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SPECIAL FEATURE AMERICAN ACADEMY OF EMERGENCY MEDICINE CEO’S PERSPECTIVE DR. HARISH PILLAI, CEO – ASTER HOSPITALS & CLINICS INNOVATE PROTEMBO CEREBRAL PROTECTION SYSTEM
What Ails
EMERGENCY MEDICINE in India
Lack of standardisation, fragmented training landscape and distrust relation among doctors M Neelam Kachhap
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Challenges in Emergency Medicine EMERGENCY MEDICINE leaders will meet at the 20th Annual National Conference on Emergency Medicine EMCON2018 which opens at Bengaluru shortly. Among the clinical advancement and professional camaraderie, this elite group of specialists will also discuss on challenges of getting the emergency medicine community united to further the cause of the specialty. Consensus, Advances and Innovation is the theme of the event. Although, EM is regarded as the fastest growing new discipline in the field of healthcare worldwide and shares an interest with every other existing medical discipline, in India it has still not gained the importance it should get. The emergency and trauma care in India still lacks fervor and the fragmented professional community does not help either.
There is no consensus on who brought EM to India and therefore no “Father” or “Mother” of emergency medicine in India For instance, there are two associations and leaders belonging to both these associations claim they got the MCI to recognise EM as a specialty. There is no consensus on who brought EM to India and therefore no “Father” or “Mother” of emergency medicine in India. The rift among the different EM professional associations on training modules and development of the specialty has become evident in the past few years. There are a number of overlapping issues regarding betterment of EM in India. However, despite the potential for cooperation these associations remain elusive and without defined strategic mission. Despite denials that all is well among the professionals complains regarding illegal certification and practices continue to emerge in the media. The lack of concurrence and cooperation will not benefit the patients and certainly not the young individuals enthusiastic about EM. Let’s hope that this gap is bridged soon and will pave way for consolidation and all round development of EM in India. As always, if you have any comment on the magazine or are interested in contributing, please contact editorial@indiamedtoday.com
in any form without the permission of the publishers in writing. Printed and published by M Neelam Kachhap, 301, Grazia, 1st main, 2nd Cross, Lingrajpuram, Bangalore 560084 on behalf of Neelam Publishing (OPC) Private Limited, Printed at Supriya Print Art 143, Pragati Industrial Estate, N M Joshi Marg, Lower Parel West, Mumbai - 400011. and published at 301, Grazia, 1st main, 2nd Cross, Lingrajpuram, Bangalore 560084.
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UPFRONT 03 Editorial 06 Letters 07 News roundup 37 Events 38 Event Report 41 Q&A APPROACH
CEO’s Perspective
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Advances in Stroke Management
Dr. Harish Pillai, CEO – Aster Hospitals & Clinics, India Aster DM Healthcare
COVER STORY
What Ails Emergency Medicine in India SPECIAL FEATURE
Emergency Medicine: Gaining Grounds
PULSE
28
Training in Emergency Medicine
Gerald Jaideep, CEO, Medvarsity Online+
American Academy of Emergency Medicine
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ProtEmbo Cerebral Protection System
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NEWS ROUNDUP SAHAJANAND MEDICAL TECHNOLOGIES TO INVEST 250 CR IN TELANGANA SMT (Sahajanand Medical Technologies) a leading medical devices company, based at Surat, today announced that it will invest 250 Cr in a manufacturing unit in Telangana. BhargavKotadia, MD, SMT met K T Rama Rao, Minister for Industry & Commerce, Municipal Administration & Urban Development, ITE&C, Mines, Handlooms & Textiles, NRI Affairs at Camp Office today. Ganesh Sabat, CEO, SMT; AshishAgrawal, CFO, SMT; Jayesh Ranjan, Principal Secretary of the Industries & Commerce (I&C) and Information Technology (IT) Departments and ShakthiNagappan, Director for Life Sciences and Pharmaceutical were also part of the meeting. Later in the day K T Rama Rao tweeted about the meeting.According to the tweet, SMT has announced an investment of Rs 250 crore
to set up an integrated manufacturing unit of minimally invasive life-saving medical devices at the Medical Device Park, Sultanpur. SMT will manufacture 1.2 Mn stents and 2 MN balloon catheters in this facility, with an investment of over Rs. 250 crores and will create more than 2000 direct jobs at the Medical devices park in Sultanpur, Sangareddy district. Founded by DhirajlalKotadia in 2001,SMT became an early champion of the ‘Make in India’ initiative by being one of the first companies in Asia to indigenously develop & manufacture coronary stents.Today, SMT is the largest developer, manufacturer and market leader of minimally invasive coronary stents (drug-eluting & bare metal), renal stents, PTCA balloon catheters and other cardio vascular accessories in India.Beyond India, SMT also exports its portfolio of life saving devices to UK, Spain, Italy, Netherlands&over 60othercountries.
SMT operates a WHO-GMP certified manufacturing plant in Gujarat and two worldclass R&D centers, including one in Ireland. The Company has a strong focus on R&D and has a number of pioneering achievements to its credit including being the first company in the world to receive the CE certification for a drugeluting stent with biodegradable polymer. Further, SMT has published several clinical studies in leading cardiac journals and has multiple process/product patents.The company keeps a highly customer-centric approach while distributing its innovative products & technologies through a well-entrenched direct sales network.
LETSMD TOPS UP PRE SERIES A ROUND Delhi-NCR based healthcare fintech start-up, LetsMD, has topped up its Pre Series A round with an additional investment of INR 4 crores
Bhargav Kotadia, MD, SMT met K T Rama Rao, Minister for Industry & Commerce, Municipal Administration & Urban Development, ITE&C, Mines, Handlooms & Textiles, NRI Affairs
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NEWS ROUNDUP from Orios Venture Partners. “The investment is a combination of a primary and a secondary transaction”, announced Nivesh Khandelwal, founder and CEO, LetsMD. Existing investors SRI Capital and Waterbridge ventures also participated in the secondary transaction. The overall size of the Pre Series A round was INR 13 crores.In April 2018, the company had raised $1 million in Pre Series A round of funding led by SRI Capital and Thinkuvate with participation from existing investor Waterbridge Ventures. Speaking on the funding, Khandelwal, said, “There will be a demand-supply gap in healthcare financing due to rising out-of-thepocket expenses and healthcare inflation in the next five to 10 years. The focus has to be on ensuring the last mile availability of financing at tertiary care facilities. LetsMD aspires to create a viable option for financing the healthcare needs for people of all strata.” Further Khandelwal said, “We are growing at 30% month on month and have expanded our offering to Mumbai and Kolkata as well. We plan to launch in Pune and Bengaluru by the end of this year. The majority of our individual angel investors have exited as we prepare the company for larger institutional rounds of financing, going forward.”Founded in 2015 by Khandelwal, LetsMD allows users pay their medical bills in low interest EMIs at more than 300 hospitals across Delhi NCR, Mumbai and Kolkata.
TELERAD TECH LAUNCHES AN INNOVATIVE ARTIFICIAL INTELLIGENCE PRODUCT
Telerad Tech, a global healthcare technology company, announced the launch of a new AI-Powered product – MammoAssistto detect early-stage breast cancer as a Makein-India Initiative. MammoAssist analyzes a mammogram and processes the imaging data to recognize radiologic features of early stage breast cancer and categorizes it for BIRADS Scoring with a full-fledged structured template. This template is then made available to a radiologist who corroborates/validates
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the mammography findings and issues the official report. As per the Ministry of Health and Family Welfare (MoHFW), breast cancer ranks as number one cancer among Indian females with an incidence of 25.8 per 100,000 women with 50% survival rate. The primary reason of mortality is late detection. In urban areas, 1 in 22 women is likely to develop breast cancer during their lifetimes as compared to rural areas where 1 in 60 women are likely to develop the disease. Governments in India and globally are under huge pressure to improve this situation in a cost-effective manner. MammoAssist is a cost-effective solution to the above growing problem as it acts as a catalyst for radiologist to review mammograms in minimal time. It can reduce the costs of mass screening programs. “In breast cancer, early detection is of paramount importance in terms of improving patient outcome and reducing healthcare costs. Today, in India, most breast cancer cases are unfortunately diagnosed at a late stage, in part due to the shortage of radiologists required for interpretation of mammograms for the early detection of breast cancer. The availability of an Artificial Intelligence solution such as MammoAssist has the potential to be a game changer in terms of assisting radiologists and facilitating early detection of breast cancer,” explains DrArjunKalyanpur, Founder & Chief Radiologist of Teleradiology Solutions &Telerad Tech. “MammoAssist can play a significant role in breast cancer screening programs to eliminate negative cases with high degree of accuracy and categorizing benign and malignant cases with fully structured report with BIRADS Score in multiple languages. Our studies have shown that MammoAssist can improve the efficiency and productivity of a radiologist by more than 50 per cent. We are highly committed to improve the patient care through artificial intelligence and deep learning in the clinical environment and are targeting to release more than 40 algorithms for radiology diagnosis by 2019” says PrashantAkhawat, COO of Telerad Tech. MammoAssist can help in early stage breast
cancer detection and generate a detailed report with all significant radiologic findings such as Microcalcification, Macrocalcification, Clustered Calcification, Lesions & Lymph Node, Architectural Distortion, Bilateral Asymmetry, Breast Parenchymal Composition, Size, Shape, Location and Density analysis with BI-RADS (Breast Imaging Reporting and Data System) score. It enhances the ability of a radiologist to report cases with high accuracy and efficiency and provides a standard interface to communicate with healthcare systems like RIS-PACS, EMRs through industry standard API and protocols. MammoAssist can generate reports in multiple languages including English, Spanish, German, French, Italian, Polish, and Portuguese. MammoAssist powers Telerad Tech’s Next Generation AI Enabled RIS-PACS Platform RADSpa. RADSpa is deployed in more than 25 countries and has been used to process more than 20 million studies. RADSpa is FDA approved and CE certified.
MARUTI SUZUKI PARTNERS WITH ZYDUS, SETS UP MODERN POLYCLINIC
Access to quality and affordable health care services is a challenge in Becharaji and surrounding villages, especially as rising industrial and economic activity in the region causes a rapid increase in population. Maruti Suzuki India Limited, which has undertaken relevant CSR projects in water, sanitation, infrastructure development and school education in its 26 adopted villages in Haryana and Gujarat, has identified quality health care at affordable prices as a major need in the area. To serve this need, Maruti Suzuki has partnered with Zydus Hospitals, a leading provider of healthcare services, to set up a modern Polyclinic (Health centre) facility at Becharaji. The facility will be managed and operated by Ramanbhai Foundation through Zydus Hospitals. The facility will be fully funded by Maruti Suzuki India through its CSR arm, Maruti Suzuki Foundation.
N Aizawa, MD Suzuki Motor Gujarat, Mr K Ayukawa MD & CEO Maruti Suzuki India Limited. Mr. Pankaj Patel, Founder Chairman, Zydus Hospitals
Community Development is one of the three important pillars of Maruti Suzuki India Limited’s Corporate Social Responsibility programme – there two being in the areas of road safety and skill development. With the main objective to bring about an overall improvement in the quality of life of people residing around its manufacturing facilities, Maruti Suzuki has adopted 26 villages in Gujarat and Haryana collectively. Ensuring direct supervision and control, Maruti Suzuki’s interventions are focused to achieve results and make a meaningful impact on the lives of local people. The Polyclinic was jointly inaugurated today by Mr. Pankaj Patel, Founder Chairman, Zydus Hospitals and Mr Kenichi Ayukawa, Managing Director & CEO, Maruti Suzuki India Limited in the presence of community leaders including Sarpanch of Becharaji village, Shri Devangbhai Pandya.
MGM HEALTHCARE TO LAUNCH NEW GENERATION SPECIALTY HEALTHCARE CHAIN MGM Healthcare Group a pioneer in providing inclusive tertiary healthcare and medical education for over two decades with presence in Chennai and Pondicherry is launching new chain of hospitals. The Group will soon be launching its first 400 bed hospital state-ofthe-art hospital on Nelson Manickam Road. The hospital is built as a green hospital to qualify for platinum LEED certification (Leadership in Energy and Environmental Design). Spread over three-and-a-half lakh square feet, first hospital will have 400 beds, 50 out-patient consultation rooms, 10 operating theatres and over a 100 critical care beds. “The year-long visioning has helped us to identify areas where we can serve patients really better. We are transforming our
Healthcare vertical by investing in new chain of hospital and up-gradation of our teaching hospitals. As the Industry continues to change, we see a real opportunity to evolve faster and better. We have taken proactive steps and have made transformational investments in patient experience and IT infrastructure. There will be genuine ‘first in industry service innovations’powered by people who are driven by altruism ideal.” “The hospital chain will be one of the best IT enabled hospitals in the country. The highlights in technology will be Electronic Medical Records (EMR), Digital ICU with charting solutions and predictive analytics using Artificial Intelligence to prevent and treat any adverse clinical events in line with the global best practices in some of the leading institutions like Mayo and Cleveland. The hospital will also provide connected home healthcare facilities. The hospital will have the best infrastructure with IOT enabled Building
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NEWS ROUNDUP Management System, saidDr Prashanth Rajagopalan, Director, MGM Healthcare Pvt Ltd. He also said that MGM Healthcare will be launching a number of related ventures and more hospitals, in line with its vision of becoming a complete healthcare platform over the years. “Patient care will always be our first priority at MGMH”, said, Dr. Rahul R Menon, CEO, MGM Healthcare Pvt. Ltd.“Our vision is to be the most admired and preferred healthcare institution for patients, partners and the community. We will achieve this through our commitment to the highest standards of ethical practices and values, a dedicated team of experts and professionals who consistently deliver quality healthcare and an ecosystem that encourages and invests in the most advanced medical practices and research,”added Dr Menon.
MICROSOFT PARTNERS WITH SRL DIAGNOSTICS TO EXPAND AI NETWORK FOR HEALTHCARE TO PATHOLOGY Microsoft India and SRL Diagnostics announced their partnership to expand the AI Network for Healthcare to pathology. This collaboration will help improve the quality of digital pathology
for population screening by bringing together Microsoft’s Azure and AI innovations along with SRL’s world-class expertise in the study of cells and tissues (histology). With this addition, Microsoft’s AI Network for Healthcare has now expanded to include pathology along with eyecare and cardiology, thus representing the continued efforts made by the organisation to democratize healthcare. Growing prevalence of chronic diseases such as cancer is one of the key factors for the need for pathology to transform. Digital pathology is increasingly being preferred as it has helped bring improvement in service delivery, patient safety and communications while reducing errors and lowering costs. Histopathology is a specialized form of pathology for analyzing tissue biopsies (mounted on glass slides) and is used for detecting numerous diseases. Histopathologists require highly efficient tools to assist in diagnosis, thus augmenting the demand for automated and innovative implementation of cloud and AI. Commenting on the partnership Anil Bhansali, Managing Director, Microsoft India (R&D) Private Limited,said, “Microsoft is committed to empower both the healthcare industry and patients by using AI to democratize healthcare for all. Our partnership with SRL Diagnostics will assist pathologists by equipping them with technology that will
augment their capability. This is the third area where we have expanded our AI Network for Healthcare after eyecare and cardiology. We will continue to look for other areas where we can deploy technology to make healthcare more accessible.” Microsoft AI Network for Healthcare aims to maximize the ability of AI and cloud computing to accelerate innovation in the healthcare industry and improve the lives of people around the world. By working side-byside with the healthcare industry’s pioneering players, Microsoft is bringing its capabilities and applying AI to devices for early detection of diabetic retinopathy to prevent blindness. Microsoft has also recently launched an AIpowered Cardiovascular Disease Risk Score API for Indian population. As the largest diagnostic laboratory in the country, SRL Diagnostics has a repository of more than a million histopathology slides which would be used for training an AI algorithm. By increasing efficiency in the initial steps in a biopsy tissue analysis through artificial neural networks, it will be possible for a histopathology laboratory to cut down on inadvertent manual errors and process more samples in a day with higher level of accuracy.
BR LIFE SSNMC HOSPITAL LAUNCHES SSNMC BR Life SSNMC Hospital launched the SSNMCBRAINS Centre of Excellence (CoE) for Stroke Management, on the occasion of World Stroke Day Marking the occasion, a unique Postage stamp was also released in collaboration with The Department of Posts, Government of India. An online platform, where in one can fill in medical details and get details on the level of risk of stroke was also unveiled at the event. The postage stamp, one of the first ever initiatives carried by a healthcare chain in India, was released by M N Venkatachaliah, Former Chief Justice of India and Dr Charles Lobo, Chief Postmaster General, Karnataka Circle, released today. Stroke is one of the leading causes of disability and the third most common cause of death in India. In a year 18 to 21 million
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Launch of Postage Stamp by BR Life SSNMC Hospital
people are affected by stroke in India. Due to blood vessel abnormality, genetic abnormality or lifestyle factors, there is a rise in the occurrence of the condition among the younger generation between the age group of 25-30 years. The most prominent causes for stroke are, high blood pressure, uncontrolled diabetes, hyperlipidaemia, sleep apnea, smoking, alcoholism, sedentary and high stress lifestyle. Maintaining healthy balanced lifestyle and vitals can help prevent and reduce the chance of occurrence of stroke. Unfortunately, most people are unaware that stroke is not a one-time occurrence. Around 25 per cent of the victims suffer from recurrent stroke attack during their lifetime if not adequately monitored. There are various recent advancements in treatment of stroke but they are often ignored due to the mixed treatment methods practiced in India. Speaking at the eventVenkatachaliah,
Former Chief Justice of India, said “I feel privileged to be invited for today`s event. We have seen cases of stroke rising in India. Even today many people are not aware of the early signs of stroke. Every 10 second, one person is dying due to stroke as there is lack of awareness and the expensive treatment. Corporates and hospitals should set an example to sponsor an inexpensive insurance, which can be easily available for poor people as well. Speaking on the occasion, Dr. N K Venkataramana, Chief Neurosurgeon, BR Life SSNMC-BRAINS NEUROSCIENCES CENTER of EXCELLENCE, RR Nagar, Bengaluru, said “Stroke is a preventable condition; therefore, it is important to identify the risk factors. The first three hours during stroke known as the Golden Hour is an important period. Ideally, the patient should be treated within the golden hour for a better outcome and avoid long term problems. It is important to create awareness
that the first point of treatment must be through medical therapy and alternate therapy can be complimentary for rehabilitation.” Talking about the launch of the center of excellence Colonel Hemraj Singh Parmar, Group CEO of BR Life says“We are thrilled to partner with the Department of Posts to raise awareness about such a critical health condition. The BR Life SSNMC CoE aims to identify cases of acute and chronic stroke, with continual monitoring to prevent attacks of secondary stroke and rehabilitation to help patients get back on their feet at the earliest. We believe this will play a critical role in enhancing the lives of our patients”. Taking forward the philosophy of Care with Compassion, BR Life by starting the CoE in Stroke Management takes another step forward towards achieving the objective of providing advanced, accessible, affordable worldclass healthcare in India.
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NEWS ROUNDUP E-PHARMA RULES WILL BRING POSITIVE CHANGE IN HEALTHCARE ECOSYSTEM The Internet and Mobile Association of India [IAMAI] in its submission on the draft rules on e-pharmacy to the Ministry of Health and Family Welfare has said that e-pharmacy models provide tracking and traceability of medicines, abuse prevention, addressing consumption of drugs without prescription, tax loss and value-added services for consumer empowerment in healthcare, which are very important in national development. According to IAMAI, this model also increases entrepreneurship opportunities and in turn, accelerates innovation in healthcare. IAMAI, in its submission, has however pointed out that the definition of e-pharmacy is outdated as it doesn’t include e-commerce. E-Commerce platforms under DIPP definitions and NIC rules are a legitimate form of business where wholesalers and retailers of any goods and services reach out to buyers. IAMAI has recommended that the definition should be holistic and support innovation and FDI in this important sector. It should include the word “facilitate the sale” to encompass the
business models of the companies which don’t stock and sell the medicines but only facilitate the sale by the sellers (market places). It will be important to differentiate them from the e-pharmacy retailers or wholesalers. The word “facilitate the sale” will be consistent with existing FDI policy and will not be open for interpretations in future. The association has requested for clarification on whether small offline retailers on-boarding e-pharmacy marketplaces will also have to abide by the provisions of this Bill. The draft states that e-pharmacy registration holder is prohibited from disclosing information received from the customer by way of prescription or in any other manner for any other purposes nor shall same be disclosed to any other person. The draft says that the registration holder shall be duty bound to provide such information to the Central or State Government. Issues relating to sharing of Personal Information is presently being discussed under the Personal Data Protection Bill 2018 by the Sri Krishna Committee and all regulations pertaining to sharing of personal data of customers will be governed by that law. IAMAI has requested withholding of any
regulations till such time as the SriKrishna Committee report is finalized. The said Bill professes all businesses will have to abide by its provisions and will apply for e-pharmacies as well. While the draft rules clearly mention a central licensing authority, as far as e-pharmacies are concerned, there is also Rule 67T (3), which talks about the power of the state governments to cancel the registrations. The confusion lies around the question of where this power is coming from. Periodic inspection and jurisdiction of multiple authorities will hamper ease of doing business. In many cases, the service providers are mere technology platform providers operating under the marketplace model and not actually engaged in the act of selling medicines. According to IAMAI, the clauses need to be amended as this amount to multiple registrations with different regulatory authorities. The association has suggested a centralized registration and monitoring mechanism at pan India level to help promote digital platforms.
BIOCON AND MYLAN ANNOUNCE POSITIVE CHMP OPINION FOR OGIVRI
Biocon Ltd.and Mylan N.V. announced thatthe European Medicines Agency& Committee for Medicinal Products for Human Use(CHMP) has issued a positive opinion recommending approval of Ogivri, a biosimilar toRoche’s Herceptin (trastuzumab). The positive CHMP opinion is based on data submitted as part of the MarketingAuthorization Application which included similarity assessment in analytical testing,preclinical and clinical studies. Results demonstrated no clinically meaningful differences inquality, potency and safety; therefore, establishing biosimilarity to the reference product,Herceptin. In addition, the Phase III clinical study (Heritage) demonstrated no clinicallymeaningful differences in terms of safety, efficacy and immunogenicity when compared toHerceptin in metastatic breast
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cancer patients, further reinforcing the highly similar natureof Ogivri. The CHMP positive opinion will now be considered by the European Commission. Thedecision on approval is expected by the end of 2018.Ogivri is indicated for treatment of patients with HER2 positive early breast cancer (EBC),metastatic breast cancer (MBC) and metastatic gastric cancer (MGC). Under supervision ofthe relevant healthcare professional it can be prescribed as either monotherapy or incombination with other medicines dependent on the relevant diagnosis.
AROGYA WORLD ANNOUNCES SUMATHI RAO AS COUNTRY HEAD Arogya World, the leading global healthcare, not-for-profit advocacyorganisation, has announced the appointment of SumathiRao as Country Head, India and will bebased in Bengaluru. Sumathi has moved to Arogya World after a decade at Philips India, where sheled strategic CSR, healthcare advocacy, brand and communications. Dr. NaliniSaligram, Founder of Arogya World, USA said, “We are absolutely delighted that Sumathi isjoining us. The board joins me in welcoming SumathiRao to Arogya World and we are confident thather strong leadership and years of in-depth experience will support us in the organisation’s missionto change the course of chronic diseases across the country.” Arogya World focusses onefforts to prevent non-communicable diseases (NCDs) across the world including India. At ArogyaWorld, SumathiRao will be responsible for spearheading teams and scaling up key healthcare relatedprograms, such as Arogya’smDiabetes, Healthy Schools, MyThali and Healthy Workplaces. Sumathiwill also be responsible for building various resources needed to further shape up Arogya World’sDoorstep Health Model, which would help in taking disease-prevention plans to people, where theylive, learn and work. Speaking on the new role, SumathiRao said, “It has been a long-cherished dream to
Sumathi Rao
work and leadfrom the front, a not-for-profit professional organisation with special focus on healthcare. Non-profitorganisations play a key role in making healthcare more accessible, working closely with thegovernments, corporates and other stakeholders creating larger impact at grassroot levels. I amindeed happy to join the ongoing efforts of Arogya World in India and around the world.”
STRUCTURES OF SPHERICAL VIRUSES AREN’T AS PERFECT AS WE THOUGHT
Determining the structure of a virus is an important step in understanding and treating viral disease. For decades, structural biologists have been using cryo-electron microscopy to create increasingly accurate pictures of biomolecules, but one of the assumptions they’ve been relying on could be wrong. Flaviviruses, such as dengue and Zika, were assumed to be symmetrical icosahedrons (shapes with 20 identical faces) based on data from microscopes. But these icosahedral viruses might not be perfectly symmetrical after all, according to a new study in the journal Proceedings of the National Academy of Sciences. “Up until now, any such viruses that have
ever been examined have been looked at with the assumption that they had icosahedral symmetry,” said Michael Rossmann, the Hanley Distinguished Professor of Biological Sciences at Purdue University. “Now we realize that’s an approximation – it’s not completely accurate. A large proportion of viruses are nearly icosahedral, and just now we’re beginning to see the details.” The research team, including Richard Kuhn, the Trent and Judith Anderson Distinguished Professor of Science at Purdue, used cryoEM to determine the structures of immature and mature Kunjin virus, a strain of West Nile virus. They followed standard procedures until the end, when data from the microscope is processed to generate a structure. Where they would normally apply a symmetry requirement, the researchers opted out. Matthew Therkelsen, a graduate researcher at Purdue and lead author of the paper, first noticed something unusual when he was determining the structure of an antibody bound to the immature virus. Images of the antibody bound to the virus showed a preference for one side of the particle, and that side was a little fuzzy. “The fact that the antibody seemed to prefer one side of the particle, and that side had an unusual density, made me question the assumptions we’d been making about icosahedral symmetry,” Therkelsen said. “After that, I started doing asymmetrical reconstructions.” What he found looked sort of like a “belly button” on the exterior of the virus. This deviation in symmetry could come from the way the virus is produced. When enveloped viruses are assembling new virus particles, they burrow into a cellular membrane and push until they’ve created their own protective layer. When this layer is almost fully enclosed, the virus gives one final nudge and buds from the membrane. The researchers think it’s at this point, where the new virus membrane is attempting to close, that the virus’ previously perfect structure gets a little distorted. “The neck of this budding particle gets very narrow as it pinches off, and the glycoproteins
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NEWS ROUNDUP surrounding the shell begin hitting one another,” said Kuhn. “We think they might not grab the right number of proteins to make an icosahedron, and the result is a particle that has a distortion on one side.” While both the immature and mature virus had “belly buttons” on their outer layer, the immature virus had another flaw. The core structure of the virus, the nucleocapsid, isn’t in the center of the envelope – it comes closer to the membrane on one side. Some other viruses have uniquely positioned cores, but the flavivirus core is unique because it repositions as the virus becomes an “adult.” Maturation is an important part of the viral life cycle, and these findings could provide insight into what’s going on during this process and why. The researchers believe these findings will open the door to future experiments. In addition to the true structures of several, if not all, icosahedral viruses, there are many other unknowns. Does the unique pole of the virus have a function when it binds to the next cell? Does it facilitate binding to the receptor? Does it influence the exit of the RNA on the inside? These details are all important to understanding the life cycle of flaviviruses.
AIMED & BUSAN TECHNOPARK INK MOU In a bid to further provide an impetus and boost Indian & Korean Medical Device Industry, The Association of Indian Medical Device Industry (AiMeD) has inked a memorandum of understanding (MoU) with BUSAN TECHNOPARK from Republic of Korea to jointly work to promote medical devices industry in both the countries. The agreement was signed by Rajiv Nath, Forum Coordinator, AiMeD and Soo-Hoo Shin Chief of Healthcare Tecnique Division from BUSAN TECHNOPARK. The objective of the MoU signed between the two Countries is to promote the development of business relation between India and Republic of Korea, promoting bilateral trade, investment in both countries
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MoU Signing Rajiv Nath, Forum Coordinator, AiMeD and Soo-Hoo Shin Chief of Healthcare Tecnique Division from BUSAN TECHNOPARK
and the development and exchange of technology.Additionally, to encourage and promote participation from both the countries at various business platforms created byIndian Medical Devices Industry Association and BUSAN TECHNOPARK. “We are honoured and delighted to join forces with BUSAN TECHNOPARK to help India & Korea become global hubs for medical device manufacturing.” Mr. Rajiv Nath said. “We know the roadblocks that need to be addressed for both India & Korea and will focus on getting collaborations and joint ventures for both the countries &encourage information and economic exchange”AddedMr.Nath. “We look forward to work with AiMeD to bring in investment to the medical devices sector in both the countries and make effort for mutual exchange and support for economic cooperation and market entry in the elderly and medical industry India is a huge market and we can aid with Korean technologies Indian manufacturers and the patients and the medical profession.” said Mr. Shin of BUSAN TECHNOPARK. Through this cooperation AiMeD and BusanTechnopark will provide assistance for visiting delegations, comprising of officials and businessman, on both side with a view
to promote their business missions and facilitate business collaborations..AiMeD will also offer business-to-business match making with regard to promotion of technology and investment tie-ups to companies based in Republic of Korea. Similarly, BusanTechnopark will assist AiMeD Members in their business endeavours. “The medical devices sector is being seen as the next big thing after IT and Defence sectors and India has the potential to emerge as a major manufacturer and exporter on the lines of pharma products. The government has undertaken several measures to promote its ambitious ‘Make in India’ mission in Medical Devices. The MoU between AiMeD and BUSAN TECHNOPARKis in line with realising these national objectives,” Mr. Nath said.
AMETEK INDIA OPENS STATE-OF-THE-ART TECHNOLOGY SOLUTIONS CENTRE IN BANGALORE WITH AN INVESTMENT OF US$ 5.5 MILLION AMETEK Instruments (India) Pvt., Ltd. has established a technology solutions centre at
its headquarters in Whitefield, Bangalore, to support the growth of its electronic instrument and electromechanical products businesses in India. AMETEK invested US$ 5.5 million in establishing the Technology Solutions Centre and expects it to be a great resource for its customers in designing new products, selecting the right equipment to meet their application needs, servicing and calibrating devices, and providing hands-on demonstrations and training. AMETEK India is a unit of AMETEK, Inc., a leading global manufacturer of electronic instruments and electromechanical devices with annualized revenue of more than US $4.8 billion and headquartered in Berwyn, Pennsylvania, USA. AMETEK has 17,000 colleagues at more than 150 operating locations, and a global network of sales, service and support locations in 30 countries around the world.“We are very pleased with our new Technology Solutions Centre. It represents a significant expansion of our technical and support capabilities in India and reflects the importance of our growing customer base in India. We now can provide customers with a wider range of services and support, including product demonstrations, training seminars and application workshops, along with factorydirect service, repair and support,” commented MilindPalsule, AMETEK Managing Director for India and the Middle East. AMETEK is celebrating 10 years in India we expect very strong growth in as we continue to expand our capabilities and presence across India. It is not only a key market but a great resource for global R&D hub & sourcing too and AMETEK is committed to investing in India growth & supporting our customers, commented EmanuelaSperanza, VP & GM of AMETEK Europe, India and Brazil. The Centre is equipped with products from nearly 20 AMETEK businesses. It showcases the latest AMETEK solutions for Aerospace & Defense, Academia & Scientific Research, Automotive, Power, Metal, Pharma and Process instrumentation, Factory automation, and Precision manufacturing instruments and electro-mechanical devices. Among AMETEK India’s customers
are many of India’s leading companies in aerospace; automotive manufacturing; energy production; glass, metal and steel processing; industrial and academic research; ultraprecision manufacturing, and other high technology fields
APOLLO MUNICH LAUNCHESICAN: A CANCER-SPECIFIC INSURANCE PLAN
Reaffirming its commitment in making India health confident, Apollo Munich Health insurance today introduced a comprehensive cancer plan, aptly-named iCan. It is a lifelong coverage plan and comes with an annual renewal policy year after year, even after claim. The plan not only covers the basic medical needs but also provide complete financial security to the patient as well as the family at all stages of cancer. This distinctive and innovative cancer plan covers all forms of cancer, at both early and
advanced stages. Apart from the standard plan that covers conventional treatment like Chemotherapy, Radiotherapy and organ transplant, this policy also gives an optional benefit of getting advance treatments like Proton beam therapy, Hormonal therapy, Stem cell transplantation, Immunotherapy. The plan comes with features such as CritiCare and FamilyCare wherein the policy holder gets 60 per cent of sum insured as the lumpsum payment on diagnosis of cancer and 100 per cent on diagnosis of advanced stages or recurrence of cancer, which is in addition to the hospitalization cost. It also offers lifelong renewal that covers the policyholder regardless of the health status or claims of policy holder. Speaking on this announcement, Suraj Mishra, CEO – South & Central Zone, Apollo Munich Health Insurance said, “With the changing lifestyle, we have been witnessing an increase in number of people getting diagnosed with cancer. Every year over 7 lakh Indians are registered as cancer patients and today the estimated number of Indians living with cancer is around 2.5 million. It is perhaps for figures such as these that thought-through cancer policies are the need of the hour.” “We have conceptualized this plan keeping in mind three aspects – i) The economic burden of cancer negatively impacting families’ ability to manage their cost of living with high treatment costs pushing them further into poverty, ii) The cost of advance treatments, if the person reaches advanced stage, iii) cancer treatment is often long and expensive. With the launch of iCan, we have introduced customer centric features like support for family, pre and post hospitalization including lifelong renewal among several others. It is a “future ready” product which covers advanced treatments while also offering second opinion by using sophisticated cognitive systems like using IBM Watson for Oncology to enable people make more informed treatment decisions. We look forward to serve our customers with improved products and we are confident that iCan will bring positive change in the communities at large through this distinctive offering,” he added
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NEWS REPORT
Making Markets Work for Affordable Healthcare Competition Commission of India brings out Policy Note on Healthcare Market OVER THE nine years of enforcement of the Competition Act, 2002 (the Act), the Competition Commission of India has received 52 cases pertaining to the pharmaceutical and healthcare sector. The Commission, while deciding on the cases, has observed that information asymmetry in the pharmaceutical/healthcare sector significantly restricts consumer choice. In the absence of consumer sovereignty, various industry practices flourish which have the effect of choking competition and are detrimental to consumer interest. Such practices may not always violate the provisions of the Act, but they create conditions that do not allow markets to work effectively and healthy competition to drive the market outcomes. The response to these issues can, in many instances,take the form of appropriate regulations that can pre-empt market-distorting practices and help create pro-competition conditions. As the competition authority of the country, the Commission felt the need for close examination and focused deliberations on these issues, which have implications for markets and competition in this sector of critical importance. In pursuance of the same, a series of initiatives has been taken up by the Commission over the years in the pharmaceutical and healthcare sector, which culminated in a Technical Workshop on ‘Competition Issues in the Healthcare and Pharmaceutical Sector in India’ organised on August 28-29, 2018 in New Delhi with representatives of all stakeholder groups, including pharmaceutical industry, healthcare
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service providers, civil society organisations, regulators, healthcare think tanks. The issues identified and recommendations suggested by the stakeholders have been documented in a Policy Note by the Commission titled ‘Making Markets Work for Affordable Healthcare’.Thekey issues and recommendations are as under: Role of intermediaries in drug price build-up One major factor that contributes to high drug prices in India is the unreasonably high trade margins. The high margins are a form of incentive and an indirect marketing tool employed by drug companies. Further, self-regulation by trade associations also contributes towards high margins as these associations control the entire drug distribution system in a manner that reduces competition. Efficient and wider public procurement and distribution of essential drugs can circumvent the challenges arising from the distribution chain, supplant sub-optimal regulatory instruments such as price control and allow for access to essential medicines at lower prices. Electronic trading of drugs, with appropriate regulatory safeguards, could be another potent instrument for bringing in transparency andspurring price competition among platforms and among retailers, as has been witnessed in other product segments.
Quality perception behind proliferation of branded generics Worldwide, generic drugs are seen as a key competitive force against the patent-expired brand name drugs marketed at monopoly prices. In India, the pharmaceutical market is dominated by ‘branded generics’ which limit generic-induced price competition. The branded generic drugs enjoy a price premium owing to perceived quality assurance that comes with the brand name. Quality consideration may be a reason behind the prescription of branded generics by doctors. However, it is also equally possible that the brand proliferation is to introduce artificial product differentiation in the market, offering no therapeutic difference but allowing firms to extract rents. The regulatory apparatusmust address the issue of quality perception by ensuring consistent application of statutory quality control measures and better regulatory compliance. Unless the quality of drugs sold in markets can be taken to be in conformance of the statutory standards regardless of their brand names, generic competition in the true sense of the term cannot take off. The practice of creating artificial product differentiation for exploitation of consumersmay be addressed through a one-company-one drugone brand name-one price policy. Vertical arrangements in healthcare services In view of the incentive-based referral system that pervades the healthcare landscape, issuing of periodic validated data by hospitals relating to mortality rate, infection rate, number of procedures etc. could help patients make informed choice. The in-house pharmacies of super specialty hospitals are completely insulated from competition as inpatients are typically not allowed to purchase any product from outside pharmacies. This calls for regulation that mandates hospitals to allow consumers to buy standardised consumables from the open market. All accredited diagnostic labs should meet the same quality standards in terms of
infrastructure, equipment, skilled manpower etc. for getting accreditation. This will ensure the same degree of reliability and accuracy of test results across labs. There is no regulatory framework that ensures and governs portability of patient data, treatment record, diagnostic reports between hospitals. This acts as a constraint for patients in switching from one hospital to another and creates a lock-in effect.Portability of patient data can help ensure that a patient is no longer locked into the data silos and do not bear additional cost for switching medical services and that doctors/hospitals can have timely access to patient data.
Regulation and competition Owing to the multiplicity of regulators governing the pharmaceutical sector at the centre and state level, implementation of regulations is not uniform across the country. This has resulted in multiple standards of same products and also different levels of regulatory compliance requirements. A mechanism may be devised under the aegis of the CDSCO to harmonisethe criteria/processes followed by the state licensing authorities to ensure uniformity in interpretation and implementation.
It is also imperative to make the approval of new drugs time-bound along with publication of detailed guidelines governing each stage of new drug approval process. Finally, two other major issues that affect the healthcare sector and thus warrant policy response are: (i) shortage of healthcare professionals in the country owinginter aliato high cost of medical education and (ii) inadequacy in health insurance. Public health delivery is a complicated policy matter. The focus of the Policy Note does not lose sight of legitimate public policy objectives, but endeavours to determine the extent to which choice and competition can improve outcomes consistent with those objectives. Accordingly, the Policy Note is being shared with Ministry of Corporate Affairs, Ministry of Health and Family Welfare, Department of Pharmaceuticals and NITI Aayog. The Commission will continue to enforce antitrust rules in the pharmaceutical and healthcare sector to ensure that effective competition is not undermined in these markets. However, since enforcement cannot address all competition issues in the sector, the instrument of competition advocacy isemployed with more vigour to facilitate discussions and make policy changes that are necessary to address the conditionstriggering non-competitive market outcomes.
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COVER STORY
What Ails
EMERGENCY MEDICINE in India
Lack of standardisation, fragmented training landscape and distrust relation among doctors M Neelam Kachhap
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COVER STORY
A
bout 150,000 people are killed in India every year in road traffic accidents and experts believe that this number would increase to 250,000 by year 2025. On the other hand, a recent study published in The Lancet shows that heart ailments caused more than 2.1 million deaths in India in 2015. In fact, heart disease and stroke together contributed to 28•1 per cent of total deaths in India in 2016. In addition, we are diseases. Add to this infection due to Dengue, Zika and Nipah virus.These figures pose major challenges to our health system and paint a grim picture of our future. The question is can we arrest the progression of these premature deaths? Are our emergency departments poised to tackle this onslaught of disease? Emergency Medicine in India Even though emergency medicine is a fairly new speciality in India; caring for the critically ill is not new. Indian hospitals have always had causality departments and physicians looking after these departments. With the recognition of emergency medicine as a speciality around the world, India also aspired to have its own mark in this segment. A number of socio-economic conditions furthered the development of emergency medicine in India; growth of private healthcare being one of the main drivers along with the unfortunate natural calamities that hit India in the 2000s, pushed the narrative on developing emergency medicine here.In addition, the training and exposure of Indian physicians to emergency medicine departments in western countries led to better discussion and dialogue among peers. And in time we sawhospitals both in the public and private sector establishing emergency medicine departments. As the field gained traction there was an opportunity to unite all dialogue, ing and training under one umbrella and thus in 1999, the Society for Emergency Medicine, India (SEMI), was formed. This allowed for formal training and knowledge sharing for emergency medicine in India. EM Professionals Emergency departments run 24x7 and take care of a number of acute emergencies of the critically ill patients. One would expect then that the department would have super specialist managing the show. In fact, most EDs need multi-modality approach to treat acute cases. But in reality, emergency medicine departments are short staffed and ill equipped to diagnose and treat critical ill patients, at the earliest. Added to this is the fact that a majority of the cases brought to ED are medico-legal in nature and demands not only care but also a lot of paper-work and additional court related duties. In recent times, emergency medicine departments have borne the brunt of disgruntled patient relatives and untoward violence towards medical professionals. Needless to say, then that not many young graduates would opt for such a demanding job. This is where the associations come in not only to inspire and create a pool of trained physicians but also to establish structured training programs for the speciality. However, for emergency medicine the going looks tuff.
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Incidentally, there are very few seats for training in emergency medicine in India. In 2009, MCI and in 2013 NBE recognised emergency medicine as a specialty. At present there are around 80 MD seats and about 250 DNB seats available to students apart from 1-year diploma and fellowship courses run by individuals and hospitals. But the catch here is that all these therefore lack cohesion and standardization. Even the acceptance of these certifications varies in India affecting the remuneration and professional recognition for the professionals. The professional discord among EM professionals is evident from the fact that there is no cohesive central voice of EM in India. Trust and Relationship Although parallel associations, working towards common goal of the growth of a specialty is not uncommon,the professional distrust is very apparent in emergency medicine. The rift between SEMI and Emergency Medicine Association (EMA)are evident from the very public spat between the two organizations in the media. Discontent among professionalshas led to the institution of parallel associations in emergency medicine. One among these is the Indo-US Emergency and Trauma Collaborative (INDUSEM). Founded by AIIMS, New Delhi and University of South Florida
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COVER STORY Emergency Medicine in USA, INDUSEM’s focuses mainly onadvancing patient centred initiatives in education, research and care using institutions of learning in health and medicine across the world and they have worked with different stakeholders like the MCI and the DNB to bring consensus on many initiatives. The reason for divide and discontent among the emergency medicine professionals was partly due to personal conflicts and partly due to underlying institutional rivalries opine industry experts. But the pinching fact was the ‘unregulated’ postgraduate training programs, run by some hospitals and emergency medicine physicians. In fact, the MCI has on many occasions recorded their displeasure on unregulated training programs and advised students to not fall prey to such programs. Even state medical councils like the Tamil Nadu
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Medical Council has clamped down on physicians who do not have proper PG degrees yet registered themselves as specialists, after the EMA filed a complained against them recently. Lack of Data In 2016, Dr Jen HengPek, Department of Emergency Medicine, Singapore General Hospital published an article in Acute Medicine & Surgery on the similarities and differences in areas of EM development, workload, workforce, capabilities and support in the Asia region. The article has comprehensive data on the working of EM in different Asian countries. India was one among the 10 countries studied. However, the authors regret that there were no Indian data provided as there is no approved national data. In fact, the academic journals of EM like Vitals and Journal of Emergency Medicine India (JEMI), Indian Journal of Emergency MedicineandNational Journal of Emergency Medicine(NJEM)were neglected and did not take root, let alone generating Indian evidence and research data. In this regard the efforts of the Journal for Emergencies, Trauma & Shock (JETS)published by the INDUSEM have to be acknowledged
as it has been promoting translational research by striking a synergy between basic science, clinical medicine and global health for the past 10 years. The importance of nurturing a speciality like emergency medicine cannot be stressed enough. Effective emergency medicine departments can help reduce the burden of death and disability, in turn reducing healthcare costs. “EMS and private hospital systems must interact in such a way that there is a synchronized effort in saving patients’ lives.”
REFERENCES 1. Sriram V, Hyder AA, Bennett S. The making of a new medical specialty: a policy analysis of the development of emergency medicine in India. Int J Health Policy Manag. 2018;7(11):993–1006. doi:10.15171/ijhpm.2018.55 2. Pek JH, Lim SH, Ho HF, et al. Emergency medicine as a specialty in Asia. Acute Med Surg. 2015;3(2):65-73. Published 2015 Aug 27. doi:10.1002/ams2.154 3. Sameer S, Verma D. Emergency medicine: The emerging medical field in India .Int J Health Allied Sci 2013;2:298-9 4. https://timesofindia.indiatimes.com/india/illegal-pg-degrees-plague-emergency-medicine/articleshow/59044598.cms 5. https://www.thehindu.com/news/national/kerala/unhealthy-trend-in-emergency-medicine/article24422331.ece
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INTERVIEW
Emergency Medicine Department: CEO’s Perspective medico legal cases, there is an emerging trend of setting up a full-fledged Emergency Department. An Emergency Medicine Department greatly adds to the seamless continuity of care, especially in the management of poly trauma and mass incidents. A well trained cross functional team equipped with clinical pathways can be highly successful in saving lives during the “golden hour” window period. What are the hallmark of successful EM department
Dr. Harish Pillai, CEO – Aster Hospitals & Clinics, India Aster DM Healthcare
It should be part of the comprehensive clinical program and strategy of the hospital. The space planning, Why is it difficult to set-up and run an emergency medicine department ?
Tell us about the ED set-up in India?
planning with recruitment and retention of talented personnel ranging from doctors, nurses and technicians. An important aspect is the robust PostGraduate training program to enlarge to pool of human resources. There should be outreach programmes between the main hospital and peripheral centers and community based engagement programmes to reduce the incidents of trauma. Efforts should be made to embed the Emergency Department as part of a larger public emergency response network. There should be adoption
Majority of the hospitalsin the bed category of 50 to 200 usually have a smaller Casualty Department. However, with the rising expectations of patients and incidents of
the hospital should frequently conduct of mock drills, disaster drills and trauma codes.
An Emergency Department is usually a vast and advanced setup which aims to manage any criticality. This is greatly different from a Casualty Department which mostly consists of just 2-3
greater. Moreover, the acute shortage in qualified human resources in India to serve in such departments adds to the challenges.
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November 2018
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SPECIAL FEATURE
Emergency Medicine: Gaining Grounds Girish Bobby Kapur MD, MPH, FAAEM, FIFEM Chief of Emergency Medicine Division Jackson Memorial Hospital Miami, Fl American Academy of Emergency Medicine: Board of Director
David A. Farcy MD, FAAEM, FACEP, FCCM. Chairman, Department of Emergency Medicine Director, Emergency Medicine Critical Care. Emergency Medicine and Critical Care Attending Mount Sinai Medical Center Miami Beach, FL. American Academy of Emergency Medicine: President
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November 2018
EMERGENCY MEDICINE (EM) is a relatively new specialty within medicine. Although internal medicine and surgery have a historical context that goes back more than a century, the first organized delivery of emergency care by dedicated physicians working 24 hours a day in hospital Emergency Departments only began in the 1960’s in the USA and UK. At that time it was recognized that physicians working in the Emergency Department did not have the breadth of training that covered the vast and complex nature of presentations of a multitude of different diseases. One example that often has been used is “how much training did a general surgeon have in the interpretation of an electrocardiogram (EKG)?” The Beginning In 1971, Dr. David Wagner created the first three-year EM residency, and by 1975, there were more than 31 residency training programs in the USA. In the US, The American Board of Medical Specialty (ABMS) initially turned down (in 1976) the request for the creation of the American Board of Emergency Medicine (ABEM) as a primary board but approved it as a secondary board.In 1979 ABEM became the 23rd recognized medical specialty, and 10 years later, ABMS
had formed an organization called the American Academy for Emergency Medicine in India (AAEMI), which
is now a chapter within the American Academy of Emergency Medicine (AAEM). The Medical Council of India approved Emergency Medicine as the 29th specialty in 2009. Today’s ED What separates Emergency Medicine from other specialties is the need to evaluate and diagnose patients with undifferentiated symptoms (chest pain, fever, abdominal pain) in a rapid manner to address potentially time-sensitive conditions using risk stratification. For example, a patient
issues facing Emergency Medicine globally. Emergency Physicians do not have the luxury to order every test or make sure they have the right diagnosis. They need to maintain the flow and assure that every patient is evaluated, treated and has a plan of care based on EM training. This decision for disposition determines whether the patient needs immediate emergency care, stabilization, admission for continuous management, or safe dischargefor outpatient treatment. Emergency Care Delivery First, health system development requires a well-organized prehospital care system to transport patients with acute medical conditions (such as stroke and heart attack) or
trauma to Emergency Departments. Unified emergency call numbers, like 911 in the US, and ambulances with highly trained paramedics are key component in the “chain of survival� for
will receive the same high standard of care. Third, diagnostic studies, both laboratory tests and radiology imaging tests, are an important component of Emergency Medicine. Time-sensitive conditions require rapid diagnostic studies to make accurate diagnoses. We have seen advances in lab tests that now allow for rapid diagnosis of a wide range of pathologies such as heart failure, sepsis, and pancreatitis. Emergency Medicine is also witnessing the rise of Point of Care Testing (
ing the specific matched blood to the patient, and discharging the patient home without a life-threatening condition. The Electronic Health Record (EHR) has helped with entering appropriate
traumatic injuries. As diagnostic technology becomes faster, less costly and more widespread, the delivery of Emergency care is also rapidly improving around the globe. Quality and Efficiency In addition to an emphasis on the direct delivery of care to each patient, Emergency Medicine is now focusing on systems issues such as quality and
Emergency Medicine must have a continuousgoalof achieving zero errors. Areas of emphasis include ordering the correct studies on the patient, administering the correct medication to the patient, transfus-
to maneuver patients through complex Emergency Departments. These improvements in efficiency provide more timely care to patients and improve outcomes. As the initial point of entry for many patients, the Emergency Department is a highly important
minimum standard for all patients in our local communities.
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PULSE
Training in Emergency Medicine IN THE course of a medical career, the most difficult challenge that a doctor might face is dealing with an emergency case, as it involves a lot of critical thinking, analysing the patient, evaluating
Need for EM Specialist There are close to 2 lakh hospitals in India, but only about 100 Emergency Medicine (MD) seats available each year to MBBS graduates for specialisation. Most fresh graduates that are hired yearly to work in emergency departments are
Gerald Jaideep, CEO, Medvarsity Online Ltd
India were preventable if the proper emergency care and follow up protocol had been observed. Therefore, better emergency services and better training to existing emergency medicine physicians has a direct impact on this mortality number.
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November 2018
in this field and a need for them is only increasing. Any training program in the specialty needs to have a good curriculum and a lot of commitment to carry it out in a proper manner,� says Dr NitinJagasia, Head Emergency Medicine Apollo Hospitals Mumbai.
Training inEmergency Medicine In 1999 The Society of Emergency Medicine was formed to bring together professionals who were interested in impacting this critical area. It took a decade for Emergency Medicine to be recognised as a specialisation by the Medical Council of India (2009). In the meantime, emergency cases were generally handled by critical care consultants or those that work in the ICU. Online Learning Platform In early 2000s, before MCI recognized it as a specialty, an online learning platform, as part of the Apollo Hospitals, introduced FEM (Fellowship
and these include MRCEM examination, from the Royal College of Emergency Medicine, UK and FAEM Course from CMC Vellore. Additionally, corporate hospitals, in the recent times, have also started their own short term emergency medicine courses along with collaborations and accreditations to upskill their workforce. The main focus of these courses is to help deal with the dearth of emergency physicians in India. President of SEMI DrImronSubhan, had to say this about the situation of emergency medicine and careers in the field, “It is one of the most sought after
doing it, but would rather go for one year certification courses in it, such as the one offered by online learning platforms. This is a fast paced area, for people who would like to see real time results, be it those working with the ER, disaster management, ambulance services, pre hospital care, etc.” Over the years, online learning platform has trained and certified 2000+ Emergency Medicine professionals with its Fellowship
in Emergency Medicine course. The course adopts a
of lack of Emergency Physicians in the nation and create competent workforce in the field of emergency medicine. “It opens a new scope for newly graduated MBBS doctors to explore the emerging field of EM. After I
corporate hospitals in Hyderabad,” says Dr Atif M AMoiz, alumnus, Medvarsity. High standards and regulated systems are being established in emergency services to deliver better care. By creating a competent workforce of Emergency Medicine professionals who are capable of handling a wide array of emergency situations, the aim is to improve the performance of healthcare industry, on the whole.
According to a 2017 BMC Health research 58 per cent of trauma related deaths in India were preventable if the proper emergency care and follow up protocol had been observed
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INNOVATE
ProtEmbo Cerebral Protection System IMT Team
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November 2018
PROTEMBIS, A medical device start-up company with its R&D base in the engineering and technology city of Aachen, Germany has developed a Cerebral Protection System called the ProtEmbo, to minimize the risk of stroke and other neurological injury in heart valve interventions. Nowadays, the calcified native aortic valve can be replaced by an artificial heart valve, which is advanced via a catheter into the left ventricle, specifically to the site of the calcified native valve. This procedure is called transcatheter aortic valve implantation (TAVI or TAVR). TAVI is a quicker and less invasive procedure and is conducted while the heart is beating; it is associated with less pain and a shorter hospital stay than the alternative open-heart surgery.
In both methods, however, there is a risk that calcific debris from the native heart valve or aorta is detached and then migrates to the brain via the bloodstream, where it can cause stroke or other neurological complications. The drugs used before, during and shortly after the heart valve procedure do not provide complete protection against this risk. The heart valve prosthesis is opened, presses the old and defective native valve against the vessel wall and thus takes over its function. “Literally every TAVI intervention leads to particle migration to the brain” says Karl von Mangoldt, co-managing director and co-founder of Protembis. “Recent clinical studies have shown that up to 9 percent of TAVI patients suffer a stroke” adds Conrad Rasmus, also comanaging director and co-founder of Protembis. The Protembis team wants to minimize this risk with its novel device. The ProtEmbo is a catheter-based filter device which is advanced intuitively, safely and quickly via the radial artery of the left arm before the start of a TAVI procedure and removed again at the end of the procedure in order to prevent the migration of particles to the brain. The permeable material of the filter covers all arteries leading to the brain while allowing free passage of blood cells and
blocking even the smallest embolic particles. The filter is coated with heparin to prevent it from clotting during the procedure, as well as prevent thrombus formation on the filter surface. “Patient safety should always be our top priority,” says Dr. Thorsten Siess, Chief Technology Officer at Abiomed. “We see great potential in Protembis’ technology to make TAVI neurologically safer and thus enable TAVI to be used in an even larger patient population”. ProtEmbo Human Studies Protembis has already successfully demonstrated the initial safety and feasibility of the ProtEmbo in a first-in-human clinical study – the effectiveness of the technology was also shown. Darren Mylotte, M.D., and his team at Galway University Hospital, Ireland, performed the first-in-human procedure with the ProtEmbo System. He commented: “Over the next 10 years, TAVR procedures are expected to increase fourfold. With TAVR shifting to younger and lower-risk patients, cerebral protection becomes even more important. Clinical data from two recent studies of intermediate-risk patients undergoing TAVR suggest 30-day stroke risk as high as 5.5%. It is therefore critically important that we have a cerebral-focused protection device that will reduce the frequency of embolic events. The ProtEmbo System shows tremendous promise in reaching this clinical objective – firstin-human use of the device was safe and feasible.” The objective of the current ongoing European trial is to demonstrate the safety and feasibility of the ProtEmbo System when used to provide embolic protection during TAVR. The ProtEmbo System was successfully deployed via the left radial artery across all three branches of the aortic arch for the duration of the TAVR procedures. The procedures were conducted under conscious sedation. On completion of the valve implant, the ProtEmbo System was safely withdrawn without difficulty. None of the patients experienced a stroke event and there were no other device-related adverse events. Renu Virmani, M.D., President and Medical Director at CVPath Institute, U.S., commented: “Our preclinical work with the ProtEmbo System prior to this clinical trial resulted in no safety or
“Literally every TAVI intervention leads to particle migration to the brain” Karl von Mangoldt, co-managing director and co-founder of Protembis
“We plan to conduct further clinical studies in renowned heart centers in Europe and the U.S.A. and want to bring the ProtEmbo to market as quickly as possible” Oliver Schumacher, Chief Technology Officer at Protembis
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31
INNOVATE biocompatibility concerns. These initial findings from Europe now confirm our previous results. Despite the small pore size of the ProtEmbo System, there is no thrombus formation on the filter. This is promising because it may enable physicians to deflect even smaller particles away from the brain.” Rasmus, explained: “Clinically detectable strokes are just a tiny fraction of embolic events that occur in TAVR,and even small infarcts and micro emboli may have adverse long-term effects on brain function. Certainly, we need a simple yet effective way to protect the brain during TAVR, and the ProtEmbo System is designed to be this solution.” Mangoldt added, “The low-profile access of the ProtEmbo System by way of the left radial artery is the optimal access route because it offers a simple, quick and easy way to protect the brain while not interfering with the valve replacement procedure. We look forward to expanding our clinical successes in Europe with the ProtEmbo System.”
“Recent clinical studies have shown that up to 9 percent of TAVI patients suffer a stroke” Conrad Rasmus, co-managing director and co-founder of Protembis “We plan to conduct further clinical studies in renowned heart centers in Europe and the U.S.A. and want to bring the ProtEmbo to market as quickly as possible” says Oliver Schumacher, Chief Technology Officer at Protembis. Source: Protembis GmbH
MAY 2018, VOLUME 2 ISSUE 5 `200 INDIA MED TODAY
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MEDICAL DEVICE MARKET IN INDIA Is the medical devices Regulatory environment in India Conducive for business?
WHAT IT MEANS TO BE A CARDIOLOGIST IN INDIA TODAY?
IS HEART FAILURE A PUBLIC HEALTH PRIORITY IN INDIA? SMALL HOSPITALS AND NURSING HOMES BUILD TRUST, REPUTATION
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MAY 2018
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November 2018
21st 21st National National Health Health Conference Conference 21st National Health Conference 21st National Health Conference
CLAIRVOYANCE CLAIRVOYANCE CLAIRVOYANCE CLAIRVOYANCE 2018 2018 2018 2018
Nov Nov 24-25, 24-25, 2018 2018 |TISS, |TISS, Mumbai Mumbai Nov 24-25, 2018 |TISS, Mumbai Nov 24-25, 2018 |TISS, Mumbai FEATURE FEATURE SPEAKERS SPEAKERS FEATURE SPEAKERS FEATURE SPEAKERS Early Early Bird Bird Early Bird Early Bird Registration Registration Registration Registration till till 15th 15th Nov Nov till 15th Nov till!!! 15th Nov !!!!!! !!!
COMPETITIONS COMPETITIONS COMPETITIONS COMPETITIONS
PAPER PAPER PAPER PAPER PRESENTATION PRESENTATION ApproacApproacPRESENTATION ApproacPRESENTATION Approaches hes forfor multidiscliplinary multidiscliplinary hes for multidiscliplinary hes for multidiscliplinary collaboration collaboration forfor better better collaboration for better collaboration for better healthcare healthcare and and public public health health healthcare and public health healthcare and public health POSTER POSTER PRESENTATION PRESENTATION POSTER PRESENTATION POSTER PRESENTATION Can Can technology technology bridge bridge gaps gaps Can technology bridge gaps Can technology bridge gaps inhealthcare/public healthcare/public health? health? ininhealthcare/public health? in healthcare/public health? BUSINESS BUSINESS MODEL MODEL BUSINESS MODEL BUSINESS MODEL Innovative Innovative healthcare healthcare model model Innovative healthcare model Innovative healthcare model forfor anan inclusive inclusive tommorow tommorow for an inclusive tommorow for an inclusive tommorow AD AD DESIGN DESIGN Get Get engaged engaged AD DESIGN Get engaged AD DESIGN Get engaged with with health health with health with health
SESSIONS SESSIONS SESSIONS SESSIONS
Assessing Assessing scope scope Assessing scope ofofof Assessing scope of Ayushman Ayushman Bharat Bharat Ayushman Bharat Ayushman Bharat Operationalizing Operationalizing Operationalizing Operationalizing strategy strategy forfor better better strategy for better strategy for better hospital hospital care care hospital care hospital care Confronting Confronting new new Confronting new Confronting new menaces: menaces: Mental Mental menaces: Mental menaces: Mental Health, Health, Food Food Safety, Safety, Health, Food Safety, Health, Food Safety, Epidemic Epidemic Epidemic Epidemic Management Management Management Management Health Health reporting reporting Health reporting Health reporting Revolutionary Revolutionary models models Revolutionary models Revolutionary models of healthcare healthcare ofofhealthcare of healthcare
Sundari Sundari Ravindran Ravindran Sundari Ravindran Sundari Ravindran
Vikram Vikram Patel Patel Vikram Patel Vikram Patel
Sunil Sunil Chandy Chandy Sunil Chandy Sunil Chandy
Vidya Vidya Krishnan Krishnan Vidya Krishnan Vidya Krishnan
School School of Health Health Systems Systems Studies Studies School ofofHealth Systems Studies School of Health Systems Studies Tata Tata Institute Institute of Social Social Sciences, Sciences, Mumbai Mumbai Tata Institute ofofSocial Sciences, Mumbai Tata Institute of Social Sciences, Mumbai Website: Website: http://www.tissclairvoyance.com/ http://www.tissclairvoyance.com/ M:M: 9920878027(Dr 9920878027(Dr Nikita Nikita Ganpule) Ganpule) Website: http://www.tissclairvoyance.com/ M: 9920878027(Dr Nikita Ganpule) Website: http://www.tissclairvoyance.com/ M: 9920878027(Dr Nikita Ganpule)
APPROACH
Advances in Stroke Management Dr NK Venkataramana, Founder & Chief Neurosurgeon, Brains, Bengaluru
34
November 2018
STROKE (BRAIN ATTACK) is a sudden catastrophic condition where, either the blood supply to the brain gets blocked or reduced leading to paralysis termed as Ischemic stroke, or on the other hand bleeding into the brain called, Haemorrhagic stroke. In both the situations, the consequence can be dangerous resulting in paralysis, loss of vision, loss of speech and loss of balance and also death depending upon the magnitude. When the blood supply to the brain cannot meet the demands of metabolism the resultant effect or
deficiency will result in a stroke. This can be either due to the abnormalities of the blood or the blood vessels. In addition to this, a host of auto-immune conditions were identified recently as one of the significant causes of stroke leading to both loss of blood supply as well as bleeding into the brain. When the extent of a stroke is large, one can become unconscious and this in turn can cause secondary events like brain swelling, fits, electrolyte disturbance adding further as complications.
Golden Hour In case of a stroke, the first three hours is very crucial and considered the golden period in which the clots can be dissolved or removed through endovascular techniques that can reestablish the blood circulation again. If this is done at the right time the brain damage can be minimized and one can regain the normal functioning of the body. Any delay can lead to permanent brain damage, resulting in lifetime disability. Advances in Stroke Management In the last three decades, several advances have taken place in the area of stroke, especially with regards to stroke treatment. Primarily, the risk factors have been identified and this has paved the way for better treatment. Among all, the most common risk factors are hypertension, diabetes, obesity, smoking, excess drinking, sedentary lifestyle, lack of exercise and associated sleep disorder. People who have had a stroke or have a family history of stroke especially in younger age are considered high-risk group and they need to be under strict vigilance for controlling the risk factors, containing the damage and thereby promoting quick brain recovery and also preventing yet another stroke. Above all, one needs to be clear that stroke can be prevented by bringing about certain changes in the lifestyle, and that it can be treated as well, provided they get the required medical interventions at the correct time. Occlusions of Blood Vessels Further, a range of diseases that affects blood vessels of brain starting from Atherosclerosis, Fibromuscular dysplasia (FMD), APLA syndrome, Vasculitis and auto-immune disorders have been known as the cause of recurrent occlusions of the blood vessels or narrowing that can lead to stroke. Moya-moya Disease Incidentally, stroke is the leading cause of disability across the world today. Annually 180210 per 1 lakh population are getting affected with stroke. Additionally, yet another significant worrying fact is that, even young people,
those less than 40 years and even children are getting affected with stroke. Well, this could be due to increasing awareness and improvement in diagnostic abilities. In young children moya-moya disease that affects the large blood vessel of the brain causing progressive occlusions of blood vessels leading to multiple strokes is also well understood. Stroke in young have become an entity wherein metabolic, endocrine and genetic factor have been evaluated. Advanced imaging of brain as well as the blood vessel of brain can help us in prediction the risk of the stroke, the outcomes as well as the recurrent strokes of the future. Depending upon the area of stroke involvement, complications like malignant cerebral edema or the death risk can also be evaluated. Neuro vascular Interventions The Neuro vascular interventions have become popular in delivering the clot dissolving drugs at the site (thrombolysis) as well as mechanical removal of blood clots (thrombectomy) have become the gold standard in re-establishing the cerebral circulation. Carotid endarterectomy and large vessel stenting have also become the standard in preventing the future risk of major stroke.
In case of a stroke, the first three hours is very crucial and considered the golden period in which the clots can be dissolved or removed through endovascular techniques that can re-establish the blood circulation again www.indiamedtoday.com
35
APPROACH Incidentally, stroke is the leading cause of disability across the world today. Annually 180-210 per 1 lakh population are getting affected with stroke Neuro-sonology of carotids and vertebral arteries has become the gold standard screening technique for the high risk individuals to predict the stroke as well as to monitor these patients while on treatment. Stroke in young people with strong family history of stroke as well as those who have had stroke needs such screening to prevent a major brain attack. Many effective medications are available to dissolve the clot and also to prevent atherosclerosis and blood vessel occlusions with long term medications. Carotid endarterectomy is the surgical procedure primarily conducted if there is critical stenosis of the carotid arteries. This is one of the advanced surgical procedure to open or clean the carotid artery in order to prevent a stroke.Cerebral by-pass procedure can be done
36
November 2018
in case the major arteries cannot be re-opened. Decompressivecraniectomyis yet another surgical procedure which is absolutely life saving in those with rapidly progressing stroke associated with brain edema(swelling). Other Advancements Apart from the treatment, several advances have taken place in the neuro-rehabilitation as well as neural regeneration. Neuro-rehabilitation is basically aimed at reducing the degree of disability and to promote the functional ability. Yet another significant advancement that has come up in the recent times, in terms of stroke management is the Stem Cell Therapy. Stem cell therapies are promising to promote the recovery of the brain as well as to reduce the disability. In terms of drugs and medications, many more newer and safer anti-coagulant drugs, drugs to promote the brain recovery as well as neuro protective medications are in the pipeline. All said and done about the advancements in stroke management, which has no doubt brought about a sea change in the way stroke was treated a decade ago, but still there are certain challenges that needs to be addressed. First of all, the biggest challenge is getting these patients within the golden hour (first three hours) to the stroke centre in order to apply all these advances. Second challenge, is the myth that is surrounding stroke treatment. The myth that there is no proper treatment in allopathy for stroke still exists, there by pushing them to go for alternative therapies by choice. Hence, the goal is to create awareness and to increase the number of stroke centres and to treat them within the golden period. Rest of the tradition can follow, and can be taken up as a complimentary treatment procedure. Apart from the advanced treatment, bringing about a change in the lifestyle and following a healthy diet is also equally important when it comes to stroke management. Following the treatment, a rigorous neurorehabilitation, also considered as a possibility of future neuro-regeneration is a must as this will help in regaining the functional abilities tremendously.
EVENTS ADVANTAGE HEALTHCARE-INDIA 2018 Date: Dec 4-6, 2018 Noida; Dec 6, 2018
Premier Global Healthcare Destination and
Mumbai
to enable streamlined medical services
Venue: India Expo Centre and Mart,
exports
Greater Noida(NCR) India
objective is a unique conglomeration of
T
from
India.
This
underlying
the ‘5 – Ts’ - talent, tradition, technology, he
medical
industry
has
value
travel
emerged
as
tourism and trade. The
event
will
host
three
days
one of the fastest growing
exhibition with B2B meetings and hospital
following topics: best practices, challenges, new tools and innovation, regulation, assessment, and management (procurement, technical specifications, donations, maintenance and appropriate safe use) of medical devices. The list of priority medical devices by health care facility, disease or clinical interventions will be presented.
AHPI GLOBAL CONCLAVE 2019
segment of tourism industry
inspection. Along with Proposed Health
despite the global economic downturn.
Minister’s round table meeting followed
According to the FICCI – IMS Report, India
by Networking Dinner hosted by Hon’ble
is one of the key MVT destinations in Asia
Health Minister. There will also a proposed
with over 500,000 foreign patients seeking
Tourism Minister’s round table meeting
Date: Feb15-16, 2019 Venue: Hotel Radisson Blu, Kaushambi
treatment. MVT can be a 9 billion USD
followed by Networking Dinner hosted
(Delhi-NCR)
opportunity by 2020 through adequate
by Hon’ble Tourism Minister. Along with
focus and effective execution. The objective
networking dinner on last day hosted by
of this summit is to promote India as a
FICCI.
Organiser: AHPI Click: http://ahpi.in/ahpi_global_conclave/ Contact: Shikhar Gupta - Assistant Director,
CLAIRVOYANCE 2018 Date: Nov 24-25, 2018 Venue: TISS Convention center, Mumbai Organiser: TISS, School of Health Systems
Studies Click: http://www.tissclairvoyance.com/ Contact: BhaweshJha, 77699 26880
C
lairvoyance is the annual signature conference of the School of Health Systems Studies, TISS. The word Clairvoyance means “the faculty of perceiving events in the future.” In the past 20 years, every edition of Clairvoyance has served as a platform for interaction between celebrated faces in health care and public health sector, reputed local, national and international organizations and other delegates from medical and public health colleges across India. The event will have paper presentation, poster presentation, innovative business model and Ad designing contest.
4THWHO GLOBAL FORUM ON MEDICAL DEVICES Date: Dec 13-15, 2018 Venue: AMTZ-Kalam Convention Centre,
Visakhapatnam, Organiser: MHFW, WHO and AMTZ Click: https://www.4gfmd2018.org Contact: global-forum-med-dev@who.int
T
he 4th Global Forum will build upon the work that was accomplished at the 1st Global Forum in Bangkok in 2010, the 2nd in Geneva in 2013, and the 3rd also in Geneva in 2017. The most recent Global Forum was attended by approximately 600 participants from over 100 Member States. These events function as the main opportunity to disseminate and share information on medical devices for global health. Health technologies are essential for a functioning health system. Recognizing this important role of health technologies, the World Health Assembly adopted resolution WHA 60.29 and WHA 67.20. The resolution covers issues arising from the inappropriate deployment and use of health technologies, and the need to establish priorities in the selection, regulation, assessment and management of health technologies, specifically medical devices. By adopting this resolution, delegations from Member States acknowledged the importance of health technologies for achieving health-related development goals; urged expansion of expertise in the field of health technologies, in particular medical devices; and requested that the World Health Organization (WHO) take specific actions to support Member States. The programme will include sessions on the
9540859694 ssociation of Healthcare Providers (India) represents the majority of healthcare providers in India. It works as “not for profit” organization and advocates with the government, regulatory bodies and other stake holders on issues, which have bearing on enabling its member organizations to deliver appropriate healthcare services to community at large. The association functions through an empowered secretariat which facilitates the member organizations in improving their systems, processes and outcomes on continuous basis, in line with the vision, mission and objectives of the association. The theme for its Global Conclave is ‘Outcome Based Healthcare Delivery Systems’ through collaborative efforts of Hospitals, Pharmaceuticals, IT and Medical Equipment companies. AHPI believes that ‘Health for All’ can only be realisedthrough collaborative approach involving all Stake holders. The conclave will take holistic view of composite issues and would try to present practical solutions to meet with the emerging challenges. Attempt will be made to present a model by which Universal Health Coverage can be made possible within the existing resources. There will be comprehensive debate by experts on; Patient Safety, Patient Centric Hospitals and How to make use of it tools and develop Smart Hospitals.
A
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EVENT REPORT
SMART HOSPITALS Conference Empowering Small Hospitals to become Smarter SMART HOSPITALS focus was created to equip and encourage small hospitals in tier 3, 4 towns to become smarter and stronger to deliver smart care delivery to the community. It is the small hospitals in these towns which actually address the accessibility issues while delivering patient care in rural belts. The Conference held at Pune on October 6th 2018 was attended by hospital owners from many small hospitals from 15 - 75 beds. Around 65 participants attended from various small towns and participated in the discussions. The session started off with an introductory
Lighting of Kuthuvillaku by Dr. Aniruddha Chimote, Director, Hosconnn Consulting Services as organisers look on
38
November 2018
note by Tarun Katiyar, Founder & Director Hospaccx Healthcare Business Consulting, Mumbai about smart hospitals conference theme and way forward. Smart hospitals framework is built around three pillars - operational efficiency, clinical excellence and patient centricity. The conference had good speakers and experts who added lot of value to the discussions that took place. One format which was received well was the unconference sessions. The impromptu discussions that took place in these sessions were the highlight of the conference.
During the conference, experts from all over India shared their knowledge to support small and mid-sized hospitals to improve their efficiencies into robust sustainable models. The knowledge exchange was very intense and vast during the Conference. “This is a ‘Not for Profit’ initiative aimed solely for the purpose of knowledge dissemination, so we have restricted the number of registrations. An exclusive group also promotes a better learning experienceand excellent exchange of knowledge.” said Dr Aniruddha Chimote, Director, Hosconnn Consulting Services in an interview. Unconference Session on raising service standards in healthcare delivery has attracted excellent participation from delegates. All panel discussions were well received by the audience and the intense interactions were very insightful. One such session on falling revenue models in hospitals and way forward had attracted lot of interest from delegates. Much emphasize was on the importance of operational efficiencies that were cost effective. “A systematic, unbiased audit and objective based process driven control will lead to improved efficiencies at all levels” as Dr Mudit Saxena emphasized that was well received by the audience. One of the highlights of the conference was the demonstration of the importance of forming a core panel of doctors to check the clinical outcomes of treatments. Another very important factor for better patient satisfaction & better clinical outcomes with tangible results is the importance of discussing treatments with the patients and their families. Another important take away message in the discussion was ‘patient centricity’ has to be the way of life for all hospitals. Every person from the hospital who touches base with a patient is a ‘sales person’ selling the hospital’s facilities, so the need to constantly train the staff to focus on ‘patients first’ approach. Few sessions which had attracted delegates’ interest were the Blue Ocean Strategy focus for small hospitals, which touched upon the need for small hospitals to create their own uncontested market space with new service offerings, focusing on their competencies etc. instead of fighting with other hospitals in the same market space.
The Organising Team
Dr Salil Choudhary, Director, HealthPod India_ Dr Mudit Saxena, MD & CEO, Ovum Hospitals_ Ram Natesan, CEO, SRM Institute of Medical Health Sciences & Research_ Dr Shrihari Dhorepatil, MD, Shree Hospital & Diagnostic Cent
The session on changing business models of small hospitals threw light on the need for smaller facilities through re-visit their way of doing business, business models, to adapt themselves to the changing business dynamics, in the current market scenario. Two other interesting sessions on smart technology and procurement solutions for small hospitals emphasized the need for the smaller hospitals to migrate to using adaptable technology solutions to improve their operations and also to save huge procurement costs by looking at smart procurement solutions which will ultimately result in improved bottom lines for smaller hospitals. The future smart hospitals need to focus on using virtual solutions for improving
people skills and process efficiencies. And this was beautifully echoed by Naveen, Director of Pranam Academy. The unconference session on medical equipment planning had interactive engagement from audience. As the session focused on the smart medical equipment planning strategies to be adopted small healthcare facilities which will directly impact saving cost. The other unconference session on planning and designing of future smart hospitals focused on the need to build lean and ‘no frills’ healthcare facilities which shall reduce the investment size of smaller hospitals thereby making healthcare cost in the long run. The heavy ornamentation under the guise of design in hospital planning has pushed up the infra-
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39
EVENT REPORT structure cost of creating and maintaining a healthcare facilities which needs to have a relook on effectiveness The conference ended with a panel discussion on smart marketing solutions for future small hospitals where the focus was on migrating smaller hospitals to ONLINE marketing solutions platforms to stay connected with their end customers ie patients on 24x7 basis. In the era of smart engagement, it is highly imperative for small hospitals to become smarter to stay connected with their smart and digital savvy customers. The overall feedback of the conference was excellent from the selection of topics to speakers and ambience. “Infact, what, we as organisers learnt from the feedback is that the audience learnt and liked the unconference sessions more than the usual sessions. So, we are certainly planning to intensify such unconference sessions through various learning techniques,” said Rama
Audience at Smart Hospital conference
Venugopal, Executive Director, Value Added Corporate Services. Hospaccx Healthcare Business Consulting Services; Hosconnn Consulting Services; Value Added Corporate Services; XFactor Innovations; Infrabees Project Management Consultancy Services; BCC Healthcare Consulting ; Dr. Sam’s Healthcare Consultancy Services were the organisers of the conference. IndiaMedToday was
OCTOBER 2018, VOLUME 2 ISSUE 10 `200 INDIA MED TODAY
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the media partner for the event. Our prestigious Eco System Partners were Sukraa Software; Scheulke India; Forum Business Research, Medika Bazaar; HealthPod India; Pranam Academy; Virtual Advisor and Association for Indian Medical Device Industry (AIMED) was the Industry Partner. The future smart hospitals will be the lean the green, and the smart facilities.
12 + 3 FREE issue.
IMPACT OCTOBER 2018
HOW SWITZERLAND IS LEADING INNOVATION GOING FORWARD
Indiamedtoday magazine reports on the issues and trends that are shaping the business of healthcare in India and abroad today. Each month, the print magazine discusses long-term strategies to meet the challenges posed by an evolving healthcare marketplace. In every issue, our readers discover the practical advice, analysis, and insight on management trends, innovative concepts, market strategies and real-world solutions they need to navigate the changing landscape of the business of healthcare.
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Q&A
ASK THE EXPERT
Running a private medical practice in India comes with the risk of lawsuits and property damage. As a medical professional, you are probably well aware of the devastating effects of legal cases and security threats that await doctors who face the blunt of an angry patient. We encourage you to share your queries and concerns regarding legalities of practicing medicine in India to learn more about legal framework, legal cases and the experience of fellow doctors
Q:
What should be the process to follow
clarify?
fracture requiring surgery and he claims
Dr V R Gupta Ans: Consent alone by a competent patient is sufficient for legal purposes. Please remember that signature of indifferent witness is must to complete the document legally.Signature of doctor is also must on consent form.
there is absolutely no one for him and no relatives will ever come and is willing to pay the required advance and insists on proceeding with the surgery. If any untoward complication occurs and the
Prof ( Dr ) R K Sharma, President, Indian Association of Medico-Legal Experts , New Delhi will answer questions from our readers. Please send in your queries to editor@indiamedtoday.com
of witness by third person ismust? Please
if an adult comes to emergency with a
patient dies what process should be followed?
Q: I am an MBBS graduate from India and
Dr. Anton Job Romesh Prasad Ans: Adult person is competent to give consent for any operation even without presence of attendants even if it is risky and can cause death.Inform police if such person dies as state has responsibility to take care of such eventuality. Police will find out relatives or dispose of body if none is there. Do take ID of this person before proceeding for operation.
then went to UK. I am fully trained gastro-
Q: If some online app hires any consultant then what is legal responsibility for both?
Dr Pratik Vora Ans: Please remembers both have legal responsibility although responsibility will differ. Consultant is fully responsible for all actions he performs and is liable individually in criminal prosecution. Online app has vicarious responsibility to all actions of consultant. Q:
If a patient comes in OPD for UGI
Endoscopy undersedation and he is alone. Can signature by patient himself and doctorconstitute full consent or signature
intestinal surgeon and have acquired the FRCS. I do not have a postgraduate degree in India. I have now relocated back to Bangalore for good. I wanted to know what would be the legal implications for my practice here. Thank you for your advice?
Raghu Ans: Please note that FRCS from UK is recognised medical qualification by Medical Council of India, so there is no problem for you. It is advised that you add this qualification in your Indian medical registration certificate from Karnataka medical Council. Q:
Doctors charge a lot in India, is it
correct?
Ans: The following is fee structure of doctors of allopath in India. In tier 3 cities - Rs 100 per consultation include medicines; in tier 2 cities- Rs 300 per consultation that may include medicines in some cases; in tier 1 cities – Rs 400 per consultation; in metropolitan citiesMBBS doctor charge Rs 500 per consultation,
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41
specialist charges in metropolitan cities- Rs 1200-2000 per consultation, maximum charge, very few doctors in India Rs 3500-3500 per visit. I have yet to come across any doctor who charges Rs 10,000 per consultation.Please inform me if you know such doctor. However, I know a lot of High court / Supreme Court lawyers who charge Rs 10000 / per consultation. Do we charge a lot? It’s up to you to decide. Average doctor earns more than average lawyer but a good lawyer earns 10 times more than a good doctor. Q:
Sir, I am postgraduate working in a
government medical college. According to our college protocol all postgraduates are insisted to put notes of same patient during morning 8 am round. And different treatment charts will be written at same time by different postgraduates. One patient expired because of extra dose of one injection but it was not mentioned in nurse’s chart. Patient relatives applied via RTI for case sheet. Is it correct to put three different notes for same patient if we find different findings at same time. Is
Q: Can
we charge medical representative
from primary health center and district
it correct to put different treatment drug
for consuming my time for the benefit of
hospital.Sir please tell if medico legal
charts for same patient at same time?
his company.Keeping hope of less than
x-rays are not prescribed / advised by
Name withheld Ans: Please note that case sheet is a document legally created on actual treatment, which is given. It can be scrutinized by court of law and other agencies including police.How can you put different treatment in it? Please ask your teachers to create dummy case sheets, which can be filled by PGs and used only for academic purposes. The college should stop current practices otherwise sooner or later they are going to face music.
999 rupees considering MCI guiding of less
primary physician, is it negligence, not to
than 1000 rupees. Kindly specify if no or
prescribe x-ray by treating doctors; are
Q:
What are two most common mistakes
committed
by
surgeons
while
taking
consent in India?
Ans: First problem is taking a general consent at the time of admission. Secondly, taking consent from parents / spouse / children / relatives of an otherwise competent adult patient. Suggestion - Take consent from patient if he is competent and ask relatives to sign as witness. General consent is not complete consent for surgery. Take specific consent
42
November 2018
yes with reasoning?
they responsible for it?
Dr KJS Narula Delhi Ans: Please note that medical representative is employee of a pharma company. If you charge them, it means charging pharma company which they would gladly accept. But it would mean that you are accepting payment from a pharma company which is illegal. Please do not think that if you accept less than Rs 1000, you would not be prosecuted but let off with a warning. Accepting less than Rs 1000, just to avoid technicalities can land you in serious problem with MCI.Simple solution is, if you do not have time, just ask them to leave literature of product in your clinic which you may read when you have time.
Dr Ashok Yadav Orthopedics,Nehru hospital,BRD Medical College, Gorakhpur Ans: Please remember whether x-rays are needed in a case or not, it is discretion of doctor attending it. If he is referring a case to a higher centre, he may not advise x-rays as it would be waste of time. Majority of primary health centres do not have x-rays facilities, so no question of ordering them.
Q:
While working in medical college we
often encounter patients of fire or arms injury and other medico legal problems
Disclaimer: This material has been prepared for informational purposes only, and is not intended to replace, and should not be conveyed or constitute legal advice. You should consult professional lawyer and legal advisors before engaging in any legal matter.
