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Finally blood pressure medication news amlodipine 5 mg with amex, without thorough cleaning hypertension kidney infection order 2.5mg amlodipine amex, which removes any organic matter remaining on the instruments that could protect microorganisms during the 1 Adapted from: Tietjen heart attack young squage order amlodipine with a visa, Cronin and McIntosh 1992 blood pressure medication young adults cheap 2.5 mg amlodipine amex. Infection Prevention Guidelines 11 1 Sterilization sterilization process blood pressure medication urination buy discount amlodipine 10mg online, sterilization cannot be assured blood pressure chart english purchase amlodipine australia, even with longer sterilization times. Remember: When instruments and equipment are sterilized by high High-pressure steam sterilization is an effective method of sterilization but pressure steam (autoclaving), is the most difficult to do correctly (Gruendemann and Mangum 2001). It is it is essential that steam generally the method of choice for sterilizing instruments and other items reach all surfaces. Where electricity is a problem, instruments can example, steam sterilizing be sterilized in a nonelectric steam sterilizer using kerosene or other fuel as a closed containers will sterilize only the outside of heat source. Dry-heat sterilizers (ovens) are good in humid climates but need a continuous supply of electricity, making them impractical in many remote (rural) areas. Standard Conditions for Heat Sterilization Steam sterilization (Gravity): Temperature should be 121qC (250qF); 2 pressure should be 106 kPa (15 lbs/in); 20 minutes for unwrapped items; 30 minutes for wrapped items. Or at a higher temperature of 132qC (270qF), 2 pressure should be 30lbs/in; 15 minutes for wrapped items. Note: High-speed (flash) prevacuum sterilizers are Allow all items to dry before removing them from the sterilizer. Sterilizing time for unwrapped instruments by Dry heat: this method is shorter, only taking 4 minutes. Remember: x Exposure time begins only after the sterilizer has reached the target temperature. The material used for wrapping instruments and other items must be porous enough to let steam through but tightly woven enough to protect against dust particles and microorganisms (see Appendix G for wrapping and packaging instructions). Wrapped sterile packs should remain sterile until some event causes the package or container to become contaminated. An event can be a tear or worn area in the wrapping, the package becoming wet or anything else that will allow microorganisms to enter the package or container. They occur in animals (dogs, cows and primates) as well as humans and are rapidly fatal once symptoms develop. In addition, chemical disinfectants, including sterilants such as glutaraldehydes and formaldehyde, are not strong enough to eliminate prion infectivity on contaminated instruments and other items. Therefore, surgical instruments and other critical devices contaminated with high-risk tissue. Infection Prevention Guidelines 11 3 Sterilization x Following surgery, noncritical items such as the operating table, Mayo stand and other environmental surfaces can be decontaminated Note: Do not soak by wiping with a cloth soaked with 0. It is many times more effective in conveying this type of energy to the item than is hot (dry) air. In a kitchen, potatoes can be cooked in a few minutes in a steam pressure cooker while cooking may take an hour or more in a hot-air oven, even though the oven is operated at a much higher temperature. Steam, especially under pressure, carries thermal energy to the potatoes very quickly, while hot air does so very slowly. Second, steam is an effective sterilant because any resistant, protective outer layer of the microorganisms can be softened by the steam, allowing coagulation (similar to cooking an egg white) of the sensitive inner portions of the microorganism. Certain types of contaminants, however, especially greasy or oily materials, can protect microorganisms against the effects of steam, thus hindering the process of sterilization. This re emphasizes the need for thorough cleaning of objects before sterilization. Requirements Steam sterilization requires four conditions: adequate contact, sufficiently high temperature, correct time and sufficient moisture. Although all are necessary for sterilization to take place, sterilization failures in clinics and hospitals are most often caused by lack of steam contact or failure to attain adequate temperature. All four conditions are discussed, in order of their importance in ensuring complete sterilization by steam, in Appendix G. This 2 Devices and instruments that are not heat-resistant or are difficult to clean should be incinerated. This practice, however, is not recommended because of the additional risk of sterilizer damage and exposure of health workers to chemical toxicity. Disadvantages x Requires a continuous source of heat (wood fuel, kerosene or electricity). If using a pressure cooker or kerosene-powered (nonelectric) gravity displacement steam sterilizer, bring the water to a boil and let steam escape from the pressure valve; then turn down heat, but keep steam coming out of the pressure valve. Allow instrument packs to dry completely before removal, which may take up to 30 minutes. Unwrapped items must be used immediately or stored in covered, sterile containers. Ideally, a steam sterilizer log should be kept, noting time: x heat begun, x correct temperature and pressure achieved, x heat turned down, and x heat turned off. Keeping a log can help ensure that the required amount of time will be observed, even when multiple, new or hurried workers are responsible for overseeing sterilization. A convection oven with an insulated stainless steel chamber and perforated shelving to allow the circulation of hot air is recommended, but dry-heat sterilization can be achieved with a simple oven as long as a thermometer is used to verify the temperature inside the oven. Effectiveness Dry-heat sterilization is accomplished by thermal (heat) conduction. Initially, heat is absorbed by the exterior surface of an item and then passed to the next Remember: Just as with layer. Eventually, the entire object reaches the temperature needed for steam sterilization, thorough cleaning of the object prior to sterilization. Death of microorganisms occurs with dry heat by a process of dry heat sterilization is slow destruction of protein. If an instrument is sterilization, because the moisture in the steam sterilization process not properly cleaned, significantly speeds up the penetration of heat and shortens the time needed sterilization cannot be to kill microorganisms. Hypodermic or suture needles should be placed in glass tubes with cotton stoppers. Loose items should be removed with sterile forceps/pickups and used immediately or placed in a sterile container with a tight-fitting lid. If objects need to be sterilized, but using high-pressure steam or dry-heat sterilization would damage them or Note: Chemical sterilization of hypodermic equipment is not available (or operational), they can be chemically sterilized. Common disinfectants that can be used for chemical may remain even after sterilization include glutaraldehydes and formaldehyde. Both glutaraldehydes and formaldehyde require special handling and Note: Because boiling and steaming does not reliably leave a residue on treated instruments; therefore, rinsing with sterile water is inactivate all endospores, essential if the item must be kept sterile. Also, if not rinsed off, this residue rinsing with boiled water can interfere (cause sticking) with the sliding parts of the laparoscope and can contaminate sterile cloud the lens. It is, however, the only acceptable alternative if sterile water Although formaldehyde is less expensive than glutaraldehydes, it is also is not available. When using either glutaraldehydes or formaldehyde, wear gloves to avoid skin contact, wear eyewear to protect from splashes, limit exposure time and use both chemicals only in well Remember: Do not dilute formaldehyde with ventilated areas (Clark 1983). If these are not available or practical, use the solution only for the minimum recommended time and change it if it is diluted by wet instruments or is visibly cloudy. Wear gloves and eyewear, limit exposure time and use both chemicals only in well-ventilated areas. Biological Indicators Monitoring the sterilization process with reliable biological indicators at regular intervals is strongly recommended. Measurements should be performed with a biological indicator that employs spores of established resistance in a known population. The biological indicator types and Remember: Different minimum recommended intervals should be: sterilization processes have different monitoring requirements. These indicators should be used on the inside and outside of each package or container. External indicators are used to verify that items have been exposed to the correct conditions of the sterilization process and that the specific pack has been sterilized. Internal indicators are placed inside a pack or container in the area most difficult for the sterilization agent to reach. Chemical indicators, such as heat sensitive tape or glass vials containing pellets that melt at certain temperatures for a given time, do not guarantee that sterilization has been achieved. They do, however, indicate whether mechanical or procedural problems in the sterilization process have occurred. Mechanical Indicators Mechanical indicators for sterilizers provide a visible record of the time, temperature and pressure for that sterilization cycle. This is usually a printout or graph from the sterilizer, or it can be a log of time, temperature and pressure kept by the person responsible for the sterilization process that day. This storage area is best located next to or connected to where sterilization occurs, in a separate enclosed area with limited access that is used just to store sterile and clean patient care supplies. In smaller facilities, this area may be just a room off the Central Supply Department or in the operating unit. Note: Sterile packs will not remain sterile unless x Date and rotate the supplies (first in/first out). An event can be a tear or worn area in the wrapping, the package becoming wet or anything else that will enable microorganisms to enter the package or container. Therefore the shelf life of sterilization depends on the following factors: x Quality of the wrapper or container x Number of times a package is handled before use x Number of people who have handled the package x Whether the package is stored on open or closed shelves x Condition of storage area. To make sure items remain sterile until you need them: x prevent events that can contaminate sterile packs, and x protect them by placing them in plastic covers (bags). Before using any sterile item, look at the package to make sure the wrapper is intact, the seal unbroken and is clean and dry (as well as having no water stains), then you can be reasonably sure it is sterile regardless of when it was sterilized (Gruendemann and Mangum 2001). In some healthcare facilities where replacement of supplies is limited and the cloth used for wrapping is of poor quality, time as a limiting factor also serves as a safety margin. If plastic covers (bags) are unavailable for the sterilized items, limiting the shelf life to a specific length of time. One of the first uses of formaldehyde gas was to fumigate rooms, a practice long since shown to be ineffective and unnecessary (Schmidt 1899). There are, however, automatic, low temperature steam formaldehyde sterilizers that are effective and can be used to process heat-sensitive instruments and plastic items. As mentioned previously, because formaldehyde vapors are irritating to the skin, eyes and respiratory tract, the use of formaldehyde in this form should be limited. In addition, it requires sophisticated equipment and skilled staff specially trained for its safe use, making it impractical for use in many countries (Gruendemann and Mangum 2001). Finally, because ethylene oxide, a toxic product, is classified as a potential carcinogen as well as a mutagen, disposing of it is difficult (Gruendemann and Mangum 2001). This can take long periods of time leading to complete cycle times of 24 hours or more (Steelman 1992). The acid is rapidly effective against Sterilants all microorganisms, organic matter does not diminish its activity and it decomposes into safe products. It is usually used for sterilizing different types of endoscopes and other heat-sensitive instruments. This solid polymer of formaldehyde may be vaporized by dry heat in an enclosed area to sterilize objects (Taylor, Barbeito and Gremillion 1969). This method can sterilize items in less than 1 hour and has no harmful by products. A specialized sterilizer is required for performing gas plasma sterilization (Taurasi 1997). Questions and answers regarding Creutzfeldt-Jakob disease infection-control practices. Handling of surgical instruments in a presymptomatic familial carrier of Creutzfeldt-Jakob disease. High-level disinfection can be achieved by boiling in water, steaming (moist heat) or soaking instruments in chemical disinfectants. Hepatitis B virus, which is one of the most difficult viruses to kill, is inactivated in 10 minutes when heated to 80qC (Kobayashi et al 1984; Russell, Hugo and Ayliffe 1982). The highest temperature that boiling water or low-pressure steam will reach is 100qC (212qF) at sea level. This provides a margin of safety for variations in altitudes up to 5,500 meters (18,000 ft), and at the same time eliminates the risk of infection from some, but not all, endospores. Infection Prevention Guidelines 12 1 High-Level Disinfection Boiling Versus Steaming Boiling and steaming both use moist heat to kill microorganisms. Steaming has several distinct advantages over boiling for the final processing of surgical gloves and other items, such as plastic cannulae and syringes. It is less destructive and, because it uses much less fuel than boiling, it is more cost-effective. Also, discoloration of instruments from calcium or other heavy metals contained in some tap water does not occur, because the steam contains only pure water molecules. Finally, although boiling and steaming gloves are equally easy to do, drying boiled gloves is not practical because it is difficult to prevent contamination while they are air drying.

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And it shows how we will save taxpayers a further 700 million in reduced administrative costs across providers and commissioners both nationally and locally high blood pressure medication z 5mg amlodipine mastercard. But our view is that amendment to the primary legislation would signifcantly accelerate progress on service integration heart attack young man buy 5 mg amlodipine amex, on administrative effciency blood pressure vs age amlodipine 10 mg cheap, and on public accountability hypertension 9 code generic amlodipine 10mg without prescription. Our National Health Service was founded in 1948 in place of fear the fear that many people had of being unable to afford care for themselves and their families blood pressure levels usa 2.5mg amlodipine fast delivery. And it was founded in a spirit of optimism at a time of great uncertainty blood pressure systolic order discount amlodipine line, coming shortly after the sacrifces of war. We have high levels of patient satisfaction, generally improving outcomes, strong overall effciency, and relatively high levels of care coordination1. Then illness which cannot be prevented should where possible be treated in community and primary care. If care is required at hospital, its goal is treatment without having to stay in as an inpatient wherever possible. And, when people no longer need to be in a hospital bed, they should then receive good health and social care support to go home. Yet, despite improvements, too often when, where and how care is being delivered is a source of frustration, waste and missed opportunity for patients and the teams looking after them. For the emergency patient in A&E waiting for a bed still occupied by someone stuck in hospital waiting for a social care package at home. For the patient with a long-term condition called back for a pointless outpatient appointment every six months. More fundamentally, with the right support, people of all ages can and want to take more control of how they manage their physical and mental wellbeing4. There is no contradiction between wider collective action on health determinants, and a recognition that different individuals will beneft differently from tailored prevention. Indeed one-size-fts-all statutory services have often failed to engage with the people most in need, leading to inequalities in access and outcome. People will get more control over their own health, and more personalised care when they need it. Patient satisfaction with access to primary care has declined, particularly amongst 16-25 year olds. This investment guarantee will fund demand pressures, workforce expansion, and new services to meet relevant goals set out across this Plan. Over the next fve years all parts of the country will be asked to increase the capacity and responsiveness of community and intermediate care services to those who are clinically judged to beneft most. In addition, all parts of the country should be delivering reablement care within two days of referral to those patients who are judged to need it. This will help prevent unnecessary admissions to hospitals and residential care, as well as ensure a timely transfer from hospital to community. Extra recovery, reablement and rehabilitation support will wrap around core services to support people with the highest needs. As part of a set of multi-year contract changes individual practices in a local area will enter into a network contract, as an extension of their current contract, and have a designated single fund through which all network resources will fow. In many parts of the country, functions such as district nursing are already confgured on network footprints and this will now become the required norm. This will be supported through the ongoing training and development of multidisciplinary teams in primary and community hubs. Community hospital hubs will play their full part in many of these integrated multidisciplinary teams. This will support the goal of improving immunisation coverage, using local coordinators to target variation and improve groups and areas with low vaccines uptake. People resident in care homes account for 185,000 emergency admissions each year and 1. Evidence suggests that many people living in care homes are not having their needs assessed and addressed as well as they could be, often resulting in unnecessary, unplanned and avoidable admissions to hospital and sub-optimal medication regimes. For example, in Nottinghamshire, people resident in care homes within the Vanguard experienced 29% fewer A&E attendances and 23% fewer emergency admissions than a matched control group6. This will ensure stronger links between primary care networks and their local care homes, with all care homes supported by a consistent team of healthcare professionals, including named general practice support. As part of this, we will ensure that individuals are supported to have good oral health, stay well hydrated and well-nourished and that they are supported by therapists and other professionals in rehabilitating when they have been unwell. Care home residents will get regular clinical pharmacist-led medicine reviews where needed. Primary care networks will also work with emergency services to provide emergency support, including where advice or support is needed out of hours. People are now living far longer, but extra years of life are not always spent in good health7, as Table 1 shows. They are more likely to live with multiple long-term conditions, or live into old age with frailty or dementia, so that on average older men now spend 2. Males Females Country Life Proportion Life Proportion Life Proportion Life Proportion expectancy (%) in poor expectancy (%) in poor expectancy (%) in poor expectancy (%) in poor at birth health at age 65 health at birth health at age 65 health France 79. Extending independence as we age requires a targeted and personalised approach, enabled by digital health records and shared health management tools. Primary care networks will from 2020/21 assess their local population by risk of unwarranted health outcomes and, working with local community services, make support available to people where it is most needed. Using a proactive population health approach focused on moderate frailty will also enable earlier detection and intervention to treat undiagnosed disorders, such as heart failure. Based on their individual needs and choices, people identifed as having the greatest risks and needs will be offered targeted support for both their physical and mental health needs, which will include musculoskeletal conditions, cardiovascular disease, dementia and frailty. Integrated primary and community teams will work with people to maintain their independence: for example, 30% of people aged 65 and over, and 50% of those aged 80 and over, are likely to fall at least once a year9. Falls prevention schemes, including exercise classes and strength and balance training, can signifcantly reduce the likelihood of falls and are cost effective in reducing admissions to hospital10. This could include a set of digital scales to monitor the weight of someone post-surgery, a location tracker to provide freedom with security for someone with dementia, and home testing equipment for someone taking blood thinning drugs. To do so requires major work to digitise community services, as set out in Chapter Five. The latest Census found that 10% of the adult population has an unpaid caring role, equating to approximately 5. Many carers are themselves older people living with complex and multiple long-term conditions. We will improve how we identify unpaid carers, and strengthen support for them to address their individual health needs. We will do this through introducing best-practice Quality Markers for primary care that highlight best practice in carer identifcation and support. We will go further in improving the care we provide to people with dementia and delirium, whether they are in hospital or at home. One in six people over the age of 80 has dementia and 70% of people in care homes have dementia or severe memory problems. Research investment is set to double between 2015 and 2020, with 300m of government support14. There have also been substantial reductions in the proportion of people with medium and high dependency who live in care homes16. However we have an emergency care system under real pressure, in the midst of profound change. The number of A&E patients successfully treated within four hours is 100,000 per month higher than fve years ago. For those that do need hospital care, emergency admissions requiring an inpatient stay (up by 2. That, plus good results from action to cut delayed hospital discharges, means inpatient emergency bed days are now actually falling. Over the period of this Long Term Plan, by expanding and reforming urgent and emergency care services the practical goal is to ensure patients get the care they need fast, relieve pressure on A&E departments, and better offset winter demand spikes. In looking forward to the next fve years, the balance of need for hospital beds will be a product of continuing pressures from an ageing population partially balanced against further gains from changing the model of care, as set out in this chapter. Instead we have provided both for the hospital funding and the staffng as if trends over the past three years continue. This will provide specialist advice, treatment and referral from a wide array of healthcare professionals, encompassing both physical and mental health supported by collaboration plans with all secondary care providers. We will work with commissioners to put in place timely responses so patients can be treated by skilled paramedics at home or in a more appropriate setting outside of hospital. We will continue to work with ambulance services to eliminate hospital handover delays. New diagnostic and treatment practices allow patients to spend just hours in hospital rather than being admitted to a ward. This also helps relieve pressure elsewhere in the hospital and frees up beds for patients who need quick admission either for emergency care, or for a planned operation. This is a model co-developed by the Royal College of Physicians and the Society of Acute Medicine, which is being successfully deployed in an increasing number of hospitals. Figure 3: Relative growth in emergency admissions: zero day and 1+ day length of inpatient stay. Under this Long Term Plan, every acute hospital with a type 1 A&E department will move to a comprehensive model of Same Day Emergency Care. This will increase the proportion of acute admissions discharged on the day of attendance from a ffth to a third. Hospitals will also reduce avoidable admissions through the establishment of acute frailty services, so that such patients can be assessed, treated and supported by skilled multidisciplinary teams delivering comprehensive geriatric assessments in A&E and acute receiving units. For people who arrive in A&E following a stroke, heart attack, major trauma, severe asthma attack or with sepsis, we will further improve patient pathways to ensure timely assessment and treatment that reduces the risk of death and disability. We will develop a standard model of delivery in smaller acute hospitals who serve rural populations. Smaller hospitals have signifcant challenges around a number of areas including workforce and many of the national standards and policies were not appropriately tailored to meet their needs. We will work with trusts to develop a new operating model for these sorts of organisations, and how they work more effectively with other parts of the local healthcare system. Without access to timely and accurate data we cannot maximise the opportunities to improve care for all patients. We will develop an equivalent ambulance data set that will, for the frst time, bring together data from all ambulance services nationally in order to follow and understand patient journeys from the ambulance service into other urgent and emergency healthcare settings. Where people are discharged vs where Figure 5:would be best for themDifferences in where people are discharged compared to where would be best for them. People will get more control over their own health and more personalised care when they need it 1. Advances in precision medicine also mean treatment itself will become increasingly tailored to individuals, and patients will be offered more personalised therapeutic options. For example, this summer new research showed that, based on their tumour genetics, thousands of women with breast cancer could now avoid chemotherapy. We will support and help train staff to have the conversations which help patients make the decisions that are right for them.

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Asit Kumar Panja Participated in a Program in January 2017 organised by Rajasthan Assistant Professor Ayurveda Vigyanparishad hypertension kidney specialist generic amlodipine 2.5 mg without prescription, Jaipur and delievered a Lecture on Bengal Tradition of Clinical Practice heart attack demi lovato sam tsui chrissy costanza of atc order 2.5mg amlodipine amex. Asit Kumar Panja Participated in a Program organised on 12-2-2017 by National Assistant Professor Institute of Indian Medical Heritage heart attack 35 purchase generic amlodipine canada, Hyderabad and delieved a Lecture on Ayurveda Classification of Disease heart attack young squage mp3 purchase amlodipine 10mg with mastercard. Asit Kumar Panja Participated in a Program in March 2017 organised by Rajasthan Assistant Professor Ayurveda Vigyanparishad pulse pressure is purchase generic amlodipine canada, Jaipur and delievered a Lecture on Traditions of Rasashastra in Bengal prehypertension dizziness buy discount amlodipine 10 mg on-line. Asit Kumar Panja Paper Co-authored: Analytical Study of Variant Reading in the Assistant Professor Commentaries of Charaka Samhita in Clinical Practice and Presented by a Scholar in 7th World Ayurveda Congress held on 1-4 December, 2016 at Kolkata. Asit Kumar Panja Paper Co-authored: Role of Trikantakadyaghritam in the Assistant Professor Management of Prameha A Conceptual Study and presented by a Scholar in the Seminar organised by All India Institute of Ayurveda, New Delhi on 5-7 March 2017. Asit Kumar Panja Paper Co-authored: Case Study of Newly Diagnosed Prameha & Assistant Professor Management in Ayurveda. Shailaja Bhatnagar Participated in Workshop on Scientific Writing organised by Assistant Professor National Institute of Ayurveda on 8-9 February 2017. Guest Lectures: Following Guest Lectures were deliverd in various Workshops and Programs by the Faculty Member of the Department for the benefit of students and scholars: Name of Faculty Sl. Asit Kumar Panja Specialty in Ayurveda April 2016 A Program organised by Loverly Assistant Professor Classical Clinical Professional University, Punjab Practice. Asit Kumar Panja (i) Concept of Diet in 18-19 April, International Nutrition Week, Assistant Professor Ayurveda in Relation 2016 Tel-Aviv. Asit Kumar Panja Non-communicable 9-8-2016 Training of Trainers Program Assistant Professor Diseases and Their for Physicians organised by Ayurvediya Department of Ayurveda, Govt. Asit Kumar Panja Life Style Disorder 13-8-2016 Training of Trainers Program Assistant Professor Ayurvediya Treatment for Physicians organised by Approach. Asit Kumar Panja Practical Examination 26-8-2016 Training of Trainers Program Assistant Professor of Nadipareeksha. Asit Kumar Panja Classical Clinical 24-9-2016 A Program organised by Tilak Assistant Professor Practices with special Ayurveda College Pune. Asit Kumar Panja Clinical Practices of 23-10-2016 A Program organised by Arya Assistant Professor Various Schools of Vaidya Pharmacy, Coimbatore. Asit Kumar Panja Life Style Disorder 5-10-2016 Training of Trainers Program Assistant Professor and their Ayurvediya for Physicians organised by Treatment. Asit Kumar Panja Exploration of Wealth 12-13 A Program organised on by Assistant Professor of Clinical Practice in November Jadhavpur University, Bengal. Asit Kumar Panja Life Style Disorder November Training of Trainers Program Assistant Professor and Their Ayurvediya 2016 for Physicians organised by Treatment. Asit Kumar Panja Prameha and Its A Program organised by Assistant Professor Complication Stage Rajasthan Ayurveda Wise Treatment Vigyanparishad, Jaipur Protocol. Asit Kumar Panja Basic Principles, 9-1-2017 Short Term Training Assistant Professor History of Evolution. Programme for Korean Students organised by National Institute of Ayurveda, Jaipur. Govind Pareek Prakriti, Janam, Desha, 13-01-2017 Guest lecture for Korean Assistant Professor Deha and Manas Delegates National Institute of Ayurveda, Jaipur. Govind Pareek Madhumeh Ka 05-02-2017 Sambhasha 2017 Assistant Professor Vishleshnatmak National Institute of Ayurveda, Adhayan Jaipur. The details of which are given below: Development of Audio-Visual-History Repository/Museum for Teachers and Students of Ayurveda Dr. Sarvepalli Associate Professor Radhakrishnan Rajasthan Ayurved University, Jodhpur. Conducted Examinations, as External Examiner, at Banaras Hindu University, Varanasi and Ayurveda & Unani Tibbiya College, New Delhi. Member of Safeguard against Sexual Harassment of Women at Work Place and Grievances Committee. Worked as Member of Catering Committee for Sambhasha organised by the Institute during 5-7 February 2017. Run a Manuscript Unit to explore Classical Ayurveda Wisdom for Assistant Professor Common people since 2015. Visited three Manuscript Libraries in Udaipur Zone to Explore Ayurveda Manuscripts in 14-15 July 2016. Worked as organizer in Rashtriya Hindi Vigyana Sammelana in December 16-17, 2016 organised at Rajasthan University, Jaipur 6. Attended Diabetic Awareness Camps on the occasion of Ayurveda Day on 28-10-2016 at Naturopathy Hospital, Jaipur. Worked as Incharge of Departmental Library, Anti Ragging Committee, Student Welfare Committee etc. Attended Mobile Camp conducted during World Ayurveda Congress on 1-4 December, 2016. Govind Pareek, Assistant Professor recieved Best Citizen Award and Dhanvantari Sammaan. Ayurveda mainly treat the patient by either Samshodhana (Purificative / Bio-cleansing) or Samshamana (Palliative) Treatment. Panchakarma which include five major procedures Vamana(Therapeutic emesis), Virechana(Therapeutic purgation), Niruha Basti(Therapeutic Cleansing Enema), Anuvasana Basti(Therapeutic Oil Enema), Nasya(Therapeutic Nasal Administration of Medicine) are mainly bio cleansing in nature. Apart from this several other internal and external therapies are administered in the department of Panchakarma for the treatment of various diseases mainly musculo skeletal, neurological, skin, metabolic, life style, Allergic, Respiratory and Psychiatric diseases are effectively treated by Panchakarma. This department renders service to the society by treating almost all type of patients. It extends support to other departments for treating the patients through Panchakarma. D level mainly on Management of various Diseases like Rheumatoid arthritis, Sciatica, Hemiplegia, Diabetes, Psoriasis, Hypertension, Obesity, Sexual dysfunction, Dislipidemia. During the year under report, 1 Associate Professors and 2 Assistant Professor with other supporting technical and non-technical staff were working in the Department. Besides theoretical as well as practical teaching, training and guidance, the Department also engaged students in bed-side clinics in Panchakarma. Gopesh Mangal A comparative clinical study on the role of Shamana Assistant Professor Snehapana and Yapana Basti with Asthishrinkhladi Ghritam and Aswagandha Ksheerpaka followed by Abhadi Churna in the Management of Asthikshaya w. Gopesh Mangal A clinical comparative study on the role of Vamana, Assistant Professor Virechana, Sarivadi Ghanavati and Vatapatradi Lepa in management of Mukhadushika w. Sharma A Comparative Clinical Study on the Role of Associate Professor Katibasti with Shvadanstradi Taila and Dr. Gopesh Mangal Erandamuladi Kala Basti in the Management of Assistant Professor Gridhrasi w. Sarvesh Kumar A Comparative Clinical Study to Evaluate the Role of Singh Janu Basti and Matra Basti along with Adityapaka Assistant Professor Gugglu in the Management of Janusandhigata Vata w. Gopesh Mangal A Comparative Clinicl Study on the Effect of Vamana Bhaumik Assistant Professor and Virechana Karma followed by Kushthaghna Mahakashaya in the Management of Ekakushtha w. Sharma An Open Label Randomized Comparative Study of Khanday Associate Professor the Efficacy of Sadhyo Virechana and Basti with Dr. Sarvesh Kumar Eranda Tail and Vaitaran Basti respectevely along Singh with Amritadi Churna and Baluka Swedan in the Assistant Professor Management of Amavata w. Sarvesh Kumar A Comparative Clinical Study on the Role of Juvaneeta Jansz Singh Katibasti with Balataila and Erandamuladi Niruha Assistant Professor Basti along with Erandapaka in the Management of Katishool w. Gopesh Mangal A Comparative Clinical Study on the Effect of Assistant Professor Ksheerbalatailamatrabasti and Erandmooladi Dr. Sarvesh Singh yogabasti followed by Rasnaguggulu in the Assistant Professor Management of Gridhrasi w. Sarvesh Singh A Comparative Clinical Study on the effect of Assistant Professor Triphalavidangadi Lekhana Basti & Vidangadi Dr. Sarvesh Singh A Comparative Clinical Study to Evaluate the Effect Kumar Pathak Assistant Professor of Ksheerbalataila in Matrabasti and Janupichu Dr. Gopesh Mangal along with Aswangandhashatavariksheer Pak in the Assistant Professor Management of Janu-Sandhigatavata w. Sarvesh Singh A Comparative Clinical Study on the Role of Kuswaha Assistant Professor Virechana and Uttar Basti, along with Yoga Basti in Dr. Hetal Dave the Management of Vandhyatva with special Assistant Professor reference to Female Infertility. Gopesh Mangal A Comparative Clinical Study On the Of Effect Of Assistant Professor Vamana Karma,Virechana Karma, Followed By Vyaghri Haritaki Rasayana In the Management Of Tamaka Shavasa W. Gopesh Mangal A Comparative Clinical Study of Vamana & Kumawat Assistant Professor Virechana Karma and followed by Aragwadha Patra Lepa with Samana Yoga (Lelitaka Gandhaka) in the Management of Kitibha Kushtha w. Gopesh Mangal the Role of Shadbindu Sarpi Nasya and Shadbindu Assistant Professor Sarpi Pana in Ardhavabhedaka (Migraine). Gopesh Mangal A Comparative Clinical Study Of Vamana Karma Assistant Professor With two Different Vamaka Yoga and Virechana Karma in the Management of Mandal Kushtha w. Gopesh Mangal A Comparative Clinical Study to evaluate the Damar Assistant Professor Efficacy of Janu Basti and Matra Basti with Shvadanstra Taila in the Management of Janu Sandhigatavata w. Sharma A Comparative Clinical Study of effect of Guduchi Associate Professor Bhadra Mustaadi Lekhana Basti and Guduchi Dr. Gopesh Mangal Bhadra Mustaadi Ghana Vati in the Management of Assistant Professor Sthoulya w. Sarvesh Kumar A Clinical Study to Compare the efficacy of Janu Singh Dhara and Matra Basti with Sahachara Taila in the Assistant Professor Management of Janu-Sandhigatavata w. Sarvesh Kumar A Comparative Clinical Study to Evaluate the Singh Efficacy of Matra Basti and Kati Basti with Assistant Professor Sahachara Taila in the Management of Katigraha w. Sharma A Comparative Clinical Study on the Efficacy of Chaudhary Associate Professor Shahchara Taila Matra Basti and Patrapinda Dr. Sharma Clinical Study to Compare the efficacy of Greeva Associate Professor Basti with Ashwangandhya Taila and Lepana with Dr. Sarvesh Kumar Singh Assistant Professor During the year under Report, the following research works of Ph. Gopesh Mangal A Clinical Study on the effect of Vamanottara Assistant Professor Virechana Karma, Darvyadi Ghanavati and Lifestyle Modification in Prameha w. Gopesh Mangal A Clinical Study to Assess the Safety and Efficacy of Assistant Professor Vamana and Virechana Karma followed by Ksheer Ghrita Rasayan in Healthy Individuals. Gopesh Mangal A Comparative Clinical Study on the effect of Samadhan Hivale Assistant Professor Treatment as per Chikitsasutra, Nitya Virechana, Indukant Ghrita and Amritadi Guggulu in Amavata w. Gopesh Mangal A Standard Controlled Clinical Study of Vamana Sharma Assistant Professor Karma and Koshatakyadi Kaphanashaka Basti followed by Deepinya Mahakashaya Ghanavati in the Management of Dhatwagnimandya w. Clinical: Clinical services were rendered to Indoor and Outdoor patients of the hospital by this Department and provided treatment through Panchakarma Therapy to the patients of Balpakshghat, Pakshaghat, Aamavata, Sandhi Vata, Katishool, and Siraha Shool, Skin Diseases etc. The Panchakarma Department has separate sections as well as masseurs for male and female patients for application of various therapies like Abhyanga (Snehan), Nasya, Shirodhara, Anuvasana Basti, Kati Basti, Nadi Sweda, Shiro Abhyanga, Shiro Basti, Vamana, Virechana, Sarvanga Swedana, Niruha Basti, Shastikashalipindasweda, Patrapindsweda, etc. Encouraging results have been achieved in Rasayana and Vajikarana by purification of the body through Panchakarma and subsequent administration of drugs. Weekly Seminars Weekly Seminars were held regularly on topics with regard to Journal, Thesis and Clinical Case Presentation, respectively. Sarvesh Kumar Singh Ayurvedic Approach in the Ancient Science of Life Assistant Professor Management of Spinocerebellar 2016, 35 Ataxia-2. Sarvesh Kumar Singh Clinical Evaluation of Ksira Basti and Journal Of Ayurveda Assistant Professor Ksira Paka of Balya Drugs on 2015; 9(1) Karshya. Sarvesh Kumar Singh A Comparative Study of the Role of Journal Of Ayurveda Assistant Professor Nasya Karma and Shirodhara in the 2015, 9(2) Management of Ardhavabhedaka w. Assistant Professor Based Seminar on Traditional And Complementary Medicine Organized by Malaysian Medical Association, Malaysia on 7 May 2016. Gopesh Mangal Workshop to Develop To Develop Manual for Good Assistant Professor Manual for Good Practice Practice Guidelines on Varmam Guidelines Organized by Therapy. Gopesh Mangal Workshop on Ayurveda & Dincharya (Daily Routines): Assistant Professor Yoga for Holistic Health Ayurvedic Approach to Healthy organized by Netaji Subhash Life. Chandra Bose Indian Cultural Centre, High Commission of India, Kualalumpur, Malaysia on 9 July 2016. Gopesh Mangal 6th Malaysian International Assistant Professor Conference on Holistic Healing for Cancer organized by Cansurvive Centre Malaysia Berhad, Malaysia on 20 August 2016. Gopesh Mangal Workshop on Ayurveda and Assistant Professor Yoga organized by Netaji Subhash Chandra Bose Indian Cultural Centre, High Commission of India, Kualalumpur on 27 Nov. Gopesh Mangal Workshop on Ayurveda & Stress Management: the Assistant Professor Yoga organized by Netaji Ayurvedic Way. Assistant Professor 7th World Ayurveda Congress & Arogya Expo held on 2-4 December 2016 at Kolkata. Sarvesh Kumar Singh Workshop on Scientific Assistant Professor Writting at National Institute of Ayurveda Jaipur on 8 February 2017. Assistant Professor Fourth Evidence Based Seminar on Traditional And Complementary Medicine, organized by Malaysian Medical Association, Malaysia on 7 May 2016. Assistant Professor organized by Johor State Department of Health, Johor Bharu, Malaysia on 18 May 2016. Gopesh Mangal Workshop organized by Dinacharya Assistant Professor Netaji Subhash Chandra (Daily Routine in Ayurveda). Bose Indian Cultural Centre, High Commission of India, Kualalumpur, Malaysia on 27 November 2016. Gopesh Mangal Workshop organized by Stress Management: the Assistant Professor Netaji Subhash Chandra Ayurvedic Way. Bose Indian Cultural Centre, High Commission of India, Kuala Lumpur, Malaysia on 18 December 2016. Gopesh Mangal Career Talk on Traditional School Sekolah Tun Fatimah, Assistant Professor Indian Medicine: Johor Bahru organized by Johor Professionalism & Wellness State Department of Health Johor Therapy & Promotion of Bharu, Malaysia on 19 May 2016. Gopesh Mangal Persatuan Kamban, Ayurveda & Yoga for Stress Assistant Professor Seremban, Malaysia on 12 Management & Promotion of June 2016. Bahau, Jempol, Negeri Sembilan organized by Persatuan Kamban, Seremban, Malaysia on 20 July 2016.

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For instance hypertension icd code 9 buy amlodipine cheap online, if an examination is developed to assess knowledge of the cardiovascular system prehypertension at 20 buy discount amlodipine on line, the blueprint might have two dimensions: 1) disease-based heart attack statistics buy discount amlodipine 10mg on-line. The blueprint would likely include items along both dimensions arteriovenous oxygen difference generic amlodipine 2.5mg on line, and might call for six items on hypertension arrhythmia or dysrhythmia purchase online amlodipine, four on systolic heart failure arrhythmia specialist purchase discount amlodipine on line, two on diastolic heart failure, ten on ischemic heart disease, and so on. A clear and comprehensive blueprint or other set of test specifca tions should always be available so that item writers can stay focused on the important topics and write sufcient numbers of items for each topic. Rule 2: Each item should assess application of knowledge, not recall of an isolated fact. The frst step in writing an item is to develop an appropriate stimulus to introduce the topic, such as a clinical or ex perimental vignette, to provide context to the question being asked. If there is no such stimulus, the resulting item will generally be assessing knowledge recall. It can be helpful to use actual cases previously encountered as a source of ideas for items and vignettes. However, you should avoid relying on or adhering too closely to actual patient cases because these ofen have atypical features that may divert from a typical or representative case and lead to confusion. Additionally, in some instances, such as the example with systolic heart failure, there will be an additional step that you must keep in mind: you should consider the underlying cause of the heart failure. Patient demographics, past medical history, and other factors will difer de pending on the etiology of the condition. Patients with systolic heart failure from a viral cardiomyopathy versus from ischemic heart disease may have diferent demographics and a diferent history;. A systolic heart failure vignette for a novice, such as a second-semester frst-year medical student, would include very typical features and classic symptoms: shortness of breath with physical activity that improves with rest; awakening at night short of breath, relieved by sit ting up; pedal edema; and pertinent negatives such as the absence of chest pain. Risk factors might include an upper respiratory illness two weeks ago, or a history of heavy alcohol ingestion over 20 years. For more advanced test-tak ers, such as those sitting for a specialty certifying examination, the vignette could include some atypical features, as is the case with many actual patients. The demographic information may or may not be signifcant for the more ad vanced test-takers. For instance, every patient lives somewhere and many will have a current or past occupation that may or may not be related to the cause of their illness. In a vignette for a 30-year-old man with shortness of breath and wheezing in which the diagnosis is asthma, the demographic information might or might not be related to the diagnosis. Rule 3: The item lead-in should be focused, closed, and clear; the test-taker should be able to answer the item based on the stem and lead-in alone. Ideally, afer reading the vignette and the lead-in, a test-taker should be able to answer the item without seeing the options. Another reason to use a closed lead-in is because it helps to avoid certain item faws, such as grammatical cueing. Rule 4: All options should be homogeneous and plausible, to avoid cueing to the correct option. Once you have written your item, you should take a step back and look closely at its structure. The bulk of the text (vignette or case information) should precede rather than follow the lead-in. The clinical or experimental vignette should make sense and follow a logical sequence: frst list patient demographics, then history, physical exam ination, laboratory data, and so on. The lead-in should be closed, and the wording of the lead-in should logically gen erate a homogeneous option set. The use of a template to ensure all of these sections are in place and correctly structured is highly recommended. If the options were removed, could a knowledgeable test-taker answer the question correctly Is there anything in the phrasing or text that would confuse the knowledgeable test-taker Finally, you should ask a colleague to review the items you have written, in particular for content, clarity, and appropriateness for your particular test-taker population. Conversely, topics that are the focus in some medical schools might be omitted from the exam. The analogy for individual schools and courses within schools is to determine the student test-taker population and purpose of the scores. An exam that is intended for formative feedback at a mid-point of a course will have a diferent focus and diferent content than an exam to determine end-of-clerkship grades. Traditionally, test questions have been classifed as requiring recall, interpretation, or problem solving (memory, comprehension, and reasoning), depending on the cognitive processes required to answer the question. The difculty with these classifcations is that the cognitive processes required to answer a question are as de pendent on the background of the student as they are on the question content. Additionally, the selection of item types depends on the intent of their use: for a medium to high-stakes summative examination, the use of vignettes that require higher-order thinking skills and application of knowledge would be preferable to simple recall items. Use of recall items may be best utilized for formative assessment purposes and the evaluation of simpler concepts that might not lend themselves to clinical or experimental scenarios (see Figure 1 for the advantages of each item type in each assessment type). The cognitive processes involved in responding to a question are stu dent-specifc, making the taxonomic approach difcult to use. An alternate approach divides items into two cate gories: application of knowledge vs. If a question requires a test-taker to reach a conclusion, make a prediction, or select a course of action, it is classifed as an application of knowledge question. If a question assesses only rote memory of a fact (without requiring its application), it is classifed as a recall question. Fetal cystic hygroma on ultrasound exam most as if he or she is charged with performing fetal B. Previous child with spina bifida waiting room and select the patient who is most appropriate. The inclusion of the vignette leads to a more realistic task, because the test-taker would need to be able to both recall specifc information and synthesize that information to know which studies should be ordered. Family history is unre markable except that both of her brothers have intellectual developmental disorder, her mother died of breast cancer at age 55, and her father is estranged. Second, the questions are more likely to focus on important information, rather than trivia. Tird, these questions help to identify those test-takers who have memorized a substantial body of factual information but are unable to use that information ef fectively in clinical situations. Writing application of knowledge questions is relatively straightforward in the clinical sciences. The stem should begin with the presenting problem of a patient, followed by the history (including duration of signs and symptoms), physical fnd ings, results of diagnostic studies, initial treatment, subsequent fndings, and so on. Each vignette may include only a subset of this information, but the information should be provided in a consistent order across items. The lead-in of the stem must pose a clear question so that the test-taker can answer without looking at the options. The following stem provides sufcient information and can be an swered without referring to the options. A 52-year-old man has had increasing dyspnea and cough productive of purulent sputum for 2 days. The grid under each item shows the percentage of High (top 20%) and Low (bottom 20%) students who selected each option. Almost all of the High group (99%) and the Low group (90%) se lected the correct option (indicated by the asterisk) in the non-vignette format. The short and long-vignette formats were not markedly more difcult for the High group, but were for the Low group; the correct answer was selected by 82% of the Low group in the short-vignette format and 66% in the long-vignette format. Schonlein-Henoch purpura with nephritis Short Vignette A 2-year-old child has a 1-week history of edema. His A B C* D E blood pressure is 100/60 mm Hg, and there is general ized edema and ascites. Clinical knowledge and science exams require test-takers to demonstrate profciency in sorting through patient information, synthesizing the important fndings, and reaching a conclusion. As a result, these items may have extraneous information as well as the essential information to answer the question. However, it is possible to avoid these traps while writing good-quality clinical vignettes that stress application of knowledge by asking test-takers to make clinical decisions, rather than to simply recall isolated facts. The vignettes tend to follow a standard structure and pose questions that are clinically natural, and the use of a template allows for development of high-quality vignettes with a lower risk of adding too much verbiage or unnecessary or confusing information. Use of Real Patients As mentioned previously, item writers should be careful when basing vignettes on real patients, particularly for tests aimed at students. As a general rule, real patients are complicated, and the elements that are complicated are not al ways those that are important for assessment. Physicians use multiple cues to determine how truthful a patient is and many of these cues cannot be trans lated into written form. Some sample lead-ins and example items to guide item writing eforts for each physician (or other provider) task competency are provided below. Additional lead-ins can be found in Appendix B, Sample Lead-Ins Based on Provider Task Competencies. Foundational (Basic) Science Foundational science comprises items that require understanding and application of basic science. Tese items should require clinical knowledge as well as knowledge of one or more foundational science principles that would likely have been learned during preclinical study and reinforced during clinical rotations. Diagnosis The diagnosis competency is subcategorized into more detailed concepts: Obtaining and Predicting History and Physical Examination, Selecting and Interpreting Diagnostic Studies, Formulating the Diagnosis, and Determining Prognosis/Outcome. A 28-year-old woman has palpitations that occur approximately once a week, last 1 to 5 minutes, and consist of rapid, regular heart pounding. The episodes start and stop suddenly and have not been associated with chest discomfort or dyspnea. There is a midsystolic click at the apex and a grade 2/6 early systolic murmur at the left upper sternal border. Health Maintenance and Disease Prevention: Items in this topic area assess the ability to evaluate risk factors, under stand epidemiologic data, and apply preventive measures. Health Maintenance and Disease Prevention items com monly fall into one of the following categories: 1) screening tests, 2) constructive interference, 3) immunizations/travel medicine, or 4) emergency intervention. In general, the writer should open the items with a clinical vignette that describes a patient. In addition to physical examination fndings, these vignettes may include in formation about immunization history, risk factors, and family history. Information about the community may be relevant and therefore included, but the question should focus on the individual patient. For example, avoid asking about the leading cause of death in some subpopulation; instead, focus on the application of this knowledge. In asking about immunizations or screening tests, consider providing a chart of customary practices to avoid memorization of conficting recommendations. Which of the fol found on routine screening to have a total serum choles lowing is the most appropriate intervention No change in diet* A 33-year-old woman, gravida 1, para 1, spontaneously An asymptomatic 33-year-old man has a blood pressure delivers a 2460-g (5 lb 7oz) female newborn at 38 of 166/112 mm Hg.

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