Starting a Journal the way to go

How to reduce bleeding in FESS

Reducing Bleeding fess from Balasubramanian Thiagarajan

D.N.B. in surgery and surgical specialities Is it a failure in India?

Introduction:

Diplomate in National Board (DNB) conducted by National Board of Examinations is considered to be equivalent to post graduate degree in the concerned medical speciality.  This program was initially started with a noble intention of providing post graduate training to a large number of students utilizing facilities available in the public and private sector hospitals.  Now students have started asking whether it is really worthwhile pursuing this stream of education particularly in surgery and surgical specialities.  At present DNB program is available in 54 specialities.

What ails the program?

1. There is no structured teaching program to train post graduate students as these courses are held in Non PG teaching Institutions.  Medical colleges with structured Post graduate program cannot conduct DNB courses.

2. Private institutions cannot give surgical chances to these students as they need to keep their finances in mind.

3. The DNB students are just treated as cheap labor by the training institutions

4. There is virtually no mentoring of the students in most of the Institutions

It should be stressed that surgery cannot be learnt from text books or from watching videos.  A trainee acquires surgical skill only by repeated practice.  Surgical training is virtually non existent for these students in private DNB training institutions.

What are the Pluses of structured university guided Post graduate training program?

1. Training is objective and module based

2. Teaching schedule is structured

3. In Government Institutions clinical material are available in plenty.

4. Student teacher ratio are scrupulously maintained because of constant MCI vigilance

5. Professors spend lot of time with post graduate students mentoring them because they are paid for the job.

At present the drop out rate among DNB students is rather high (more than 60%).  We should understand that the present day students spend a lot of time and resources preparing for a career, hence they have every right to  be disappointed.

The way out:

National Board should stress on the importance of practical training.  It should keep a constant vigil on the quality of education imparted.  It should clearly evolve  compulsory skill sets a student is supposed to posses after completion of the course.

Every DNB training centre should be accredited to the near by Post graduate training Medical Colleges so that students can attend lecture classes conducted in these institutions.

DNB training centers should have free teaching beds.  Currently even though they submit that they have free beds at the time of accreditation it is not so.

Let us at least now be impassionate, wake up to the reality and take corrective measures lest the program with meet its eventual end.  

PG guide book for otolaryngology students

Otolaryngology PG Guide Book by Dr. T. Balasubramanian

Open Monograph press installation manual

Open monograph press Installation to functioning by Dr. T. Balasubramanian

Eprints - Complete Installation Manual

Eprints Complete Installation manual by Dr. T. Balasubramanian

Selected articles on the topic Rhinology

Rhinology Selections by Dr. T. Balasubramanian

Old issues of Otolaryngology online journal archived at skydrive

Eprints from below upwards the manual that was missed

Eprints from below upwards the manual that was missed by Dr. T. Balasubramanian

Anatomy of orbit

Anatomy of Orbit – ENT SCHOLAR by Dr. T. Balasubramanian

Ent scholar volume 2 issue 1 2013

Ent scholar Volume 2 issue 1 2013 by Dr. T. Balasubramanian

Lingual thyroid our experience

Proptosis Otolaryngologist's perspective

proptosis

Proptosis current management trends

Proptosis from Balasubramanian Thiagarajan

Nasolacrimal system examination

Reducing bleeding during FESS

This article discusses the importance of anesthesia in endoscopic sinus surgery. Major aim of anesthetist in FESS should be to reduce blood pressure to such a level that bleeding is minimized. It also discusses the various steps that should be followed by surgeons to reduced intra operative bleeding during the procedure.

Introduction:

Bleeding is one complication that could increase the risk of complication during endoscopic sinus surgery.

Considerable amount of attention should be paid to reduce bleeding on the table during the surgical

procedure. Dry surgical field not only improves visibility during endoscopic sinus surgery, it also shortens the

duration of surgery. In this regard both anesthesiologist and the operating surgeon have a vital role to play.

Endoscope becomes rather useless when the operating field bleeds. Bleeding is more common if surgery is

performed on allergic / inflamed nasal mucosa. This is where operating surgeon should take extra precaution

in preparing the patient. Reduction of nasal allergy and inflammation is also known as mucosal preparation

prior to surgery. This is done by administering a course of antibiotic, antihistamine and topical steroid spray ¹.

Ideally patient should be prescribed these medications at least 1 week prior to surgery.

View the entire article from here.

Concept of unified airway

According to European rhinological society guidelines chronic rhinosinusitis with nasal polypi and chronic rhinosinusitis without nasal polypi are two different entities. This article attempts to review published literature which attempts to study link between nasal polyposis and lower airway disorders. The concept of unified airway attempts precisely to explain this linkage. Developmentally and functionally it makes sense to combine both upper and lower airways in studying pathophysiology of various airway disorders.

Introduction:

An attempt to define the following terminologies will not be out of place.

Rhinosinusitis / Nasal polyposis:

Number of authors have attempted to define this condition, majority of these definitions were based on symptomatology and duration of the disease. Till date there is no universally accepted definition of this condition ¹. European rhinological society has stepped in to define rhinosinusitis in unambiguous terms.

The concept of unified airway disorders has infact shifted the focus from individually managing various disorders affecting the components of airway to that of unified management modality. This calls for multidisciplinary approach in managing these patients in an optimal manner. Specialities involved in designing management protocol for unified airway disorders include Thoracic medicine and otolaryngologists.

You can view the whole article from here.

Lets make teaching and learning simple

Thanks to Dr Vijay Govindarajan of Vellore, I had the providence of viewing his simplistic teaching tool.  With the advent of modern audio visual teaching aid classic black board teaching is a forgotten art.  It has been ages since i have written something on a board.  After seeing this video i really want to go back to old ways………Classic Black Board Teaching.  Now lets sit back and enjoy one of his demonstration of making a larynx  …..Yes with a piece of paper and your very own hand.

Disorders of external ear a presentation

Rhinophyma