tissue fillers

• Facial skin resurfacing

• Anatomy of the aging face

• Forehead rejuvenation

• Blepharoplasty

• Secondary blepharoplasty:

• Asian facial cosmetic surgery

• Cutaneous Resurfacing: Chemical Peeling, Dermabrasion and laser resurfacing

• Filler Materials

• Botulinum Toxin

• Structural Fat grafting

• Blepharoplasty

• Rhinoplasty

• Liposuction

• Abdominoplasty and Lower Truncal Circumferential Body Contouring

• Facial Skeletal Augmentation with Implants

• Osseous Genioplasty

• Hair Transplantation

• Facelift

• Neck rejuvenation

• Structural fat grafting

• Skeletal augmentation

• Anthropometry, cephalometry, and orthognathic surgery

• Medico-legal issues in Plastic Surgery

• Photography in Plastic Surgery

• Patient safety in Plastic Surgery

• Local anesthetics in Plastic Surgery

• Evidence-based medicine and health services research in Plastic Surgery

• Genetics and prenatal diagnosis

• Principles of cancer management

• Stem cells and regenerative medicine

Aesthetic

• Managing the cosmetic patient

• Aesthetic Surgery of the Face

• Nonsurgical skin care and rejuvenation

• Botulinum toxin (BoNT-A)

• Soft-tissue fillers

• Facial skin resurfacing

• Anatomy of the aging face

• Forehead rejuvenation

• Blepharoplasty

• Secondary blepharoplasty:

• Asian facial cosmetic surgery

• Cutaneous Resurfacing: Chemical Peeling, Dermabrasion and laser resurfacing

• Filler Materials

• Botulinum Toxin

• Structural Fat grafting

• Blepharoplasty

• Rhinoplasty

• Liposuction

• Abdominoplasty and Lower Truncal Circumferential Body Contouring

• Facial Skeletal Augmentation with Implants

• Osseous Genioplasty

• Hair Transplantation

• Facelift

• Neck rejuvenation

• Structural fat grafting

• Skeletal augmentation

• Anthropometry, cephalometry, and orthognathic surgery

• Hair restoration: A comprehensive review of techniques and safety

• Abdominoplasty procedures

• Lipoabdominoplasty

• Lower bodylifts

• Buttock augmentation

• Upper limb contouring

• Post-bariatric reconstruction

• Aesthetic genital surgery

Breast

• Anatomy of the breast

• Breast augmentation

• Current concepts in revisionary breast surgery

• Mastopexy

• Breast Reduction

• Gynecomastia

• Breast Reconstruction: Prosthetic Techniques

• Latissimus Dorsi Flap Breast Reconstruction

• Breast Reconstruction: Tram Flap Techiniques

• Breast Reconstruction- Free Flap Techniques

• Nipple Reconstruction

• Breast cancer: Diagnosis therapy and oncoplastic techniques The oncoplastic approach to partial breast reconstruction

• Patient-centered health communication

• Imaging in reconstructive breast surgery

• Congenital anomalies of the breast

• Poland syndrome

• Fat grafting to the breast

Principles of Craniofacial distraction

Skin and Soft Tissue

• Dermatology for Plastic Surgeons

• Mohs Micrographic Surgery

• Congenital Melanocytic Nevi

• Malignant Melanoma

• Thermal, Chemical and Electric Injuries

• Principles of Burn Reconstruction

• Radiation and Radiation Injuries

• Lasers in Plastic Surgery (Direct 6 years course)

Congenital Anomalies and Pediatric Plastic Surgery

• Embryology of the Head and Neck

• Vascular Anomalies

• Cleft Lip and Palate

• Non syndromic Craniosynostosis and Deformational Plagiocephaly

• Craniosynostosis syndrome

• Craniofacial Microsomia

• Orthognathic Surgery

• Craniofacial Clefts and Hypertelorbitism

• Miscellaneous Craniofacial Conditions

• Otoplasty and Ear Reconstruction

Head and Neck

• Soft tissue and Skeletal injuries of the Face

• Head and Neck Cancer and Salivary Gland Tumors

• Skull Base Surgery

• Craniofacial and Maxillofacial Prosthetics

• Reconstruction of the Scalp, Calvarium and Forehead

• Reconstruction of the Lips

• Reconstruction of the Cheeks

• Nasal Reconstruction

• Reconstruction of the Eyelids, Correction of Ptosis and Canthoplasty

• Facial Paralysis Reconstruction

• Mandible Reconstruction

• Reconstruction of Defects of the Maxilla and Skull Base

• Reconstruction of the Oral Cavity, Pharynx and Esophagus

• Tumors of Head & Neck

Cleft Lip and Palate and Craniofacial Anomalies

• Embryology of head and neck (excluding central nervous system).

• Regional anatomy of head and neck.

• Embryogenesis of cleft lip and palate.

• Cleft lip and palate, alveolar clefts.

• Velopharyngeal incompetence.

• Orthodontics, speech therapy in cleft lip and palate.

• Principles of craniofacial surgery.

• Rare craniofacial clefts, Tessier's clefts.

• Craniosynostosis, hypertelorism, craniofacial microsomia

Trunk and Lower Extremity

• Thoracic Reconstruction

• Abdominal Wall Reconstruction

• Lower- Extremity Reconstruction

• Foot and Ankle Reconstruction

• Reconstruction of the Perineum

• Lymphedema

• Pressure Sores

• Reconstruction of the Penis

• Diabetic Foot Care

Hand

• Development of Hand Surgery

• Principles of Upper Limb Surgery

• Radiologic Imaging of the Hand and Wrist

• Soft- tissue Reconstruction of the Hand

• Fractures and Ligamentous Injuries of the Wrist

• Fractures, Dislocations, and Ligamentous Injuries of the Hand

• Tendon Healing and Flexor Tendon Injury

• Repair of the Extensor Tendon System

• Infections of the Upper Limb

• Tenosynovitis

• Compression Neuropathies in the Upper Limb and Electrophysiologic Studies

• Thumb Reconstruction

• Tendon Transfers

• Congenital Hand Anomalies

• Duputyren's Disease

• Replantation in the Upper Extremity

• Upper Limb Arthritis

• Upper Limb Amputation and Prosthesis

• Management of Spastic Hands

• Basic principles of Wrist Surgery

Burns

• Thermal burns.

• Electrical burns.

• Chemical burns.

• Radiation burn.

• Pathophysiology of burn shock.

• Nutrition in burns.

• Facial burns.

• Tangenital excision and sequential excision.

• Reconstruction of burn hand and upper extremity.

• Post burn contractures –treatment of sequelae.

• Burn wound infection, sepsis.

• Principles of planning in event of burn disaster.

• Organization of Burns Unit

• Principles of Skin Banking

General Principles

• History of Plastic Surgery (Direct 6 years course) and its broad scope at the present time.

• Anatomy and functions of skin.

• Split skin grafts and full thickness skin grafts, their take and

• Subsequent behaviour.

• Local skin flaps.

• Pedicled skin flaps and tubs.

• Unstable scar and scar contracture.

• Care of wounds, dressing, techniques and splints.

• Wound healing.

• Grafts – fat, fascia, tendon, nerve, cartilage, bone.

• Infective skin gangrene.

• Hospital infections.

• Suture instruments.

• Surgical instruments.

• Implant materials used in Plastic Surgery (Direct 6 years course).

• Principles of genetics and general approach to the management of congenital malformations.

• Flaps-Fasciocutaneous muscle, musculocutaneous, congenital malformations.

• Local anaesthesia, nerve blocks, regional anaesthesia.

• Principles of anaesthesia for infants, adults, hypothermia, hypotensive anaesthesia.

• Tissue expansion.

• Keloid, hypertrophic scans.

• Endoscopy in Plastic Surgery

Management of and relationships with the Plastic Surgery (Direct 6 years course)

outpatient and inpatient

• Principles of Reconstructive Surgery

• Principles of Aesthetic Surgery

• Management of Acute Trauma

• Malignant Skin Tumours

• Benign Skin Conditions

• Administration

• Basic sub-specialty training in:

i. Burns

ii. Paediatric Plastic Surgery

iii. Head & Neck Tumours

iv. Hand Surgery

v. Burn

vi. Head and Neck Tumours

vii. Cleft Lip and Palate

viii. Reconstruction of Genitalia

ix. Oculoplastic Surgery

x. Limb Trauma

xi. Aesthetic Surgery

xii. Acute and Chronic Wound care with special emphasis on Diabetic Foot Care

xiii. Oncoplastic Breast Surgery

• Biostatistics, Research Methodology and Clinical Epidemiology

• Ethics

• Medico legal aspects relevant to the discipline

• Health Policy issues as may be applicable to the discipline

IV. COMPETENCIES

• Acquisition of basic surgical skills in instrument and tissue handling.

• Incision of skin and subcutaneous tissue: Ability to incise superficial tissues accurately with suitable instruments.

• Closure of skin and subcutaneous tissue: Ability to close superficial tissues accurately.

• Knot tying: Ability to tie secure knots.

• Haemostasis: Ability to achieve haemostasis of superficial vessels.

• Tissue retraction: Use of suitable methods of retraction.

• Use of drains: Knowledge of when to use a drain and which to choose.

• Tissue handling: Ability to handle tissues gently with appropriate instruments.

• Skill as assistant: Ability to assist helpfully, even when the operation is not familiar

• The DNB resident should do the dressings of the patient that have been operated/assisted by them and of patients in Burns ICU.

• The DNB resident should note down the History and examination of admitted patients and should daily put progress notes in files.

• The normal working hours will be from 8.00 AM to 8.00 PM. When on emergency duty, the resident is supposed to stay overnight in the resident room.

• The DNB resident is to get one day off every week

Knowledge & Clinical Skills

1. Incision of skin and subcutaneous tissue:

• Langer's lines

• Healing mechanism

• Choice of instrument

• Safe practice

• Basic Surgical Skills course

• Closure of skin and subcutaneous tissue:

• Options for closure

• Suture and needle choice

• Safe practice

• Ability to use scalpel, diathermy and scissors

• Closure of skin and subcutaneous tissue:

• Accurate and tension free apposition of wound edges

2. Knot tying

• Single handed

• Double handed

• Superficial

• Deep

• Instrument

3. Choice of material

4. Haemostasis:

• Techniques

• Tissue retraction:

• Choice of instruments

• Use of drains:

• Indications

• Types

• Management/removal

• Tissue handling

• Choice of instruments

• Control of bleeding vessel (superficial)

• Diathermy

• Suture ligation

• Tie ligation

• Clip application

• Tissue retraction:

• Tissue forceps

• Placement of wound retractors

• Use of drains:

• Insertion

• Fixation

• Removal

Clinical Skills

• An understanding of burns assessment and resuscitation

• An understanding of burn wound excision and grafting

• An understanding of burn wound dressings

• An awareness of the roles of nursing staff, physiotherapists and occupational therapists in rehabilitation

• Wound care – both acute and chronic and techniques for cover.

• Basics of Skeletal fixation of fractures. (needed for both facial fractures and hand fractures)

• Ability to assess major trauma

• Ability to debride an infected wound or a dirty wound

• Ability to plan and execute soft tissue cover for defects got due to trauma, infection and cancer

Practical

History, examination and writing of records:

• History taking should include the back ground information, presenting complaints and history of present illness, history of previous illness, family history, social and occupational history and treatment history.

• Detailed physical examination should include general examination and systemic examination (Chest, Cardio-vascular system, Abdomen, Central nervous system, locomotor system and joints), with detailed examination of the abdomen.

• Skills in writing up notes, maintaining problem oriented records, progress notes, and presentation of cases during ward rounds, planning investigations and making a treatment plan should be taught.

Bedside procedures & Investigations

• Therapeutic skills: Venepuncture and establishment of vascular access,

• Administration of fluids, blood, blood components and parenteral nutrition,

• Nasogastric feeding, Urethral catheterization, Administration of oxygen,

• Cardiopulmonary resuscitation, Endotracheal intubation.

Clinical Teaching

• General, Physical and specific examinations of Maxillofacial & Hand Injuries should be mastered. The resident should able to analyse history and correlate it with clinical     findings. He should be well versed with all radiological procedures like CT Angio, CT Face with 3D Reconstruction and X-Ray of face. He should present his daily admissions in morning report and try to improve management skills, fluid balance, and choice of drugs. He should clinically analyse the patient & decide for pertinent Investigations required for specific patient.

Teaching Programme

• General Principles

• Acquisition of practical competencies being the keystone of postgraduate medical education, postgraduate training is skills oriented.

• Learning in postgraduate program is essentially self-directed and primarily emanating from clinical and academic work. The formal sessions are merely meant to supplement this core effort.

Teaching Sessions

• The teaching methodology consists of bedside discussions, ward rounds, case presentations, clinical grand rounds, statistical meetings, journal club, lectures and seminars. Along with these activities, trainees should take part in interdepartmental meetings i.e clinico-pathological and clinico-radiological meetings that are organized regularly.

• Trainees are expected to be fully conversant with the use of computers and be able to use databases like the Medline, Pubmed etc.

• They should be familiar with concept of evidence based medicine and the use of guidelines available for managing various diseases.

Teaching Schedule

• Following is the suggested weekly teaching programme in the Department of Plastic Surgery (Direct 6 years course):

1. Seminar once a week

2. Journal club once a week

3. Case Presentation once a week

4. File Audit/Stat Meet once month

5. Grand Round/Interdepartmental Meet once a month

• Each unit should have regular teaching rounds for residents posted in that unit.

• Then rounds should include bedside case discussions, file rounds (documentation of case history and examination, progress notes, round discussions, investigations and management plan), interesting and difficult case unit discussions.

• Central hospital teaching sessions will be conducted regularly and MCh residents would present interesting cases, seminars and take part in clinicL- pathological case discussions.

Conferences and Papers

• A resident must attend at least one conference per year.

• One paper must be presented in at least 3 years.

POSTING

1st year (12 + 3 months)

• First 3 months to be spent in the parent Plastic surgical unit to know the basics of plastic surgery

• Next 12 months to be spent in General Surgery to learn the basics of surgery

2nd year (9 months)

• To undergo Peripheral superspeciality postings

• 1 month in Surgical oncology

• 1 month in Paediatric surgery

• 1 month in Neurosurgery

• 1 month in Gastro Intestinal Surgery

• 1 month in Vascular Surgery

• 1 month in Cardiothoracic Surgery

• 1 month in Anaesthesiology & Intensive Care

• 1 month in Orthopaedics

• 1 month in Dermatology

3rd year (Back to parent plastic surgical unit)

• Basics / Basic Plastic Surgery theory, assisting in major plastic surgery procedures with assistants

4th Year

• To do Basic Plastic Surgery Procedures independently and assist major Plastic surgical procedures

5th Year

• To go to peripheral postings (To other plastic Surgical units in India or abroad. Two or 3 months as agreed by the parent unit academic supervisor)

• To assist major plastic surgical procedures and do basic procedures

6th year

• To do major Plastic Surgical procedures under supervision

Schedule of Posting

• OPD: Twice a week

• OT: Twice a week

• Emergency: Twice a week

Rotation of DNB Candidates in Other institutions

No single unit in the country can boast to be good in all aspects of the wide gamut of Plastic Surgery (Direct 6 years course) as the branch of Plastic Surgery is very wide. In addition it is beneficial to observe the working patterns and learn different techniques used by various stalwarts of this speciality. Hence DNB candidates must be rotated in other units in the country/abroad. The DNB candidate should get a letter from his/her DNB supervisor permitting them to visit the institutions of their choice. The DNB candidates must maintain a log book regarding what they learnt and observed in the institutions that they visit. At the end of the visit to each centre, they should get their logbooks attested by the head of the plastic surgical programme that they visit.

Period: 2 months mandatory, and 3 months upper limit. Location:

• It can be to institutions having an approved DNB/MCh Plastic surgical

• programme in India.

• Under exceptional circumstances a non teaching institution in India can be accepted provided the DNB supervisor agrees and vouches for the quality of work of the chosen institution.

• DNB candidates can observe and train under surgeons/institutions abroad provided the DNB supervisor agrees and vouches for the quality of work of the chosen institution

Job Responsibilities

Outdoor Patient (OPD) Responsibilities

• The working of the residents in the OPD should be fully supervised.

• They should evaluate each patient and write the observations on the OPD card with date and signature.

• Investigations should be ordered as and when necessary using prescribed forms.

• Residents should discuss all the cases with the consultant and formulate a management plan.

• Patient requiring admission according to resident's assessment should be shown to the consultant on duty.

• Patient requiring immediate medical attention should be sent to the casualty services with details of the clinical problem clearly written on the card.

• Patient should be clearly explained as to the nature of the illness, the treatment advice and the investigations to be done.

• Resident should specify the date and time when the patient has to return for follow up.

In-Patient Responsibilities

• Each resident should be responsible and accountable for all the patients admitted under his care. The following are the general guidelines for the functioning of the residents in the ward:

• Detailed work up of the case and case sheet maintenance:

• The trainee should record a proper history and document the various symptoms.

• Perform a proper patient examination using standard methodology.

• He should develop skills to ensure patient comfort/consent for examination. Based on the above evaluation the trainee should be able to formulate a differential diagnosis and prepare a management plan

• Should develop skills for recording of medical notes, investigations and be able to properly document the consultant round notes.

• To organize his/her investigations and ensure collection of reports.

• Bedside procedures for therapeutic or diagnostic purpose.

• Presentation of a precise and comprehensive overview of the patient in clinical rounds to facilitate discussion with senior residents and consultants.

• To evaluate the patient twice daily (and more frequently if necessary) and maintain a progress report in the case file.

• To establish rapport with the patient for communication regarding the nature of illness and further plan management.

• To write instructions about patient's treatment clearly in the instruction book along with time, date and the bed number with legible signature of the resident.

• All treatment alterations should be done by the residents with the advice of the concerned consultants and senior residents of the unit.

Admission day

• Following guidelines should be observed by the resident during admission day.

• Resident should work up the patient in detail and be ready with the preliminary necessary investigations reports for the evening discussion with the consultant on duty.

• After the evening round the resident should make changes in the treatment and plan out the investigations for the next day in advance.

Doctor on Duty

• Duty days for each Resident should be allotted according to the duty roster.

• The resident on duty for the day should know about all sick patients in the wards and relevant problems of all other patients, so that he could face an emergency situation effectively.

• In the morning, detailed over (written and verbal) should be given to the next resident on duty. This practice should be rigidly observed.

• If a patient is critically ill, discussion about management should be done with the consultant at any time.

• The doctor on duty should be available in the ward throughout the duty hours.

Care of Sick Patients

• Care of sick patients in the ward should have precedence over all other routine work for the doctor on duty.

• Patients in critical condition should be meticulously monitored and records maintained. If patient merits ICU care then it must be discussed with the senior residents and consultants for transfer to ICU.

• Resuscitation skills

• At the time of joining the residency programme, the resuscitation skills should be demonstrated to the residents and practical training provided at various work stations.

• Residents should be fully competent in providing basic and advanced cardiac life support.

• They should be fully aware of all advanced cardiac support algorithms and be aware of the use of common resuscitative drugs and equipment like defibrillators and external cardiac pacemakers.

• The resident should be able to lead a cardiac arrest management team.

• Discharge of the Patient

• Patient should be informed about his/her discharge one day in advance and discharge cards should be prepared 1 day prior to the planned discharge.

• The discharge card should include the salient points in history and examination, complete diagnosis, important management decisions, hospital course and procedures done during hospital stay and the final advice to the patient.

• Consultants and DM Residents should check the particulars of the discharge card and counter sign it.

• Patient should be briefed regarding the date, time and location of OPD for the follow up visit.

In Case of Death

• In case it is anticipated that a particular patient is in a serious condition, relatives should be informed about the critical condition of the patient beforehand.

• Residents should be expected to develop appropriate skills for breaking bad news and bereavements.

• Follow up death summary should be written in the file and face sheet notes must be filled up and the sister in charge should be requested to send the body to the mortuary with respect and dignity from where the patient's relatives can handed over the body

• In case of a medico legal case, death certificate has to be prepared in triplicate and the body handed over to the mortuary and the local police authorities should be informed.

• Autopsy should be attempted for all patients who have died in the hospital especially if the patient died of an undiagnosed illness.

Bedside Procedures

• The following guidelines should be observed strictly:

• Be aware of the indications and contraindications for the procedure and record it in the case sheet. Rule out contraindications like low platelet count, prolonged prothrombin time, etc.

• Plan the procedure during routine working hours, unless it is an emergency.

• Explain the procedure with its complications to the patient and his/her relative and obtain written informed consent on a proper form. Perform the procedure under strict aseptic precautions using standard techniques. Emergency tray should be ready during the procedure.

• Make a brief note on the case sheet with the date, time, nature of the procedure and immediate complications, if any.

• Monitor the patient and watch for complications(s).

OT responsibilities

• The 1st year resident observes the general layout and working of the OT, understands the importance of maintaining sanctity of the OT, scrubbing, working and sterilization of all the OT Instruments. The trainee is to assist seniors while operating as well as work as a junior surgical trainee in general surgery.

• The 2nd year DNB resident is posted in various super specialities and he should observe their work and assist the senior surgeons. The trainee should also actively take part in the academic activities of the respective departments

• The 3rd year DNB resident is to assist his/ her seniors for plastic surgical procedures

• The 4th year DNB resident should be able to do minor plastic surgical procedures independently and assist seniors for major surgeries.

• The 5th year DNB resident should be able to do minor plastic surgical procedures and some major surgical procedures with the assistance of his/her seniors

• The final year resident should be able to perform minor/medium/major surgeries independently and assist in medium/major/extra major surgeries. The trainee

• should be able to handle all emergencies and post op complications independently and is responsible for supervision and guidance of his/her juniors.

Medico-Legal Responsibilities of the Residents

• All the residents are given education regarding medico-legal responsibilities at the time of admission in a short workshop.

• They must be aware of the formalities and steps involved in making the correct death certificates, mortuary slips, medico-legal entries, requisition for autopsy

• They should be fully aware of the ethical angle of their responsibilities and should learn how to take legally valid consent for different hospital procedures & therapies.

• They should ensure confidentiality at every stage

V. LOG BOOK

A candidate shall maintain a log book of operations (assisted / performed) during the training period, certified by the concerned post graduate teacher / Head of the department / senior consultant.

This log book shall be made available to the board of examiners for their perusal at the time of the final examination.     

The log book should show evidence that the before mentioned subjects were covered (with dates and the name of teacher(s) The candidate will maintain the record of all academic activities undertaken by him/her in log book.

1. Personal profile of the candidate

2. Educational qualification/Professional data

3. Record of case histories

4. Procedures learnt

5. Record of case Demonstration/Presentations

6. Every candidate, at the time of practical examination, will be required to produce performance record (log book) containing details of the work done by him/her during the entire period of training as per requirements of the log book. It should be duly certified by the supervisor as work done by the candidate and countersigned by the administrative Head of the Institution.

7. In the absence of production of log book, the result will not be declared.

VI. RECOMMENDED TEXT BOOKS AND JOURNALS

Suggested Books

• Grabb & Smith: Plastic Surgery – 7th Edition

• Neligan P. Ed Plastic Surgery – 6 Volume set 4th Edition, 2017.

• Mc Gregor: Fundamental techniques of Plastic Surgery

• Diego Marre. Fundamental Topics in Plastic Surgery

• Plastic and Reconstructive Surgery Ed. Karoon Agrawal

• Green's: Operative Hand surgery

• Grab's: Encyclopedia of flaps

• Flaps and Reconstructive Surgery – Wei and Mardini. 2nd ed

• Paediatric Burns-Total Management of the Burned Child by Marella L     Hanumadass and K Mathangi Ramakrishnan

• Total Burn Care – David Herndon. 4th Ed.

• Mc Carthy: Current therapy in Plastic Surgery

• Practice Manual of Microvascular Surgery – Acland RD and Sabapathy SR

• Maxillofacial Surgery – Peter Ward Booth, 2 vol set. 2nd ed.

Suggested Journals

• Indian Journal of Plastic Surgery

• Plastic and Reconstructive Surgery

• Journal of Plastic Reconstructive and Aesthetic Surgery

• Burns

• Clinics in Plastic Surgery

• Hand Clinics

• Journal of Hand Surgery (am)

• Aesthetic Surgery Journal

Former Massachusetts Institute of Technology professor David Sabatini attempted to influence a legal investigation into complaints of gender bias and sexual harassment at his lab, according to what appears to be a copy of the investigation report, leaked online Wednesday. The report further found his denials were not credible. Portions of the report had been leaked earlier.

A spokesperson for MIT’s Whitehead Institute, which commissioned the investigation by a law firm, declined to comment on the leaked document.

Continue to STAT+ to read the full story…

Two senior reporters made history by being awarded the first Journalism Fellowships for Childhood Obesity and NCD Prevention on December 15.

Marlon Madden of Barbados TODAY and Regina Selman Moore of The Barbados Advocate were selected to receive the Fellowship, which was launched in May 2021 through a partnership between the Barbados Association of Journalists and Media Workers (BARJAM) and the Heart and Stroke Foundation of Barbados (HSFB).

Pre-COVID research shows that an alarming 31 per cent of children in Barbados are obese or overweight. It is especially critical that young people, parents and policymakers be informed on how to tackle this health crisis that is inextricably linked to the extremely high prevalence of Non-Communicable Diseases (NCDs). Current statistics indicate that eight out of every ten deaths in Barbados is due to an NCD.

An analysis of media coverage in Barbados between June 2021 and March 2022 revealed that articles by Madden and Selman-Moore highlighted childhood obesity, the increasing challenge of NCDs, and its impact on the social, economic and financial sectors.

General Secretary of BARJAM Emmanuel Joseph congratulated the journalists and applauded the initiative. 

“The Association is delighted and celebrates with Regina and Marlon on being chosen for the fellowship. I thank you both for your good work against all the odds, because journalism can be a thankless job as a lot is demanded of us, with very little returns,” said Joseph.

He also thanked the HSFB for the collaboration and urged the two journalists to capitalise on the fellowship and to continue drawing attention to the issue of childhood obesity, as it is a matter of life and death. He noted that the fellowships are key to bringing this concern into public discourse and raising awareness about the issue. “We look forward to the transformation that reporting on childhood obesity (and NCDs) will bring to the local landscape,” he said.

The journalists will each be awarded Bds$1, 200 to support their six-month fellowship, which began on December 1, 2022. During this period, the journalists are challenged to produce evidence-based in-depth articles and stories that further explore the various aspects related to childhood obesity and NCDs at the national and global level, and continue to sensitise Barbadians to the issues. 

 Offering her congratulations, Chief Executive Officer of HSFB Michelle Daniel stressed that the media continues to be an important partner in advocacy efforts for childhood obesity.

“We have noted some very dedicated journalists who understand the metrics of a situation as alarming as childhood obesity and are able to present this information in easily comprehensible ways. Our public cannot be informed about the factors influencing childhood obesity without the support and input of the media. We are heartened to award professional and dedicated journalists to be on the right side for our children as we continue this battle,” she said. 

The presentation to the winning journalists took place at the Heart and Stroke Foundation of Barbados. 

(PR)

The post Reporters receive inaugural Journalism Fellowship appeared first on Barbados Today.

PAHO makes COVID-19 therapeutic available to 16 countries

Oscar Reyes

21 Dec 2022

Despite the intervention of the Ministry of Public Health and the Dominican Red Cross, who have installed four sanitized water containers at the mouth of the “Zurza Abajo,”  where four active cases of cholera are currently maintained, the people of the place continue to prefer the comfort of drinking the water that comes to their homes, over sanitation. “The water sometimes comes with green, greasy, dirty, or bad-smelling straws, and when that happens, I don’t drink it,” said Maria Victoria, who thanked health officials for intervening yesterday.

Contrary to Maria, various residents of the area stated that the State’s intervention in search of improvement or prevention has been insufficient. “Tell me, what is the point of coming down and putting a water tank down here if the same garbage is still everywhere?” According to Pulman Cena, who has lived in the area for over forty years and has never been sick or suffered damage due to the supposed contamination of the waters.

At the expense of this, Cena left the crystalline pool of La Zurza, from which plastic waste, caps, clothing remnants, and garbage can be seen at the bottom; additionally, he filled gallons and buckets in his house with water that he claimed came from an aqueduct connected to the Santo Domingo Aqueduct and Sewerage Corporation (CAASD) tank, which supplies the neighborhood market.

 

You want it to be the most wonderful time of the year, but issues like fatigue, pain and brain fog, while navigating the holidays safely, could make that difficult. We also cannot forget the other holiday stressors for persons living with a...