Analyzing the Role and Liability of Paramedics in the Indian Healthcare System

The Nursing and staff serves as backbone of a healthcare system. Despite being central to any healthcare system, not much has been written about them, especially on the issue of their regulations and legal liabilities emanating from their professional activities. Though they are governed by National and State councils, the implications of their acts are different in Civil Law, Criminal Law and under their respective regulations. These differences are primarily the subject matter of this paper.

How Difficult Is It To Implement A Competency-Based Medical Education In India: The Next Steps?

Background:Medical Council of India is in the revamping mode to align the medical curriculum to the emerging health care needs of the society, by introducing Competency-Based Medical Education (CBME). This new medical curriculum intends toimpartthecompetencies that are needed to produce medical graduates who would function efficiently as Physicians of first contact or basic doctorsin the community. The ECE program would enhance the knowledge, skills, and attitude of the medical graduates if it is implemented. We conducted this study to assess the challengescurrently facedby faculties for the implementation of this new curriculum.Material and Methodology:It is a cross-sectional study conducted at NC Medical College, Israna during the study period was July 2021 to November 2021. The study team regularly scrutinized the data collection process and met periodically to review the study conduct and computing of data. At the end of the study period, the consolidated data were analyzedusing IBM SPSS version 22.Result:A total of 50 teaching faculties, we acknowledged 48questionnairesthat were complete. 96% faculties showed positive and opportunistic be haviourtowards the new curriculum of CBME with constructive ideas but 4% faculties declined.Conclusion:CBME is theparadigm shift in the teaching and learning approach of medical education. Mostof the medical facultymembersare aware of the need and have attained a positive attitude for theapplication of CBME. However significant barriers do exist in the form of manpower, new time mapping and resources which need to be addressed.

Congenital adrenal hyperplasia presenting as hematuria and acute renal faliure.

We present a neonate who presented with hematuria and acute renal failure. Classical 21 hydroxylase deficiency was diagnosed on the basis of features of salt wasting, response to treatment with corticosteroids and mineralocorticoids and a positive ACTH stimulation test. Renal vein thrombosis secondary to hemoconcentration due to salt wasting was attributed as the cause of hematuria. Follow-up revealed clinical improvement and normalization of renal parameters. This is the first report of congenital adrenal hyperplasia presenting as hematuria and renal failure to the best of our knowledge.

Patent ductus arteriosus in preterm neonates.

Failure of the ductus arteriosus to close within 48-96 hours of postnatal age results in a left to right shunt across the ductus and overloading of the pulmonary circulation. This is more likely to happen in premature neonates with respiratory distress syndrome. Deterioration in the respiratory status on day 3-4 in a ventilated neonate and unexplained metabolic acidosis may be the earliest indicators of a patent ductus arteriosus (PDA). Indomethacin is the main stay of medical management of PDA in preterm neonates. Guidelines for administration of indomethacin have been described in the protocol. Restricted fluid therapy may be beneficial in the prevention of PDA in preterm neonates. Presence of PDA in a term neonate should be investigated to rule out an underlying congenital heart disease.

Hypocalcemic heart failure masquerading as dilated cardiomyopathy.

Hypocalcemia is a rare, but reversible, cause of congestive heart failure. We report a 4-month-old boy diagnosed as dilated cardiomyopathy who had prolonged QoTc with low blood levels of calcium, normal phosphate, elevated alkaline phosphatase and findings suggestive of rickets. In view of non response to calcium and vitamin D3, a possible diagnosis of VDDR I (Vitamin D-dependent rickets) was made and he was treated with calcium and calcitriol. The serum calcium levels normalised within 10 days, along with resolution of the signs and symptoms of heart failure, near normal left ventricular function and normalisation of QoTc. Pediatricians should be aware of the association of hypocalcemia with cardiac dysfunction and should keep it as a possible reversible cause of heart failure in children.