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Internal Medicine Clinical Cardiac Electrophysiology A feld of special interest within the subspecialty of Cardiovascular An internist is a personal physician who provides long-term 20 mg prilosec with visa, Disease cheap 20mg prilosec with mastercard, which involves intricate technical procedures to evaluate heart comprehensive care in the offce and in the hospital prilosec 10 mg lowest price, managing both rhythms and determine appropriate treatment. Internists are trained in the diagnosis and treatment of cancer, infections, Critical Care Medicine and diseases affecting the heart, blood, kidneys, joints, and the digestive, An internist trained in Critical Care Medicine has expertise in the respiratory, and vascular systems. They are also trained in the essentials diagnosis, treatment, and support of critically ill and injured patients, of primary care internal medicine, which incorporates an understanding particularly trauma victims and patients with multiple organ dysfunction. Endocrinology, Diabetes and Metabolism Specialty training required prior to certifcation:Three years An internist (endocrinologist) specializes in the diagnosis and management of disorders of hormones and their actions, metabolic Subspecialties disorders, and neoplasia of the endocrine glands. This specialist cares for To become certifed in a particular subspecialty, a physician must be patients with diabetes mellitus, thyroid disorders, disorders of calcium certifed by the American Board of Internal Medicine and complete and bone, hyperlipidemia, obesity and nutritional disorders, pituitary additional training as specifed by the board. Adolescent Medicine An internist who specializes in Adolescent Medicine is a multidisciplinary Gastroenterology health care specialist trained in the unique physical, psychological, and An internist (gastroenterologist) who specializes in diagnosis and social characteristics of adolescents, their health care problems and treatment of diseases of the digestive organs including the stomach, needs. This specialist treats conditions such as abdominal pain, ulcers, diarrhea, cancer, and jaundice and performs Adult Congenital Heart Disease complex diagnostic and therapeutic procedures using endoscopes to An internist or pediatrician who specializes in Adult Congenital Heart visualize internal organs. Disease has the unique knowledge, skills, and practice required of a cardiologist for evaluating and delivering high quality lifelong care for a wide range of adult patients with heart disease diagnosed at birth. This specialist cares for geriatric patients in the when the kidneys do not function. This specialist consults with surgeons patient’s home, the offce, and long-term care settings such as nursing about kidney transplantation. Pulmonary Disease Hematology An internist (pulmonologist) who treats diseases of the lungs and An internist (hematologist) who specializes in diseases of the blood, airways. This specialist diagnoses and treats cancer, pneumonia, pleurisy, spleen, and lymph. This specialist treats conditions such as anemia, asthma, occupational and environmental diseases, bronchitis, sleep clotting disorders, sickle cell disease, hemophilia, leukemia, and disorders, emphysema, and other complex disorders of the lungs. Rheumatology Hospice and Palliative Medicine An internist (rheumatologist) who treats diseases of joints, muscle, An internist who specializes in Hospice and Palliative Medicine provides bones, and tendons. This specialist diagnoses and treats arthritis, back care to prevent and relieve the suffering experienced by patients with pain, muscle strains, common athletic injuries, and collagen diseases. This specialist works with an interdisciplinary Sleep Medicine hospice or palliative care team to optimize quality of life while An internist who specializes in the diagnosis and management of addressing the physical, psychological, social, and spiritual needs of both patient and family. This specialist is skilled Infectious Disease in the analysis and interpretation of comprehensive polysomnography, An internist who deals with infectious diseases of all types and in all and well-versed in emerging research and management of a sleep organ systems. Infectious disease specialists may also have expertise in preventive medicine and An internist who specializes in preventing, diagnosing, and treating travel medicine. In addition to the study of those felds that focus on prevention, diagnosis, treatment, Interventional Cardiology and management of injuries, Sports Medicine also deals with illnesses An area of medicine within the subspecialty of Cardiology, which uses and diseases that might have effects on health and physical performance. Selection of Medical Oncology appropriate recipients requires assessment by a team having experience An internist (medical oncologist) who specializes in the diagnosis in evaluating the severity and prognosis of patients with liver disease. This specialist decides on and administers therapy for these malignancies, as well as consults with surgeons and radiotherapists on other treatments for cancer. This specialist is trained to evaluate individuals of all ages Medical geneticists specialize in medicine that involves the interaction who are at risk for hereditary conditions. They are trained to evaluate, diagnose, manage, treat, and counsel individuals of all ages with hereditary Clinical Molecular Genetics and Genomics disorders. This specialist uses modern cytogenetic, molecular, genomic, and biochemical genetic testing to assist in specialized diagnostic A clinical molecular geneticist demonstrates competence in performing evaluations, implement needed therapeutic interventions, and provide and interpreting molecular analyses relevant to the diagnosis and genetic counseling and prevention through prenatal and preimplantation management of human genetic diseases, and is a consultant regarding diagnosis. The medical geneticist plans and coordinates screening for laboratory diagnosis of a broad range of inherited disorders. To become certifed in a particular subspecialty, a physician must complete additional training as specifed by the board. Specialty training required prior to certifcation:Two years Medical Biochemical Genetics To become certifed in a particular area of Medical Genetics and A medical biochemical geneticist demonstrates competence in the Genomics, a physician must complete additional training before diagnosis, medical treatment, and management of individuals with residency as specifed by the board. The subspecialist provides Primary Specialty Certifcates direct care and consultative care for individuals of all ages who are Clinical Biochemical Genetics diagnosed with inborn errors of metabolism. A clinical biochemical geneticist demonstrates competence in Molecular Genetic Pathology performing and interpreting a wide range of specialized, laboratory A molecular genetic pathologist is expert in the principles, theory, biochemical genetic analyses relevant to the diagnosis and management and technologies of molecular biology and molecular genetics. The specialist acts as a consultant expertise is used to make or confrm diagnoses of Mendelian genetic regarding laboratory diagnosis on a broad range of inborn errors of disorders, of human development, infectious diseases, and malignancies metabolism. A molecular genetic pathologist provides information about gene structure, function, and alteration and applies laboratory techniques for diagnosis, 18 19 treatment, and prognosis for individuals with related disorders. Neurological Surgery constitutes a medical discipline and surgical specialty A neurologist specializes in the evaluation and treatment of all types of that provides care for adult and pediatric patients in the treatment of disease or impaired function of the brain, spinal cord, peripheral nerves, pain or pathological processes that may modify the function or activity of muscles, and autonomic nervous system, as well as the blood vessels the central nervous system (e. They also have special competence in genetic and metabolic problems, malformation, retardation, and other Specialty training required prior to certifcation: Seven years of neurodevelopmental problems of childhood. At minimum, this time must consist of 4 1/2 years of core clinical surgery, including: Specialty training required prior to certifcation: Five years • Twelve months as chief resident; Subspecialties • Three months of basic neuroscience; To become certifed in a particular subspecialty, a physician must be • Three months of critical care relevant to neurosurgery patients, and certifed by the American Board of Psychiatry and Neurology and • Six months of structured education in general patient care (e. Brain Injury Medicine Neuromuscular Medicine Brain Injury Medicine is a subspecialty focused on the prevention, A neurologist, child neurologist, or physiatrist who focuses on evaluation, treatment, and rehabilitation of individuals with acquired the evaluation and treatment of disorders of nerve, muscle or brain injury. Sleep Medicine Epilepsy A neurologist or child neurologist with demonstrated expertise in the A neurologist or child neurologist who focuses on the evaluation diagnosis and management of clinical conditions that occur during sleep, and treatment of adults and children with recurrent seizure activity that disturb sleep, or that are affected by disturbances in the wake- and seizure disorders. This specialist is skilled in the analysis and interpretation of possess specialized knowledge in the science, clinical evaluation, and comprehensive polysomnography, and well-versed in emerging research management of these disorders. Hospice and Palliative Medicine Vascular Neurology A neurologist, child neurologist, or psychiatrist who specializes in A neurologist or child neurologist who focuses on the evaluation and Hospice and Palliative Medicine provides care to prevent and relieve treatment of vascular events affecting the brain or spinal cord, such as the suffering experienced by patients with life-limiting illnesses. This ischemic stroke, intracranial hemorrhage, spinal cord ischemia, and spinal specialist works with an interdisciplinary hospice or palliative care team cord hemorrhage. Neurodevelopmental Disabilities A child neurologist or pediatrician who focuses on the evaluation and treatment of chronic conditions that affect the developing and mature nervous system such as cerebral palsy, mental retardation, and chronic behavioral syndromes or neurologic conditions. These labeled tracers during, and after childbearing years, diagnosing and treating conditions of are most often used to produce images that provide information the reproductive system and associated disorders. Molecular imaging can be combined with Specialty training required prior to certifcation: Four years plus two years in clinical practice before certifcation is complete. The most common diagnostic applications of Nuclear Medicine include the early detection Subspecialties of coronary artery disease, cancer diagnosis and staging, and the evaluation of the effect of cancer treatment. The fusion of molecular To become certifed in a particular subspecialty, a physician must be and anatomical information increases diagnostic accuracy and changes certifed by the American Board of Obstetrics and Gynecology and medical management. Radioactive materials are also used to treat a complete additional training as specifed by the board. Critical Care Medicine Specialty training required prior to certifcation: Sixteen months to An obstetrician/gynecologist who specializes in Critical Care Medicine three years, depending on prior training in other specialties has expertise in the diagnosis, treatment, and support of critically ill and injured patients, particularly trauma victims and patients with multiple organ dysfunction. Female Pelvic Medicine and Reconstructive Surgery A subspecialist in Female Pelvic Medicine and Reconstructive Surgery is a physician in Obstetrics and Gynecology or Urology who, by virtue of education and training, is prepared to provide consultation and comprehensive management of women with complex benign pelvic conditions, lower urinary tract disorders, and pelvic foor dysfunction. Comprehensive management includes those diagnostic and therapeutic procedures necessary for the total care of the patient with these conditions and complications resulting from them. Maternal and Fetal Medicine Ophthalmology An obstetrician/gynecologist with specialization in Maternal and Fetal Ophthalmology is a specialty focused on the medical and surgical Medicine focuses on patients with complications of pregnancy and their care of the eyes. Ophthalmologists are the only physicians medically effect on both the mother and the fetus. They can Reproductive Endocrinology/Infertility prescribe glasses and contact lenses, dispense medications, diagnose and The reproductive endocrinologist concentrates on hormonal functioning treat eye conditions and diseases, and perform surgeries.

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Approach to management of common abdominal symptoms -pain generic prilosec 10mg, vomiting cheap 20mg prilosec with mastercard, constipation discount prilosec 40 mg otc, rectal bleeding etc 15. Approach to a child with lower respiratory infection (pneumonia, bronchiolitis) 17. Approach to a child with chronic fever (evaluation and management of pulmonary tuberculosis) 3. Emphasis on Pediatric history taking, physical examination, anthropometry and assessment of growth and development 2. The students are expected to maintain a diary of all the cases admitted on those 4 beds. The student should be acquainted with the diagnosis and day to day progress of the child. Pediatrics Clinical case discussion with emphasis on history taking, physical examination, nutrition and developmental assessment, differential diagnosis, investigations and management. Diagnosis and management of common conditions in community including diarrhea, respiratory tract infections, infections and malnutrition 2. Case discussion of common pediatric conditions including diarrhea, malnutrition and lower respiratory tract infection Subjects for tutorials/ demonstration 1. Re-emphasis on taking a detailed Pediatric history, conducting an appropriate physical and development examination of children including neonates, making a clinical diagnosis, interpreting common laboratory results and planning therapy 2. Evaluation and management of emergencies including neonatal and pediatric resuscitation 3. Management of neonates requiring special care (including low birth weight and preterm babies) 4. Exposure to diagnostic and therapeutic procedures such as intravenous access, naso-gastric feeding, venesection, pleural tap, ascitic tap, bone marrow aspiration, lumbar puncture, liver and kidney biopsy 5. The students are expected to maintain a diary of all the cases admitted on those 4 beds. The student should be acquainted with the diagnosis and day to day progress of the child. Pediatrics Clinical case discussion with emphasis on history taking, physical examination, nutrition and developmental assessment, differential diagnosis, investigations and management. Skull (suture separation, enlarged sella, and raised intracranial tension) List of Instruments 1. The theory paper will have 10 short notes, which will be divided into two sections A and B. Short notes (2-3): Mortality indices and National programmes, Growth and development, Nutrition and Immunization 2. Short notes (5-6): Emergencies and Systemic Pediatrics Section A will have 5 short notes and will be set and evaluated by the external examiner The duration of this section will be 90 minutes. The content for this section will include all the above 3 components Section B will have 5 short notes and will be set and evaluated by the internal examiner. Practical Total marks in final examination shall be 50 Pediatrics 141 The practical examination will be held over 2 days, 25 students each day. Viva voce 10 marks (Growth cards, nutrition tray, emergency drugs, instruments) Pre-Professional Examination The pattern will be similar except that the marks allotted will be half as compared to final assessment. The division of marks for the subject of Pediatrics in the Final Professional examination will be as follows: Total marks 200 Theory 100 Practical 100 Theory marks: 1. Understand the concept of motivation, its impact on human behaviour and illness related behaviour. Understand different types of emotions and their impact on health of the individual. State methods of effective learning and demonstrate application of learning in treatment. Understand different cognitive processes, comprehend memory process, describe short term memory and differentiate with long term memory. Understand nature of intelligence, explain growth of intelligence, compare role of heredity and environment in intellectual development. Define personality, list determinants of personality, understand different theories of personality and learn methods of personality assessment. Introduction: General introduction to Behavioural Psychology What is behavioural psychology, components, individual differences and applications of behavioural sciences in patient care and medical education. Motivation Definition of motivation, theories, types –physiological and social motives, Maslow‘s hierarchy of Psychiatry 143 motives, clinical application 3. Emotion and its application to health Theories of emotions, type and impact on health. Components of learning, classical conditioning, operant conditioning, cognitive, social, biological and observational learning. Cognitive process and memory Sensation, perception, illusion, memory process, short term and long term memory, causes of forgetting and methods to improve memory. Thinking and problem solving Definition of thinking, components of thinking-imagery recollection, language, steps in problem solving, abnormalities in thinking, decision making. Theory of intelligence, growth of intelligence, stability of intelligence, determinants of intelligence, assessment of intelligence, extremes of intelligence. Awareness of general issues about etiology of psychiatric disorders and methodology used to study etiology of these disorders. To know the role of counseling and psychological therapies in treatment of psychiatric disorders. Introduction and classification of Psychiatric disorders Concept of psychiatric disorders; need for classification; types of classification e. Aetiology of Psychiatric disorders Overview of contribution of different scientific disciplines to psychiatric aetiology – clinical descriptive studies, epidemiology, social sciences e. Bipolar disorders Epidemiology, clinical features, diagnosis, overview of aetiology, course, treatment – pharmacological. Depression Epidemiology, clinical features, diagnosis, overview of aetiology, co-morbidity with organic disorders, course, treatment – pharmacological. Hysterical neurosis (Conversion and Dissociative disorders) Epidemiology, clinical picture, diagnosis, differential diagnosis, aetiology, prognosis, treatment. Personality disorders Concept of personality disorders, epidemiology, classification, assessment, overview of clinical features, aetiology, prognosis. Drug and Alcohol dependence Concept of abuse and dependence, epidemiology of alcohol and opiate dependence; clinical features, withdrawal symptoms including complicated withdrawal, psychosocial complications, aetiology, outcome, treatment. Psychiatric disorders of childhood and adolescence, Classification of childhood psychiatric disorders, epidemiology, clinical features, aetiology, assessment. Counselling and psychological therapies Counselling process, skills, different counseling approaches, behaviour therapy, cognitive therapy and its applications.

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The ability of the ring system of riboflavin to exist as a semiquinone allows the flavin coenzymes to accept electrons either + + singly or in pairs discount prilosec 10mg on line. Erythrocyte enzyme activity measurements (Glutathione reductase) is used to determine Nutritional status of Riboflavin prilosec 40mg low cost. Niacin Nicotinamide Nicotinic Acid Niacin is not a vitamin in a strictest sense of the word purchase prilosec 20mg with amex, since it can be synthesized from Tryptophan. However, conversion of Tryptophan to Niacin is relatively inefficient (60 mg of Tryptophan is required to produce 1mg of Niacin) and occurs only after all the body requirements for Tryptophan is met. Source: Milk, Lean meat, Unrefined grains, cereals and from Metabolism of Tryptophan. The requirement increases with increased intake of calories, illness, severe injury ,infection ,burns, high corn (maize) diet, pregnancy and lactation. Skin lesiondevelop when exposed to sunlight, become redend, thickened and becomes scaly. The patient develops gingivitis and stomatitis (Tongue gets swollen) General effects of deficiency are Failure of growth, loss of weight and anemia. Vit B6 (Pyridoxine) Pyridoxine Pyridoxal Pyridoxamine Exists in three forms: Pyridoxine, Pyrodoxal & pyridoxamine and their corresponding phosphates. All pyridoxal phosphate-requiring enzymes act via the formation of a Schiff base between the amino acid and coenzyme. A cation (a metal or a proton) is essential to bridge the phenolate ion of the coenzyme and the imino nitrogen of the amino acid. This bridging maintains the planarity of the structure, which is essential for catalysis. The most important catalytic feature of the coenzyme is the electrophilic nitrogen of the pyridine ring, which acts as an electron sink, drawing electrons away from the amino acid and stabilizing a carbanion intermediate. It is also used for the synthesis of Neurotransmitter, Serotonin and Nor-Adrenalin. Used as a component of Sphingolipids necessary for myelin formation and Heme synthesis as well. It is an essential component of Glycogen phosphorylase;it is covalently linked to a lysine residue and stabilizes the enzyme. Deficiency: usually is not common, but may result due to intake of drugs like Isoniazid and contraceptives. Isoniazid binds to pyridoxine and makes it unavailable as a vitamin, causing peripheral neuropathy. Biotin Biotin Is a vitamin and a coenzyme commonly associated with enzymes performing carboxylation reactions. Biotin is typically linked covalently to carboxylase enzymes through the -amino nitrogen of lysine. Patients on oral antibiotics for a long period of time require more of this vitamin. Avidin, a glycoprotein in egg white binds tightly to biotin and makes it unavailable for the necessary carboxylation reactions. The symptoms in this case are: Dermatitis, Glossitis, Muscle pain, depression, alopecia (Loss of hair), Loss of appetite and Nausea. Figure: Structure of Cobalamin The metal cobalt in vitamin B12 is coordinated with a tetrapyrrole ring system, called a corrin ring, which is simiilar to the porphyrin ring of heme compounds. The cyanide attached to the cobalt in the structure is an artifact of the isolation and is replaced by water or a hyrdoxyl group in cells. The presence of cobalt and amide nitrogens gives B12 compounds the name cobamides or cobalamins. Only two reactions occur to a significant extent in mammalian metabolism: the synthesis of methionine from homocysteine 167 B12- requiring reactions involve either (1) methyl group transfer or (2) adenosylcobalamin- dependent isomerizations. The isomerizations exchange a carbon-bound hydrogen with another carbon-bound functional group. Gastric tissue secretes a glycoprotein called intrinsic factor, which complexes with ingested B12 in the digestive tract and promotes its absorption through the small intestine into the blood stream. Outlines a probable explanation for why failure to absorb B12 leads to the deficiency of red blood cells that define anemias. When B12 levels are low, flux through the methionine synthase reaction decreases but, because adequate dietary methionine is usually available, protein metabolism is not immediately disturbed. Reduction of 5,10-methylenetetrahydrofolate to 5-methyltetrahydrofolate continues because this reaction is virtually irreversible. Because methionine synthase is the only mammalian enzyme known to act on 5- methyltetrahydrofolate, the decreased intracellular activity of this enzyme causes 5- methyltetrahydrofolate to accumulate, at the expense of depleted pools of the other tetrahydrofolate coenzymes. Thus, even though total folate levels may seem ample, there is a functional folate deficiency, with insufficient levels of the formyl and methylene derivatives needed for synthesis of nucleic acid precursors. The vitamin itself was discovered in the 1930s, when it was found that people with a certain type of megaloblastic anemia could be cured by treatment with yeast or liver extracts. The condition is characterized, like all anemias, by reduced levels of erythrocytes. The cells that remain are characteristically large and immature, suggesting a role for the vitamin in cell proliferation and/or maturation. Naturally occurring folates may differ from this compound in the number of glutamate residues per molecule of vitamin, which ranges from three to eight or more. These residues are linked to one another, not by the familiar peptide bond but rather by a modified peptide bond involving the -amino group and the -carboxyl group. Source: The vitamin is abundant in leafy green vegetables such as spinach, so is named folic acid, from the same root as foliage, whole grain cereals and Liver. In this condition production of erythrocytes slows down, Macrocytic erythrocytes with fragile membrane are formed. Inadequate Folate Levels During the early stages of 169 Pregnancy Increases the risk of Neural tube defects (a type of birth defect) and spontaneous Abortions. Folate deficiency is common in Alcoholics and in people who are on drugs like anti convulsants and oral contraceptives. Figure: Structure of Pantothenic Acid Pantothenic acid is a vitamin that forms an essential part of the acyl-carrier moiety, coenzyme A. Coenzyme A (A for acyl) participates in the activation of acyl groups in general, including the acetyl group derived from pyruvate. A free thiol on the last moiety is the functionally significant part of the coenzyme molecule; the rest of the molecule provides enzyme binding sites. In acylated derivatives, such as acetyl-coenzyme A, the acyl group is linked to the thiol group to form an energy-rich thioester. The energy-rich nature of thioesters, as compared with ordinary esters, is related primarily to resonance stabilization. Stabilization involves Pi- electron overlap, giving partial double-bond character to the C-O link. In thioesters, the larger atomic size of S (as compared with O) reduces the Pi-electron overlap between C and S, so that the C-S structure does not contribute significantly to resonance stabilization. Thus, the thioester is destabilized relative to an ester, so that its G of hydrolysis is increased.

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Furthermore generic prilosec 10 mg with amex, the International Air Transport As- sociation expressly disclaims any and all liabil- ity to any person or entity cheap prilosec 10mg free shipping, whether a purchaser of this publication or not generic prilosec 10mg line, in respect of anything done or omitted, and the consequences of any- thing done or omitted, by any such person or en- tity in reliance on the contents of this publication. The practice of airline medicine has changed substantially since the last edition of the Medical Manual was written and this is reflected in the fully revised document. This comprises the medical directors of 10 airlines from all regions of the world. The Medical Manual covers many of the facets of airline administration and operations from the medical perspective. It draws on the various medical specialties that are essential to the safe and smooth operations of an airline and includes public health, aviation medicine, occupational health, and travel medicine. The content has been changed to reflect current issues of interest within the airline industry. There are different models of Medical Services (in-house, outsourced, hybrid, etc. The level of service will be influenced by many factors such as size of the airline, the type of operations, the type of labour force, the culture, the labour laws, the availability and cost of the services, etc. For instance, an airline that has its own maintenance department may need a stronger occupational health expertise. However, regardless of the size of the airline, the role and responsibility of the airline medical services must be clearly defined by the airline chief executive and a clear operating plan laid out with core objectives and responsibilities. The Medical Services, like any other airline department must function efficiently, providing a cost effective service. The Medical Services also need to have a reporting line such that medical issues that may affect either passengers or employees are brought to the attention of the most senior airline staff without delay and these are recognised and evaluated quickly so prompt action can be taken. Some airlines are prepared to subsidise their medical departments, allowing them to provide the required services at a loss, but many insist on strict budgetary controls. Some Medical Services operate very effectively on a system of costing and charging other areas of their company for their services. This might seem unduly bureaucratic, but it can show most clearly to other departments within the organisation the value of the Medical Services and the costs relative to external providers. Within these domains it may provide any or all of the following functions: - Passenger health - Occupational health - Aircrew health and medical certification - Alcohol and other drugs programs - Health and wellbeing promotion - Health strategy and risk management - Primary care service 1 Medical Manual 1. Advisory service for passenger health standards, policy and procedures, and strategic matters In this area, the issue of passengers with reduced mobility requires particular attention as many States have specific regulations on this matter. In addition to setting standards, policy and procedures, the Medical Services can address passengers’ real or perceived concerns about their flight directly, or indirectly through travel agents or the airlines’ sales agents. The use of pamphlets at points of sales, and in ticket wallets, airline internet sites and in-flight magazines are all useful vehicles to provide important health information and advice for passengers and their medical advisors. This function insures that the traveling ill passenger meet established standards and policy, and will minimize the chance of deterioration in-flight. Investigation and review of data for inflight medical events including medical diversions, resuscitations and deaths with advice on remedial actions or system improvements. Inflight medical events and provision of inflight medical care received frequent media attention. The Medical Services can provide a balanced scientifically based view, keeping abreast of medical research, using proven medical data which is made widely available to all. Advisory service for public health outbreaks of airline significance and medical business issues. In this context, it is strongly recommended that the airline maintain good and regular contact with the local and national public health authorities and align each other’s emergency response plan for public health emergencies. Among other things, this relationship is very profitable for both parties to deal with contact tracing when required. The Occupational Medicine service provides specialist medical advice that augments and integrates an Occupational Rehabilitation Service. Specialist advice on standards, policies and procedures involving fitness for duty In order to protect its employees and comply with local laws, the company needs policies and processes for medical assessments such as pre-employment/pre-placement assessments, functional capacity assessments and confined space assessments. The importance of pre-employment/pre-placement assessments cannot be over emphasised. A proper pre-employment/pre-placement medical assessment may avoid many problems including serious medico-legal issues later on. The examining health professional must be aware of the physical and mental components of specific jobs and the possible hazards of the environment in which the applicant will be required to work. The assessment should focus on the safety of the applicant and others, and on the airline’s duty of care. Any relevant past medical history needs to be carefully checked and assessed for its potential impact on future employment in the airline. The pre-employment/pre-placement assessment provides the base information for the employee’s occupational health record. Failure to have such at the pre-employment stage can result later in significant and serious implications for the airline if the employee alleges an illness/injury or condition is the direct result of their employment. A declaration such as follows, gives a reasonable degree of safety to both parties: 3 Medical Manual “I hereby declare that the answers to the above questions are correct and that I have not withheld any relevant information or made any misleading statements in relation to any medical condition experienced by me either in the past or at present. In order to ensure safety and for various operational reasons, we require you to complete this form in good faith and to make a full and frank disclosure of your medical history. Your employment, and continued employment, by the Company is conditional on your having provided us with complete details of your medical history and existing medical conditions. In the event that you fail to disclose any medical condition, such failure will entitle the company, at its discretion, to withdraw your offer of employment or to terminate your contract of employment, whichever is appropriate. In addition, failure to disclose medical conditions may, in certain circumstances, invalidate insurance policies such as medical insurance and life and personal accident insurance, provided to you by the Company. This is driven by their own requirements, local labour laws and where staff is recruited from. In many airlines a simple health questionnaire plus declaration is all that is required, others, depending on the type of job, require more details, for example, flight deck crew, cabin crew, engineering staff. Some airlines provide very specific additional protocols depending on the job applied for, which concentrate on gathering information about the individual’s medical status in relation to that function. Additional biometric testing may be required such as audiometry and visual acuity for those working in the noisy airside areas. The Medical Services can also provide advices on first aid and medical emergency procedures for employees including any workplace defibrillator access program. Depending on the size of the base, the number of working employees, and the local medical facilities available in the community, an in-house medical service can sometimes provide the first aid and emergency response itself. Such a service can also consider functioning as a poison control centre, maintaining a list of all possible toxic substances and their antidotes. Similarly, a roster of centres for the treatment of the severely burned patient should be readily available. Airlines operate globally to destinations all over the world where health standards and endemic disease patterns vary greatly.