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This equation is often used for estimating sample sizes of laboratory ex- 9 periments discount 10mg toradol pain treatment meridian ms. It may not be as accurate as using other methods in estimating sample size toradol 10 mg on-line jaw pain tmj treatment, but gives a hint of the appropriate sample size where parameters such as expected standard deviations or expected differences in values between groups are unknown or very hard to estimate (Kirkwood et al buy toradol 10mg visa myofascial pain treatment center reviews. The Mead’s resource equation is: E= N-B-T toradol 10mg generic allied pain treatment center, where N is the total number of included units (minus 1), T is the number of treatment groups, including the control group, (minus 1), B is the blocking component (minus 1) and E is the degree of freedom, which should be equal to or more than 10. The initial screening of the titles and abstracts resulted in 20 full-text papers that met the inclusion criteria. The table includes a short summary of the study design, the results of the selected studies and the authors’ con- clusions. Implant abutments/bodies with polished/ma- chined surfaces or titanium discs/sheets/cylinders simulating those surfaces were evaluated in eight studies (Gantes & Nilveus 1991; Speelman et al. Pereira da Silva (2005) studied surfaces blasted with aluminium oxide particles of different diameters, and Zablotsky et al. Li- popolysaccharide from Escherichia coli or Porphyromonas gingivalis was used in two studies (Zablotsky et al. Four studies used single-species 2 bioflm, such as Streptococcus mutans (Schmage et al. Eight 3 studies used an in situ model to contaminate titanium surfaces with supragingival plaque by placing titanium discs in splints in the mouth of either beagle dogs (Gantes & Nilveus 1991; Speelman et al. Finally, in one study subgingival plaque was left to accumulate on healing abutments placed in the mouth of patients with implants (Kawashima et al. Non- metal curettes/scalers and rubber cups with pumice were evaluated in two studies (Speelman et al. The air powder abrasive system was the instrument mostly evaluated, as it was tested in nine out of the fourteen included studies (Parham et al. A sodium bicarbonate powder was used in the majority of the studies (Parham et al. Finally, three other powders (TiO2 powder, hydroxyl- apatite sintered powder and calcium phosphate powder) were used in one study (Tastepe et al. None of these cleaning methods created …titanium dental implant surfaces: a systematic review 73 1 a cleanliness score better than 3 and none of them appeared to be superior to the other. In the same study single polishing with a composite bur (Stainbuster®) in combination with sodium bicarbonate powder was found to have the least cleaning potential (score 5), while 2 weekly rubber cup polishing with pumice for 10 s once a day for three months resulted in the highest surface cleanliness (score 1,2). Af- ter one week of plaque accumulation in the mouth of patients that underwent implant treat- ment, the subgingival area of the abutments was treated for 60 s with the three ultrasonic scalers. After instrumentation, the abutments were removed and the amount of remaining plaque and calculus in the mesial proximal area was estimated using the same ranking score as in the study of Speelman et al. The authors reported that all three instruments suc- cessfully removed plaque from the abutment surfaces. This study also evaluated the detoxifying effects of a 30 s application of an air powder abra- 5 sive system with a sodium bicarbonate powder. Group 1 was composed of titanium sheets with a machined surface, and group 2 and 3 of titanium sheets blasted with aluminium oxide particles with different diameters: group 2 was blasted with 65-μm particles (moderate rough surface) and group 3 with 250- μm particles (very rough surface). The colony forming units were counted before and after treatment, and no viable cells were detected after treatment in all of the surfaces …titanium dental implant surfaces: a systematic review 75 1 examined. All powders decreased the initial amount of bioflm signifcantly, although the TiO2 pow- 7 der was not as effcient as the others. All applications resulted in remnants of the powder particles left or impacted on the surface. A 60s treatment of the machined surfaces with the air abrasive resulted in signifcant decrease in the amount of bioflm. The average percentage of residual bioflm in relation to the untreated control was 2. Quality assessment and grading the ‘body of evidence’ The quality assessment of the various studies is presented in Table 3. Of the fourteen studies that evaluated the cleaning effcacy, ten were considered to have a high potential risk of bias and four were considered to have a moderate risk. Most of the studies used titanium discs, sheets or strips, which are considered to be less clinically representative. Five studies pro- vided data regarding randomisation of the treatment, but no study provided data regarding the allocation concealment. Regarding the sample size of the included studies, twelve studies used an adequate sample size, as it was calculated by the reviewers using the Mead’s resource equation, while two studies (Parham et al. There were suffcient available data regarding the use of air abrasive with sodium bicarbonate or amino acid glycine powder to clean titanium surfaces. The available data were consistent, 3 indirect and rather precise and had a high potential risk of bias. The data reporting on the cleaning effcacy of 4 the other mechanical instruments were limited, which made grading of the evidence not feasible. Metal (stainless steel) curettes were found to be ineffective in removing 8 calcifed deposits from machined surfaces (Speelman et al. Different non-metal curettes were 9 found to be ineffective in removing bacteria as well as calcifed deposits from smooth as well as rough titanium surfaces (Speelman et al. This study showed that it was impossible to remove the plaque from the depth of the screw-like threads or the plasma-sprayed surfaces with plastic curettes. The inadequate effect of these instruments has been attributed to their limited fexibility, which prevents exact placement and applica- tion, particularly in the case of threaded implants (Augthun et al. After 60 s, removal of artifcial debris was signifcantly better when using the Vector system compared to the conventional scalers with metal and plastic tips. No signifcant differences were observed between the scalers after treatment for 60 s. The apparent discrepancies may be due to the differences between removing artifcial debris and plaque and the inherent differences 8 between in vitro and in vivo settings. The friction during removal of the treated abutments from the mouth of the patients in order to be microscopically evaluated may have affected 9 the amount of remaining bioflm on the surface. In a systematic review evaluating the effect of different mechanical instruments on titanium implant surfaces (Louropoulou et al. The surface roughness produced by these instruments may promote new bioflm formation and impede the preservation of implant health. These results are sup- ported to an extent by the fndings from another study that assessed the effect of rotating titanium brushes in combination with four chemical agents on titanium surfaces covered by a Staphylococcus epidermidis-based bioflm. The combination of the titanium brushes with the chemical agents resulted in a 1 greater reduction of the bioflm compared to the use of the same chemical agents alone (Gus- tumhaugen et al. All studies reported more than 84% removal of bacteria or bacterial products irrespective of the surface type. When comparing the air-abrasive with sodium bi- 4 carbonate powder to a plastic curette (Augthun et al. These results are in agreement with a recently published literature review focusing on the air abrasive (Tastepe et al. The authors of this review reported: “In vitro cleaning effcacy of air powder abrasive treatment 6 on titanium strips, discs or implants is high. This review included in vitro, animal and human studies and the authors concluded that “for decontamination of infected implant sur- faces air-abrasive treatment seems to work”. A less abrasive amino acid glycine powder seems to be effective in removing 9 single bacteria species and plaque from titanium discs with smooth and structured surfaces (Schwarz et al. Moreover, this powder has been found to be gentler to the implant surface than the sodium bicar- bonate powder. Similarly, the air-polishing treatment with glycine powder of titanium abutment surfaces caused no detrimental surface alterations on the smooth surface, while an increased surface roughness with crater formation was observed when a sodium bicarbonate powder was used (Cochis et al. The powder seems to be an important parameter for the effcacy of the air abrasive.

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Packing of the Diseases of the External Ear 53 canal with gauze soaked in 10 per cent icthyol Treatment in glycerine is helpful buy 10mg toradol with amex treatment pain from shingles. It reduces the oedema Local treatment is necessary and very help- and supports the canal wall thus helping to ful buy generic toradol 10mg line allied pain treatment center news. Most of the cases of furun- piece of ribbon gauze soaked in any antibiotic- culosis are helped by the above treatment buy toradol 10mg mastercard pain treatment center albany ky. Antibiotic-hydro- cillinase resistant antibiotics like cloxacillin are cortisone drops are used for a few weeks buy cheap toradol 10mg on line myofascial pain treatment center san francisco. When the abscess is pointing, it Systemic antibiotics may be prescribed for a needs drainage. Attention is given to the underlying or It is a chronic infection of the ear canal. The common part of seborrhoeic dermatitis or a generalised fungi involved are Aspergillus niger, Aspergillus skin disorder such as eczema. The disease is of chronic otitis media may irritate the skin of more frequent during the rainy season as the the canal and produce its inflammation. The condition may follow from negative group such as Proteus and Pseudo- swimming in infected water. The common symptoms of this disease are itching, pain, discharge and excessive desqua- The patient may complain of discomfort in the mation. The canal appears narrowed, and the skin The canal wall is hyperaemic and the is red, swollen and dry. The epithelial debris fungal debris is seen in the canal with some may be seen filling the canal. Aspergillus niger produces black colonies The tympanic membrane should be and Candida albicans presents as white examined by gently passing the speculum into granules resembling wet blotting paper. Scalp and other areas of the skin the debris is removed, the tympanic memb- are examined for skin lesions. Local applica- The condition may be associated with tions of nystatin in glycerine drops or other chronic bronchitis or bronchiectasis. Foreign bodies in the ear are common in children who may put beads, peanuts, beans, Clinical Features pieces of lead pencil (inanimate), etc. Grains of maize and paddy are commonly process and causes destruction of the tissues found both in children and adults particularly of the canal, preauricular and postauricular during the harvest season. Heavy doses of antibiotics like gentamicin or carbenicillin, local cleaning and debridement Clinical Features of necrotic tissues and control of the The patient may present with pain in the ear underlying diabetes are recommended. A living foreign body may be killed by tion of the epithelium in the deep external instilling some oily drops into the ear. Metallic foreign bodies, glass beads and The desquamated epithelium assumes proper- small sized foodgrains may be removed by ties similar to cholesteatoma and causes bony syringing. Diseases of the External Ear 55 If the foreign body is in the outer part of Syringing Syringing of the ear may be neces- the canal, an ear hook may be useful for its sary to remove the wax or a foreign body. It removal by expert with the patient in the should not be done if there is perforation of proper position. The fluid and minous and sebaceous glands of the external the debris are collected in the kidney-shaped auditory canal. If the wax or foreign body is directly hit by the stream of water it moves deeper and The wax may get accumulated and impacted may get impacted. Excessive force used while in the canal wall producing symptoms of syringing may damage the canal wall or the deafness, discomfort, itching and pain. If the water used is not pain occurs because of pressure on the nerve at body temperature, it produces caloric endings. The canal should be mopped dry plug of wax filling the canal and obscuring after syringing. Hard wax may be softened by using oily substances, sodium bicarbonate in Myringitis bullosa is a viral infection charac- glycerine drops or by a number of other wax terised by formation of vesicles on the tym- solvents instilled for a few days before panic membrane and on the adjacent skin of syringing. The curette should be used gently Clinical Features without traumatising the ear canal. The tip of the curette should be kept in view to avoid The main symptom is severe pain in the ear. The patient complains of pain in the ear, deafness and sometimes blood-stained Treatment discharge. In Examination reveals the perforation with some cases a picture of encephalitis may ragged edges and the membrane may show develop as a complication. Systemic antibiotics and decongestant Aetiology drops in the nose are used to prevent Perforation of the tympanic membrane may infection of the middle ear through the occur due to foreign bodies usually pointed eustachian tube. The cautery, patching or myringoplasty may be membrane may get damaged in head injury. The predisposing factors include adenoi- It usually follows acute rhinitis and leads to ditis, chronic infection in the nose and sinuses, acute otitis media if not treated well in time. The epithelial lining of the tube becomes congested and oedematous resulting in tubal blockage without involving the middle ear. Clinical Features The presenting symptom is intermittent Clinical Features deafness with discomfort. Symptoms continue as long as the nasal catarrh persists and clear up when the cold Treatment settles down. Rest in a ventilated room, nasal decongestants Politzerisation or eustachian catheteri- and anti-histaminics are all which are needed. The most common organisms Acute suppurative otitis media is a pyogenic include Haemophilus influenzae, Pneumococcus bacterial infection of the middle ear. It is a (particularly in infants, diabetics, and in the common disorder occurring at all ages and aged), Moxarella catarrhalis, beta haemolytic particularly in children. Streptococci, Staphylococcus aureus, non-haemo- Aetiology lytic Streptococcus, etc. The other path through which infection The predisposing factors include the following: may reach the middle ear is a traumatic i. Anatomical factor: Short, straight and Pathology and Clinical Presentation wide eustachian tube in young children Various stages which occur during this disease viii. Carelessness on the part of mother in process are the following: keeping the baby in a flat position while feeding, thus allowing milk to regurgi- Stage of tympanic congestion The mucoperio- tate into the nasopharynx and to the steum of middle ear reacts to the invading middle ear cavity through the eustachian organism by hyperaemia. The tympanic memb- by which infection travels from the nose and rane looks congested. Acute Suppurative Otitis Media and Acute Mastoiditis 59 show various types of tympanic membrane perforations. Radiological examination of the mastoid at this stage shows clouding of the air cells but the bony partitions between the air cells remain intact. Stage of convalescence or recovery The disease starts subsiding and the recovery process begins. Stage of acute mastoiditis Continued infection in absence of the proper therapy causes hyper- aemia and thickening of the mucoperiosteum, thus impeding the drainage of secretions and promoting stasis. Hyperaemic decalcification of the walls of the mastoid air cells causes the smaller air cells to coalesce into large cavities and this leads to bony erosion. The patient complains of intensity following the stage of suppuration marked pain in the ear with deafness. The intensifies with increase in deafness and tympanic membrane shows bulging and looks profuse discharge continues to drain from the more congested.

Ideally order 10mg toradol with visa pain treatment quotes, the instruments used to effectively clean smooth surfaces should cause minimal or no surface damage 10 mg toradol for sale chest pain treatment guidelines, should not create a surface that is more conducive to bacterial colo- 6 nisation buy cheap toradol 10 mg line treating pain in dogs with aspirin, and should not affect the implant-soft tissue interface 10 mg toradol free shipping treatment for dog neck pain. If, however, the soft tissue attachment is disrupted, the instrumentation procedure should maintain a surface that is 7 conducive to re-establishment of the soft tissue seal (Kuempel et al. In case of peri-implantitis, the implant threads, which generally have a roughened sur- face to promote osseointegration, can become exposed to oral micro-organisms and bacte- 8 rial colonisation of the titanium surface can occur, leading to the loss of osseointegration. The treatment of peri-implantitis includes among others the decontamination of the surface 9 exposed to the bioflm to eliminate infammation and to render the exposed surface biocom- patible, with re-osseointegration as the ultimate goal. Non-metal instruments and rubber cups were found to cause minimal or no damage to smooth implant surfaces. Similarly, non-metal instruments and air-abrasives were the instruments of choice for structured surfaces when maintenance of the surface integrity was required. Metal instruments and burs were recommended only in cases that required smoothing of the surface roughness. Whereas this review addressed in detail the issue of surface alterations, it still remains unclear how effective mechanical instruments are at cleaning contaminated titanium im- plant surfaces. Surface alterations may be of secondary interest if the means of instrumenta- tion prove to be ineffective in removing accretions. The search was conducted up to May, 2013 and was designed to include any published study that evaluated the effcacy of mechanical instruments on cleaning contaminated titanium 7 surfaces. All reference lists from the selected studies were manually searched by two reviewers (A. The papers that fulflled all of the selection criteria were processed for data extraction. After a preliminary evaluation of the selected pa- pers, considerable heterogeneity was found in the study characteristics, instruments used, outcome variables and results. Consequently, 7 it was impossible to perform valid quantitative analyses of the data or a subsequent meta- analysis. This equation is often used for estimating sample sizes of laboratory ex- 9 periments. It may not be as accurate as using other methods in estimating sample size, but gives a hint of the appropriate sample size where parameters such as expected standard deviations or expected differences in values between groups are unknown or very hard to estimate (Kirkwood et al. The Mead’s resource equation is: E= N-B-T, where N is the total number of included units (minus 1), T is the number of treatment groups, including the control group, (minus 1), B is the blocking component (minus 1) and E is the degree of freedom, which should be equal to or more than 10. The initial screening of the titles and abstracts resulted in 20 full-text papers that met the inclusion criteria. The table includes a short summary of the study design, the results of the selected studies and the authors’ con- clusions. Implant abutments/bodies with polished/ma- chined surfaces or titanium discs/sheets/cylinders simulating those surfaces were evaluated in eight studies (Gantes & Nilveus 1991; Speelman et al. Pereira da Silva (2005) studied surfaces blasted with aluminium oxide particles of different diameters, and Zablotsky et al. Li- popolysaccharide from Escherichia coli or Porphyromonas gingivalis was used in two studies (Zablotsky et al. Four studies used single-species 2 bioflm, such as Streptococcus mutans (Schmage et al. Eight 3 studies used an in situ model to contaminate titanium surfaces with supragingival plaque by placing titanium discs in splints in the mouth of either beagle dogs (Gantes & Nilveus 1991; Speelman et al. Finally, in one study subgingival plaque was left to accumulate on healing abutments placed in the mouth of patients with implants (Kawashima et al. Non- metal curettes/scalers and rubber cups with pumice were evaluated in two studies (Speelman et al. The air powder abrasive system was the instrument mostly evaluated, as it was tested in nine out of the fourteen included studies (Parham et al. A sodium bicarbonate powder was used in the majority of the studies (Parham et al. Finally, three other powders (TiO2 powder, hydroxyl- apatite sintered powder and calcium phosphate powder) were used in one study (Tastepe et al. None of these cleaning methods created …titanium dental implant surfaces: a systematic review 73 1 a cleanliness score better than 3 and none of them appeared to be superior to the other. In the same study single polishing with a composite bur (Stainbuster®) in combination with sodium bicarbonate powder was found to have the least cleaning potential (score 5), while 2 weekly rubber cup polishing with pumice for 10 s once a day for three months resulted in the highest surface cleanliness (score 1,2). Af- ter one week of plaque accumulation in the mouth of patients that underwent implant treat- ment, the subgingival area of the abutments was treated for 60 s with the three ultrasonic scalers. After instrumentation, the abutments were removed and the amount of remaining plaque and calculus in the mesial proximal area was estimated using the same ranking score as in the study of Speelman et al. The authors reported that all three instruments suc- cessfully removed plaque from the abutment surfaces. This study also evaluated the detoxifying effects of a 30 s application of an air powder abra- 5 sive system with a sodium bicarbonate powder. Group 1 was composed of titanium sheets with a machined surface, and group 2 and 3 of titanium sheets blasted with aluminium oxide particles with different diameters: group 2 was blasted with 65-μm particles (moderate rough surface) and group 3 with 250- μm particles (very rough surface). The colony forming units were counted before and after treatment, and no viable cells were detected after treatment in all of the surfaces …titanium dental implant surfaces: a systematic review 75 1 examined. All powders decreased the initial amount of bioflm signifcantly, although the TiO2 pow- 7 der was not as effcient as the others. All applications resulted in remnants of the powder particles left or impacted on the surface. A 60s treatment of the machined surfaces with the air abrasive resulted in signifcant decrease in the amount of bioflm. The average percentage of residual bioflm in relation to the untreated control was 2. Quality assessment and grading the ‘body of evidence’ The quality assessment of the various studies is presented in Table 3. Of the fourteen studies that evaluated the cleaning effcacy, ten were considered to have a high potential risk of bias and four were considered to have a moderate risk. Most of the studies used titanium discs, sheets or strips, which are considered to be less clinically representative. Five studies pro- vided data regarding randomisation of the treatment, but no study provided data regarding the allocation concealment. Regarding the sample size of the included studies, twelve studies used an adequate sample size, as it was calculated by the reviewers using the Mead’s resource equation, while two studies (Parham et al. There were suffcient available data regarding the use of air abrasive with sodium bicarbonate or amino acid glycine powder to clean titanium surfaces. The available data were consistent, 3 indirect and rather precise and had a high potential risk of bias. The data reporting on the cleaning effcacy of 4 the other mechanical instruments were limited, which made grading of the evidence not feasible. Metal (stainless steel) curettes were found to be ineffective in removing 8 calcifed deposits from machined surfaces (Speelman et al. Different non-metal curettes were 9 found to be ineffective in removing bacteria as well as calcifed deposits from smooth as well as rough titanium surfaces (Speelman et al. This study showed that it was impossible to remove the plaque from the depth of the screw-like threads or the plasma-sprayed surfaces with plastic curettes. The inadequate effect of these instruments has been attributed to their limited fexibility, which prevents exact placement and applica- tion, particularly in the case of threaded implants (Augthun et al. After 60 s, removal of artifcial debris was signifcantly better when using the Vector system compared to the conventional scalers with metal and plastic tips.

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The hospitals must designate a trained nurse as Infection control nurse exclusively for infection control work cheap toradol 10 mg with mastercard knee pain treatment exercises. The committee will also do the gap analysis in their respective institutes with the help of a checklist developed for the same or through some standardized proforma toradol 10 mg low price pain treatment studies. The aspects covered must 276 relate to 10mg toradol for sale fibromyalgia treatment guidelines pain, among other things purchase 10mg toradol with amex neck pain treatment exercise, infrastructure and policies and procedures being followed. Hospitals will be required to organize regular meetings of the patient safety committee to review various patient safety issues, adverse events reported, actions taken and maintain records of all the meetings of their patient safety committees Research: – Under the programme the globally accepted interventions for ensuring Patient Safety shall be implemented, however, it is appropriate to know the magnitude of the problem to know the baseline existing situation in the country so that the progress of the programme can be assessed periodically. Patient Safety surveys will also be undertaken at the level of each medical college and district hospital to identify the gaps and take appropriate corrective measures. Research shall also be undertaken to develop appropriate models for implementing various strategies. Awareness generation - it is necessary to create requisite awareness regarding the problem so as to draw the attention of all the stakeholders as well as community in general. Awareness generation shall be undertaken at all three levels; National, medical college and District Hospital. Media, both electronic as well as print, may be used to create impact among the general public. Advocacy workshops for all stakeholders shall be organized or academic forums like conferences etc. In this endeavor the services of professional medical associations and similar bodies will help in creating awareness and training programmes. Moreover, the participation of these bodies will result in "buy in" of the concept of patient safety among healthcare professionals. Patient safety day shall be celebrated to highlight its importance in the country every year. Training – Master trainers will be identified at National Level and if necessary capacity building of Nodal officers of the programme and Master trainers shall be organized. Mater trainers will impart Training of Trainers through workshops to train the identified trainers/ programme officers from States/Medical colleges regarding the concepts of patient safety to implement the steps in their institutions for providing safe patient care. These trained professionals shall act as Patient Safety Champions/Ambassadors for further training at the level of medical colleges/district Hospital level so as to percolate the practices at all levels of care including District Hospitals, Sub-district Hospitals and Community Health Centers. Regional Patient safety centers - Some of the medical colleges and hospitals can be encouraged to assume the role of Regional centers and they can adopt hospitals in their region for propagating the patient safety culture. Activities of the Programme To implement the above strategies, the activities of programme at the three levels will be as given under Central level 1. Monitoring and Evaluation Medical Colleges th All 149 medical colleges will be covered during the 12 Plan. Many of such diseases are very fatal and also have potential to spread very rapidly. The history is full of such instances where diseases prevalent in a country has spread to other countries causing severe damage to the mankind. Recent outbreak of swine flu pandemic is still poised to be threat to the world security. In order to prevent cross country spread of such infectious diseases, traffic restriction are being applied to the travelers and cargo since the time immemorial. In our country there are 2 set of rules known as “Indian Aircraft (Public Health) Rules, 1954, and “Indian Port Health Rules, 1955” to be applied at international Airports and ports respectively. Already there are 21 such health units functioning in our country since 1950s at various airports, ports and land border of the country for implementation of statutory regulations. Existing infrastructure There are 21 such health units already functioning at various airport, ports and land borders of the country established under the regulatory provision. Ministry of Civil Aviation has been requested to provide space for these organizations. Out of these 10 airports 5 (Bengaluru, Hyderabad, Lucknow, Ahmedabad, and Trivandrum) are under plan scheme. Functions: Following are the major functions of Port/Airport Health Organizations 1. Supervision of sanitation, drinking water supply, anti-mosquito and anti-rodent work. Administration of yellow fever vaccine and issue of yellow fever vaccination certificate at identified yellow-fever vaccination centres. Inspection of food stuff, catering establishments inside the premises of airport and ports under the Prevention of Food Adulteration Act. Sampling of imported food items and forwarding the lab analysis report, as and when requested by custom authorities. The Organizations use to keep constant vigil on all the factors leading to outbreak of diseases of international concern and take all preventive measures to safeguard country’s health. Most of these unit were established way back in 1950s and since then are functioning with almost same sanctioned manpower even though the workload has increased manifold during all these years due to increase in the international traffic. There is urgent need to strengthen the organizations in terms of technical manpower. Need for continuation of existing units Out of the 21 units 7 are working under plan scheme and being statutory in nature , continuation of the organization is essential till these schemes are converted in to non plan scheme. If the remaining 23 entry points to international traffic are not equipped with proper health infrastructure, the whole purpose of existing units will be diluted. Further, like custom and immigration, these are statutory organizations and every airport/port/Land border needs to be established under provision of Indian Aircraft (Public Health) Rules and Indian Port Health Rules. The list of these places is given below: List of new International Airports, Ports &Land borders Airport Port Land Border 1. Patna th Proposal for consideration of 12 Plan Continuation of existing plan scheme There are 2 plan schemes already running to operationalise 7 ( 6 +1) such units. As explained above, these are performing statutory nature of functions and hence needs to be continued. Total th expenses required for these two schemes during the 12 plan will be to the tune of Rs. These units were created way back in 1950s and since then these are working with the same manpower, although, the workload has increased tremendously due to increase in the international traffic. In view of this, there is an urgent need to strengthen the technical manpower in terms of medical officers, health inspectors and nurses of these organizations. There is a need of 39 medical officers, 38 health inspectors and 16 nurses additionally required for which an amount of Rs 20. The objective of these units is to protect the country from invasion of dangerous infectious diseases like swine flu from abroad. Most of these unit were established way back in 1950s and since then are functioning with almost same sanctioned manpower even though the workload has increased manifold during all these years due to increase in the international traffic. Details of these airports and their location are given below: Out of these 21 units, 7 units are functioning under Plan scheme which was approved in 2004. Land quarantine border: Attari border Quarantine Centre at Amritsar The load of international traffic has tremendously increased during the last few decades. Consequently, the units are not able to discharge the statutory functions smoothly due to paucity of technical staff. But otherwise are fully equipped in terms of infrastructure to undertake these responsibilities. In this connection, the guidelines have been framed by Directorate General of Health Services for the minimum requirement of manpower in the existing circumstances of repeated outbreak of dangerous diseases of international concern. Minimum technical staff required as per laid down criteria for each unit : To be filled To be filled in Post Minimum th th during 12 plan during 13 plan Requirement Medical Officer 4 3 7 Nursing staff 4 1 3 Health inspector 8 4 4 Total 19 10 9 282 Additional Manpower and financial implication Accordingly, the details of existing strength of various types of manpower and the required strength have been calculated and are reflected in the following table: Medical Officer Proposed Expenditure on Expenditure per S. Existing Additional Expenditure Name of Organisation Strength in additional annum on the No.

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