IndiaMedToday

JANUARY 2018, VOLUME 1 ISSUE 4 `200

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THINKING OUTSIDE THE BOX

HEALTH INSURANCE

Evaluating the current scenario to bring offerings based on core competences and new directions of customer demand.

How IOT

is transforming healthcare

How to prepare

for MRCOG without going to the UK

Change management

& capacity building for smooth adoption of digital health

NEWS FEATURE

THE BACTERIAL ‘GAME OF THRONES’

Understanding bacterial wargames inside our body

MUCH LIKE animals and to a degree humans, bacteria enjoy a good fight. They stab, shove and poison each other in pursuit of the best territory. While this much is clear, little is known about the tactics and strategy that bacteria use during their miniature wargames.

In a study published in Current Biology, researchers at the University of Oxford have shed light on this area of bacterial behaviour, revealing that bacteria approach conflict in much the same way as an army by responding to a threat with a coordinated, collective retaliation.

The team studied pairs of Escherichia coli strains as they fought against each other. Each strain uses a particular toxin to try to overcome its competitor. A strain is immune to its own toxins, but it can kill other strains. This type of competitive interaction plays a key role in how individual bacteria establish themselves in a community, such as the human gut. By engineering the strains to have a fluorescent-green colour, the authors were able to clearly follow their combat in real time.

The findings revealed that not all strains of bacteria fight the same way. Each approaches conflict with a different level of attack, some being hyper-aggressive and others much more passive. In addition to these basic differences in aggression, the research also shows that some strains can not only detect an attack from an incoming toxin, but they can also respond quickly to warn the rest of the colony. Cells on the edge of the colony will detect the incoming attack, and share this information with the cells behind the battlefront, allowing them to respond as a collective, in a coordinated and surprisingly sophisticated fashion.

While these phenomena are well known in animals, the study is a first of its kind for

Photo Credit: Kevin Foster

Two bacterial colonies fighting on solid media using toxins. Upon detecting an incoming attack from the red strain, cells of the bottom strain pass this information on to others in the colony leading to a massive collective attack against the red strain. Green colour indicates toxin production.

observing this behaviour in bacteria. Professor Kevin Foster, senior author on the work and Professor of Evolutionary Biology in the Department of Zoology at the University of Oxford, said: ‘Our research shows that what appear to be simple organisms can function in a very sophisticated manner. Their behaviour is more complex than we have previously given them credit for. Much like social insects, such as honey bees and wasps and social animals like birds and mammals who use alarm calls, when under predation, they are capable of generating a coordinated attack’.

Since the human body plays host to vast numbers of bacteria, particularly our gut microbiome, this effectively means that there is a bacterial war going on inside us. Understanding bacterial competition

can help us to understand how bacteria spread, where and why. Professor Foster explains: ‘We know from other studies that toxins are important for whether or not a particular strain will establish in a community. But understanding how bacteria release toxins and out-compete others is very important for understanding the spread of infection.’

The team are in the process of building on this work to understand how bacteria can use toxins to provoke and misdirect aggression in their opponents. Dr DespoinaMavridou, one of the lead authors on the study, said: ‘Warfare based on provocation can be beneficial. It is most likely taking place in the gut, where bacteria may provoke multiple opponents to attack and wipe out each other.’

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NEWS FEATURE

CANCER’S GENE- DETERMINED ‘IMMUNE LANDSCAPE’ DICTATES PROGRESSION OF PROSTATE TUMORS

Analyzing individuals’ genotypes and immunotypes could yield customized treatments

THE FIELD of immunotherapy - the harnessing of patients’ own immune systems to fend off cancer - is revolutionizing cancer treatment today. However, clinical trials often show marked improvements in only small subsets of patients, suggesting that as-yet unidentified variations among tumors result in distinct paths of disease progression and response to therapy.

Now, researchers at the Cancer Center at Beth Israel Deaconess Medical Center (BIDMC) have demonstrated that genetic variations driving prostate cancer determine the composition of the immune cells that have been found to infiltrate primary prostate tumors. These immune cells, in turn, dictate tumor progression and response to treatment. The data, published in Nature Medicine, suggest that profiling patients’

tumors based on this new information could lead to more successful clinical trials and tailored therapies for patients.

“We observed that specific genetic events resulted in striking differences in the composition of immune cells present in and around the tumor - results with important therapeutic implications,” said senior author Pier Paolo Pandolfi, MD, PhD, Director of the Cancer Center and Cancer Research Institute at BIDMC. “Our data may be especially relevant for tailoring immunological therapies and for identifying responsive-patient population.”

The third leading cause of cancer-related death in U.S. men, prostate cancer, is linked to a number of diverse genetic mutations that drive the disease. For example, the loss of the tumor suppressor gene PTEN is a frequent event in

16 January 2018

IMPACT

HOW THE INTERNET OF THINGS IS TRANSFORMING THE HEALTHCARE INDUSTRY

Tim Sherwood, Vice President, Mobility &IoT Solutions, Tata Communications

IN THE face of ever-increasing competition and evolving demands of patients in different geographies, healthcare service providers need to innovate and plan for digital transformation. In the developed world, they need to be equipped to treat an increasingly aging population whereas in the developing world, a big challenge still is how to reach more and more people in regions and communities with not enough healthcare staff.

Given these varying demands, to stay ahead, more and more healthcare organisations are investigating machine-to-machine communications and the Internet of Things (IoT).

While patients are already used to decentralised treatment centres, self-diagnosis portals and even telemedicine, this is just a beginning. Process management and cloud-based applications are unleashing new ways of working such as remote monitoring and support

of patients, and delivering innovative ways for customers to access healthcare services.

The supply chain is changing too, with more and more collaboration across the entire ecosystem to bring down costs, accelerate the digitisation of medical records and introduce more patient-centric treatment models. This brings very real benefits to the quality of patient care, as local practitioners have more up-to-date data on their patients and their conditions at their fingertips, enabling doctors and nurses to make better informed data-led decisions with regards to remedies and patient care.

Now the IoT looks set to change the healthcare sector once again. It’s worth investigating the key factors that are going to be crucial during this next evolution.

Healthcare will go global Health organisations need to take digital trans-

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your name and give a start. There is no need for formal planning or having a banquet party to declare that “I am preparing for MRCOG”. The less number of people know about it, the better it is. As the famous saying goes ‘work hard in silence, let the success roar’.

Remember, Newton’s 1st law of motion. The most difficult part is to break the inertia. Just set a deadline, when you would like to appear for the exam. Once you fix the deadline, you must appear for it, no matter whether your preparation is complete or not. Say, today, you decide to appear for Part 2 in July 2018 but in May 2018, you feel that you need more time (as it can happen because of many other commitments in family, practice, health etc); still you MUST appear in July (think about the amount of money that will get wasted). This is important, to keep yourself in the inertia of motion with acceleration (Newton’s 2nd Law), to check your deficiency and also to know what types of questions are expected.

What materials to collect? This is very much important. If it’s done properly, half the job is done. It’s up to you whether

The less you read the books, the better it is. Only two books are needed. The first one is “Handbooks of Obstetric Medicine” by Catherine Nelson-Piercy. The second book is Luselay and Baker’s “Obstetrics and Gynaecology”

you are comfortable with soft copy or need printed format. The way I did it is by making separate folders in computer and then editing them to make charts, to highlight important points in Microsoft Word Format and then took print and kept them in separate files. That’s to cut short a big guideline into a shorter one and then again further shortening it while reading.

RCOG website

Download whatever guidelines you are getting. In order of importance are Green Top Guidelines (GTG- The Bible For You), Best Practice

And Good Practice Guidelines And Scientific Impact Papers (SIP). Don’t forget to download RCOG Consent Forms And RCOG Patient Information Leaflet (PIL). All statistics from CON- SENT FORMS and PIL are important and you cannot pass the exam without remembering them (no matter, how boring it would appear). PIL will also introduce you to colloquial words, that they use in day to day practice. Remember, these are updated continuously. So, please keep a habit of looking at the site periodically.

NICE guideline

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FEATURE

HEALTH - IT

CHANGE MANAGEMENT AND CAPACITY BUILDING FOR SMOOTH ADOPTION OF DIGITAL HEALTH

Prof. Supten Sarbadhikari, Dean (Academics and Student Affairs) and Professor (Health Informatics), International Institute of Health Management Research, New Delhi

DIGITAL HEALTH electronically connects the points of care so that health information can be shared securely to help deliver safer, better quality healthcare.

The broad scope of Digital Health includes categories such as mobile health (mHealth), health information technology (IT), wearable devices, telehealth and telemedicine, and personalized medicine. Digital health is about electronically connecting the points of care so that health information can be shared securely. This is the first step to understanding how digital health can help deliver safer, better quality healthcare.

Today, Health Information Management (HIM) professionals are well trained in the latest information management technology applications and understand the workflow in any health care provider organization. Health Information managers are vital to the daily operations management of health information and electronic health records (EHRs). They ensure that data quality is maintained, by

applying the principles of change management and continuous capacity building through education and training. They ensure that the health information and records of a patient are complete, accurate, protected and meet the desired and stipulated medical, legal and ethical standards. Therefore, it must be made mandatory to appoint an adequate number of health information managers, according to the size of the healthcare organization, to ensure safe and smooth adoption of digital health in India, leading to informed healthcare delivery.

These professionals affect the quality of patient information and patient care at every point in the health care delivery cycle. They work on the classification of diseases and treatments to ensure they are standardized for clinical, financial, and legal uses in health care. HIM professionals care for patients by caring for their medical data. This, in turn, leads to informed healthcare delivery, especially when and where the information is translated into actionable outputs.

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FEATURE

HEALTH - IT

Among these nine core competencies, the third one membership of a multidisciplinary health team is perhaps the most important. The student will learn to put a high value on effective communication within the team, including transparency about aims, decisions, uncertainty and mistakes. Teambased health care is the provision of health services to individuals, families, and/or their communities by at least two health providers who work collaboratively to accomplish shared goals within and across settings to achieve coordinated, high quality care. Program objectives will aim at making the students being able to recognize, clearly articulate, understand and support shared goals in the team that reflect patient and family priorities, possess distinct roles within the team; to have clear expectations for each member’s functions, responsibilities, and accountabilities, which in turn optimizes the team’s efficiency and makes it possible for them to use division of labor advantageously, and accomplish more than the sum of its parts. In addition develop mutual trust within the team to create strong norms of reciprocity and greater opportunities for

shared achievement.

Most important of all is to communicate effectively so that the team prioritizes and continuously refines its communication channels creating an environment of general and specific understanding.

Last but not the least, recognize measurable processes and outcomes, so that the individual and team can agree on and implement reliable and timely feedback on successes and failures in both the team’s functioning and the achievement of their goals. These can then be used to track and improve performance immediately and over time.

As this model curriculum is competencybased, it connects the dots between the ‘know what’ and ‘do how’ for HIM professionals.

The National Health Policy-2017 advocates extensive deployment of digital tools for improving the efficiency and outcome of the healthcare system. The policy aims at an integrated health information platform or system which serves the needs of all stakeholders and improves efficiency, transparency, and citizen experience. Delivery of better health outcomes in terms of access, quality,

The National Health Policy-2017 advocates extensive deployment of digital tools for improving the efficiency and outcome of the healthcare system

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