Latest news with #DME
Medscape
20 hours ago
- Health
- Medscape
Supplemental Oxygen Therapy: Tailor to Your Patient's Needs
Nothing captivates patient (or physician) imagination quite like oxygen. Its power and necessity are considered self-evident. Also a given is the need for saturation to be 90% or above. It's a nice round number, and we're taught early on it's the tipping point on the sigmoidal hemoglobin curve. No one wants to be caught on the steep portion. So, the floor nurse sneaks a nasal cannula onto your patient at night, and the intern walks them wearing a pulse-ox before discharge. At $2 billion per year for oxygen, we have a problem. JAMA recently published a 'patient-centered' oxygen review. It's excellent reading. Table 1 summarizes studies of patient and caregiver feedback on oxygen use, and Box 1 provides an individual patient narrative. The described experience and related complaints are painfully familiar to anyone caring for a patient on oxygen. There isn't any 'news' here, and others have called for oxygen reform. The review highlights the evidence — or lack thereof — and is notable for its practical depiction of oxygen devices, durable medical equipment (DME) companies, and overall oxygen logistics. I regularly receive emails from the American Thoracic Society (ATS) oxygen interest group asking for feedback to help support passage of the Supplemental Oxygen Access Reform Act. I can't speak to the substance of the act, but — per its proponents — it's designed to achieve what the JAMA review advocates: oxygen reimbursement and supply tailored to individual patient needs. Great. There are things we healthcare providers can do now, though. De-implementation (or deprescribing) is critical to cost efficiency, but it's a distant second to not ordering oxygen at all. Outside of the mortality benefit for those with resting hypoxia, outcomes from oxygen prescriptions range from inconsistent to nonexistent. So, to start, if your patient does not have resting hypoxia, think twice (or perhaps three times) before walking them or doing an exercise test. This brings us to the walk-of-life prior to hospital discharge. The resulting ambulatory oxygen prescription is meant to be 'short-term,' but it is rarely so. More often, it's a gateway drug, driving long-term prescriptions and patient dependence. This is well recognized, and both the ATS and CHEST College list deprescription as part of the their 'Choosing Wisely' campaign. Therapeutic overconfidence and time constraints, along with psychological patient dependence, conspire to prevent it. Discharge is typically handled by general medicine clinicians, house staff, or advanced practice healthcare providers, none of whom are comfortable withholding therapy from someone who desaturates with ambulation. However, to quote an old adage from The House of God , 'if you don't take a temperature, you can't find a fever.' If you don't walk your patient before discharge… I'd take the same approach to nocturnal hypoxia. The Centers for Medicare & Medicaid Services (CMS) reimbursement for desaturation at night is a modern-day medical mystery. The data isn't there and there aren't guidelines recommending it. Past reviews have argued against screening or prescribing. Anecdotally, I see this less now; but again, if you eliminate reimbursement. I'm confident it won't be seen at all. Lastly, there's oxygen education to improve health literacy. This is critical but it's a heavy lift. It takes time and resources, and both are in short supply. The JAMA review recommends an oxygen specialist to shepherd the anaerobe through the DME gauntlet. If only the authors could help me pay for one. Maybe I can negotiate with CMS myself. I'll stop ordering nocturnal and ambulatory oxygen supplementation. With the savings generated, CMS will pay for a respiratory therapist to do deprescription and DME navigation. Now that's choosing wisely.
Time of India
a day ago
- Health
- Time of India
Vision loss due to Diabetic Retinopathy: A national crisis
As India grapples with an escalating diabetes crisis, with 101 million 1 diagnosed and 136 million with pre-diabetes, the country is faced with an urgent but unrecognised public health threat from Diabetic Retinopathy (DR), Diabetic Macular Edema (DME) and Vision-Threatening Diabetic Retinopathy (VTDR). A staggering 16.9% of people with diabetes suffer from DR, and 3.6% from VTDR 2 and face irreversible blindness. It strikes people in their most productive years, severely impacting their quality of life and creating profound economic and social ramifications. As India aims to become a developed economy by 2047 (Viksit Bharat), improving citizens' quality of life is a key government agenda. Retinal diseases, often overlooked, demand the same urgency and national focus that transformed cataract care in the country. In response to this urgent challenge, Mission Vision has been launched to elevate retinal health to the forefront of India's public health agenda. Mission Vision: A confluence of expertise Mission Vision, a public health initiative by The Vitreo Retinal Society of India (VRSI) and Times of India, supported by Roche, has been launched to tackle preventable blindness and improve retinal health in India. Under Mission Vision, the VIEW Council, a multi-stakeholder task force of retina experts, ophthalmology societies, policymakers, and industry partners has been formed to focus on reducing the burden of avoidable blindness due to DR. The inaugural meeting saw strong participation from the VRSI leadership, alongside other leading experts. The Council pledged to drive multi-stakeholder action, build awareness, advocate for early screening, and better access to treatment across India. [L to R] Dr. Vinod Aggarwal (Professor of Vitreo Retina Services, AIIMS, New Delhi); Dr. Muna Bhende (Director Vitreo Retinal Services, Sankara Nethralaya, Chennai); and Dr. Rajeev R Pappuru (Consultant Ophthalmologist, Vice Chair, L V Prasad Eye Institute, Hyderabad) Founding members of the VIEW council Dr. R Kim (President, VRSI and Chief Medical Officer, Aravind Eye Hospital, Madurai) Dr. Manisha Agarwal (General Secretary, VRSI and HOD, Vitreo Retina Dept, Dr Shroff's Charity Eye Hospital, New Delhi) Dr. Vishali Gupta (Chief of Retina and Uvea Services at Post Graduate Institute (PGI) of Medical Education and Research, Chandigarh) Dr. Muna Bhende (Director Vitreo Retinal Services, Sankara Nethralaya , Chennai) Dr. Vinod Agarwal (Professor of Vitreo Retina Services, AIIMS, New Delhi) Dr. Rajeev R Pappuru (Consultant Ophthalmologist, Vice Chair, L V Prasad Eye Institute, Hyderabad) Dr. Chaitra Jayadev (Senior Consultant- Vitreoretina Services, Narayana Nethralaya, Bengaluru) Dr. Partha Biswas (President, AIOS and Medical Director at Netralayam and Trenetralaya , Kolkata) Dr. Ajay Aurora (Executive Director Vitreoretina Consultant , Vision Plus Eye Centre, Noida) Ms. Rajwinder (Rajji) Mehdwan (CEO and MD, Roche Pharma) [L to R] Ms. Rajwinder (Rajji) Mehdwan (CEO and MD, Roche Pharma); Dr. Muna Bhende (Director Vitreo Retinal Services, Sankara Nethralaya, Chennai); Dr. Rajeev R Pappuru (Consultant Ophthalmologist, Vice Chair, L V Prasad Eye Institute, Hyderabad); Dr. Manisha Agarwal (General Secretary, VRSI and HOD, Vitreo Retina Dept, Dr Shroff's Charity Eye Hospital, New Delhi); and Dr. R Kim (President, VRSI and Chief Medical Officer, Aravind Eye Hospital, Madurai) The experts acknowledged the tremendous efforts taken by the government to combat blindness secondary to cataract; however, the tide of retinal disorders due to diabetes is a growing and urgent problem. A recurring theme was the critical need for a massive, nationwide awareness campaign. Nearly nine out of 10 patients with diabetes had never had a retinal examination 3 , showing the enormity of the problem. Driving focus on retinal disorders and making annual retinal examinations a national priority will ensure this growing disease burden is addressed. [L to R] Dr. Manisha Agarwal (General Secretary, VRSI and HOD, Vitreo Retina Dept, Dr Shroff's Charity Eye Hospital, New Delhi) and Dr. R Kim (President, VRSI and Chief Medical Officer, Aravind Eye Hospital, Madurai); Dr. Chaitra Jayadev (Senior Consultant- Vitreoretina Services, Narayana Nethralaya, Bengaluru); Dr. Vishali Gupta (Chief of Retina and Uvea Services at Post Graduate Institute (PGI) of Medical Education and Research, Chandigarh); and Dr. Partha Biswas (President, AIOS and Medical Director at Netralayam and Trenetralaya, Kolkata) Dr. R Kim emphasised the need for a collaborative approach, stating, 'Several stakeholders must be involved to increase awareness. Not only the patients with diabetes, but even primary care physicians, diabetologists, chemists, and optometrists must be made aware of the dangers of retinal disorders like DR. It is about starting a national conversation where every patient asks for an eye exam. We cannot afford to lose another person's vision to silence.' This sentiment was echoed with a call for making screening ubiquitous. Dr. Manisha Agarwal drew a powerful analogy for its ideal accessibility, 'Diabetes is silently stealing the sight of millions across urban and rural India, often without any warning. The real tragedy is that blindness due to DR is preventable. DR screening should be as accessible as the availability of a weighing machine at railway stations. On the other hand, the inclusion of intravitreal injections in Ayushman Bharat , with its need being assessed by OCT, can go a long way towards improving access to treatment.' Experts also highlighted the need to leverage government schemes. Dr. Vishali Gupta pointed out, 'Ayushman Bharat has been a phenomenal effort to ensure that treatment reaches the most vulnerable. NGOs and strategic public-private partnerships can also help in improving awareness and DR screening at the grassroots level. However, a lot needs to be done towards upskilling the ophthalmologists to screen and evaluate patients with retinal disorders effectively.' Creative strategies for awareness such as reaching out to schools and organizations with a large sedentary population were also discussed. Dr. Muna Bhende suggested a two-pronged approach for different demographics. 'School children can become your primary influencers, and sensitize their parents to the dangers of blindness due to DR. Also, awareness programmes can leverage the trust that NGOs have built with the local population to ensure the message reaches every corner of India.' Setting a clear, ambitious goal was seen as crucial. Dr. Rajeev R Pappuru articulated a powerful vision for the future. 'By 2030, no diabetic should go without an eye check-up, including a retinal screening. From the first diagnosis of diabetes to annual follow-ups, DR screening should become an integral part of diabetes care, with access at the patient's doorstep.' To achieve all of this, patient empowerment is key. Dr. Vinod Agarwal said, 'Our growth over the past few decades has been due to the demand in services. Raise awareness to the level that the patients demand DR screening and we can then offer it as a service. That will help in widespread adoption of screening and also help in mandating the availability of fundus cameras at all centres. Also, the inclusion of intravitreal injections in Ayushman Bharat can go a long way towards improving access to treatment for DR.' Currently, Ayushman Bharat includes DR screening in 12 states but only upon submission of an OCT photograph, which restricts its use by physicians who may not have an OCT machine. In some states, the government has supplied physicians and diabetologists with non-mydriatic fundus cameras which help in detection of DR. Expansion of DR screening under Ayushman Bharat to all states and the implementation of such scalable screening models can improve DR detection significantly, the experts opined. Dr. Chaitra Jayadev emphasised, 'Every physician who encounters a patient with diabetes must urge them to go for retinal screening. The outstanding success with the pulse polio program shows us that widespread awareness campaigns can yield results. Our country's technological prowess can be leveraged to develop low-cost screening devices that can help us reach every patient. Linking the Aadhar ID/digital health IDs to medical records can also help clinicians track the patient's progress and ensure adequate follow-up.' Alongside awareness, building capacity is also important. With only 3500 retinal specialists available, striking a balance by finding innovative avenues to upskill the workforce is essential. Dr. Partha Biswas stressed, 'Academic enhancement and capacity building should go hand-in-hand with increasing awareness. Training postgraduate students in fundus screening and enhancing their ability to detect these disorders can help improve access to care.' Addressing the infrastructure gap is another critical piece of the puzzle. Dr. Ajay Aurora provided a stark reality check. 'There are 806 districts in India but only 50% have district hospitals, and only two-thirds of those have ophthalmology services. Putting a hub-and-spoke model in place so that patients are referred to adequately equipped care centres is essential.' Speaking on the need for urgent action, Roche Pharma's Rajwinder (Rajji) Mehdwan said, 'To millions suffering from retinal diseases, the gift of vision should be a guarantee, a right, supported by the very best of our science, our policy, and our collective will. The question is not if we can eliminate preventable vision loss, but how soon we act to build a future where sight is accessible for all. Vision health is not a luxury but a necessity for every individual to live a fulfilling life. By making it a national priority, we can ensure a world where everyone has the opportunity to see clearly and experience life to its fullest. Roche is committed to bringing its global healthcare ecosystem shaping expertise to make Mission Vision a reality.' [L to R] Dr. Indu Bhushan (Former CEO, National Health Authority & Ayushman Bharat) and Dr. Rajni Kant Srivastava, ICMR- Chair for Disease Elimination The discussion coalesced around the need for concrete policy action with contributions from eminent policymakers. Dr. Indu Bhushan (Former CEO, National Health Authority & Ayushman Bharat), drawing from his extensive experience, noted, 'Retina health is closely tied to the twin silent epidemics of Diabetes and Hypertension in India. Policy change can happen if there is enough evidence. A policy document that explains the scale of the problem, its economic and social impact, existing gaps in the ophthalmology space, and how they can be plugged can help put things in perspective.' Providing an update on current government efforts, Dr. K Madan Gopal (Advisor, Public Health Administration, NHSRC, Ministry of Health & Family Welfare) said, 'We have defined norms through the Indian Public Health Standards for all levels of care. Furthermore, at our 1,70,000 Ayushman Arogya Mandirs, we are already equipping our Community Health Officers for the basic screening of eye disorders, including the use of an ophthalmoscope.' Talking about best practices that can be replicated, Dr. Rajni Kant Srivastava , ICMR- Chair for Disease Elimination said, 'Though India is a land of vast disparities, states like Kerala have prioritized eye health. For instance, the Nayan Amritham initiative was a successful and scalable programme in which ASHA workers identified diabetic patients for retinopathy screening using handheld non-mydriatic cameras. The images were sent to a central hub for evaluation and treatment advice. Telemedicine can also help in ensuring care reaches remote areas.' The VIEW Council charter: A roadmap to help India see better The culmination of these deliberations was a comprehensive charter, a clear and actionable roadmap designed to make retinal screening a fundamental right in India and aiming to decrease VTDR to less than 1%. Mission Vision will focus on driving large-scale public awareness about DR, integrate retinal screening with existing NCD screening programmes, design protocols for every patient to undergo retinal screening, build capacity for widespread screening and diagnosis, and ensure advanced treatment options, like intravitreal injections, are made available through programmes like Ayushman Bharat. The VIEW Council's inaugural meeting marks a decisive and powerful step towards safeguarding the vision of millions. With a clear charter, the journey to make retinal health a national priority has officially begun. References -
India.com
3 days ago
- Politics
- India.com
MP NEET UG 2025 Counselling Begins at dme.mponline.gov.in, Know key details here
9. विदेश में मौके कैसे बढ़ते हैं? MP NEET UG 2025: The Directorate of Medical Education (DME), Madhya Pradesh, has announced the Madhya Pradesh National Eligibility cum Entrance Test Undergraduate (MP NEET UG 2025) counselling schedule on its official website. Candidates who have cleared the MP NEET UG examination and want to register for the counselling can now do it via the official DME portal – The online registrations will begin from July 21 and will continue till July 29 (11:59 PM). The Board will publish the vacancies on July 28 and the objection window against the vacancies will remain open till July 29, 2025. MP NEET UG 2025: Important Dates • Online registration starts on 21 July and ends on 28 July, up to 11:59 PM. • Vacancies will be published on 28 July. • Objection window opens on 29 July. • Objections will be addressed, and the final vacancies along with the state merit list will be published on 30 July. • Registered MP domicile candidates can complete choice filling and locking between 31 July and 4 August, up to 11:59 PM. • The allotment result will be announced on 6 August. • Colleges will physically verify the documents from 7 August to 11 August, upto 6 PM. • Candidates can register or cancel their admission online at the college level from 7 August to 16 August and opt for upgradation for Round 2. MP NEET UG 2025: Steps to Register for Counselling For the convenience of the candidates, we have provided the step through which candidates can register for the online counselling for MP NEET UG 2025: Step 1. Go to the official website of DME, MP – Step 2. On the homepage, click on the 'MP NEET UG Counselling 2025' registration link. Step 3. Enter your login credentials (such as registration ID and password) Step 4. Fill the application form and make the payment of application fee. Step 5. Download and take a printout for future reference Candidates will be allotted seats for NEET UG 2025 counselling on the basis of combined NEET scores, available seats, reservation guidelines, and candidates submitted preferences. Candidates are advised to visit the official website of DME, MP for more related details and updates.
Time of India
4 days ago
- Health
- Time of India
Nursing council to offer faculty simulation-based training in Delhi
Chennai: In light of growing evidence that nearly 50% of training for nursing degrees can be done through simulation, faculty from nursing colleges in Tamil Nadu will be provided training at a programme organised by the Indian Nursing Council with support from Union govt, said Indian Nursing Council (INC) president T Dileep Kumar on Saturday. Tired of too many ads? go ad free now The council will bear the expenses, including ticket fare, for the training planned at SGT University in Delhi, he said at a nursing graduation ceremony organised for the govt nursing institutions. Simulation is a powerful and essential component of modern nursing education, bridging the gap between theoretical knowledge and practical application, he added. The council realises that it is important to attract people into nursing and retain them, he said. State govts, including Tamil Nadu, must increase the sanctioned strength of nurses to improve the nurse-patient ratio, he said. In many parts of India, a nurse takes care of more than 40 patients in some hospitals, and in rural areas, there are one or two nurses on night duty for the entire hospital, he said. All govts must follow the Staff Inspection Unit (SIU) for nurses, which recommends staffing standards for nursing personnel in Indian hospitals. "These norms specify the ideal nurse-to-patient ratio in various hospital departments and wards, aiming to ensure adequate staffing for optimal patient care," he said. Nurses from India and Philippines are most employed in developed countries. "At least one in seven nurses in these countries are not people who are trained in their land," he said. To retain nurses, India must offer leadership training to practising nurses and allow them to take part in important activities within the hospital. Tired of too many ads? go ad free now "For instance, they must be able to decide and roll out policies for infection control. For this, we must offer better training in theory, soft skills, and leadership. Nurses work with multiple professionals within the hospital," he said. Earlier, INC registrar Ani Grace Kalaimathi said this is the first time the govt has organised a graduation ceremony for nurses. At least six govt colleges offer degrees in nursing, and 26 others offer diploma programmes. Health secretary P Senthilkumar and DME (in-charge) E Theranirajan also took part in the event.
The Hindu
4 days ago
- Health
- The Hindu
Telangana DME awarded for contributions to paediatric thoracic surgery
Telangana's Director of Medical Education (DME) Dr. A. Narendra Kumar has been conferred with an award of appreciation by the Society of Paediatric Thoracic Surgery (SPTS), a section of the Indian Association of Paediatric Surgeons (IAPS), in recognition of his contributions to the field. The award was presented during the SPTSCON 2025, held at the Dr S.M. Bhandari Auditorium, IRCAD India Centre, Indore, Madhya Pradesh on July 19. The society credited Dr. Kumar for playing a foundational role in shaping paediatric thoracic surgery in the country. In 2006, he was instrumental in establishing Thoracic Chapter of IAPS, which has since evolved into a key pillar in advancing specialised surgical care for children in India. Over the course of his career, Dr. Kumar has performed thousands of minimally invasive, life-saving surgeries, leaving a lasting impact on paediatric surgical practices nationwide, said a release. Health Minister C. Damodar Raja Narasimha lauded Dr Kumar's service to the State and the nation. 'His dedication has strengthened our medical infrastructure and brought national visibility to the expertise within Telangana's public health system,' the Minister said.
