THE PULSEVOL.I ISSUE VII DECEMBER, 2013

CASE REPORT: MENINGIOMA BED SORES

Dr. Arun Bansal Dr. Udeek Singh(Consultant-Neurosurgeon) (Medical Officer-SICU)

A female patient 55Y was admitted inAmar hospital recently with complaintsof headache and vomittings. MRI of brainwas done. It showed large left frontotemporal convexity meningioma. Patientwas operated on 22nd October 2013. Leftfronto temporal parietal craniotomy wasdone. Total excision of tumor was done.

Biopsy report came out to be meningioma as expected. Patientrecovered without any neurological deficit. .Meningiomas are derived from mesoderm probably from cellsgiving rise to the arachnoid granulations. These tumors areusually benign and attached to the dura. Meningiomes mostoften occur along the sagittal sinus, over the cerebralconvexities, in the cerebellpontine angle and along the dorsumof the spinal cord. They are more frequent in women than menwith a peak incidence in middle age. Total resection is curative.If total surgical resection cannot be achieved, radiotherapyreduces the recurrence rate to <10%. For Meningiomas thatare not surgically accessible, gamma knife radiosurgery isconsidered. Small asymptomatic Meningiomas incidentallydiscovered in older patients can safely be followedradiologically.

NEW INITIATIVES

1. Expansion of Dialysis Unit

2. Paediatrics Surgery

3. Hair Transplant

Bed sore is also known as pressureulcer or decubitus ulcer. It is alocalized injury to the skin &underlying tissue over a bonyprominence as a result of pressure.This is a big concern in hospitalizedpatients, so we should keep in mindabout development, prevention &

treatment of bed sores. We can only prevent the formation ofbed sores if we know the pathophysiology of bed soredevelopment. .Pathophysiology: When a patient remains in a single positionfor a long period of time, it leads to compression of softtissues by pressure of bone against the surface which resultsin inadequate blood flow and Ischemia to tissues. If this isleft untreated, can lead to tissue Necrosis. This is what wesay as “Bed Sore”. Initially, there is intact skin with redness ofa localized area over bony prominence, classified as Stage I.If there is partial thickness, loss of dermis with shallow openulcer without slough, It is Stage II. If full thickness tissue losswithout exposed bone, tendon & muscle then it is Stage III.When full thickness tissue loss with exposed bone, tendon& muscle is there, we classified it into Stage IV. .Most Common site affected by Bed Sore is Buttocks. Othersmay be Ischial tuberosity, over heads of metatarsals, overocciput, over shoulders & in heel etc. .Factors which increase the development of Bed sores are:Immobility, Inactivity, Moisture, Malnutrition, Friction,Neuropathy, Paralysis, Arteriosclerosis, Old Age, DiabetesMellitus & Infection or Septicemia etc. .

PREVENTION & TREATMENT OF BED SORESBed sores are preventable and treatable if detected early butcan be very difficult to prevent & treat in critically illpatients. Primary prevention is to redistribute the pressureover tissues by turning & re-positioning the patient regularly.Keeping skin dry and free from exposure by urine & stool andby giving balanced diet. Bed Sores can be treated bydebridement, applying antiseptics & dressing withCadexomer Iodine Silver. Clean full thickness Bed Sorescan be closed with surgery using tissue flap, free flap or bysome other closure method etc.

PIC.1 MRI OF BRAIN

PIC.1 PER OPERATIVE PICTURE

Meningioma

Empty Space afterremoval of Tumor

Ms. Joginder Kaur is working as General DutyAttendant since April 2012. She is a veryhardworking employee and has proved the sameby handling three departments i.e. NICU, MICUand Labour Room. Acknowledging her hard work,the management has decided to reward her asEmployee of the Month for November 2013.Joginder is very responsible and ensures smooth

Ms. Joginder Kaur

(GDA)

KUDOS - SHINING STAR/EMPLOYEE OF THE MONTH

running of the department. She is a good team player and alwayssets example for her subordinates to take initiative for any jobrelated to her area. Thank from the entire team for sheer dedication!

BETTER SAFE THAN SORRY CENTRAL STORE PROCESSES

NURSING EXHIBITION DAY

Provide regular communication on patient safety to staffand organize campaigns and events to promote awarenessand participation.Encourage transparency through a blame free system forreporting errors.Ensure right numbers of staff and focus on training.“No compromise on safety” message comes frommanagement: Practicing safe and high quality medicinewill result in good financial sense.Spend more time in planning, rather straight away “doing”things in a hurry.Educate staff and make them alert to preventing unsafeacts, as well as responding quickly when things go wrong.A systematic way of working is important.Staff should not accept any deviation and need toempower to “speak out” and take the lead when processdeviation are supported.Implement patient safety education for staff, physician,patient & family.Review performance and set goals for improvement.Celebrate small wins & keep staff motivated.

Rupinder Kaur(ICN) Ms. Namita Sood

(Asst. Manager-Store)

KEY DO'S FOR IMPROVINGPATIENT AND STAFF SAFETY:

No one in healthcare profession wants to make mistakes.

Those who enter healthcare sector, do so because they want

to help people not harm them. .

Doctor Leape says, “Incompetent people are at most one

percent of the problem and other 99% are very good people

trying to do a good job who make a very simple mistake and

it's the process that set them up to make mistakes.”

I am working with Amar hospital since 2009. During my work period the team of Amarhospital has been very Co – operative.Recently, we have framed Process Manualfor Central Store. Purchase Policy has beenframed and all staff members are followingit. I feel much honored to have got theopportunity to discuss the processes and

policies of store with all members of Hospital through this

monthly magazine for which I would like to thank the

management of Amar Hospital. The store is center point of

hospital to fulfill all the requirements of respective departments.

Items like Stationary, Printing, Disposable, Housekeeping,

Linen etc. are issued to the respective departments through a

process mentioned in Manual of Central Stores. We always

make purchase order in advance, to avoid stock out problems.

A Purchase indent is raised from different departments by their

HOD'S. Purchase indents get approved from COO / CEO.

After approval the orders are sent off to vendors. We receive

t h e i t e m s a s p e r r e q u i r e m e n t a n d a g a i n s t t h e

Purchase Order (P.O.). .

We always make sure about the quality of the products we

purchase. There is a store keeper to help in the smooth running

of the store. There is a fixed timing for issuing the items

i.e. 12:00P.M. - 02:00P.M. In Case of emergency only, Items

are issued out of the mentioned time. .

Access to store is limited. Only authorized store personals can

enter the main storage area. Graphical Analysis of the purchase

& consumption pattern of different kind of items is done every

month and is compared with that of the previous month so as

to be able to understand the change in purchase and

consumption pattern of items and to help the department in

demand forecasting and material planning. We manage the

timely availability and quality of material. .

I hope that all the staff members including the management

team will help me with the smooth running of the store.

thNursing Exhibition was organized by Management on 29 November 2013. Five Teams from the Nursing Department i.e. SICU, rd nd3 Floor, 2 Floor, NICU & Block B participated in the exhibition. All the teams presented Models on different topics like

Bio-Medical Waste, Hand Hygiene and Department Working & Functions. Participants from SICU presented a 3-D Modelexplaining the working of their department and were declared as the winners of the Exhibition Competition. The winning teamparticipants were – Sis. Harpreet Kaur, Sis. HarpreetDhillon, Sis. Gurpreet Kaur & Sis. Amanjot Kaur. The Runner ups were fromTeam NICU, namely – Sis. Rachpal Kaur, Sis. Beant Kaur, Sis. ManjitKaur & Sis. Sukhpinder Kaur.

Sis. Harpreet Kaur Sis. Amanjot KaurSis. Gurpreet KaurSis. Harpreet Dhillon

BIRTHDAYS IN DECEMBER FIND THE WORDS-HEALTH PROBLEMS

A GLASS OF MILK PAID IN FULL

nd1. Harjit Kaur (Diagnostic - Dialysis) – 02 Decembernd2. Mehakpreet Kaur (Customer Care) – 02 December

rd3. Manjit Singh (Billing) – 03 Decemberrd4. Ashok Kumar (IT) – 03 December

rd5. Dr. Prabhsimran Kaur (Medical) – 03 Decemberth6. Gurjeet Singh (IT) – 05 December

th7. Jagdeep Kaur (Nursing) – 05 Decemberth8. Sukhwinder Kaur (Nursing) – 05 December

th9. Gurdeep Kaur (Nursing) – 06 Decemberth10. Pardeep Kaur (Nursing) – 06 December

th11. Madhusudhan Lakhanpal (Diagnostic) – 10 Decemberth12. Ruby Rani (Diagnostic - Helpdesk) – 10 December

th13. Ramandeep Kaur (Nursing) – 10 Decemberth14. Manpreet Kaur (Nursing) – 12 December

th15. Vipindeep Kaur (Nursing) – 13 Decemberth16. Ranjit Singh (Support Services) – 15 December

th17. Harsh K Handa (Diagnostic - Radiology) – 17 Decemberth18. Dr. Atul Garg (Medical) – 19 December

th19. Sandeep Kaur (Nursing) – 19 Decemberst20. Raman Kumar (Support Services) – 21 December

nd21. Kuldeep Singh (ECHS) – 22 Decemberth22. Mehar Singh (Support Services) – 24 December

th23. Baldeep Kaur (Nursing) – 27 Decemberth24. Harpreet Kaur Billing (Nursing) – 29 December

One day, a poor boy who was selling goods from door to door to pay his way through school, found he had only one thin dime left, and hewas hungry. He decided he would ask for a meal at the next house. However, he lost his nerve when a lovely young woman opened thedoor. Instead of a meal he asked for a drink of water. She thought he looked hungry so brought him a large glass of milk.

He drank it slowly, and then asked, “How much do I owe you?”“You don't owe me anything.” She replied. “Mother has taught us never to accept pay for a kindness.”

He said, “Then I thank you from my heart.”

As Howard Kelly left that house, he not only felt stronger physically, but his faith in God and man was strong also. He had been readyto give up and quit.

Year's later that young woman became critically ill. The local doctors were baffled. They finally sent her to the big city. Where theycalled in specialists to study her rare disease.

Dr. Howard Kelly was called in for consultation. When he heard the name of the town she came from, a strange light filled his eyes.Immediately he rose and went down the hall of the hospital to her room.

Dressed in his doctor's gown he went in to see her. He recognized her at once. He went back to the consultation room determined to dohis best to save her life. From that day he gave special attention to the case.

After a long struggle, the battle was won. Dr. Kelly requested the business office to pass the final bill to him for approval. He looked at it,then wrote something on the edge and the bill was sent to her room.

She feared to open it, for she was sure it would take the rest of her life to pay for it all. Finally she looked, and something caught herattention on the side of the bill. She began to read the following words:

“Paid in full with one glass of milk” Signed, Dr. Howard Kelly

Find the words given below:1. Cold 2. Headache 3. Fever 4. Cough 5. Stomachache6. Sore throat 7. Earache 8. Runny Nose 9. Stuffy Nose10. Sunburn 11. Toothache 12. Cut 13. Cramp14. Broken Leg 15. Bruise 16. Health 17. Problem

GET TO KNOW YOUR CONSULTANTS

Dr. Bhupinder Singh(Consultant - Gastroentrologist)

* Thanks to all the participants who have given their valued time and opinion. Anybody who wishes to contribute in this

monthly newsletter please do not hesitate to submit your material with HR.

1. What's your current position? Howlong have you been in this position? Canyou give me a brief overview of what itis you do in your work? .A. I am serving as consultantGastroenterologist and Hepatologist atAmar Hospital since Sep 2012. Besidesmanaging out-patient and in-patients withGI and liver related problems, I am doing

2. What would you say most motivates you to do what youdo? What are you most excited or passionate about? .A. I thank Almighty for giving me an opportunity to be a partof health fraternity. Words like "Thank you doctor " and apositive feedback by the patient motivates me the most. I ammost excited about successful outcome of endoscopicinterventions which are able to provide comfort to the patient. 3. What are the goals you most want to accomplish inyour work? Not so much the goals that are in your jobdescription, but the goals you hold personally? .A. Besides correct clinical management, commitment towardspatients and patient satisfaction are the most important goalswhich I try to accomplish in my work. At personal level, I wishto see everyone around me smiling. .4. How has been your experience at Amar Hospital?A. It has been a great one year experience at Amar hospital. Iappreciate the management for being able to create and maintainan atmosphere of great bonding and togetherness among themanagement, doctors and staff members. I thank themanagement for their constant support and encouragement.5. If you were not working as a doctor, what professionyou would have chosen? .A. I wanted to become a Chartered Accountant but destiny hadplanned it this way. Today I am very much content with mypresent profession, rather I am grateful to the Almighty forgiving me an opportunity to serve the people where I havegrown-up. .6. Can we go way back in time? Where did you grow up?Which College did you go to? What part of College Life doyou miss the most? .A. I was born at Patna Sahib (Bihar) and did my schooling atSophia Convent School, Kota (Rajasthan), St Peter's Academy(Patiala) and subsequently at Kendriya Vidyalaya (Patiala). I didmy graduation from Government Medical College, Patiala andPost-graduation in Medicine from Christian Medical College,Ludhiana. I did my fellowship in Gastroenterology andHepatology from Global Hospitals, Hyderabad. I miss the timespent with friends at medical college while pursuing mygraduation. .7. Did you have any key mentors or people who deeplyinfluenced who you are, what you believe in and what you'recommitted to in your work and life? Tell us about them.A. While growing up I was deeply influenced by my father andmother who played a major role in making me what I am today.While doing my residency in Medicine, I learnt a great deal ofclinical skills from Dr Jasbir Dhanoa (HOD, Dept of Medicine,CMC, Ludhiana). However, I regard Dr Dharmesh Kapoor ( my

Tea whether green or black is heart friendly.People who drink 5-6 cups of green teaeveryday cut the risk of dying from CVDby 42%. .Antioxidants named catechins in green teahelp in reducing the negative effects of badcholesterol, lowering triglycerides levels &increasing the production of good

BENEFITS OF GREEN & BLACK TEA

Dr. Rachna Kaura(Dietician)

cholesterol. It speeds metabolism. .Green Tea helps to fight cancer. It prevents cavities, strengthenstooth enamel and reduces plaque and Bacteria in your mouth. Italso prevents bad breath. It prevents heart diseases bymaintaining a healthy circulatory system. It detoxifies body andact as Anti-Viral Agent. It prevents food poisoning and diabetesand dementia. It gives us healthy skin. .People who drink 3 cups of black tea cut the risk of dying by30%. Black tea is more oxidized. It is very flavorful and caffeineladen. Black tea is very beneficial. It is very low in sodium, fatand calories. Pure & plain black tea is ultra-low in sodium, fatand calories. It is very useful for losing weight. Too muchsodium & too much fat gives rise to many diseases. Increasedconsumption of black tea reduces cardio-vascular problems.Black tea has bountiful of antioxidants. It helps in treatment ofbrain injury cases, hearing loss cases & Parkinson's disease. Italso helps in fighting against cancer. .Green Tea is less processed, less caffeinated, more suitable &paler than black tea. Try green tea with differentflavours! .

guide while doing Super-specialization) as a key- mentor, whohelped me in improving my clinical and patient managementskills. Last but not the least, I am grateful to my spouse for herconstant support and professional guidance. .8. Did you have any life-changing experiences that putyou on the path that led you to be doing what you're doingtoday? Tell us about them. .A. Not had any major life- changing experiences till now.9. What do you do when you are not working? .A. Though I don't get much free time, I love spending time withmy family especially kids. I also like to play cricket and explorenewer destinations. .10. Tell us something about your family. .A. I am the only child of my parents. We are a close knitfamily of six members; my father has retired from IndianRailways, while my mother is a house-wife. My wife is aAnesthesiologist working as Assistant Professor at Gian SagarMedical college, Banur (Patiala). We are blessed with twins- adaughter and a son who are four years old. .11. Would you like to say something to our readers (AmarHospital Staff) .A. There is no short-cut to success. Hard-work, self- righteousness and determination to succeed can help one winover difficult situations. I wish Amar Hospital family and all thereaders a healthy and prosperous 2014. .

diagnostic and therapeutic endoscopies including ERCP's.