Monthly Archives: November 2016

Second Opinions July Newsletter

11/11/2016

Happy July from the Second Opinions Team!

As we speed through the summer,  Second Opinions wants to thank all of our customers for your positive feedback and patience with some of the system errors we have had and recently.  We apologize for the convenience and we are improving every day thanks to you!

July is the month with the least dedicated awareness topics, but they are some of the least recognized health topics:

Cord Blood Awareness Month – The collection, preservation and use of the stem cell rich cord blood in medical experiments and treatments has remained highly controversial as the innovation of scientific integration with medical discoveries

cordawareness

International Group B Strep Throat Awareness Month – Approximately 1 in 4 pregnant women carry GBS, the leading cause of sepsis and meningitis in newborns according to the U.S. Centers for Disease Control and Prevention (CDC.) GBS can also infect babies during pregnancy and the first few months of life.

strep-throat-b

Juvenile Arthritis Awareness Month – Also known as pediatric rheumatic disease, JA is an umbrella term used to describe the many autoimmune and inflammatory conditions or pediatric rheumatic diseases that can develop in children under the age of 16.

juvenile-idiopathic-arthritis-3-638

National Cleft & Craniofacial Awareness & Prevention Month – Cleft and craniofacial conditions affect thousands of infants, children, teens and adults in the United States each year.  Some are born with congenital anomalies like cleft lip and palate, others with more complex, life-threatening craniofacial conditions.

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Although we are all busy, let’s take a few minutes to consider how these health topics may factor into a major health decision in our own lives.  While you may not actually know someone whose life has been directly affected, the awareness leads to action in every individual, as we improve our own lives through awareness, we also make an impact on those around us.

Second Opinions thanks all of our customers for sharing their personal Second Opinions stories, like the one that inspired the company.  You can watch the video version here: http://youtu.be/HRzW9Tb7FSU We published in April our “How Second Opinions Changed my Life” contest and we invite you to share your story!

If you haven’t gotten a Second Opinion already, one of our favorite Health institutions has a great article with reasons you should get a Second Opinion: “Why you Should Consider a Medical Second Opinion”  Remember as a registered user, you gain access to our Resources, we have also updated our Tutorials page with more videos including a walk through of our website.

We appreciate your feedback, involvement and look forward to helping you with your Medical future through Second Opinions services.

Pattern of Medico-legal Cases in the Casualty Department of A Teaching Hospital, Bareilly, Uttar-Pradesh

11/11/2016

J Indian Acad Forensic Med. October-December 2015, Vol. 37, No. 4ISSN 0971-0973338 Original Research Paper Pattern of Medico-legal Cases in the Casualty Department of A Teaching Hospital, Bareilly, Uttar-Pradesh 1AtulSaxena, 2Vinod Kumar, 3S. R. Chaudhary, 4Jasvinder Singh, Sadhana Awasthi Abstract Casualty department is the Heart of any hospital and is an important key area because most of medical and surgical emergencies and almost all medico-legal cases first reported here. It is the duty of first attending doctor to prepare report of all the medico-legal case with all required guidelines. Considering the importance of this work this retrospective study was conducted to analyze the pattern and magnitude of all the medico-legal cases registered in the casualty department of SRMS IMS Medical College Bareilly between January-December 2014. This study revealed that RTA constituted majority (64.39%) of medico-legal cases followed by poisoning (17.80%) and fall from height (3.79%). Majority of cases were male (81.44%). The most of the cases were in the age group 21-30 years (30.68%). The most of cases were reported in casualty between 12 p.m. to 6 p.m. (35.61%) followed by 6 p.m. to 12 a.m. (35.23%). The maximum casewere reported in November (17.05%) followed by July (12.5%). The most of cases reported in Rainy season (July-October) (38.64%) followed by winter (34.85%).Key Words: Medico-legal cases, Pattern, Road Traffic Accident, Season, Casualty departmen tIntroduction: The casualty department is the very important area of any hospital. Almost all Medical and Surgical emergencies reported first to Casualty Department of Medical College and apart from these emergencies all medico-legal cases are registered in casualty and all medico-legal formalities are require to be fulfilled here. Casualty Medical Officer (CMO) is the first contact doctor. First and prime duty of CMO is to give First Aid and save the life of patient and another duty of CMO is to do all medico-legal formalities concerned to patients. A medico-legal cases is a case of injury or illness where attending doctor after eliciting, listing and examining patient; is of opinion that some investigation by law enforce agencies is essential to establish and fix responsibility for the case in accordance with the law of the land.[2]Corresponding Author: 1Junior Resident IInd year Department of Forensic Medicine and Toxicology SRMS IMS, Medical College, BareillyE-2Prof & HOD, 3Assoc. Prof, 4Assist. Prof, 5Assoc. Prof, Dept. of Community Medicine, Government Medical College, HaldwaniDOR: 06.05.2015 DOA: 22.05.2015DOI:10.5958/0974-0848.2015.00088. 3Profiling of Medico-legal cases is an integral aspect for the prevention of preventable causalities in future and to study the crime rate in area. [3]In present study an attempt is made to know the pattern and magnitude of medico-legal cases inaspect of types of cases, age andsex of cases, time of arrival in casualty department, months and seasons of arrival of cases in casualty and analyze the data and find out suggestion for improvement of medico-legal work in casualty.Material and Methods:This is a record based retrospective study of medico-legal cases registered in medico-legal register in casualty of SRMS IMS Medical College Bareilly from January to December 2014. Related general data like type of medico-legal cases reported in casualty during this period, age and sex of cases, time of arrival, months and season concern in arrival of medico-legal cases in casualty were collected from medico-legal registered. During this study period the total 264 medico-legal cases were registered in casualty of SRMS IMS Medical College Bareilly.The collected data was analyzed and presented in tables, graphs and pie charts by using various parameters and compared with other studies. Summer season means cases reported in months of March, April, May and June, Rainy season means July, August, September and October and Winter season
J Indian Acad Forensic Med. October-December 2015, Vol. 37, No. 4ISSN 0971-0973339means November, December, January and February.Observations and Results:In this one year retrospective study from 1 January 2014 to 31 December 2014, a total number of 264 medico-legal cases were reported and studied.Out of all cases, maximum number of cases were RTA (64.39%) followed by poisoning (17.80%) and fall from height (3.79%). Minimum number of cases reported was sexual offences (Rape) (0.38%). (Table 1)In our study maximum cases were between 21-30 years of age (30.68%)followed by between 11-20 years (21.59%), 31-40 years(21.59%). Number of medico-legal cases reported between age, 11-20 year and 31-40 year were same (21.59%). Minimum cases (3.41%) reported were between age 60 to above years. (Table 2) Present study showed that out of total cases reported in casualty male cases (81.44%) predominant over female cases (18.56%).(Table 3)Maximum number of cases were reported between 12 p.m. to 6 p.m. (35.61%) followed by 6 p.m. to 12 p.m. (35.23%), 6 a.m. to 12 p.m. (17.80%). Time of arrival of cases was the time mentioned in medico-legal register.It was observed that minimum cases were reported at night time i.e. 12 a.m.to 6 am(11.36%). It was also observed that maximum numbers of cases were reported between 12 p.m. to 12 a.m. (70.84%) in comparison to 12 am to 12 p.m. (29.16%).(Table 4)In our study maximum number of cases registered in casualty were in November (17.05%) followed by July (12.50%). Minimum number of cases was reported in January (3.41%).(Table 5) This study also showed that maximum cases reported in Rainy season (38.64%) followed by winter(34.85%) as compared to summer (26.52%). (Table 6)Discussion:Present study showed that maximum cases reported to casualty were RTA. This finding was consistent with other studies. [1, 2, 6-8, 10, 11] Malik Y [3] and Yadav A [4] studies observed that maximum cases reported to casualty were of poisoning which differ to our study. It may be because both medical institutes are situated in rural area with most of the people involved in agriculture related activities with more accessibility to pesticidesin their studies.Hussain SN [5] study also showed maximum number of case reported to casualty were of burn which was differ to our study because at Akola Govt. Medical College all medico-legal cases reported to casualty and also due to fact that there are very few private burn unit in Akola and surrounding district so that all such cases report to casualty of Akola Govt. Medical College.In our study maximum numbers of cases reported to casualty were from age group 21-30 years (30.68%) followed by 31-40 years (21.59%) and 11-20 years (21.59%), similar to other authors studies. [2-5, 9-11] This may be due to fact that individual of these age group lead more active life, involved more in outdoor, sports and recreation activities and take risk for work, which leads to more injuries and accidents among these group.In our study male (81.44%) outnumbered female (18.56%) as seen in others. [2-5, 9-11] This is because males are more involved in outdoor activities so they are more vulnerable to accident or injuries.Present study showed that maximum number of medico-legal cases reported to casualty between 12 p.m. to 6 p.m. (35.61%) because in this time of day most of people are maximally involved into their activities. This is similar with the study of Garg V [2], Gupta B [7] and Mahesh & Rahul. [10] As the day progress frustration of person was increased and the temperature and humidity level of environment was also high during this time period of day. [10]This study also showed that minimum number of medico-legal cases reported to casualty between 12 am. to 6 am.(11.36%). [10]Our study showed that maximum number of medico-legal cases reported to casualty were in month of November(17.05%) followed by July (12.5%). This is differ with the study of Mahesh & Rahul[10], Garg V[2]and Hussian S.N[5], their studies reported maximum number of cases were noted in to the month of October andSeptember. Discrepancies may be due to fact that later studies were conducted in rural setup where people are more involved in agricultural activities.In this study maximum number of medico-legal cases were reported during Rainy season (38.64%), followed by winter (34.85%) and summer season (26.52%). Garg V[2]and Hussian SN[5]studies showed similar result in respect of Rainy season but differ in winter and summer season. Reason of difference is that our Medical College is situated near Bareilly-Nainital Highway and in winter season there is dense fog which was responsible for RTA cases. That was the mean reason in our study number of cases in winter was grater then summer.

2International Journal of Health Information and Medical ResearchVol: 1, Issue: 1, Jan 20Guidelines for Handling Medico Legal Cases

11/11/2016

2 International Journal of Health Information and Medical Research Vol: 1, Issue: 1, Jan 2014 Guidelines for Handling Medico Legal Cases Vinay M Raj1, Vasudeva D S2, Gagan S3 edicolegal knowledge is an es-sence for a medical professional, irrespective of their specialty. Law is common to all. Knowledge about Medico legal is-sues is not optional for a treating Doctor but a mandatory social re-sponsibility. Proper knowledge of the roles and responsibilities of a health care provider is of im-mense importance while han-dling these cases to facilitate so-cial and legal justice. A health care provider along with the medical records called to the court as an expert witness is of pivotal importance for the pro-ceedings of the trial and any in-competence by the health care provider can result in grave con-sequences for both the Institution and self.The health care provider must therefore exercise vigilance and proper documentation while treating a Medico Legal Case. It is advisable to follow the legal as-pects to avoid embarrassment in the court of law due to the lack of knowledge or awareness regard-ing MLC’s and their practices.Hence, this effort is done to compile a set of basic guidelines to be practiced in a hospital when dealing with MLCs. The follow-ing is a non-exhaustive list of guidelines compiled to effectively handle MLCs in a hospital.Role of Doctor in CasualtyRemain calm, do not panic, and treat as a regular case.Lives saving measures are always FIRST in priority.MLC workup is done SOON after it.Casualty services are 24×7 CMOs are supposed to reg-ister MLC by entering the follow-ing in the MLC register. Preliminary data:Name –Full name should be taken with ini-tials,Age Sex Address –local and permanent. Identification marks:Two reliable identifi-cation marks have to be noted preferably from the peripheral parts of the body,If not found then it could be from private parts Mole/scar/birth mark/ deformity/ any other peculiar mark can becon-sidered. Consent of the patient / relative has to be taken:Signature/ thumb impression of the patient.Signature of the rela-tive / guardian. Brief history of the inci-dent –time/ place/nature of in-cident. Examination findings:Injuries must be noted in the order of Head to toe or major to minor injuries.

Treatment given:Immediate treat-ment givenReferral to the concerned department. If referred outside –Place where it is referred should be mentioned. Information given to police –Name of the Police Station.Deciding a case as Medico-Legal or not, is based solely on the treating DoctorMLC can be registered at any time after the patient has come to the hospital –arrival/ later –based on the time of suspi-cionAny Doctor at any point of their treatment should inform the CMO regarding any suspicion about any foul play suggestive of unnatural means in the case.It is better to register as MLC and later easy to convert into non MLC than vice versa if the Doctor is in dilemma about the case.Once MLC done –either in our hospital or outside is suffi-cient –no need to repeat the same.

Dept. Of Forensic Medicine,2Principal, 3Dept. Of Community Medicine,S N Medical College &Research Centre. Address for Correspondence: Dr Vinay M Raj, Assistant Professor, Dept. Of Fo-rensic Medicine, Akash Institute of Medical Sciences &Research Centre, Deva-nahalli –
International Journal of Health Information and Medical Research Vol: 1, Issue: 1, Jan 2014 copy of the same should be at-tached to the file.If patient is referred from our hospital after registering un-der MLC, the same has to be men-tioned in the referring letter and inform the same to the police.History told by the patient or the relatives has to be entered in the same words preferably, if any doubt regarding the history has to be asked specifically. Avoid guessing, assumptions about the facts. All the information written should be legible, understandable and simple in nature. Try to avoid scientific and medical terminolo-gies as much as possible.To document, use ball point pen preferably. Avoid use of ink or gel pen. Avoid over writing, scrib-bling, etc. and any corrections made must be initialed along with the date.Saving the life of the pa-tient is a priority, irrespective of availability of attendees/ relatives for consent. However only lives saving procedures are allowed. Anything other than life saving procedures has to be with the con-sent.Life saving procedures Stabilizing the patient –Airway, Breathing, Circula-tion.oCPR. Based on knowledge/skill/experience, the treating Doctor will decide the most appropriate life sav-ing procedures needed for the patient at that specific time.Eg: Medical emer-gencies –Patient with chest pain with ECG changes suggestive of myocardial infarction should be treated with aspirin & clopidogrel Patient in Hypovo-lemic shock –need fluid re-placement.

CMO can take the ad-vice from the concerned de-partment if needed any time. Concerned specialist will decide the specific treat-ment required and the same can be done under their guid-ance during their physical ab-sence.Delay in payment should never be the reason to deny the treatment. ‘FIRST SAVE THE LIFE THEN TAKE THE PAYMENT’.MLC register & Police Inti-mation Register has to be kept in a locker and the Doctor at casualty is in charge of the key. At the time of change of duty, the concerned doctor has to handover the key to the reporting Doctor along with the instructions.If anybody found safe guarding of the patient from legal circumstances either the treating Doctor or any other person in-volved is punished asper the sec-tion IPC 201.Cases to be Regis-tered as MLCThe following is an in-exhaus-tive list of cases to be registered as MLC

Alleged history of assault

Road traffic accident –Ve-hicle collision / pedestrian injury.

Firearm injuries4.Self fallinjuries not con-sistent with the history

Poisoning / drug over dos-age6.

Alcohol intoxication & drunkenness Anaphylaxis due to thera-peutically injected drugs Victims of Animal ferocity

Snake Bite/ scorpion sting; however Bee sting or other insect sting being an exception

.Attempted Suicide –self in-flicting injuries/ poisoning / any means.

.Attempted Homicide -Hanging / strangulation / poison-ing

Burns except for minor do-mestic nonfatal accidental burn injuries

Electrocution/ Lightning.14.Any patient with uncon-sciousness/ unexplained coma.15.Death occurring within 24hrs of hospitalization without establishment of a diagnosis.16

Alleged Criminal abortion Any brought dead/ Death on arrival, without any corrobora-tive history supports death.Case of AssaultAll cases ofassault have to be registered as MLC and MUST be informed to the police without fail.Injuries have to noted down from oHead to toe or major to minor oThey have to be num-beredoDescription of the injury –size, site, shape, position from bony landmark should be noted, preferably take the measurement using measur-ing tape.oAging of the injury has to be mentioned.Fresh / dark brown/ brown/ black/scar  Type of weapon in-flicted can be assessed and cor-related with the type of injuryInjury certificate has to be issued only with the patient’s or police request.