THE LABORATORY REPORTS TO BE SINGED BY DOCTORS WILL IT SERVE THE PURPOSE ?
Dr.T.V.Rao MD The recent order by Medical council of India that all reports to be signed by Medical personal registered with Medical council,if we think sincerely it will bring some accountability on the Medial profession and bring in dignity to Medical gradates, Good idea but it truly works a great question? I hope this will meet the same fate as prescription of Generic drugs? My experience prove matters have gone beyond correction in laboratory Medicine, many practitioners are interested in Kick backs, and many unnecessary tests are prescribed, and many times the clinicians who have prescribed rarely look into the matters seriously
TEACHING HOSPITALS NO BETTER The tragic state of affair in meany private run medical colleges, and many in government run Medical colleges, the so called professors, seniors and above all many retired join the private medical colleges for the sake of monetarily benefits and glued to chairs as Heads to entrust the work and rarely do anything constructive, and same is imitated by young MD gradates also start imitating bosses, as a person committed to work can rarely survive, I have to confess the truth of a Institution many seniors and professors rarely or never come to the laboratory the matters entrusted to technicians and juniors in the department who controls and signs all the reports, ultimately private medical colleges soon feel the threat as without a proper scientific approach to laboratory testing and will lead to missed diagnosis and unnecessary use of dangerous medicine with improper laboratory increasing morbidity and mortality reports it will certainly the reasons many sensible quit bad system or become part of the system, as the managements interested to make greater profits, and other Professor says no rules for her, and made everything suitable and thinks academics is making time table to suit her ignorance and happy with what she did for 30 years in government college, and many seniors think below dignity to take classes and many are existing as professors heads, and examiners not knowing fundamentals of laboratory medicine I think it is not corruption of MCI but self driven interests of the seniors ruined the present system. Above all these people are happy to live as a parasites rather than professors with dignity and respect, It is unfortunate many young graduates do little expert work and if we wish to control the matters they revolt it is all technicians work and just signing is their duty and leading to poor and dangerous reports are generated, The present regulation will certainly prove a another grave failure and many managements appoint some house surgeon or a resident doctors to sign these reports, to overcome the MCI regulations, as we see many professors come for few day sand stay least time in the departments, and run the departments by politics and grouping the staff, However the laboratory medicine is complex specialty needs a better understanding and academic perceptions HOWEVER WE NEED A BETTER LABORATORY MEDICINE TO SAVE THE LIFE IN CRITICAL TIMES, ALL UNETHICAL PRACTICES IN LABORATORY MEDICINE COSTS MAN Y LIVES AND THREAT TO THE PROFESSION
Till yesterday we have many dummy reports generated to convince the MCI, soon many fake signatures to justify the law created by Medical council of India.
HOWEVER I AM HAPPY THAT THERE IS GROWING AWARENESS OF THE WRONG LABORATORY TESTS AND EXPLOITATION FOR THE SAKE OF PROFIT THAN FOR THE BETTERMENT OF THE HUMAN LIFE
Dr.T.V.Rao MD

WRONG CLINICAL DIAGNOSIS -LIFE AT RISK
Dr.T.V.Rao MD It is really a life threatening situation hunting many, Never to forget everyone a potential patient and subject to many medical vagaries, as we observe Doctors today pay least attention to the clinical problem and clinical examination, it is true experience they do least attention and immediately try investigating through unneeded expensive investigations and insist on most available investigations in the medical laboratory market, as person belonging to laboratory Medicine, most laboratory tests are done by very ill qualified technicians, and truly sad state of affairs in many teaching hospitals too,. Most diagnoses are relatively straightforward and don’t require a second opinion, and many examinations, Just check how much the Doctor paid attention to investigations he was written, every laboratory investigation done without a basic understanding is counterproductive. Patients should trust their doctor in determining whether a second opinion is desirable.Wrong diagnoses can lead to the wrong treatment, harming patients, the study stated, referring to a recent report by the National Academy of Medicine.When your doctor gives a diagnosis of a complicated disease, it often pays to get an independent second look, according to a study from Mayo Clinic published,Second medical opinions given at the famed medical institute most often result in a refined or totally new diagnosis, the study found.
In 21 percent of cases, Mayo Clinic doctors gave a completely different diagnosis than the original. The diagnosis was refined or extended in 66 percent of cases. Think about our own circumstances in India the conflict of interest is a growing problem, In the remainder, the diagnosis was unaltered.In general, patients seeking a second opinion should look for an academic medical center close to them, While second opinions add to medical bills, they can prevent even most costly consequences of a misdiagnosis. A misdiagnosis ruins the health of many in India,like many other countries, Even the developed countries dependent on good clinical examination and trained physician must come to near diagnosis and patients not to be treated as experimental animals So much of what we do depends on taking a history, performing a physical examination, and repeating studies we think might need repeating,”“That is all part of practicing medicine. Simply looking at outside records of laboratory is not practicing medicine. It is a poor proxy of medicine itself. However the patients too want to know how accurate his Doctor in treating them , believing the laboratory medicine is certainly a threat to life without a proper clinical examination
TRY KNOWING THE DIAGNOSIS BEFORE EXPERIMENTED , Read more at
Ref First medical diagnosis often incomplete or plain wrong, study finds,James Naessens, a health care policy researcher at Mayo Clinic, summarizes the results of a study on results of second opinions.
Bradley J. Fikes
Dr.T.V.Rao MD

EVERY DAY IS A GIFT - HOW WE LIVE MAKE

A DIFFERENCE
Dr.T.V.Rao MD With many advances and materialistic world we are less interested in others and try to live for self and concentrate more on only near and dear, and accumulating wealth and materialistic comforts, More higher you are placed less we are interested in others,This would be a great question if the assumption that the world is "full" of selfish and manipulative people was true.However this world is not full of bad guys. Though they are growing in numbers, there is still a majority of nice people living in the world. Best way to survive in the world world remains with our own The genuinely honest mechanic technicians even a laborer will never be without customers, the genuinely nice person will attract a genuinely nice person to marry, the genuinely nice teacher will spark a love of learning in their students. If someone asks me who is your genuine strength it is my students, and few of my professionals colleagues necessarily not all but few always wishing to know my welfare, and try connected with my knowledge ,Let us forget about the negative people who live to criticize others, ignoring is the first step and walk to positive world which is positive ideals with your self creativity ,Don't let the negativity of people affect you.
"Don't let the storm outside affect your inner peace"
Try live with peace of happiness when you wake up as God allowed to stay in the world to do better things so, try spending the first hour of your morning doing something you like. It could be music, some exercise or simply positive thoughts. I wake with great dreams to make my little knowledge interesting tomany If you do this then there is nothing anyone could do to upset you. Never forget the people brood on others, on destroy the system and self too , Life goes for better when I really ignore trivial matters and good of others Remember you don't have control on external things but you have control on what goes out from you makes you more interested in life
Today my Choice is to live with passion and thinking better of the world
Dr.T.V.Rao MD@Living every day

ANTIBIOTIC MISUSE - CATASTROPHIC HUMAN HEALTH CRISIS ?
Dr.T.V.Rao MD 
Today if we look at the world of medicine most terrifying thing continues to be misuse of Antibiotics next to Tobacco and alcohol abuse, Antibiotic resistance caused by misuse or overuse, growing menace If we look at many prescriptions, the physician ,clinicians and even chemists prescribe and dispense a hazardous combinations of antibiotics terrible to think of combination of new generation of Cephalosporins Vancomycin Ofloxacin and Levofloxacin group of Antibiotics, Indian drug industry mostly ridden with conflicts and unfortunately markets flooded with terrible combination and science can never imagine to happen, we have poor research wings, and doctors made their success of the day killing the future of Antibiotics, Patients should realize much of the Antibiotics the patients are consuming are not effective and above all create a path for more resistant infections. And Antibiotic resistance is posing a major threat to public health around the world. Doctors and hospitals are now dealing with multidrug resistant infectious disease, organisms that are either difficult — or impossible — to treat.Abuse of antibiotic use creating havoc and Turing normal humans to carriers and spread of Multidrug resistant microbes . THE TRAGEDY OF MISUSE OF ANTIBIOTIC CONTINUES- 
Antibiotic overuse or misuse is largely to blame for the emerging superbugs in our hospitals and communities. While antibiotics are only effective against bacterial infections, certain fungal infections and some types of parasites, they are frequently prescribed improperly for other ailments., If we look at developing world too patients are treated and experimented with broad spectrum and new generation of antibiotics without rationalism and control above all the physicians too anxious to save their patients, Prevailing conditions in many developing countries include lack of infrastructure of Microbiology departments few Microbiologists interested to work with scientific spirit it is unfortunate that even the Medical and Health care teaching institutes least emphase the hygiene and simple ways to prevent the infectious diseases, However it is difficult to control the Medical Profession and professionals in India with conflicts of interests, I wish we have to empower the public and common man on ANTIBIOTIC MENACE and until patients and lay man realise the true problem it is a matter of CATASTROPHIC HUMAN HEALTH CRISIS 
I wish the Microbiologists should be lead persons to spread the message on Hygiene and a simple hand washing can create a sense of well being and reality check on the spread of infections, 
Irrational use of Antibiotics have lead to Major health crisis beyond the control of science TIME TO THINK 
JUST WASH YOUR HANDS SAVE LIVES 
Dr.T.V.Rao MD contributed for public health resources on world wide web

d. My experience is that most people don't love their work. The system runs as many like it, some tolerate it, but it is a minority who find work they love that also supports their lifestyle.It is certain the most worthy people realize to find a solution to do well their job, Start your day with a smile and realize that we are born to be part of the world which bring in lot of comfort as well the unhappiness to many It is critical to distinguish between the job and the way you do it. This is important because every job has aspects that will be very unpleasant for you. You need to be able to get through them with a smile on your face. I had terrible challenges, today many live as non living objects in many of the work places, and create the importance of self with manipulations, and great cause of politics in our educational system, and many organization sink sooner than later, If you work sincerely always there are solutions and ray of hope is generated for us to live better But remember, while you are searching for that perfect job, enjoy the way you are doing your present one, and keep celebrating and expanding all the other joys of life that surround you.
I have put lively poster in a Department which says
NEVER
NEVER
GIVE UP
I too realize no one can make us happy except ourselves, try find a solution sooner than later Start living in and loving our Job true short cut to many ills in the system we live
Dr.T.V.Rao MD

House Surgeon on Duty – A Night Too Long
Every Medical student on being successful in examinations turns into a Junior Doctor (House surgeon) who starts imagining in the beginning that he/she is on the top of the world for few days. Sooner if not later, realizes that human suffering is much deeper than one's imagination. As teacher when I listen to my students that they were excited to take up the new challenges, I always convey that if you are on emergency duty a night is too long for you. I wish them that success or failure in saving a patient in a teaching hospital or for that matter in any Institution depends on the decisions of the inexperienced Junior Doctors, as we are aware that role of the Senior consultants are limited to busy working hours. Several serious complications and critical complications can arise any time, it is certain their survival depends on how you manage the issues in the golden hour, do realize you are hero in the hour of crisis; make your contribution useful to others. In spite of having best Institutes in the country and most talented Doctors, we do not have any organized training to our residents on FIRST AID. It is unfortunate several valuable lives are lost; many become disabled in major cases of accidents due to mishandling of patients at the site of accident. Do remember you are in for a similar situation in a busy teaching hospital when we are dealing with several casualties in the dead of the night. In the last two decades the role of Internship in a teaching hospital is reduced to a state of spectator interested in upgrading his theoretical knowledge to search opportunities for higher education, thus in turn has created a great impact in lowering standards of MBBS graduates. After 6 years of training in a Medical college we are making graduates with doubtful skills and imaginary theoretical ideas. After realising the consequences of producing many highly skilled specialists, developed countries are revising their programmes on Internists; they expect that 21st century Doctors should be Oslerian generalists, seasoned clinicians possessed of knowledge of Internal Medicine both wide and deep and of clinical acumen such as follows from several years of experience caring for sick patients. Making the best use of Internship continues to be ideal goal for learning the better knowledge in life, poor and helpless are at your mercy. The men of wisdom have realized that your human touch is more important than your doubtful, unaffordable theologies and controversial treatments. The Doctors should remember you should be concerned with people who suffer from disease and illness regardless of their economic and social status, poor people accept your inadequacies, pardon your mistakes and spread your kindness to several people they meet in life. The seniors have a role to train the young doctors make them familiar with compelling problems which they never fail to diagnose or treat. All the early aspirations of the young doctors may not come true in early life to become a specialist or a super specialist; however they can be accommodated as good human being to serve the society with an honorable title already awarded as DOCTOR. Try to be an effective Human being to serve the co humans, rather than competent manipulator to become rich. The Internship programme is an opportunity for few months which will never return in life, mind the words of Jose Ortegay Gasset, ( The revolt of Masses ) " the specialist knows very well his own tiny corner of Universe, he is radically ignorant of all the rest, so begin the career as generalist, before becoming ambitious to be specialist and Super specialists. Today there are few opportunities in the profession to become a specialist in view of several graduate doctors. Majority have to continue as just Medical Professional, One's great success and failures depend on simple procedures you perform, to think it is easy but most difficult to perform at the dead of the night. Let us upgrade our knowledge every day of our career; patients too know several relevant facts of their disease, that with an increasing number of patients having access to an increasing amount of health information through the Internet,. This trend has the potential, at a minimum, to greatly reduce the current imbalance in competence between doctors and laypersons, possibly resulting in a DE-professionalization of medicine, Spend at least few hours with Information Highway (Internet) and read recent periodicals, so we don’t lose contact with recent advances. "Supported by humanity's need for a healing class and by physicians' genuine technical competence, the [medical] profession will survive,” I still feel young to be inspired by the words of Jawaharlal Nehru on the Bronze bust in J.N Medical College, Belgaum," Success often comes to those who dare and act and seldom it goes to timid". Every generation of Doctors are worried about their future; do remember the words of Swami Vivekananda "that you alone create your destiny". Every Medical professional's destiny starts with Internship, how you make the best use of the given duty you perform, makes your too long night duties to golden path of success in future. Dr.T.V.Rao MD Professor of Microbiology email doctortvrao@gmail.com

WHY YOUNG DOCTORS NEED COURAGE - IN TIME OF CRISIS 
Dr.T.V.Rao MD Today our profession certainly is in crisis, many voices condemn us and few support us in spite better things we do to save many lives, Many of my students informed me they have crossed the student life to become a house surgeons, Whatever we are wherever we live we need professionalism to thrive , we need professional educational mentors to teach their students and help them become lifelong learners. Such an approach requires leaders at academic medical centers to commit to the establishment of communities in which the virtues flourish. We all need courage to practice and teach the young ones, I always learnt many matters during my residency and many great teachers gave great impact on my career, Courage therefore spurs novice participants to devote themselves to one another and to the achievement of the internal goods of a practice. Medical students and residents will expose themselves to a range of communicable diseases, untimely emergencies at dead of night fighting the life and death, never forget a courageous Doctors save many lives than just very knowledged Doctor, They take part in the difficult medical decisions confronting physicians and patients, wherein the wrong choice could result in disability or death or perhaps a claim of malpractice. Today we face much attacks from unruly patients and ignorant relatives as well bystanders who expect nobody should die or suffer, In response to such hazards, students and residents might be tempted to avoid physical risks or to distance themselves from patients in order to reduce emotional risks. The best physicians, and young residents try to , cultivate authentic relationships with patients. And have seen many successful doctors make a break into the real challenges with knowledge and professional attitude at the time of crisis, and they never forget to consult the senior doctors in the unit, and make a note of you informing the seniors and taking the instructions in details and documentation with clarity . It is better to admit than hide facts,and admit when they make mistakes or are unsure what to do. Such perseverance in the face of danger takes courage.students and physicians must draw upon not only the traditions of medicine dating back to Hippocrates but also the cultural and religious traditions of their own moral formation. Although it would not end all controversy, education in the virtues could provide new direction and energy to the debate about the moral formation of physicians, as it would allow educators and students to engage with traditions of virtue ethics as we cannot change the profession and fighting to live with challenges is a true concern in the changing circumstances in the profession when we get minimal cooperation from our professionals, and certainly self courage drive to better shores of our life .
Dr.T.V.Rao MD

WHY MIND OUR OWN BUSINESS ? – The best way to survive in the system which is complex, loaded with self-interests best way to mind your own business The best statement that any wise person can see as encouragement and best advice ever.” Remain proficient with your job, when somebody troubles me I say read more, teach more learn more about yourself, there ends the problems. People who are unable to mind their own business are most likely internally miserable. They seek to find faults within others just to make themselves feel better. Even if you don’t agree with what someone else is doing sometimes, you need to take a backseat and let them make their own mistakes. “Everyone has faults and there is a fine line in helping someone get through their indiscretions and chastising them for it.The gossip flies faster than wind Every fault we make it counts to life and career, are we ready to face it ? .
Dr.T.V.Rao MD A great idea for many

ailing education and medical education is no less, Most discussed and criticized continues to be Medical education India With MCI regulations Many of us exist as teachers on Roles of the colleges and Universities, there is certainly a dying professionalism whatever one says promoting the matters to the self advantage, and no rules exist, and live by cheating and truly our administrators love the fake people as they are at their door to manipulate the matters for benefits, The rapid expansion of our professional colleges and many medical colleges, many seniors retired and even young think their presence is divine and ruin the system a senior retired professor says there are no rules and make everything convenient to her /him and kill the system, and today many teachers are taking the students to back to ignorance with their own ignorance, Many using even the Institution to selfish ends Truly happening In the departments many are doing fake research, publishing scientific papers on unrelated matters for elevation in career and promotions, Ultimately all unprofessional and corrupt, teachers rule the system to bring in downfall of these Medical colleges, and many managements are happy with shortcuts to success and making money.As a Professional teacher we strive to interact effectively with one another. Anyhow we have least relations with many of our colleagues, In Spite of many limitations some of the departments which have progressed have teachers in the same department may collaborate to share teaching strategies, and analyze data and discuss issues with the curriculum. Teachers who are focused on professionalism participate in these events regardless of the requirements. They are committed to staying up-to-date on best practices and other strategies for teaching. They regularly read books, magazines and blogs about education and leadership, and conduct research to help improve their teaching methods and the performance of their students. As a teacher, we have to serve as a role model to your students. Failing to act professionally sets a bad example and may also cause you to lose the respect of your students. To retain the respect of your students and colleagues and provide your students with the best education possible, demonstrate professionalism in all aspects of our career., and just got of the system with challenges and counter challenges,
It is time to rethink on the system we run and associated with organization we work, it is not the organization we also perish with inefficiency in the bad system we work
THIS IS MY TRUE EXPERIENCE AND TRULY HAPPENING
Dr.T.V.Rao MD Former professor of Microbiology

o R C H SCREENING IMPLICATIONS OF SCREENING FOR TOXOPLASMOSIS 
Dr.T.V.Rao MD Today we get many queries in interpretation of testing the pregnant women after doing a TORCH screening, TORCH tests means (Toxoplasmosis, Rubella, Cytomegalovirus and Herpes) refers to infections that may be a cause for miscarriage. Or congenital deformities, After many scientific evaluations these tests are not worthwhile for most patients. A positive TORCH test simply means the patient has positive antibody levels against that particular infection and is therefore protected against them.Many gynecologists do the testing in patients with bad obstetric history,However any test done without proper understanding will be counter productive, lead to errors in judgments, I wish the physicians should send the samples to a reference or accredited laboratories and certainly worrisome if performed by serology laboratories without any clinical understanding of the problems with privatization and commercial interests many physicians suggest to get the TORCH tests done as a routine matter and labs now offer "TORCH panel" testing on a routine basis.,A positive TORCH test simply means the patient has positive antibody levels against that particular infection, may be anytime in the past.. 
UNDERSTANDING SEROLOGY There are 2 types of antibodies - IgG and IgM. Thus, a positive Toxo IgG test means that the patient has anti-toxoplasmosis antibodies which protect her against a repeated toxoplasmosis infection. This means a positive test is actually a good sign and suggests that the patient is protected against that infection because she has been exposed to that infection in the past. As it was done historically aa RUBELLA PARTIES and many young and teenage girls exposed to RUBELLA infected patients so the young girls infected will have a productive immunity when in infected during pregnancy 
WHY TOXOPLASMOSIS IS WORRISOME -Vertical transmission of the parasite through the placenta can also occur, leading to congenital Toxoplasmosis. Following primary infection, Toxoplasma gondii can remain latent for the life of the host; the risk for reactivation is highest among immunosuppressed individuals,The clinical microbiologists get lot of calls from Obstetricians on interpretation of TOXOPLASMA SEROLOGY .Seroprevalence studies performed in the United States indicate that approximately 9% to 11% of individuals between the ages of 6 and 49 have antibodies to Toxoplasma gondii.,Infection of immunocompetent adults is typically asymptomatic. In symptomatic cases, patients most commonly present with lymphadenopathy and other nonspecific constitutional symptoms, making definitive diagnosis difficult to determine, Severe-to-fatal infections can occur among patients with AIDS or individuals that are otherwise immunosuppressed. Trans placental transmission of the parasites resulting in congenital toxoplasmosis can occur during the acute phase of acquired maternal infection. The incidence of congenital toxoplasmosis increases as pregnancy progresses; conversely, the severity of congenital toxoplasmosis is greatest when maternal infection is acquired early during pregnancy. Sub clinical infection may result in premature delivery and subsequent neurological, intellectual and audio logic defects.Recent or acute infection with Toxoplasma gondii can be evaluated with TOXMP / Toxoplasma gondii Antibody, IgM, When we are diagnosing the Toxoplasmosis by Serum assay, never to forget no single test can give a appropriate results, a negative test does not mean all is well, the serological tests have a better value, if done as paired samples. The Toxoplasma IgG assay should not be used alone to diagnose recent Toxoplasma gondii infection. Results should be considered in conjunction with clinical presentation, patient history, and other laboratory findings
The clinicians should send the samples to Reference and accredited laboratories with support of Clinical Microbiologist .
NEVER TO FORGET Testing for ToRCH will have legal implication with litigation's when you wish to terminate pregnancy or miss the congenital infections when missed with improper testing and wrong interpretations 
Reference - and better understanding read at Test ID: TRCHG ToRCH Profile IgG, Serum Mayo clinic Mayo clinical laboratories Dr.T.V.Rao MD Can be contacted at 
doctortvrao@gmail.com
Mob +919961785124

UPDATING BACTERIOLOGY KNOWLEDGE WITH ABIS Online – The issues regarding identification of Bacterial isolates are immense, and no one can be perfect without updating knowledge every few days at least, and referring the matters at every stage is immense help to young microbiologists, today it is at click of mouse to ABIS online resources ABIS online is a laboratory tool for bacterial identification. It is open for public use You Can Check ABIS Encyclopedia for phenotypical and cultural characters, ecology and pathogenicity data before making a final decision, you can check minute details on numerous bacterial agents and you are frequently up dated
Dear Colleagues,
In the past three months, several changes in ABIS identification databases, Antibiogram interpreter, and Encyclopedia, were applied. The most important changes are listed below:
Updates of June 2017
Antibiogram interpreter: a duplicate input field in EUCAST-Enterobacteriaceae database was corrected.
Complete revision of ABIS Encyclopedia.
Bacterial identification databases:
Reorganization of biochemical databases. The results tests are now listed in the same order with the input fields.
You can down load apps on smartphones or tablet the app ABIS online makes you updated every event happening in bacteriology
HOPE UPDATING KNOWLEDGE IS EASIER JUST WITH YOUR SMARTPHONE
 Resources ABIS online
Dr.T.V.Rao MD

SURVEILLANCE AND CONTROL OF SURGICAL SITE INFECTIONS 
Dr.T.V.Rao MD There is an increasing concern on surgical site infections, and increasing chances of morbidity and mortality, in turn to legal litigation's, Today the people are well informed of the dangers of health care, and patients wish to know the chances of post-surgical infections, for that matter any hospital associated infections, The best of medical advances are compromised with spread Hospital associated infections, Surveillance of healthcare-associated infection (HCAI) is a key requirement under the Strategy for the control of Antimicrobial Resistance, Yet we in majority of our hospitals lag the matters, the true burden of HCAI is unknown. Development of a high-quality surveillance system is essential to monitor HCAI and identify areas for improvement. Such an initiative in the long run will save public money and resources and is an essential component under the ‘quality and safety of patient care’.
ROLE OF DIAGNOSTIC MICROBIOLOGY IN SURVEILLANCE HCAI – The optimal utility of diagnostic Microbiology starts with proper specimen collection and transportation's, and Surveillance must start and end with the patient to improve patient care. Local HCAI surveillance Programme must be relevant to the needs of their patients and local priorities, therefore individual hospitals should be responsible for coordinating the surveillance Programme including collection of local surveillance data. Having a simple record of infections arising in a Hospitalized patient and had surgical intervention create a good data for follow up, and outcome of the patient survival and morbidity give a greater chance to learn the status of the matters happening in our hospitals, 
HOW TO WORK WITH LEAST RESOURCES, - Many times we have least resources to do complicated investigations. It is recommended that if an institution wants to implement surveillance in general surgery, surveillance should be commenced with a small range of General surgical procedures and the type of procedure(s) chosen should be decided locally based on resources available and local specialties. It may be preferable to choose procedures with known or suspected high infection rates and with a sufficient volume (e.g. > 20 to 30 procedures per year) to determine reliable rates of infection, to be simpler even the small hospitals can start with catheterized patients developing infections and quality care of the nursing care.
CONFIDENTIALITY IS A CONCERN The matters should be kept confidential and spill of wrong information needs to be keep under fold, A great need for A dedicated surveillance coordinator. This has been demonstrated to be crucial to the success of the SSI surveillance system in our hospitals. This would be a full-time position with responsibilities in coordinating the process, training staff, following up on surveillance forms, liaising with the analysis team and feeding data back to the surgical units. For smaller hospitals, this post might be combined with another role or shared between two smaller hospitals.
HOW TO START OUR OWN INITIATIONS MOST IMPORTANT - Administrative support for surveillance coordinator
• A consultant microbiologist and a general surgeon to drive the surveillance process and encourage compliance
• A local multidisciplinary committee should be established with representatives from surgery, microbiology, infection prevention and control, and hospital management to help drive the surveillance project and advise hospital management based on the results of surveillance data
Ref 1 Recommendations for Surveillance of Surgical Site Infection Strategy for control of Antimicrobial resistance in Ireland 
2 CDC resources on Health care associated Infection 
Dr.T.V.Rao MD Freelance reporter on Hospital associated infection

TRYING NEW IN LIFE ?– Many times we are monotonous with our thinking and actions, and rarely think change is life and stagnation creates maroons in the system we work ,we find people say that they have decades of experience in the profession they work hopefully everything in this world is changing, TODAY POPULARLY SAID IF YOU DO NOT CHANGE YOU ARE GOOD AS DEAD, However nobody will have future without adopting in new skills in life the great wonder man in Technology is Steve Jobs, the story of Steve Jobs’ youthful calligraphy after dropping out of school, the future Apple founder had a lot of time on his hands and wandered into a calligraphy course. It seemed irrelevant at the time, but the design skills he learned were later baked into the first Macs and continues to be genius computers and PCs we have. The takeaway: You never know what will be useful ahead of time. You just need to try new things and wait to see how they connect with the rest of your experiences later. You can't connect the dots looking forward; you can only connect them looking backward. So, you must trust that the dots will somehow connect in your future," As we find as teachers we become monotonous and non-impressive to transfer our knowledge to many young learning minds Albert Einstein said "If you can't explain it simply, you don't understand it well enough,
LIVE WITH A SMILE WITH SMART FRIENDS "Keep a smart company. Remember your IQ is the average of five closest people you hang out with, avoid negative people and rumor monger, they destroy themselves and others too, never forget our success depends on new skills we have or we are lost in the same place we have prospered.
NEVER FORGET TO LEARN AND TRY NEW IN LIFE THE WORLD NEEDS NEW GENERATION OF PEOPLE
 Dr.T.V.Rao MD

Emerging Need for Automation in Diagnostic Microbiology 
Dr.T.V.Rao MD- Today many laboratories all over the world are exploring the ways to automate the Microbiology specimen processing and reporting, Even much of our teaching hospitals in India lack infrastructure and technically sound manpower , in truth we hardly diagnose few conditions which need attention and facilities to report to the clinicians. Most clinical microbiology laboratories are still largely based on traditional methods for routine identification of pathogens, such as Gram staining, culture of clinical specimens, phenotypic susceptibility testing and biochemical or genotypic identification. If we are sincere the Physicians say they rarely dependent on the existing facilities, and explore matters with trial and error methods in choosing the Antibiotics, Almost it is almost salvage treatment with antibiotics in many terminally ill patients in particular septic shock, The field of infectious diseases is faced with drastic changes – emergence of multidrug-resistant organisms (MDROs), increase of international travel and therefore easier spread of infectious agents between continents, new challenges due to demographic change, and finally climate change, Due to international travel pathogens can cross international borders with ease . This can lead to the introduction of pathogens or resistance genes in previously unaffected regions or populations This might also influence the growing prevalence rates of MDROs which have been detected all over the world, especially in Gram Negatives Infections with MDROs usually have higher mortality rates mainly due to the obviously higher risk of treatment failure and ineffective initial antimicrobial therapy, In the present state most of the teaching institutes too use a traditional methods which are more than half century old are practiced , the main reason being automation needs much investments and technically sound manpower and above all cost effectiveness, Until now, scientific research assessing the benefits of automation in clinical microbiology is scarce, and many of thought the Magic bullet - the Antibiotics will solve all the purpose truly no more, Many developing countries too are scarce with resources switching to polling of Laboratory services with creation of better laboratory facilities, Finally, while quality of the diagnostic results was mainly based on the experience and expertise of the microbiology staff in the past, in the course of automation it will much more depend on the method or apparatus used. Many corporate hospitals too following the trend with appointment of technically sound technologists and matters are controlled by Clinical Microbiologists for better interaction between the clinicians and diagnostic microbiology. WHAT TO DO WITH THE AUTOMATION HOW FAR WE REACH OUR GOALS A QUESTION HUNTS AFTER INVESTING GREAT AMOUNT OF MONEY. I WISH TIME IS RIGHT TO GET OUR POSTGRADUATE STUDENTS TO BE TRAINED IN ACCREDITED LABORATORIES WITH AUTOMATION AND MOLECULAR METHODS AND MORE OF THE SYLLABUS TO STRUCTURED ON AUTOMATION WITH EQUAL EMPHASIS ON IMPORTANCE ON CONVENTIONAL MICROBIOLOGY. However it is certain no one can be a better Microbiologist without understanding the basics and traditional system to control the automation from errors. Hope it is time all the people placed helm of affairs to rethink on what really happening in our laboratories and certainly we work with primitive facilities, and many seniors and even professors lack the work culture and matters are left to inexperienced technical staff and juniors, and accounts to increased morbidity and mortality.
It is certainly frightening to know how the people in ICU and critical care areas treated with unscientific way of trying all available antibiotics, Never to forget our ICU are real sources of Super bugs and certainly need attention with coordinated scientific approaches with modern facilities in Automation and dedicated clinical Microbiologists
TIME TO THINK
Dr.T.V.Rao MD

WE CAN MAKE A CHANGE TODAY? Life is a process to change the choices we make a great difference, the evolution of any progressing life is a dynamic change, Today is a great day for the change for better and a matter of importance and climbing a ladder and we cannot survive in the system long without progress. Remember that your reality is a result of the things you do daily, making even the smallest changes to your daily routine can help you feel less bored with life. No matter what you have, where you are, or who you're with, your perception of your circumstances is more important than the circumstances themselves. Let us see the world most great achievers are self-made who had little support and to put this into perspective, consider this fact: at any given moment, there are other people in the world who have less money, less resources, and less loved ones than you do, never forget more we have more we complain than contended, look around many poor with little to exist with day to day living for survival are happier too Similarly, there are many richer than you, in better shape, and with more resources, who feel less fulfilled than you do. Never forget Money alone cannot make us better there are many things we can do without much help of many and money, it just means have a new idea in life. Make sure you are independent to survive alone rather than being dependent on another person or the inherited wealth and resources. The great people in the world are most flexible to change with new ideas, Hope we all can do it from TODAY
CHANGE IS LIFE STAGNATION IS DEATH
Dr.T.V.Rao MD