Nitin-Hospital Report 2nd Dec

8/8/2019 Nitin-Hospital Report 2nd Dec

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HOSPITAL TRAINING REPORT

Towards the partial fulfillment of

Doctor of Medicine (Yoga & Rehabilitation)

MD (Y & R)

A Report Submitted by

Dr. Patil N J

To

S-VYASA

SWAMI VIVEKANANDA YOGA ANUSANDHANA SAMSTHANA

(Declared as Deemed University Under Section 3 of the UGC Act, 1956)

# 19, Eknath Bhavan, Gavipuram Circle, K.G. Nagar, Bangalore- 560019, INDIA


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CONTENTS

CONTENTS ..................................................................................................................................... 2

1. Pulmonology Orientation Training Programme ........................................................................22. Gastroenterology Orientation Training Programme .................................................................... 6

........................................................................................................................................................ 10

3. Endocrinology Orientation Training Programme ......................................................................10........................................................................................................................................................ 14

4. Neurology Orientation Training Programme .............................................................................14

5. Cardiology Orientation Training Programme ...........................................................................19

6. Psychiatry Orientation Training Programme............................................................................. 24........................................................................................................................................................ 32

7. Oncology Orientation Training Programme .............................................................................34

8. Rheumatology & Immunology Orientation Training Programme. .......................................37

1. Pulmonology Orientation Training Programme

Name of the consultants:

1. Dr. Murali Mohan, MD (Gen med)

Consultant Pulmonologist

2. Dr. Ranganath DNB (Pulmo)

Consultant Pulmonologist

Course: MD (Yoga and Rehabilitation)

Work Report:Yoga and Pulmonology rehabilitation

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Duration: 1 month. From: 1-03-2008 to 31-03-2008

Hospital: Narayana Hrudayalaya.

Department: Department of Pulmonology, Narayana Hrudayalaya.

Department ofYoga, Narayana Hrudayalaya.

Objectives:

1. To understand etiology, risk factors, pathogenesis, prognosis and conventional management in

different pulmonary diseases.

2. To undergo training in investigative .Pulmonology.

3. To understand and assess the influence of psychological stress, lifestyle and health behaviors

on pulmonary events.

4. To gain knowledge about Lifestyle Modification program.

5. To understand the preventive aspects of Pulmonology.

6. To gain practical skills in pulmonary rehabilitation (post operative and preventive).

7. To gain knowledge about diet and nutrition in management of pulmonary diseases.

Activities:

Dept Activities No. of hours

PulmonologyOPD 75

IPD 50

MICU 15

Lectures 5

Case presentation 5

1. Outpatient department: Attended OPDs everyday in department of Pulmonology in Narayana

Hrudayalaya, except Sunday. Morning 9.00am is OPD start time, first session ends by

11.00am, where two pulmonologists are working, Dr. Murali Mohan, senior pulmonologist,

and Dr. Ranganath. After 11.00am, we were joining pulmonologists for inpatient rounds. This

is where we were learning a lot, mean to say all the DNB students join us and lot of case

discussions and case presentations happen. Weekly one day will be CME, where DNB students

presenting medicine and Pulmonology updates and also present some interesting cases like

Asthma, Carcinoma of Bronchus, Interstitial lung diseases etc.

2. We used to attend clinical rounds to inpatient wards with consultants and resident doctors.

During that time in clinical rounds on all days of our posting time we have seen many cases,

management of cases in intensive care unit, care of consultants towards patients, regular

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monitoring of their status and pharmacological or with the help of some invasive procedures to

improve the health of the patient.

3. We were asked to present some cases to the consultants and resident doctors. I presented a

case of COPD (Chronic Obstructive Pulmonary Disease) which has admitted in medical

emergency ward. A lot of inputs and suggestions were given by the consultants and doctors

regarding the presentation. This helped improve our knowledge in Pulmonology and

presentation skills.

4. Dr. Murali Mohan was a professor of medicine in Bangalore medical college, so he was very

much involved in teaching. Almost daily he uses to give assignment for us of different topics

related to Pulmonology. He was repeatedly ask to read the pulmonary function test reports and

asks us to interpret it. Also he taught us about interpretation of blood gas analysis reports.

5. We observed investigative procedures in Pulmonology such as Bronchoscopy, Pulmonary

function tests (PFT), allergy testing and learnt about the procedures, the indications and

contraindications and the precautionary methods to be followed.

6. Dr. Ranganath took series of lectures about investigations in Pulmonology, particularly;

regarding pulmonary function test was very informative and useful for us.

7. In the Pulmonary rehabilitation department which comprises of Yoga, physiotherapy and

nutrition and diet we learnt how to integrate these therapies in improving the clinical condition

and recovery in pulmonary inpatients and were also educated in preventive Pulmonology.

8. We were also educated regarding the possible preoperative and postoperative complications or

pulmonary events following surgical procedures and methods of their management.

9. We routinely followed up some interesting cases in the inpatient wards and outpatient

department also.

10. Many cases, particularly chronic cases, were relieved by few yoga techniques taught by us,

particularly pranayama, after pulmonologists asked us to giveyoga intervention.

Summary:

Our orientation training program in Department of Pulmonology for a month was

educative. We came across a variety of pulmonary diseases like Bronchial Asthma, COPD,

Tuberculosis, Pneumonia, Emphysema, Interstitial lung diseases...etc, during our tenure in

outpatient department. We gain knowledge on methods of managing above mentioned

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diseases. We also got to know the importance of psychological stress, diet and exercise oryoga

in managing and preventing pulmonary diseases. During our time in pulmonary department we

attended seminars on management of different pulmonary diseases/conditions. We learnt about

the use of investigative procedures and their inference in arriving at a diagnosis. We

understood the magnitude of lifestyle and stress as a risk factor in causing many of the

pulmonary ailments. We learnt a few techniques to manage stress in cardiac patients in

inpatient ward Pulmonology.

GRADE CARD Department of Pulmonology

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2. Gastroenterology Orientation Training Programme


Dr. Gayatri Gopal Krishnan. MD (Gen med), DNB( Gatro)

Consultant Gastroenterologist


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Work Report:Yoga and Gastroenerology rehabilitation



Department: Department of Gastroenterology, NH

Department ofYoga, NH

Objectives:


different gastroenterological diseases.

2. To undergo training in investigative gastroenterology.


on different digestive disorders.


5. To understand the preventive aspects of gastroenterology.

6. To gain practical skills in gastroenterological rehabilitation (post operative and preventive).

7. To gain knowledge about diet and nutrition in management of different gastroenterological

diseases.

Activities:

Department Activities No. of hours

Gastroenterology

OPD 118

IPD 40

Endoscopy 48

Seminars / Lectures 10

1. Hospital Administration: Initial few days of our training period were spent in understanding

the nuances of hospital administration. We were posted in the administration department where

we learnt about screening of new cases, keeping medical records, counseling by social workers

and understanding how best to make the patients comfortable through timely advice and

efficient service.

2. Outpatient department: We were attending gastroenterology OPDs from 10.30am to 2.00pm

everyday of our posting except on Sunday. We attended the OPDs with the following

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Consultants Dr. Gayatri Gopalakrishnan, Gastroenterologist, a Gastroenterology Surgeon. We

observed and learnt the art of clinical history taking, abdominal examination, investigative

procedures and diagnosis of digestive ailments and its subsequent conventional management.

We assisted the consultants in case taking, referring to investigative lab tests and writing

prescriptions. We acquired sufficient medical information during our posting in

gastroenterology departments.

3. Narayana Hrudayalaya is an academic center for excellence in cardiology in south India

where patients from all part of the globe, access its services. Hospital has inpatient facility for

patients of Department of Gastroenterology. Regularly we were going to inpatient wards with

consultants and gain more knowledge about emergency procedures, some invasive procedures,

its management, treatment and follow up of patients under Gastroenterology Department.

4. We used to attend clinical rounds to inpatient wards with consultants. During that time in

clinical rounds on all days of our posting time we have seen many cases, management of cases

in intensive coronary unit, care of consultants towards patients, regular monitoring of their

status and mode of management either pharmacological or with the help of some invasive

procedures to improve the health of the patient.

5. We were asked to present some cases to the consultants. I presented a case of Irritable bowel

syndrome. A lot of inputs and suggestions were given by the consultants and doctors regarding

the presentation. This helped improve our knowledge in Gastroenterology and presentation

skills.

6. We observed investigative procedures of Gastroenterology such as esophagoscopy,

gastroscopy, duodenoscopy, Colonoscopy etc and learnt about the procedures of these

investigations, the preparation of the patient for its procedure and the interpretation of the

findings. More than 50 such procedures were observed, during our posting of one month. We

were also educated about the precautions, indications and contraindications of all these

investigative procedures and also the use of such procedures in emergency medicine was

taught.

7. The hospital library facility was well equipped with the latest volumes of journals and books

in gastroenterology. Most of our post lunch hour was spend in the library going through the

topics of interest of gastroenterology and reading about the unusual conditions that we came

across in the OPD.

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8. Yoga department was managed by Dr. Swarna Gowri, from whom we learnt the art of

counseling and diet education for patients. Psychological morbidity is generally high in

patients of gastroenterology problems we assessed this in terms of perceived stress, anxiety and

depression and evaluated the improvement in these measures following yoga intervention. We

taught some pranayama, breathing techniques to different patients in the ward and observed its

effects on the mind-body component.

9. We even had an exposure to the surgical procedures done by Dr. Sanjay Govil, a surgical

gastroenterologist in the operation theatre and emergency ward. The possible preoperative and

post operative complication following surgical procedures and methods of their management

were taught to us.

10. Routine follow up of some interesting cases both in the inpatient ward and outpatient

departments was done.

Summary:

Our orientation training program in department of Gastroenterology was useful and

educative. We came across a variety of gastroenterological problems such as hepatitis, Icterus,

Inflammatory Bowel Disease; Drug induced Peptic Ulcer, Tubercular gastroenteritis, Irritable

Bowel Syndrome, Alcoholic cirrhosis of liver etc. We gained knowledge on the methods used

in the managing above mentioned diseases. We also realized the importance of psychological

stress, diet, yoga and exercise plays in the management and prevention of gastroenterological

diseases and seminars. The classes taken by Dr. Gayathri helped immensely in understanding

the management of various gastroenterology conditions. We learnt about the use of

investigative procedures and their inference in arriving at a diagnosis. We understood the

magnitude of lifestyle and stress as a risk factor in the causation of many gastroenterological

ailments. We also learnt a few techniques ofyoga, useful in the management of stress in these

patients.

GRADE CARD Department of Gastroenterology

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3. Endocrinology Orientation Training Programme


1. Dr. Shalini MD (Gen med),

Consultant Endocrinologist

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2. Dr. Nidhi Garg. MD(GM) ,

Consultant Diabetologist


Work Report:Yoga and Endocrinology rehabilitation



Department: Department of Endocrinology, NH


Objectives:


different endocrine related diseases.

2. To undergo training in investigative endocrinology.

3. To understand and assess the influence of psychological stress, lifestyle and health behaviours

on endocrine related events.


5. To understand the preventive aspects of endocrinology.

6. To gain knowledge about diet and nutrition in management of endocrinological diseases.

Activities:


Endocrinology

(1 month)

OPD 50

Diabetes education 26

Lectures 10

Case presentation 10



we learnt about screening of new cases, keeping medical records, counseling by social workers


efficient service.

2. Outpatient department: We were attended OPDs from 9.00am to1.00pm on every day except

on Sunday. We attended OPDs with the following endocrinologist: Dr. Nidhi Garg, and Dr.

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Shalini Rajesh. We observed and learnt the art of clinical history taking, clinical examinations,

investigative procedures and diagnosis of endocrinological disorders and its subsequent

conventional management. We assisted the consultants in case taking, referring to investigative

lab tests and writing prescriptions.

3. We attended rounds with the consultants and diabetes educators to their respective wards.

During which we have seen many cases, their management and care of consultants towards

patients, regular monitoring of their status and mode of management to improve the patients

health.

4. There were weekly case presentations where in we presented some cases to the consultants. I

did present a case of Hypothyroidism. The consultants gave a lot of inputs and suggestions

with regard to the presentation. This helped in improving the presentation skill and knowledge

of endocrinology.

5. We were asked to present one topic related to endocrinology as assignment. For me topic was

Insulin

6. We observed investigative procedures such as lab reports on the glucose levels, glycosylated

hemoglobin levels, thyroid tests, etc and the interpretation of results from these results. Dr.

Shalini did take a class on the diagnosis of thyroid disorders and its managements.

7. We used to spend an hour post lunch in the library, going through the topics of interest in the

subject of endocrinology, and reading about the unusual cases that we came across in the days

of OPD.

8. We were visiting theyoga department regularly every day. We learnt about the techniques and

principles ofyoga practices used in the hospital for dealing with endocrinological disorders.

We observed and learnt the art of counseling and education for patients with endocrinological

problems. We also learnt about the means of assessing their psychological morbidity in terms

of anxiety, depression and perceived stress using questionnaire and evaluated the improvement

in these measures followingyoga intervention.

9. The presence of educators in the department helped us in learning the art of patient education

especially for those suffering from diabetes mellitus. This included diet education, regular

medicine counseling, steps to prevent complications etc.


department and their changes noted.

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Summary:

Our orientation training program in Endocrinology Department for 1 month was

educative. We came across a variety of diseases like, diabetes mellitus, thyroid disorders,

Addisons disease, Cushings disease, Metabolic syndrome, Obesity etc. during our postings at

outpatient department. We gain knowledge on methods of managing above mentioned

diseases. We also got to know the importance of psychological stress, diet and exercise oryoga

in managing and preventing endocrinological disorders. We also learnt the methods of deriving

diagnosis through the interpretation of investigative procedures such as laboratory reports etc.

The posting also helped us to understand the magnitude of lifestyle and stress as a risk factor in

causing many of the endocrinological disorders. We also gained sufficient insight into the

education of preventive measures in the management and prevention of disease complications

GRADE CARD Department of Endocrinology

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4. Neurology Orientation Training Programme


Dr. Rajesh Iyer MD (Gen med), DM (Neuro)

Consultant Neurologist

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Work Report:Yoga and Neuro- rehabilitation

Duration: 2 months. From: 1-3-2009 to 30-4-2009


Department: Department of neurology, Narayana institute of neurosciences, NH


Objectives:


different neurological diseases.

2. To undergo training in investigative neurology.

3. To learn different principles of neurological examination.


on various neurological diseases.


6. To understand the preventive aspects of neurology.

7. To gain practical skills in neurological rehabilitation (post operative and preventive).

Activities:

Dept Activities No. of hoursNeurology

(2 months)

OPD 120

IPD 30

Case presentations 10

EEG 56

1. Hospital Administration: Initial few days of my training period were spent in understanding

the nuances of hospital administration. I was posted in the administration department where we

learnt about screening of new cases, keeping medical records, counseling by social workers


efficient service.

2. Inpatient department: daily from 9.00am to 10.30 am, I was joining Dr. Rajesh Iyer in

inpatient rounds. Mainly seen cases are Cerebrovascular accidents, Epilepsy, Diabetic

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neuropathy, references from various departments for neurology opinion, including in

emergency wards.

3. Outpatient department: I was attending different neurology OPDs from 10.30am to 4.00pm

on all days in week except on Sunday. We attended the OPDs with the following Consultants

Dr. Rajesh B. Iyer (Epileptologist), Dr. Shobha (specialized in headache), Dr. Rengaraajan

(specialized in movement disorders) & Dr.Rajesh .K.N.(specialized in cerebrovascular

diseases) We observed and learnt the art of clinical history taking, neurology examination,

investigative procedures and diagnosis of neurological ailments and its subsequent

conventional management. We assisted the consultants in case taking, referring to investigative

lab tests and writing prescriptions. We acquired sufficient medical information during our

posting in neurology departments. Daily during OPDs we used to see many patients with

different neurological related problems like Migraine, Stroke, Parkinsons Disease, Tension

Headache, Cervical Spondylosis, Vertigo, Sciatica, Guillian Barre Syndrome, Epilepsy,

Cerebral Palsy, Myasthenia Gravis, Muscular Dystrophy, Diabetic Neuropathy, Prolapsed

Intervertebral Disc etc and its diagnosis, complications, investigations, importance of

radiological procedures for diagnosis, and method to maintain the functions and prevent

deformity or complications in future with the help of Physiotherapy, Yoga and Naturopathy.

4. Narayana Hrudayalaya is an academic center for excellence in cardiology and

neurology in south India where patients from all part of the globe access its services. The

hospital is recognized for imparting DNB courses in neurology and many doctors undergo

residency training post MD. We attended rounds in hospitals, saw case presentation, attended

mortality meetings etc. We also got to know how to manage complications in neurology and

got to know about resuscitative and emergency procedures in neurology.

5. We used to attend clinical rounds to intensive coronary unit and inpatient wards with

consultants and resident doctors everyday from 9.00am to 10.30am. During that time in clinical

rounds on all days of our posting time we have seen many cases, management of critical cases

of neurology in intensive coronary unit, care of consultants towards patients, regular

monitoring of their status and mode of management either pharmacological or with the help of

some invasive procedures to improve the health of the patient.

6. I was asked to present some cases to the consultants and resident doctors. I presented a case

of Cerebrovascular Accident, a case of Headache, and a case of Epilepsy; and many inputs and

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suggestions were given by the consultants and doctors regarding the presentation. This helped

improve our knowledge in neurology and presentation skills.

7. I observed investigative procedures in neurology such as Sleep study, EEG, EMG, and nerve

conduction study and learnt about the procedures of these investigations and interpretation of

results from these recordings. I was also educated about the precautions, indications and

contraindications of all these investigative procedures and also the use of such procedures in

emergency.

8. Also, It was my opportunity to join consultants while they are discussing about radio

diagnostic techniques in radiology department with radiologists.

10. One more rare opportunity I got was, attended a Multiple sclerosis camp, which was

conducted by a NGO, where chief neurologist was Dr. Rajesh Iyer, where patients of different

stages and different presentations of Multiple sclerosis, I had an opportunity to show my skills

about Yoga intervention for those patients.

11. I had access to the hospital library facilities which was equipped with the latest volumes of

journals and books in neurology. We used to spend an hour every day going through topics of

interest and reading about unusual neurological conditions that we came across in OPD.

12. I was visiting the yoga department regularly every day. We learnt about the techniques and

principles ofyoga practices in neurology and the means of implementing them in neurology

inpatients. We observed and learnt the art of counseling and education for neurological patients

both preoperative and post operative counseling. We also assessed their psychological

morbidity in terms of anxiety, depression and perceived stress using questionnaire and

evaluated the improvement in these measures following yoga intervention. We taught some

pranayama, breathing techniques to different patients in the ward and observed the effect of all

this practices on patients mind-body component.

13. In the Neurological rehabilitation department which comprises ofYoga, physiotherapy and

we learnt how to integrate these therapies in improving the clinical condition and recovery in

neurological inpatients and were also educated in preventive neurology.

14. Every day in OPD consultants showed many x-ray, MRI and CT scan of different

neurological diseases and we gained more knowledge in diagnosing neurological diseases with

the help of above radiology procedures. I was also educated regarding the possible

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preoperative and post operative complications neurological events following surgical

procedures and methods of their management.


department also.

Summary:

Orientation training program in Neurology Department for 2 months was educative. I

came across a variety of neurological diseases like Headaches, Epilepsy, Cerebrovascular

accidents, Parkinson Disease, Cerebral Palsy, Cervical Spondylosis, and Muscular Dystrophy

etc during our tenure in outpatient department. I gain knowledge on methods of managing

above mentioned diseases. I also got to know the importance of psychological stress, diet and

exercise oryoga in managing and preventing many neurological diseases. During our time in

neurology department we attended seminars on management of different neurological

diseases/conditions. We learnt about the use of investigative procedures and their inference in

arriving at a diagnosis. We understood the magnitude of lifestyle and stress as a risk factor in

causing many neurological ailments. We learnt a few techniques to manage stress in neurology

patients in inpatient wards. We gained sufficient information in preventive neurology.

GRADE CARD Department of Neurology

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5. Cardiology Orientation Training Programme


Dr. Pradeepkumar MD (Gen med), DM (Cardio)

Consultant Cardiologist

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Work Report:Yoga and Cardiology rehabilitation



Department: Department of Cardiology, NH


Objectives:

To understand etiology, risk factors, pathogenesis, prognosis and conventional management in

different cardiovascular diseases.

1. To undergo training in investigative cardiology (ECG, ECHO, Angiogram, etc).

2. To understand and assess the influence of psychological stress, lifestyle and health

behaviours on cardiovascular events.


4. To understand the preventive aspects of cardiology.

5. To gain practical skills in cardiac rehabilitation (post operative and preventive).

6. To gain knowledge about diet and nutrition in management of cardiac diseases.

Activities:

Deptartment Activities No. of hours

Cardiology CCU 30

IPD 60

TMT, ECG, ECHO 160

1. Hospital Administration: Initial few days of our training period were spent in

understanding the nuances of hospital administration. We were posted in the administration

department where we learnt about screening of new cases, keeping medical records,

counseling by social workers and understanding how best to make the patients comfortable

through timely advice and efficient service.

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2. Outpatient department: We were attending different cardiology OPDs from 10.30am to

1.00pm on weekly 5 Days. We attended the OPDs with the following Consultants Dr.

Pradeep Shetty, Dr. George Cherrian. We observed and learnt the art of clinical history

taking, cardiology examination, investigative procedures and diagnosis of cardiac ailments

and its subsequent conventional management. We assisted the consultants in case taking,

referring to investigative lab tests and writing prescriptions. We acquired sufficient medical

information during our posting in cardiology departments.

3. Narayana Hrudayalaya is an academic center for excellence in cardiology in south India

where patients from all part of the globe access its services. The hospital is recognized for

imparting DNB courses in cardiology and many doctors undergo residency training post MD.

We attended the weekly seminars presented by these doctors, attended rounds in hospitals,

saw case presentation, attended mortality meetings etc. We also got to know how to manage

complications in cardiology and got to know about resuscitative and emergency procedures

in cardiology.

4. We used to attend clinical rounds to intensive coronary unit and inpatient wards with

consultants and resident doctors. During that time in clinical rounds on all days of our

posting time we have seen many cases, management of cases in intensive coronary unit, care

of consultants towards patients, regular monitoring of their status and mode of management

either pharmacological or with the help of some invasive procedures to improve the health of

the patient.

5. We were asked to present some cases to the consultants and resident doctors. I presented

a case of Acute Myocardial Infarction, patient was a known hypertensive. A lot of inputs and

suggestions were given by the consultants and doctors regarding the presentation. This

helped improve our knowledge in cardiology and presentation skills.

6. We observed investigative procedures in cardiology such as ECG, ECHO, TMT,

STRESS TEST, CARDIAC SCAN, and ANGIOGRAPHY and learnt about the procedures

of these investigations and interpretation of results from these recordings. We were also

educated about the precautions, indications and contraindications of all these investigative

procedures and also the use of such procedures in emergency.

7. We had access to the hospital library facilities which was equipped with the latest

volumes of journals and books in cardiology. We used to spend an hour every day going

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through topics of interest and reading about unusual cardiac conditions that we came across

in OPD.

8. We were visiting the yoga department regularly every day. We learnt about the

techniques and principles ofyoga practices in cardiology and the means of implementing

them in cardiac inpatients. We observed and learnt the art of counseling and education for

cardiac patients both preoperative and post operative counseling. We also assessed their

psychological morbidity in terms of anxiety, depression and perceived stress using

questionnaire and evaluated the improvement in these measures following yoga intervention.

We taught some pranayama, breathing techniques to different patients in the ward and

observed the effect of all this practices on patients mind-body component.

9. In the Cardiac rehabilitation department which comprises ofYoga, physiotherapy and

nutrition and diet we learnt how to integrate these therapies in improving the clinical

condition and recovery in cardiac inpatients and were also educated in preventive cardiology.

10. Observed invasive cardiac procedures like Angioplasty, CABG (Coronary Artery Bypass

Grafting) in cath labs and surgery wards. We were also educated regarding the possible

preoperative and post operative complications or cardiac events following surgical

procedures and methods of their management.


department also.

Summary:

Our orientation training program in Cardiology Department for 2 months was educative.

We came across a variety of cardiovascular diseases like, myocardial infarction or heart attack,

hypertensive cardiomyopathies, vascular diseases, congenital heart diseases, cardiac temponade

etc during our tenure in outpatient departments. We gain knowledge on methods of managing

above mentioned diseases. We also got to know the importance of psychological stress, diet and

exercise oryoga in managing and preventing cardiovascular diseases. During our time in

cardiology department we attended seminars on management of different cardiovascular

diseases/conditions. We learnt about the use of investigative procedures and their inference in

arriving at a diagnosis. We understood the magnitude of lifestyle and stress as a risk factor in

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causing many cardiac ailments. We learnt a few techniques to manage stress in cardiac patients

in inpatient wards. We gained sufficient information in preventive cardiology.

GRADE CARD Department of Cardiology

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6. Psychiatry Orientation Training Programme.


1. Dr. S. Varambally MD (Psych)

Assistant Professor and Consultant psychiatrist

2. Dr. Paulomi .S Phd (Psychology)

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Assisitnat professor

Department of behavioral psychology

3. Dr. Anupam Gupta MD (GM), Dip in PM

Assistant professor,

Department of Neuro- rehabilitation.


Work Report:Yoga and Psycho Neurological rehabilitation

Duration: 2 1/2 months From: 15-09-2009 to 30-11-2009

Hospital: NIMHANS, Bangalo re.

Department: Department of Psychiatry, NIMHANS

Department of Cognitive Behavioral Therapy

Department of Psycho Neurological Rehabilitation

Objectives:


different Psychiatric disorders.

2. To undergo training in detailed case history taking and diagnosis of psychiatric disorders.


on psychiatric disorders.

4. To gain knowledge about Cognitive Behavioral Therapy.

5. To undergo intensive training of Psycho Neurological Rehabilitation.

6. To undergo intensive training in occupational Therapy

Activities:


OPD 30

IPD 30

Counselling 17

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Psychiatry

(1 month)

ECT 20

Case presentation 04

Lecture / Seminar 12


Psychology

(1 month)

Counseling Sessions 40

Case presentations 12

Topic discussion 18

Library reading 30


Rehabilitation

OPD 36

Instrumental Demonstration 12

Occupation therapy 12



we learnt about screening of new cases, keeping medical records, counseling by the junior

resident doctors and understanding how best to make the patients comfortable through timely

advice and efficient service.

2. Outpatient department: We were attending the outpatient department on Mondays and

Thursdays from 9.00am-3.00pm. On these days, the outpatient departments at Psychiatry

department were headed by chief consultant Dr. B. N. Gangadhar and assisted by Dr. Jagadisha

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, Dr. Venkat and Dr. Naveen. We were assigned various junior doctors doing their MD in

Psychiatry and thoroughly enjoyed their association in the learning process of history taking,

mental status examination and diagnosis of psychiatric disorders using ICD-10 classification

for psychiatric disorders. We gained good information in these aspects during our posting in

OPDs.

3. We used to attend clinical rounds to inpatient wards with consultants Dr. Jagadisha, Dr.

Venkat on Tuesday, Wednesday and Thursday from 10.00am-3.00pm. During which we have

seen many psychiatric cases, and the art of eliciting case history and monitoring of the daily

mental health status, care of the consultants towards the patient, and the mode of management

both using pharmacological and psychological modes of intervention.

4. NIMHANS is a world famous hospital and an academic center for excellence in fields of

mental health and neuroscience. They run various postgraduate courses such as MD

Psychiatry, DNB, MPhil in Psychology, Master of Social Worker etc. Most of the afternoon

was engaged in seminars by these students in the presence of consultants, professors, clinical

psychologist, social workers and nursing staff. A lot of discussions and explanation during

these sessions helped us gain a lot of inputs regarding Psychiatry, Psychology and nursing of

the patients.

5. There were classes on various topics of psychiatric illness by doctors from department of

psychiatry and department of psycho-neuro-rehabilitation which were held twice weekly on

Monday and Friday from 8.00am-9.00am. This went on for a period of 3 months; where in the

following topics were covered:

Introduction to ICD-10 classification,

Obsessive Compulsive Disorders,

Personality Disorders,

Alcohol and Related Problems,

Somatoform disorder, Body dimorphic disorders,

Disorders of sleep and eating like Bulimia Nervosa, Anorexia Nervosa, Insomnia,

Hypersomnia, Somnambulism,

Psychosexual disorders,

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Maniac Disorders,

Dementia,

Psychiatric emergencies,

Substance use related problems, Attention deficit disorder,

Other Psychotic disorders like Schizotypal, acute psychosis, Delusional disorders

Schizophrenia,

Community Psychiatry,

Psychiatric Rehabilitiation- Social support, education, vocational support, day care, long-term

care, spiritual care

Legal Psychiatry,

Consultation Liaison Psychiatry,

Physical methods of treatment in Psychiatry,

Electro Convulsive Therapy,

Psychotherapy,

Cognitive Behavior Therapy,

Compliance Therapy,

Stress Inoculation Therapy,

Biofeedback,

Relaxation Therapy,

Behavioral and Emotional disorder of childhood

6. NIMHANS is gifted with library par excellence equipped with the latest journals and books

on psychiatry and neurosciences. We used to spend an hour everyday going through topics of

interest and reading about the psychiatric condition that we came across in the OPD.

7. On the management of psychiatric conditions, we were exposed to various methods used such

as Electro Convulsive Therapy (ECT) which was done every Saturdays from 9.00am-12pm.

The pharmacological interventional drugs used for various ailments, were mainly of the classes

of drugs such as Antidepressants, Anticonvulsants, Antipsychotics, Mood Stabilizers.

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8. We were posted in the Cognitive Behavioral Therapy for 15days, which was headed by Dr.

Mahendranath Sharma. He took classes which included both practical and theory on topics

such as Biofeedback, Mindfulness Meditation.

9. There were other MPhil students of psychology in the department, who did regular case

presentation and seminars by which we gained immensely knowledge about various aspects of

cognitive behavior therapy.

15. We gained practical skills by attending practice sessions on Jacobsons Progressive

Relaxation Technique, Counseling sessions, behavior therapy techniques.

16. Our last 15 days of posting were at the department of psycho-neuro-rehabilitation. It consists

of various departments enclosed such as physiotherapy, occupational therapy, vocational

counseling, garments section, tailoring, orthotics, balance and gait lab etc. We were posted for

2 days on each of these departments. Whereas most of the noon hours from 11.00am-3.00pm

was spent in the department of neurology rehabilitation unit with Dr. Abhishek. We observed

many cases of rehabilitation and other neurological cases, their diagnosis; prevention of

deformity and the criterias used to prescribe various rehabilitation measures for the patients.

Dr. Murali was the head of Department of Psycho Neurological Rehabilitation and took class

on the overall concept of psycho neurological rehabilitation. The community based

Rehabilitation classes were taken by Mrs. Geetha, who was doing her PhD work on the same

topic.

Summary:

Our orientation training program at NIMHANS for 2 months was very useful and

informative in covering the fields of Psychiatry, Psychology, and Rehabilitation. We came

across a variety cases of Psychiatric disorders such as OCD, Schizophrenia, bipolar mood

disorders, depression, anxiety neurosis, personality disorders, etc. During out tenure in both out

and inpatient departments we gained knowledge on the conventional methods of management

of these diseases. We also got to know the importance of psychological stress, diet, exercise or

yoga practices in management and prevention of psychiatric disorders. The various sessions,

lectures attended helped us gain in-depth insight into the respective topic of study. We also

learnt about the art of detailed mental status examination and case history taking and the

method of arriving at a suitable diagnosis. The practical steps of intervention pharmacological,

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psychological and rehabilitation wise helped us relate to the practical use ofyoga in the field of

psychiatric disorders.

GRADE CARD Department Psychiatry

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GRADE CARD Department Psychology

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GRADE CARD Department Neuro-rehabilitation

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7. Oncology Orientation Training Programme


Dr. B S Srinath MS (Oncology)

Consultant OncologistCourse: MD (Yoga and Rehabilitation)

Work Report:Yoga and Oncological rehabilitation


Hospital: Shree Rangadhore Memorial Charitable Hospital, Shankarapuram Bangalore

Department: Department of Oncology,

Department ofYoga

Objectives:

1. To understand etiology, risk factors, pathogenesis, prognosis and conventional management of

different cancers.

2. To undergo training in investigative oncology.


on oncological events.

4. To gain knowledge about practical skills to improve the quality of life of patient.

5. To understand the preventive oncology.

6. To gain knowledge about diet and nutrition in management of different types of cancers.

Activities:

Dept

Oncology

ActivitiesNo. of hours

OPD80

IPD 16

Seminars / CME 7

1. OPD: We attended OPD from 05.30pm-9.30pm with medical oncologist Dr. B.S. Srinath.

Here we observed and learnt the art of clinical history taking, clinical examination,

investigation procedures and diagnosis of different types of cancers and their subsequent

conventional management.

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2. We attended hospital rounds with the oncologist, saw case presentation, bed side clinic and

methods used to manage complications in oncology. These rounds gave us wide exposure to a

variety of cancer cases and their management, care of consultants towards patient, regular

monitoring of their status.

3. We were asked to present cases to the consultants. I presented a case of Breast carcinoma. A

lot of inputs and suggestions were given by the consultants and doctors regarding the

presentation. This helped us, both in improving the knowledge of the subject and presentation

skills.

4. The consultants found time to take separate classes for us, covering various topics of interest

such as introduction to oncology, Radiation Biology, Preventive oncology, Supportive and

Palliative care, Brachytherapy, Cancer Fatigue, Cancer and Immunity, Cancer pain

management Nutrition and cancer. These classes gave us in-depth understanding of the topics

covered, along with the experiential knowledge of the consultants.

5. We observed various treatment modalities of oncology such as Chemotherapy, Radiotherapy,

and Brachytherapy. We were also educated about the precautions, indications, methodology

and contraindications of these treatment modalities.

6. With regard to preventive oncology, Dr.B.S.Srinath stressed upon the important role yoga

plays in the prevention of a variety of cancers conditions. We attended seminars on topics

related to improvement of quality of life in cancer patients, nutrition and diet in cancer patients,

role of patient education and life style habits in the management of cancer etc.

7. Hospital has got books on oncology which was belongs to consultants. We studied topics of

interest in cancers condition in our free time in department of oncology.

8. At the conclusion of the posting, we were asked to take up a case of oncology and their

possible management usingyoga therapy. There were lot of insights we could gain from the

consultants as to how they believeyoga therapy could be useful in the management of cancer.

Summary:

Our orientation training program at Shree Rangadhore memorial charitable hospital was

very useful and educative. We came across a large number of patients suffering from a variety

of cancers such as esophageal carcinoma, carcinoma of breast, carcinoma of lung, carcinoma

of ovary, carcinoma of cervix, carcinoma of colon, carcinoma of stomach etc. We gained

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knowledge on the methods used in the management of the above mentioned diseases. During

our posting, we attended seminars and a number of classes from the consultants themselves,

which gave us specific and in depth insight into that topic of oncology. The clinical trial studies

were useful to know about the research discussions of oncology and get first hand information

about the tremendous research going on in oncology. We also got to know about the

importance of psychological stress management, yoga, diet and exercise in the field of

preventive oncology, management and rehabilitation of different types of cancer patients.

GRADE CARD Department Oncology

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8. Rheumatology & Immunology Orientation Training Programme.


Dr. R Nagratna. MD (Gen med), FRCP

Consultant Yoga therapy

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Work Report:Yoga and rheumatologic rehabilitation


Hospital: Arogyadhama - Holistic Health Home, Jigani, Bangalore

Department: Department of Rheumatology and Immunology. Arogyadhama.

Objectives:


different rheumatologic diseases.

2. To undergo training in investigative rheumatology.


on rheumatologic and immunological diseases.


5. To understand the preventive aspects of rheumatology.

6. To gain knowledge about diet and nutrition in management of rheumatologic diseases.

Activities:

Department Activities No. of hours

Rheumatology

& Immunology

(1 month)

OPD 20

IPD 50

Seminar, presenataion 10

1. First few days of my postings spent time with Resident Medical Officer, by observing method

of new case taking, clinical examination and importance of history in coming to diagnosis. We

came to know different kinds of rheumatic diseases with regard to age and sex.

2. During clinical history taking with new patients learned many new things in relation to

different rheumatic diseases, its clinical presentation, symptoms, signs, importance of

investigation in coming to diagnosis of diseases.

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3. OPD: From Monday to Saturday observed outpatient department with consultant Dr. R

Nagaratna & Dr. Srividya. Their OPD timings were different in different days. During OPD

timings on all days observed different types of rheumatic diseases, kind of approach for

different patients with different rheumatic diseases, counseling, education and importance of

investigations. Observed many kinds of rheumatic and immunological disease both new and

follow up cases.

4. In OPD observed many rheumatologic disease like Rheumatoid Arthritis, Seronegative

Spondyloarthropathy including ankylosing spondyltis, psoriatic arthritis, reactive arthritis,

arthritis associated with inflammatory bowel disease, Osteoarthritis, Gout, SLE, Scleroderma,

Sjogrens Syndrome, Polymyositis, Dermatomyositis, Fibromyalgia, Osteoporosis, Mixed

connective tissue disease, Undifferentiated connective tissue disease, Raynauds Phenomenan,

Acquired immunodeficiency syndrome, Hyperflexibility syndrome, Vasculitis and its

associated diseases etc. Every day during OPD time with consultant Dr. R Nagaratna /

Dr.Srividya, observed above mentioned cases, its pathophysiology, method of physical

examination, importance of detailed history and investigation in proper diagnosis of any

rheumatologic diseases.

5. Dr.Srividya, a Resident Medical Officer helped in understanding many concepts in

rheumatological diseases. He took class on types of rheumatologic diseases, classifications of

joint disorders, introduction to immunological diseases, clinical criteria of all rheumatological

and immunological diseases, different investigation procedures and its interpretations, etc.

6. Dr. Srividya also helped us to gain knowledge about important investigative procedures and its

specificity in different rheumatologic disease and immunological diseases. Likewise came to

know about different investigative procedures like ESR, CRP as an indicator for inflammation,

Rheumatoid Factor for Rheumatoid Arthritis, AntiCCP for confirming Rheumatoid Arthritis in

case RA factor is negative, HLA B-27 for confirming ankylosing spondylitis an inflammatory

type of arthritis, Anti Nuclear Antibody(IF) if it is positive confirms presence of connective

tissue disease, ANA Profile having different types of antibody specific for particular variety of

connective tissue disease, immunological disease. Even this investigative procedures value

helped in ruling out progress of patients health condition during follow up time and showed

importance of pharmacological management, yogic counseling and exercise in the progress of

the disease outcome.

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7. During posting time gained much knowledge about pharmacological managements of

rheumatologic and immunologic diseases. Came to know the importance of different kinds of

drugs like disease modifying antirheumatic drugs, slow modifying drugs, anti-TNF agents etc.

8. During OPD time with consultant learned much knowledge about x-ray finding in different

kinds of disease like rheumatoid arthritis, osteoarthritis, ankylosing spondylitis, osteoporosis

etc.

9. Arogyadhama has got own Physiotherapy Rehabilitation unit headed by Dr.Nagaraj Rao .

During my time one month in physiotherapy department observed different physiotherapy

treatments like exercise therapy, electrotherapy, moist heat therapy, wax therapy etc. for

different patients having variety of rheumatologic diseases. Mainly rheumatologic diseases are

progressive in nature leading to deformity and a kind of disability. So I gained knowledge

about different exercise in managing and preventing deformity in RA, exercise and postural

correction in OA, a set of range of motion exercise, stretching exercise, and strengthening

exercise in managing seronegative spondyloarthropathy and polymyositis diseases. Overall in

Physiotherapy department came to know about importance of exercise in reducing pain,

improving mobility, reducing stiffness, improving strength of muscles, preventing deformity,

maintaining independent status of patients, and improving quality of life of patients.

10 Dr. R Nagaratna, Chief consultant was herself is pioneer in Complementary and alternative

medicine (CAM) where yoga is one among them. She is the backbone to found IAYT

(Integrated Approach ofYoga Therapy), which open the door of hopes for patients. Based on

her advice I counseled many patients on importance ofyoga and its methods in managing and

preventing rheumatologic diseases. I came to know the importance of stress, anxiety as

triggering factor in increasing the pain or disease status in different disease.

11. Arogyadhama have their own library contains many text books and journals related to the

field of rheumatology and immunology. Most of the free time spent in studying those books

and making notes on it.

Dr. R Nagaratna, Dr. Padmini & Dr. Srividya took class for us on basics of immunology,

Psychoneuroimmunology and gave short, clear picture of different rheumatologic disease, its

clinical condition, investigative procedures, treatment and importance of exercise and yoga in

adding more benefit to that. Also came to know about importance ofyoga in handling all these

types of rheumatologic and immunologic diseases.

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GRADE CARD Department Rheumatology

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Summary:

My orientation training program in department of rheumatology and immunology at

Arogyadhama for 1 month was very much useful and educative. I observed in outpatient

department with consultant many different types of rheumatologic and immunologic diseases

like RA, OA, SSA, Fibromyalgia, Gout, MCTD, UCTD, SLE, Scleroderma etc. Gained much

knowledge about method of taking new patients case history, counseling, education,

importance of investigative procedures both blood and radiological examinations. During my

time in physiotherapy and rehabilitation unit came to know the importance of exercise in

managing and preventing the different rheumatological diseases. I came to know the

importance ofYoga as a mode of treatment in managing and preventing the rheumatologic and

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immunological diseases taking care of stress, anxiety, depression of patients with different

rheumatologic problems.

Nitin-Hospital Report 2nd Dec

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Transcript of Nitin-Hospital Report 2nd Dec