Vol 1 Issue. 1 ■ November 2012 PhysicianThe Journal of The British Association of Physicians of Indian Origin In this Edition ... Challenges for the National Health Service Early Results of ERAS (Enhanced Recovery After Surgery) Protocol in Orthopaedic Surgery Assessing Cardiovascular Safety in the Development of New Drugs for Type 2 Diabetes Mellitus A Review of Travel-associated Diarrhoeal Illnesses Practical Pain Management in Older People CONTENTS Contents Vol. 1 Issue 1 ■ November 2012 PhysicianThe Journal of The British Association of Physicians of Indian Origin Editor in Chief Ramesh Mehta MD, FRCP, FRCPCH, FHEA, DCH Editor Parag Singhal MD, MPhil, FRCP Managing Director Buddhdev Pandya MBE EDITORS NOTES ........................................................................... 6 [email protected] PRODUCTION TEAM EDITORIALS.................................................................................. 8 Editorial Manager Jaypreet Dhillon Preventing Avoidable Harm and Promoting Patient Safety: The Doctors’ Dilemma .................... 8 Email: [email protected] Sukhmeet S.Panesar and Rajan Madhok Editorial Assistant Jean Baptiste Marty A UK - India Health Partnership to Benefit Both Countries ............................................................... 10 Email: [email protected] Mala Rao & Bhupinder Sandhu Designed By Darren James Higginbottom Revalidation - Raising the Bar Higher ................................................................................................ 12 Email: [email protected] Joydeep Grover Research & Circulation Manager Jean Baptiste-Marty POLICY ........................................................................................ 14 Email: [email protected] Business Development Implications of the NHS Bill ................................................................................................................. 14 Ovidiu Terinte Terence Stephenson Email: [email protected] Administrator Revalidation: The Need of the Day .................................................................................................... 16 Barbara Lasco Niall Dickson PUBLISHING PARTNERS Mark A. Barker ANALYSIS .................................................................................... 18 Email: [email protected] Challenges for the National Health Service...................................................................................... 18 Martin Wright Raj Kathane Email: [email protected] PUBLISHED BY: RESEARCH ................................................................................... 22 BAPIO Publications Ltd. 178 Ampthill Road Bedford, UK Radial Artery Versus Saphenous Vein As Conduits In Coronary Artery Surgery: MK42 9PU Comparison Of Intermediate To Long-Term Outcomes .................................................................. 22 Rajdeep S. Bilkhu , Anne S. Ewing , & Vipin Zamvar MARKETING & ADVERTISING Pharma Publications Unit J413, The Biscuit Factory Early results of ERAS (Enhanced Recovery After Surgery) Protocol in Orthopaedic Surgery .......28 TOWER BRIDGE BUSINESS COMPLEX Jaydeep Shah & Keshav Singhal 100 CLEMENTS ROAD, LONDON SE16 4DG Tel: +44 0207 237 2036 Fax: +0014802475316 The Physician – ISSN – 1987 – 6329 is published quarterly by BAPIO Publications Ltd. In association with Pharma Publications. The opinions and views expressed by the authors in this magazine are not necessarily those of the Editor or the Publisher. Please note that although care is taken in preparation of this publication, the Editor and the Publisher are not responsible for opinions, views and inaccuracies in the articles. Great care is taken with regards to artwork supplied, the Publisher cannot be held responsible for any loss or damage incurred. This publication is protected by copyright. Volume 1 - Issue 1 (November 2012) BAPIO The Physician ■ Vol. 1 Issue 1 / November 2012 3 CONTENTS Volume 1 Issue 1 ■ November 2012 Contents cont. REVIEWS ...........................................................34 ADVERTORIAL .................................................. 58 Assessing Cardiovascular Safety in the The Physician speaks with Sukdip Sidhu of ARJUN Products Development of New Drugs for Type 2 Diabetes Mellitus ....................34 about the latest in Nutritional Supplements J. Rick Turner, PhD & Paul Strumph, MD LETTER FROM INDIA ......................................... 60 A Review of Travel-associated Diarrhoeal Illnesses .............................40 Barry Dyer Pitfalls of Public Private Partnership Amar Jesani Perennial Rhinitis .......................................................................................44 Glenis Scadding CASE REPORT ................................................... 62 Resurgence of Vitamin D Deficiency Rickets ........................................48 Enough to Make You Blush: A Case of REM Sleep- Related Painful M Zulf Mughal Erections Presenting with Flushing Jessica Megan Triary & Parag Singhal PERSONAL PRACTICE ......................................52 NEWS IN BRIEF .................................................. 64 Practical Pain Management in Older People ........................................52 BalMukund Bhala & Neeraj Bhala, AD INDEX ......................................................... 66 FINANCE .......................................................... 56 Making Sense of the Pension Rules .........................................................56 David Belbin, Philip Redhead & Neil Manning The Physician ■ Vol. 1 Issue 1 / November 2012 5 MESSAGES Message from the Editor in Chief Dr Mehta is a Consultant Paediatrician at Bedford Hospital, UK; Emeritus Professor of Paediatrics, Kigezi Ramesh Mehta MD, FRCP, International School of Medicine, Cambridge and Principal Regional Examiner, South Asia, Royal College of Paediatrics and Child Health. He is a Fellow of the Higher Education Academy. He has been a member FRCPCH, FHEA, DCH of the standards setting group in paediatrics & neonatology, General Medical Council and a Reviewer for the Health Care Commission. Dr Mehta is founder president of the British Association of Physicians of Indian Origin (BAPIO) and Secretary General of the Global Association of Physicians of Indian Origin (GAPIO). he launch of The Physician is another accolade for the British I am indeed grateful to Association of Physicians of Indian Origin (BAPIO) in its quest to a number of colleagues, Tprovide a high-quality continuous education platform. eminent in their own fields, for BAPIO is committed to the vision “Empowering doctors and associating with this venture dentists of Indian heritage to be the beacons of leadership and and for their willingness to professional excellence”. There is a vast pool of talent and skill contribute to its success. I amongst the doctors of Indian origin who are regarded as the welcome Dr Parag Singhal backbone of the NHS. We hope The Physician will be a vehicle for shouldering the editorial to inspire and encourage research amongst members, as well responsibilities, and Mr as provide them with opportunities for career progression. Buddhdev Pandya MBE as the Good medical practice leading to improved patient care is Managing Director of BAPIO central to the success of the NHS. Quality improvement comes Publications. from everyone understanding and implementing evidence- The launch of The Physician marks a new chapter in the based medicine. This publication will endeavour to promote history of BAPIO, and adds to the efforts to promote professional this concept while providing up-to-date information to the excellence, in turn leading to better patient care. ■ medical fraternity on scientific, social and political aspects of medicine. Dr Ramesh Mehta Editor’s Note Dr Parag Singhal is a Consultant Endocrinologist at Weston General Hospital, WSM and Divisional Director for Parag Singhal MD, MPhil, FRCP. Emergency Care. He is MRCP (PACES) examiner and Honorary Senior Lecturer, Bristol University. Dr Singhal has written papers in prestigious scientific journals and is a referee for diabetes journals. Dr Singhal is chair of BAPIO’s South West division. t is a real privilege to have been invited to support Dr Ramesh Mehta The Physician will promote and be associated with the experts in this exciting venture. Our the concept of sound clinical INational Health Service is the envy of the world as it provides quality medicine, which assumes greater healthcare to all, free at the point of need. As a voluntary organisation, relevance when high-quality care BAPIO is committed to assist the NHS in providing the best patient care. needs to be provided within limited The publication is intended to address clinical and academic resources. aspects of medicine, as well as NHS policy issues. Continuing medical It is an honour for me to education and training has remained a central pillar for BAPIO, not welcome Editorial Board members exclusive to its members but encompassing the wider medical fraternity. who have helped us in reviewing Therefore it is vital to provide a platform to disseminate knowledge to the articles and giving constructive support good medical practice and assist in many areas of regulatory feedback. issues like revalidation. The Physician will act to promote academic We are pleased to have with us Mark Barker of Pharma Publications. endeavour and innovation in the NHS. We are committed to publishing a He has several years of experience in medical publication and will help very high-quality journal. us in sustaining