THE PULSE

Dr. Amit Sood

(Plastic Surgeon)

Dr. Ashwani Guleria

(Endocronologist)

Dr. Sumeet Kumar Jhingan

(Anesthetist)

NEW JOINEES

CEO's MESSAGE INTRODUCTION TO NABH

VOL.I ISSUE II JULY, 2013

At Amar Hospital, we are passionateabout delivering the highest standardof healthcare. Be it the finest Doctors,cutting-edge medicine or state-of-the-art infrastructure. But when askedwhat distinguishes AH, my response issimple. It is the compassion of ourhighly skilled and devoted care giversthat truly defines us. Their commitment

NABH stands for National Accreditation Board for Hospitals andHealthcare Providers. It defines the minimum standards that aHospital should adopt to ensure medical quality and patient safety.It also addresses staff welfare and statutory compliances asapplicable to healthcare providers. If a facility is NABH accredited,patients are sure about the level of medical as well as service qualitythey will receive. Hospital employees are sure about the rules,regulations, processes and procedures that they have to follow – thisleaves no place for ambiguity and personal discretions. Thefacility gets preference by patients in general as well as fromthird party administrators like insurance companies, ECHS andCGHS. .Accreditation standards lay down the requirement and its up tothe healthcare organization to develop the system and mode ofmeasuring the performance. The process consists of developingpolicies and procedures for different functional areas of thehospital, implementing these processes and measuring thecompliance through indicators. Documentation plays a veryimportant role. Such documentation needs to be established,understood at all levels, reviewed at regular intervals andevidenced for its effective implementation by way of records. .

The present edition of accreditation standard is divided into10 chapters which are further divided into 102 standardsand 636 objective elements against which evaluation of thefacility is done. Out of these first five chapters are patient orientedand include – Access Assessment and Continuity of Care (AAC),Care of Patients (COP), Management of Medication (MOM),Patient Right and Education (PRE) and Hospital InfectionControl (HIC). Next five chapters are organization oriented andare – Continuous Quality Improvement (CQI), Responsibilitiesof Management (ROM), Facility Management and Safety (FMS),Human Resources Management (HRM) and InformationManagement System (IMS) .NABH Standards encompass all areas of the hospital and everyemployee has an important role to play. Efforts have been initiatedin all the fields and things are shaping up well. Activeparticipation and co-operation from all is requested. .

Dr Gurpreet Singh Battu .

Dr. Amarjot Singh Bahia

Dr. Amarjot Singh Bahia

(CEO)

to advancing the state of the art in medicine and approach to carehas earned the trust of patients and their loved ones. .We are striving to create a culture of service excellence here atour hospital. As we look to the future, it is important for me toconsider how we will be effective in achieving our goals. .In my mind, there is nothing more vital than our culture and I feelit is my responsibility to set the tone for it. From my perspective,it is the atmosphere we create every day, the behaviors that definewho we are as a people and further as an organization. It alsoencompasses our individual values, what we believe in, how weact in good times and through adversity. We're all individuals;however, collectively as Amar Hospital, we must stand together asa group and tell our story. Critical to our story is why we exist,what we believe in, and where we are going as a hospital and as aleader in this community of healthcare. .I welcome all of you, to join me in creating a culture of serviceexcellence, to view leadership not by position but as aresponsibility that we all have through our actions, and to createan atmosphere that inspires us all to put our patients first everytime. The confidence we are able to instill in our patients andphysicians by creating positive experiences will be our measure ofsuccess and only through this achievement will we attain ourvision: When people think of excellent healthcare, they thinkof Amar. .It is a privilege to be a part, and a source of great pride to beworking in an organization that affects the lives of hundreds ofpeople every day. .

Thank you for taking the time to read this letter. .Sincere Regards .

(COO)

KUDOS – SHINING STAR/EMPLOYEEOF THE MONTH

Ms. Navpreet Kaur

Dr. Sandeep Gupta

Consultant-Pulmonologist

Ms. Navpreet Kaur was selected as

Employee of the Month for the month

of June 2013 for her contribution as

Nursing Educator. She has always

been taking initiative for new tasks.

She always meets her targets and

Deadlines. She is BLS trained and

has been allocated the job of giving BLS training to all hospital

staff.

Mycobacterium tuberculosis is the leading killer of adults in developing and underdeveloped nations. HIV/ AIDS have also contributed to increasein the incidence of tuberculosis. The World Health Organization (WHO) estimated 9.2 million new cases of tuberculosis (TB) in2006 (139 per 100000 population), including 4.1 million new smear- positive cases (44% of the total) and 0.7 million HIV positive cases

1(8% of the total) worldwide. The WHO recommends the detection of acid fast bacilli (AFB) in respiratory specimens as the initial approach tothe diagnosis of PTB. However many patients with suspected PTB do not produce sputum spontaneously or are smear- negative for AFB. Thusthe diagnosis of TB in these patients is difficult, and in most cases they are treated empirically on the basis of clinical and radiographic findings.This empiric therapy may result in toxicity, increased drug resistance and delay in diagnosis and treatment of conditions other than TB whenpresent. Bronchoscopy is more invasive and expensive than sputum examination, but can provide specimens from specific sites in the lung.Therefore, BAL plays an important role in patients with occult tuberculosis or other mimicking conditions. .

ROLE OF BRONCHOALVEOLAR LAVAGE IN THE DIAGNOSIS OFSPUTUM SMEAR NEGATIVE TUBERCULOSIS

In my set up, I have treated over 70 patients who were sputum smear negative and yielded Acid Fast Bacilli(AFB) in BAL specimens. At the initial presentation, patient's three consecutive sputum samples are sent tothe lab for AFB. In case of negative report/ non- production of sputum, BAL is performed and tested for AFB.In addition, BAL also helps in detecting non- tubercular infective pathology. .Bronchoscopy should be conducted on all sputum smear negative patients and patients without expectoration,and BAL performance should be a routine procedure as it is simple and usually uncomplicated technique. Mostcontraindications of bronchoscopy are relative and should be performed whenever the benefits outweigh the risk.

1. In house BLS trainings for all staff

2. Bed Management

NEW INITIATIVES

“Good thoughts are no better than good dreams,unless they be executed.”

DO YOU HAVE GOOD RELATIONS ?YES OR NO

ARE YOU WINNER OR A LOSER ?

START A GARDEN

Plant three rows of peas:

Peas of mind

Peas of heart

Peas of soul

Plant four rows of squash:

Squash gossip

Squash indifference

Squash grumbling

Squash selfishness

Plant four rows of lettuce:

Lettuce be faithful

Lettuce be kind

Lettuce be obedient

Lettuce really love one another

There's no garden without turnips:

Turnip for meetings

Turnip for service

Turnip to help one another

Water freely with patience and

cultivate with love

There will be much fruit in your garden,

Only because YOU REAP WHAT YOU

SOW!

To conclude our garden,

we must have thyme:

Thyme for God

Thyme for family

Thyme for study

Thyme for prayer .

BIRTHDAYS IN JULY

st1. Jatinder Singla (Pharmacy) – 01 Julyst2. Dr. JyotsnaThaman (Medical) – 01 Julynd3. Shiva Kapila (Customer Care) – 02 July

rd4. Rachpal Kaur (Nursing) – 03 Julyth5. Hardeep Kaur (Nursing) – 04 July

th6. Rashmi Rani (Lab) – 04 Julyth7. Kanwelpreet Kaur (Nursing) – 07 July

th8. Rupinder K. Behniwal (Nursing) – 07 Julyth9. Komalpreet Kaur (Nursing) – 08 July

th10. Dr. Harpreet K Sandhu (Medical) – 10 Julyth11. Simranjit Kaur (Nursing) – 10 July

th12. Balwinder Singh (Accounts) – 11 Julyth13. Manpreet Kaur (Nursing) – 11 July

th14. Manpreet Singh (Pharmacy) – 11 Julyth15. Harjit K Buttar (Nursing) – 12 July

th16. Ranjit K Sandhu (Nursing) – 12 Julyth17. Sanjeev K Sharma (ECHS) – 13 Julyth18. Dr. Nitish Kumar (Medical) – 14 July

th19. Karanbeer Sandhu (Diagnostic – Lab) – 17 Julyth20. Maninder Singh (Pharmacy) – 19 July

th21. Harjeet Kaur (Marketing) – 20 Julyth22. Harpreet K Kahlon (Nursing) – 20 July

st23. Arshpreet Kaur (Nursing) – 21 Julyst24. Harpreet Kaur (Nursing) – 21 July

nd25. Mandeep Singh (Disgnostic – Radiology) – 22 Julynd26. Davinder Singh ( Diagnostic – Lab) – 22 July

th27. Dr. Sandeep Sharma (Medical) – 26 Julyth28. Sunita Rani (Nursing) – 27 July

th29. Dr. Pushpinder Singh Joshi (Medical) – 28 July

GIGGLES

Munna: Ae Circuit ye Dr. log oprationse pehle patient ko behosh kyun kartehai?Circuit: Bhai! Bole to patient oprationsikh gaya to Dr. Logo ki to wat lagjayegina.

A man asked: Dr. banne mein kitnakharcha aata hai.An Interesting answer from MedicalStudent:Paisa to kam kharch hota hai, ParJAWANI puri kharch ho jaati hai.

Dr to Ash's baby in hospitalDr.: who is ur grandpa?Baby: Big BDr.: Who is ur Mom?Baby: Miss WorldDr.: who is ur father?Baby: No idea sir jee

Agar doctors film banate to unkifilmo ke naam ye hote- X-Ray Ho Na Ho- Kaho Na Bukhar Hai- Hum Blood De Chuke Sanam- Mere Yaar Ka Operation Hai- Kash Aap Hamare Patient Hote- Main Dettol Ki Diwani Hon- Hamara Thermometer Aap K Pass Hai- Kabhi Drip Kabhi Injection- Zakham To Hona Hi Tha

Good Human Relations are:

H – Have self-confidence

U – Understand the viewpoint of others

M – Make yourself a friend to all

A – Admit it when you're wrong

N – Never make a promise you can't keep

R – Respect and courtesy are important

E – Explain Thoroughly

L – Look, learn, listen and decide

A – Avoid argument

T – Try to be approachable and sociable

I – Insist on a selfless service

O – Others first, self-last

N – Never criticize in public

S – Stress the POSITIVE always�

What's the difference?

A winner acts

A loser reacts

A winner sees a solution to all problems

A loser sees a problem in every solution

A winner always has a plan

A loser always has an excuse

A winner says, .Let me do this for you..

A loser says, .That's not my job..

A winner says, .It's not easy, but it's possible..

A loser says, It's possible, but too difficult..

A winner is always available

A loser is always overworked

JUDGE FOR YOURSELF

* 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.

GET TO KNOW YOUR CONSULTANTS

looking after the Indoor Patients of Neurology along with the EEGWork of the hospital. .2. What would you say most motivates you to do what youdo? What are you most excited or passionate about? .A. When I see Patients in altered sensorium and with markeddisability, it motivates me to help these patients to maximum sothat their sufferings are reduced. Looking after large number ofpatients in OPD & IPD to reduce their sufferings. .3. What are the goals you most want to accomplish in yourwork? Not so much the goals that are in your job description,but the goals you hold personally? .A. Work hard with honesty, selfless service, be polite to patientsand their relatives. .4. How has been your experience at Amar Hospital ? . A. It has been a wonderfully enjoyable experience working withAmar Hospital. We all work like a closely knit family. I stillremember the great words of Dr. J.S. Bahia, The Founder who usedto say “This is your Hospital and you are to carry this hospital tonew heights”. How true it is!! I feel at home in the hospital andwhenever I am in need, hospital administration comes forward tohelp. .5. If you were not working as a doctor, what profession youwould have chosen? .A. I always wanted to become a Doctor Only ! .6. Can we go way back in time?, Where did you grow up?Which College did you go to? What part of College Life do youmiss the most? .A. I had my schooling in Dhudial Khalsa School, Patiala.Pre-Medical in Govt. Mohindra College and MBBS (1975) andMD (1978) (Gen. Med) from GMC, Patiala and DM(Neurology-1987) from PGI Chandigarh. .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. Yes, my wife Dr. Manjeet Kaur, who is associate professorGynae in Rajindra Hospital Patiala, motivated me to do my DM inNeurology. She never complained about my long working hours atthe hospital. .8. Did you have any life-changing experiences that put you onthe path that led you to be doing what you're doing today? Tellus about them. .A. No, Not exactly that I know of . .9. What do u do when you are not working? . A. I read Newspapers & Watch News & Cricket on TV. .10. Tell us something about your family. .A. My wife Dr. Manjeet Kaur is working as an Associateprofessor Gynae, GMC Patiala. We have one and only child, aloving daughter who is also a Neurologist in USA. She is marriedand our son-in-law is a doctor in USA. .11. Would you like to say something to our readers (Amar Hospital staff) .A. My only desire is that every staff member should workhonestly and take Amar Hospital to further heights. In the end, Iwould pray to almighty for good health of Dr. Jeevanjot SinghBahia, The Founder of this Hospital. .

1. What's your current position? How longhave you been in this position? Can yougive me a brief overview of what it is youdo in your work? .A. I am working in Amar Hospital Patialaas a Consultant Neurologist since 01.03.1999;for about 14 years now. .I am looking after the Neurology OPD workdaily Mornings & Evenings. Besides I am

A 65 year old male presented to theoutpatient department with fatigueand tiredness. On clinical examination, thepatient was anaemic and no othersignificant findings were found. Onultrasonography, mild splenomegaly wasobserved. On laboratory investigations, thecomplete blood count (CBC) picture

ERYTHROLEUKEMIA- A RARE FORM OFACUTE MYELOID LEUKEMIA (AML)

Hence the patient was diagnosed as a case of erythroleukaemia(AML M6 according to FAB classification). . Discussion .Acute erythroidleukaemia is an uncommon form of acute myeloidleukaemia (AML), accounting for approximately 3-4% of cases.The prognosis of acute erythroidleukaemia is reported as poor.Perhaps more than other subtypes of AML, it may represent theevolution or transformation of a myelodysplastic syndrome (MDS),and may be secondary to p rev ious chemotherapy,immunosuppressive treatment or radiotherapy given for a widerange of malignant or non-malignant diseases. It is more commonlyassociated with exposure to alkylating agents or benzene than othersubtypes of AML. It is, however, important to differentiate de novofrom secondary or therapy related erythroidleukaemia, where thelater have a worse prognosis. . WHO recognizes two subtypes of AML-M6: erythroleukemia(erythroid/myeloid leukemia) and pure erythroidleukemia.Erythroleukemia is defined by > 50% erythroid precursorsand > 20% myeloblasts. Pure erythroid leukemia is definedby > 80% erythroid precursors. .Other relevant tests .Cytochemistry: The blasts are MPO negative, but often positive forNSE. The malignant red cells are PAS positive, (forming PASpositive lakes or containingcoarse chunks of PAS positivematerial). .Genetics: Chromosome Abnormalities: 8+, -5, del (5q), and -7. .Flow Diagnosis .Erythroblasts are positive for Glycophorin A (GPHA) and CD71. The erythroid component lacks MPO, CD34, CD45 and panmyeloid markers. CD117 and CD43 are often positive, whenmyeloblasts are present. .

The figure shows the morphology of M6 blasts.

Dr. Kanu Goyal(Consultant - Pathologist)�

Dr. Harminder Singh(Neurologist)

showed Hb 6.5 g/dl, Hct 20.0%, MCV 103.9 fl, MCH 33.6 pg,MCHC 32.3 g/dl, Platelets 14000/ cumm, WBC 2,400/ cumm. WBCdifferential showed 49% neutrophils, 48% lymphocytes,2% monocytes, 1% eosinophils. Peripheral smear showedmacrocytic RBCs with occasional nRBCs, decreased numberof leucocytes and decreased platelet count. .As the laboratory findings were suggestive of pancytopenia, thepatient was put on treatment but there were no signs ofimprovement. Therefore, bone marrow aspiration was done. .Bone marrow findings: .The bone marrow was cellular and revealed erythroid hyperplasiawith 50% erythroblasts. The myeloid series showed 35%myeloblasts. Megakaryocytes were normal in morphology. .