VOL.7 NO.11 PAGES 82
Market Surrogacy in India: Shedding its secrecy Strategy Eliminating pain problems in elderly
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INSIGHT INTO THE BUSINESS OF HEALTHCARE
VOL 7. NO 11, NOVEMBER 2013
Chairman of the Board
CONTENTS
Viveck Goenka Editor
STRATEGY
Viveka Roychowdhury*
Eliminating pain problems
Assistant Editor
in elderly PAGE 28
Neelam M Kachhap (Bangalore) Mumbai
KNOWLEDGE
Sachin Jagdale, Usha Sharma, Raelene Kambli, Lakshmipriya Nair,
‘‘TMG100 has become the cornerstone of my
Sanjiv Das
therapeutic success’’
Delhi
‘‘There is still a lacuna of research in the
PAGE 36
Shalini Gupta
area of diabetes in India’’ PAGE 37 MARKETING
‘‘India has the lowest HAI rates in
Deputy General Manager
South Asia’’ PAGE 38
Harit Mohanty Assistant Manager
WEST INDIA SPECIAL
Kunal Gaurav
West India Update PAGE 40-43 ‘We have also been actively promoting healthy living initiatives’ PAGE 44
PRODUCTION General Manager B R Tipnis
RADIOLOGY
Manager
Siemens presents new Somatom Perspective
Bhadresh Valia Senior Executive -
CT scanner models PAGE 46
Scheduling & Coordination
MMC and Dept of Health meet for guidelines
Rohan Thakkar
on disposal of sonography machines PAGE 46
Photo Editor
GE Healthcare introduces 'Silent Scan'
Sandeep Patil DESIGN Deputy Art Director
PAGE 13
Pie Medical Imaging Solutions in
MARKET
Surajit Patro
Swedish healthcare delegation concludes week long visit PAGE 19
Chief Designer
GE Study: Developing world faces breast cancer surge PAGE 20
Pravin Temble Senior Graphic Designer Rushikesh Konka
technology for MRIs PAGE 47
Transasia Bio Medicals wins coveted Global Business
collaboration with Cardiovascular Research Foundation PAGE 47 Coming soon: INUMAC, world's most powerful MRI scanner
Excellence Award 2013 PAGE 20
Layout
Siemens introduces HIV Combo Assay
Vivek Chitrakar
Moolchand Healthcare launches hospital in Agra
PAGE 20
PAGE 47
HOSPITAL INFRA PAGE 21
EISE celebrates two decades of advancing medical
Ask A Question PAGE 48
CIRCULATION Circulation Team Mohan Varadkar Express Healthcare Reg. No. MH/MR/SOUTH-252/2013-15 RNI Regn. No.MAHENG/2007/22045 Printed for the proprietors, The Indian Express Limited by Ms.Vaidehi Thakar at The Indian Express Press, Plot No. EL-208, TTC Industrial Area, Mahape, Navi Mumbai - 400710 and Published from Express Towers, 2nd Floor, Nariman Point, Mumbai - 400021. (Editorial & Administrative Offices: Express Towers, 1st Floor, Nariman Point, Mumbai - 400021) *Responsible for selection of news under the PRB Act. Copyright @ 2011 The Indian Express Ltd. All rights reserved throughout the world. Reproduction in any manner, electronic or otherwise, in whole or in part, without prior written permission is prohibited.
NOVEMBER 2013
education in India
IT@HEALTHCARE
PAGE 21
Anand Mahindra appointed Chairperson of PHFI PAGE 21
Healthcare IT VC funding totals $737 million
Lokmanya Hospital, Nigdi launch Spine Centre PAGE 22
in Q3 2013 PAGE 49
Data reveals one in ten adults in India suffer from hypothyroidism PAGE 22
EHR penetration is growing at
St Jude Medical announces acquisition of Nanostim PAGE 22
13.5 per cent
PAGE 50
Dr DY Patil University’s Dept of Business Management to organise HOSPI EXPRESS PAGE 24 Apeejay organises 2nd IOG Dr Stya Paul Awards 2013 PAGE 24 Alere India hosts Alere Biomarker Conclave 2013, introduces rapid diagnostic test system Triage PAGE 25 Healthcare Federation in India ‘NATHEALTH’ launched PAGE 25 Medical device players throng at Medtec India 2013 PAGE 26
EXPRESS HEALTHCARE WISHES YOU A JOYFUL SEASON OF LIGHTS
ISACON organises World Anaesthesia Day conference PAGE 26 www.expresshealthcare.in
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9
EDITOR’S NOTE Justice delayed but the struggle continues
WEEDING OUT THE BLACK SHEEP AND CREATING PROTOCOLS TO DISCOURAGE AND PREVENT BAD PRACTICES IS ESSENTIAL BECAUSE IT WILL BUILD TRUST, STRENGTHEN THE INDUSTRY FROM WITHIN AND CREATE A ROADMAP FOR SUSTAINABLE GROWTH
After 15 long years, Dr Kunal Saha's fight for justice finally ended when the Supreme Court of India awarded him compensation of around Rs 6 crores, plus interest for the death of his wife Anuradha due to the negligence of doctors at Kolkata's AMRI Hospital. While the hospital will have to shoulder the major payout, the SC has chosen to send out a strong signal to the medical practitioner community when it decreed that three treating doctors will have to pay up some share in the compensation amount as well. There are innumerable instances of medical negligence but few reach the courts and even fewer have this conclusion. What made Dr Saha's saga unique? In television debates, Dr Saha spoke of the closing of ranks within the medical community and struggle to be heard. His advantage was that he understood the technicalities of the case and could fight the system. Also, he is a US resident and therefore did not have to worry about being a social outcast. Thirdly, he was able to create global 'noise' and support for his cause by starting his own online campaign against medical negligence, called People for Better Treatment (PBT). On the PBT site, he hails the SC judgement of this October as 'historic' and invites all 'conscientious people to join PBT in future efforts to remove the deep-rooted corruption from the Indian medical system and build a negligencefree healthcare system.' Unfortunately, Aristotle's warning that “one swallow does not a summer make” rings true. Less than a fortnight after the SC judgement, Dr Ketan Desai, whose license to practice was revoked after a complaint from Dr Saha, was elected back to the very body which revoked his licence, even though he still faces charges of corruption for taking bribes to register medical colleges. This makes a mockery of the Medical Council of India. With state medical councils lobbying for power, it is only to be expected that the Centre will crack down. (See Express Healthcare October 2013 Edit: Does the MCI need a ‘medical CBI’? http://bit.ly/16NHMZ4) Industry too has to play its part. In May last year, India's healthcare fraternity came together to form the Healthcare Federation of India (NatHealth) with
the stated mission to be the voice of the industry, 'to address urgent issues and in time redefine the space' of Indian healthcare stakeholders. In a recently released white paper, PwC and NatHealth identify six enablers which need to be put in place for India to achieve the MDG goals and provide affordable healthcare access for every citizen. Some of these include the formation of funding pathways (a government corpus for a healthcare infrastructure fund as well as allowing business trusts and real estate investment trusts (REITS) in healthcare), resolving pain points like establishing a transparent and viable pricing formula for healthcare reimbursements and standardising collateral and exit clauses for PPP projects. NatHealth will have to voice the concerns of the industry as three key regulations come up for discussion in this winter session of Parliament: the Artificial Reproductive Technologies Act, the Indian Medical Council (Amendment) Bill 2013 and the Clinical Establishments Act. Beyond finance and policy matters, NatHealth should also start a dialogue on ethical issues. India should not come to be associated with cases of medical negligence or instances of profiteering like in the surrogacy debate (Read our cover story in this issue: Surrogacy in India: Shedding its secrecy). Weeding out the black sheep and creating protocols to discourage and prevent bad practices is essential because it will build trust, strengthen the industry from within and create a roadmap for sustainable growth. It is no wonder that other Asian nations like Thailand have managed to brand their countries as first choice medical destinations, while India still struggles to get its act together. It is thus critical that associations like NatHealth proactively engage with watchdogs like PBT rather than waste time and energy ignoring or worse, opposing such sentiments. For instance, if Dr Saha's complaint had been taken seriously in 1998 when his wife died, it could have raised the alarm about other laxities at AMRI's Dhakuria facility, where Anuradha was treated, much before the December 2011 fire killed 93 people, mostly patients. Could this tragedy have been averted? Viveka Roychowdhury viveka.r@expressindia.com
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www.expresshealthcare.in
NOVEMBER 2013
Letters QUOTE UNQUOTE
A great article
Well articulated article
Would like to thank you for the great article regarding absence of robust and transparent organ donation in the country that has appeared in the Express Healthcare, October 2013 issue.
Had an opportunity look at your article on RGJAY (Express Healthcare, September 2013). Please accept our congratulations for articulating it very well.
Prerna Arun Associate General Manager- Corporate Communication Fortis Healthcare
INSIGHT INTO THE BUSINESS OF HEALTHCARE
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A staggering 222 million women around the world lack access to contraceptive services, leading to 80 million unplanned pregnancies, 30 million unplanned births and 20 million unsafe abortions every year. This is a reminder that universal access to sexual and reproductive health services and care is not ensured. It is time we acknowledge that we need to make massive and strategic investments in universal access to affordable and appropriate sexual and reproductive health services
Union Health Minister Ghulam Nabi Azad
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NOVEMBER 2013
MARKET UPFRONT Singapore, India collaborate for better newborn care in TN
EH News Bureau
NOVEMBER 2013
INSIDE
O
ver the past four years, the Singapore International Foundation (SIF) and teams of neonatal specialist doctors and nurses from Chengalpattu Medical College and Hospital (CMCH) and Singapore’s KK Women’s and Children’s Hospital (KKH) have been involved in a medical mission to share knowledge, skills and resources. The aim of the SIF Specialist Volunteer (Enhancing Newborn Services) project has been to update and enhance the neonatal knowledge and clinical skills of those who care for atrisk newborns, including critically ill and premature babies. Serving as specialist volunteers with the SIF, Singapore’s KKH team of neonatologists and neonatal ICU nurses have trained some 120 healthcare professionals in Tamil Nadu, including paediatric doctors and neonatal ICU nurses from CMCH, senior health nurses, village health nurses and staff nurses from 12 primary healthcare centres in the Chengalpattu district and the Transport Nursing Team of Kancheepuram district’s Neonatal Ambulance service.The training focused on neonatal resuscitation skills and transportation practices, and raised awareness of infection control issues. Following this four-year engagement, the SIF-managed project has helped advance the hospital’s ongoing efforts to raise its standards of clinical care. Reportedly, the hospital has recorded better clinical outcomes, registering a 15 per cent reduction in infectionrelated infant mortality as a result of improved respiratory management practices and strengthened infection control standards. Apart from knowledge and skills transfer, the Singapore specialist volunteers also shared best practices from KKH.
GE Study: Developing world faces breast cancer surge 15 million years of ‘healthy life’ were lost worldwide in 2008 due to women dying early or being ill with the disease
www.expresshealthcare.in
Pg 20
Anand Mahindra appointed Chairperson of PHFI Succeeds NR Narayana Murthy, Infosys founder, Executive Chairman
Pg 21
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H How did surrogacy become popular in a country like India? The answer to this is the advancements in the field of reproductive sciences, affordable price points for foreigners, huge number of poor women who are willing to rent their wombs and lack of legal scrutiny. All of these factors ensure the boom of commercial surrogacy in India, while the rest of the world continue to debate on the philosophical and political aspects related to the concept of surrogacy.
Birthing a market Commercial surrogacy in India was initially a taboo. However, in Baby Manji’s case (2002) the Supreme Court of India held that commercial surrogacy was legal in India. Thereafter the concept picked up momentum and today India is a veritable Mecca for various couples from Israel, the US, Canada, the UK and Australia who seek to rent-a-womb to bear their children. India is among just a handful of countries - including Georgia, Russia, Thailand and Ukraine - and a few of the US states where women can be paid to carry another's genetic child through a process of in vitro fertilisation (IVF) and embryo transfer. Reproductive tourism in India alone is “valued at
DR FIRUZA PARIKH Director, Department of Assisted Reproduction and Genetics, Jaslok Hospital
Chairperson, International Fertility Centre
Reproduction is a very personal and private matter – individuals should be free to decide for themselves what they want to do without the government interfering with their decisions
Singles/gays and unmarried couples who cycled in the past have embryos and other genetic material trapped in India as the gov won’t allow them to use it or remove it outside India
more than $450 million a year” and was forecast by the Indian Council of Medical Research (ICMR) to be a $ 6 billion a year market in 2008. According to KPMG's lifesciences wing, the fertility industry in India is today worth Rs 750 crores. Surrogacy, which forms roughly seven per cent of that, stands at around Rs 54 crores. As estimated by the Confederation of Indian Industry (CII) India generates around $2.3 billion a year from fertility tourism. CII also reveals that nearly 10,000 foreign couples visit India for reproductive services and nearly 30 per cent are either single or homosexual. Well, as any other growing area, the surrogacy sector too has its own pros and cons.
surrogacy industry. Though cosmopolitan cities such as Delhi and Mumbai attract the maximum foreign couples and celebrities, B-towns such as Anand, Surat, Jamnagar, Bhopal and Indore are also growing centres for surrogacy. Dr Archana Dhawan Bajaj, Consultant Obstetrician, Gynaecologist, Fertility & IVF Expert, The Nurture Clinic speaks about how celebrities have become ambassadors of this concept. She informs that Bollywood stars, Aamir Khan and ,ore recently, Shahrukh Khan, opting for surrogacy have influenced the public so much that a large number of couples have come forward for surrogacy, breaking the orthodox mindset of Indian society. She opines, “Since the news of Shahrukh and Gauri Khan opting for surrogacy came to light, a number of couples have got influenced with the decision of the celebrity couple. I have got about 15-17 queries about IVF surrogacy. Celebrities are role models for public and their
every action has a great impact on public. Aamir Khan, Satish Kaushik and now Shahrukh Khan’s attempts have helped to shed the social stigma related to surrogacy. Therefore, Indian couples' perception has changed about surrogacy.”
Pros The increasing numbers of couples seeking surrogacy in India and the success rates of children born out of surrogacy have served to further promote India's already booming
750crores `
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Managing Director, Malpani Infertility Clinic
DR RITA BAKSHI
Since we do not have a law in place, only recommendations, every once in a while we encounter situations that are alarming or reach a roadblock
According to KPMG’s LifeSciences wing, the fertility industry in India is today worth ` 750 crores
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DR ANIRUDDHA MALPANI
www.expresshealthcare.in
Cons However, as commercial surrogacy in India is slowing overcoming social ostracism, a growing concern: will this lead to a nightmarish situation of housing the world's biggest baby farming industry? Currently, India does not have a legislation governing surrogacy; only guidelines laid down by the ICMR. It's the surrogacy agreement that governs the contractual relation between the parties. Therefore, will the lack of a proper law that binds this practice lead to exploitation ? The study, 'Surrogacy Motherhood: Ethical or Commercial?,' conducted by Centre for Social Research and supported by the Ministry of Women and Child Development in the year 2011-12, had revealed that the women who agree to be surrogate mothers get only one or two per cent of the total money a couple spends to have a child. The rest of the money is pocketed by owners of fertility clinics, doctors, nursing homes and middlemen. There has been several cases reported wherein, the surrogate mother has been ill treated or where her health NOVEMBER 2013
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has been neglected. In line with these cases, many IVF clinics have been defamed for exploitation and misconduct. Dr Aniruddha Malpani, MD, Malpani Infertility Clinic reveals, “While surrogacy is a great treatment option for some women (for example, those with Mullerian agenesis), the sad truth is that it is being overused and misused by many IVF clinics for financial reasons. For example, a lot of IVF clinics promote surrogacy as 'treatment' for older women who have failed multiple IVF cycles because of poor embryo quality. For these women, surrogacy will not help at all, because their uterus is normal. However, rather than counselling them and providing truthful information, doctors are happy to offer surrogacy as a solution to them, because it is so financially remunerative.” Exploitation of surrogate mothers is one part, what about the rights of children born out of surrogacy? And what about the legal issues that these commissioning parents face when they want to take their children back to their native lands? Citing examples of some challenges faced by surrogate mothers and commissioning parents, Dr Firuza Parikh, Director, Department of Assisted Reproduction and Genetics, Jaslok Hospital and Research Centre mentions, “The challenges are plenty and can be worrisome for both the commissioning patents and the child. Many babies born out of cross-border surrogacy have been trapped in legal tangles between the home country and India. A Norwegian woman who had twins through an Indian surrogate in 2009 was stranded for over two years as Norway refused to accept her as the biological mother. Many countries like France, Germany, Italy and Norway do not recognise surrogacy.” Giving some more examples in this context, Dr Rita Bakshi, ChairpersonInternational Fertility Centre chips in, “There have been a few recent cases in which surrogate babies have been caught in legal limbo. Even when the babies are allowed to travel back to the parents’ country of origin, it is sometimes the beginning of other complications. In 2010, a French gay man who had twins through an Indian surrogate was allowed to travel NOVEMBER 2013
back to France, where surrogacy is illegal. He is still engaged in a court battle with the government that took away the twins and placed them in foster care.” Another shocking news was of a convicted Israeli paedophile gaining custody of a four-year-old Indian girl through an agreement with a surrogate mother in India. Israel National Council for the Child (NCC), an NGO for chil-
dren's rights recently brought this story to light after they found out that the man has legally adopted the child through an agreement with the surrogate Indian mother and under current legislation, the Israeli authorities do not have the power to remove the girl away from him. According to an independent probe conducted by NCC, the man served 15 months in jail for sexually abusing
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five young children while they were under his supervision, some repeatedly, and is recognised as a paedophile by the authorities. These incidents surely raises the question that are couples seeking surrogacy in India being scrutinised for medical, socio-economic/ family backgrounds? These are just few instances of what lack of regulations can do to a technique
that was developed with the intention of enabling childless couples to have children and helping out poor women who can uplift their lives by renting out their wombs.
Steps underway for betterment
In July 2013, at the 2nd International Family Law and Practice Conference 2013 held in the London Metropolitan University, Chandigarh-based
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Supreme Court advocates Anil Malhotra and Ranjit Malhotra presented a joint paper on 'New Medical Visa Laws to Regulate Surrogacy' and pointed out that the recent instances of surrogate children from Germany, Japan and Israel born in India and leaving upon court intervention is an alarm to the legislators to enact a strict surrogacy monitoring law in India. Moreover, the recent furore about leading Bollywood actor Shahrukh Khan allegedly having
conducted a gender test before his surrogate baby was born has somehow worked as a wake up call for legislators to take the necessary steps for tightening the rules regarding surrogacy. As a result, the Government of India is all set to bring the thriving surrogacy sector under significant regulatory developments like the Artificial Reproductive Technology (ART) Bill which will be introduced in the Cabinet during the forthcoming winter session. This move has created a
lot of confusion within the industry.
Contradictory views While most of the industry experts are of the opinion that bringing in a surrogacy law is a must, there some opposing factions as well. Speaking about the ART Bill and the need for a surrogacy law Dr Bakshi feels, “The Bill describes the procedure for accreditation and supervision of assisted reproductive technology clinics and banks implying that such services need to be ethical. A law will
also ensure that medical, social and legal rights of all concerned are protected with maximum benefit to infertile couples or individuals within the recognised framework of ethics and good medical practices. The Bill will also ensure the establishment of a national advisory board which will maintain a national registry of ART clinics and banks, state boards and registration authorities and fix their responsibilities and duties. It will prescribe rights and duties of patients, donors, surrogates and children as well as
Table 1: The (Draft) Assisted Reproductive Technologies (Regulation) Bill & Rules -2010 Surrogacy: Main provisions ● Both the couple or individual seeking surroga-
●
●
● ●
●
●
●
●
16
cy through the use of assisted reproductive technology, and the surrogate mother, shall enter into a surrogacy agreement which shall be legally enforceable. All expenses, including those related to insurance if available, of the surrogate related to a pregnancy achieved in furtherance of assisted reproductive technology shall, during the period of pregnancy and after delivery as per medical advice, and till the child is ready to be delivered as per medical advice, to the biological parent or parents, shall be borne by the couple or individual seeking surrogacy. Notwithstanding anything contained in subsection (2) of this section and subject to the surrogacy agreement, the surrogate mother may also receive monetary compensation from the couple or individual, as the case may be, for agreeing to act as such surrogate. A surrogate mother shall relinquish all parental rights over the child. No woman less than twenty one years of age and over thirty five years of age shall be eligible to act as a surrogate mother under this Act. Provided that no woman shall act as a surrogate for more than five successful live births in her life, including her own children. Any woman seeking or agreeing to act as a surrogate mother shall be medically tested for such diseases, sexually transmitted or otherwise, as may be prescribed, and all other communicable diseases which may endanger the health of the child, and must declare in writing that she has not received a blood transfusion or a blood product in the last six months. Individuals or couples may obtain the service of a surrogate through an ART bank, which may advertise to seek surrogacy provided that no such advertisement shall contain any details relating to the caste, ethnic identity or descent of any of the parties involved in such surrogacy. No assisted reproductive technology clinic shall advertise to seek surrogacy for its clients. A surrogate mother shall, in respect of all medical treatments or procedures in relation to the concerned child, register at the hospital or such medical facility in her own name, clearly declare herself to be a surrogate mother, and provide the name or names and addresses of the person or persons, as the case may be, for whom she is acting as a surrogate, along with a copy of the certificate mentioned in clause 17 below. If the first embryo transfer has failed in a sur-
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●
●
●
● ●
●
●
●
●
●
rogate mother, she may, if she wishes, decide to accept on mutually agreed financial terms, at most two more successful embryo transfers for the same couple that had engaged her services in the first instance. No surrogate mother shall undergo embryo transfer more than three times for the same couple. The birth certificate issued in respect of a baby born through surrogacy shall bear the name(s) of individual / individuals who commissioned the surrogacy, as parents. The person or persons who have availed of the services of a surrogate mother shall be legally bound to accept the custody of the child / children irrespective of any abnormality that the child / children may have, and the refusal to do so shall constitute an offence under this Act. Subject to the provisions of this Act, all information about the surrogate shall be kept confidential and information about the surrogacy shall not be disclosed to anyone other than the central database of the Department of Health Research, except by an order of a court of competent jurisdiction. A surrogate mother shall not act as an oocyte donor for the couple or individual, as the case may be, seeking surrogacy. No assisted reproductive technology clinic shall provide information on or about surrogate mothers or potential surrogate mothers to any person. Any assisted reproductive technology clinic acting in contravention of sub-section 14 of this section shall be deemed to have committed an offence under this Act. In the event that the woman intending to be a surrogate is married, the consent of her spouse shall be required before she may act as such surrogate. A surrogate mother shall be given a certificate by the person or persons who have availed of her services, stating unambiguously that she has acted as a surrogate for them. A relative, a known person, as well as a person unknown to the couple may act as a surrogate mother for the couple/ individual. In the case of a relative acting as a surrogate, the relative should belong to the same generation as the women desiring the surrogate. A foreigner or foreign couple not resident in India, or a non-resident Indian individual or couple, seeking surrogacy in India shall appoint a local guardian who will be legally responsible for taking care of the surrogate
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during and after the pregnancy as per clause 34.2, till the child / children are delivered to the foreigner or foreign couple or the local guardian. Further, the party seeking the surrogacy must ensure and establish to the assisted reproductive technology clinic through proper documentation (a letter from either the embassy of the Country in India or from the foreign ministry of the Country, clearly and unambiguously stating that ▲ the country permits surrogacy, and ▲ the child born through surrogacy in India, will be permitted entry in the Country as a biological child of the commissioning couple/individual) that the party would be able to take the child / children born through surrogacy, including where the embryo was a consequence of donation of an oocyte or sperm, outside of India to the country of the party’s origin or residence as the case may be. If the foreign party seeking surrogacy fails to take delivery of the child born to the surrogate mother commissioned by the foreign party, the local guardian shall be legally obliged to take delivery of the child and be free to hand the child over to an adoption agency, if the commissioned party or their legal representative fails to claim the child within one months of the birth of the child. During the transition period, the local guardian shall be responsible for the well-being of the child. In case of adoption or the legal guardian having to bring up the child, the child will be given Indian citizenship. ● A couple or an individual shall not have the service of more than one surrogate at any given time. ● A couple shall not have simultaneous transfer of embryos in the woman and in a surrogate. ● Only Indian citizens shall have a right to act as a surrogate, and no ART bank/ART clinics shall receive or send an Indian for surrogacy abroad. ● Any woman agreeing to act as a surrogate shall be duty-bound not to engage in any act that would harm the foetus during pregnancy and the child after birth, until the time the child is handed over to the designated person(s). ● The commissioning parent(s) shall ensure that the surrogate mother and the child she deliver are appropriately insured until the time the child is handed over to the commissioning parent(s) or any other person as per the agreement and till the surrogate mother is free of all health complications arising out of surrogacy.
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prescribe the procedure for registration of complaints. It also seeks to regulate research on embryos, gametes or other human reproductive material and will regulate sourcing, handling, record-keeping for gametes, embryos and surrogate mother.” Adding to this, Dr Bajaj states, “The main motivation of bringing the ART Bill is to regulate the assisted reproductive services. It would help in eradicating the unethical practices in India. Right now the practices of ART are being misused by unmarried or gay foreigner couples. They hire Indian surrogates to meet their desire of bearing a child. But as such couples don’t get social acceptance neither do their child. The psyche of such a child gets disturbed due to social denial. Instances of child trafficking are also increasing due to malpractices of surrogacy. The proposed bill is expected to put an end to such practices.” Dr Manoj Chellani, IV Expert, Ayush ICSI Test Tube Baby Center, Raipur, Chhattisgarh, feels that bringing in a law will organise the sector. He says, “ART clinics will be more organised, it will help to maintain standards and it will prevent gay couples and unmarried couples from abroad seeking surrogacy in India. Surrogacy system will altogether be redefined with the help of this law.” Under the current draft, all fertility clinics must be registered and monitored by a regulatory authority. Surrogate mothers must be between 21 and 35 years old, they will be provided with insurance and notarised contracts must be signed between the women and the commissioning parents. The mandate also says that foreigners have to be married for at least two years, cannot be in a live-in relationships and surrogacy cannot be offered to same sex couples (for more details on
the draft refer to Table 1). Explaining the reason behind this, Dr Parikh goes on, “The rationale behind this is to ensure that the child conceived from such an arrangement is protected, brought up in a stable environment and is not abandoned later on in life. One has to be very careful of this interpretation because it would be socially contrary to consider such relationships to be unstable.”
However, certain propositions made by the Directorate General of Health Services (DGHS) such as restricting certain foreign couples, same sex couples and single parents for seeking surrogacy in India has perturbed some industry experts. They feel that these propositions are irrational and could hamper the growth of the surrogacy sector in India.
“India has done much to promote itself as a professional, safe and proficient destination for people who have infertility issues and want to have a family. We have made having a family possible for many who would previously never be able to access this type of quality medical care and treatment. Through our work we have created a demand for this service and hope for
many infertile people across the world. Clearly other nations are keen to benefit from our work as the new demand and competition is fierce. India is the first choice for many, but if we are not available they will turn to other countries for treatment,” expresses Dr Shivani Sachdev Gour, Gynaecologist & IVF Specialist, Director, SCI Healthcare.
NEARLY 10,000 FOREIGN COUPLES VISIT INDIA FOR REPRODUCTIVE SERVICES AND NEARLY 30 PER CENT ARE EITHER SINGLE OR HOMOSEXUAL NOVEMBER 2013
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Dr Bakshi feels that this move can have a bad impact on the IVF industry. She says, “If the Bill’s supporters have their way, and such a narrow definition of 'couple' is established for surrogacy eligibility, it could have a major impact not only on the fortunes of thousands of couples struggling to build a family, but possibly on the golden goose as well. India is the world’s first destination for surrogate pregnancies which is a key contributor to the popularity of India medical tourism; with the new legislation, everyone – from the medical facilities conducting the procedures and the surrogates
themselves, to hotels and medical tourism agencies who ensure safe, comfortable itineraries for overseas patients – stand to see a decrease in business.” Further she warns, “We know that singles/gays and unmarried couples who cycled in the past now have embryos and other genetic material trapped in India as the Indian government won't allow them to use it or remove it outside India. This is the situation that those who currently qualify need to monitor carefully because if a complete ban goes into place, those who start cycles now along with those who have frozen
embryos, might find themselves in the same situation that the gays and singles find themselves in currently without any rights to their genetic property (already paid for mind you) and unable to get the ear of the Indian government to act fairly on the disposition of their residual genetic material.” Dr Malpani feels that restricting same-sex couples from seeking surrogacy as an option to bear children is unfair. He stresses upon his point saying, “After all, a single woman can easily have a baby without requiring permission from anyone. Is it fair to discriminate against
Table 2: Policy recommendations by NGO Sama ● The Draft Bill should be balanced keep-
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ing in mind the interests of all the parties involved in the arrangement, which would include: ART Bank, ART Clinic, Intended Couple(s), Surrogate, Child/ren born through the arrangement. In the current form, the Draft Bill seems to be skewed in favour of private providers and intended commissioning couple(s). The Draft Bill in its current form does not make any provision for the regulation of other players like the medical tourism agencies, surrogacy agencies, surrogacy law firms etc. While it stipulates that the sourcing of surrogate only through ART Bank, the role and responsibilities of these players also need to be systematically regulated, and stringent provisions incorporated in the Draft Bill towards this. Though the Draft Bill mentions about the ‘appropriate’ insurance of surrogate mother and the child by the commissioning parent(s), it does not elaborate on the kind and extent of insurance that will be provided, particularly in the context of post delivery and follow-up care. Considering the health risks that surrogacy entails, there also needs to incorporate provision of compensation to the surrogate and her family in extreme cases of severe health complications and death. Some of the recent instances have highlighted the necessity of such provisions. Health risks in the surrogacy arrangements cannot be neglected and the health rights of the surrogate compromised during the entire process. A balanced and equitable mode of payment to the surrogate needs to be stipulated in the Draft Bill. The present Draft is exceedingly imbalanced and unfavourable towards the surrogate. In addition to increasing the number of installments from three (as in the 2008 draft) to five (2010 draft), the maximum payment of 75 per cent is to be paid as the last installment (in complete contrast to the previous draft). Independent and long-term counselling should be mandated in the Draft Bill for the surrogate and the intended parents. As of now, counseling remains a one-time information giving process
completely dependent on the discretion of the clinic. Further, there needs to be a clear demarcation between the mandatory information that should be provided and counselling. As such, counselling as a process has to be a comprehensive, balancing the needs and well being of all the parties involved in the arrangement. ● Considering the vulnerable position the surrogate occupies and the absence of any kind of legal assistance, provision of a state sponsored legal counsel should be made mandatory in all arrangements of surrogacy. Such a step would be useful in administration and preservation of the contract. This would also take care of any possible legal contests on behalf of the surrogate. ● The Draft Bill does not allow the surrogate to be the egg donor, thereby eliminating the possibility of genetic surrogacy, and only allowing gestational surrogacy (including the use of donor gametes). Such a provision closes any possible contesting claim over the baby. This also means that less invasive and expensive procedure like Intra Uterine Insemination (IUI) cannot be used for surrogacy arrangements. The option of genetic surrogacy should also be weighed in all its pros and cons before the Draft Bill is finalised. ● Comprehensive and stringent regulatory provisions towards protecting the rights and well being of the children born out of surrogacy arrangements should be included. Adequate follow up measures, especially in the context of trans-national surrogacy should ensure that no violations take place. The Draft Bill mandates the appointment of a local guardian in the case of couple staying outside the country (Indian or otherwise). The provision makes the local guardian responsible in case the intended couple does not take the responsibility of the child. The local guardian has also been entrusted with the responsibility of either bringing up the child or handing him/her to the adoption agency. The Draft Bill should make clear provision with regard to the role of the local guardian to safeguard the well being of the child.
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the poor single man? Reproduction is a very personal and private matter – individuals should be free to decide for themselves what they want to do without the government interfering with their decisions.” Dr Parikh looks at the present scenario in a different light. She says, “Whenever a new technology is offered to the society its true impact is only appreciated after a few years. Many a time the technology cannot keep pace with the demands placed by society. Several lacunae in the use of this technology cause the legal wheels to start rolling. This is what has happened with surrogacy in India. Since we do not have a law in place but only recommendations every once in a while we encounter situations that are alarming or reach a roadblock. The ART Bill needs to be further strengthened so that it protects both the surrogate and the commissioning parents.”
The way forward While the industry continues to debate on this subject, they also urge that a board comprising doctors, legal luminaries, ethicists, reputed country leaders, couples who have gone through surrogacy, social scientists and government representatives need to come together for formulating a national policy which would promote surrogacy in a practical and moral way. Moreover, they urge the media to disseminate the right information about surrogacy and the proposed law. Lending a helping hand to the government in framing the policy, Sama, an NGO engaged in assisted reproductive technologies and commercial surrogacy, through research and advocacy, has put forward some recommendations to the Planning Commission. (See Table 2). The organisation was invited by the Planning Commission as part of their Civil Society Window initiative to present its views on commercial surrogacy in India. The industry is looking forward to the upcoming winter session of the Parliament in the hope that the unorganised surrogacy market in India would undergo a much needed reformation. Till then, the churning will go on …. raelene.kambli@expressindia.com NOVEMBER 2013
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Swedish healthcare delegation concludes week long visit Delegation focussed on public healthcare, visited Maharashtra and Karnataka
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ome of Sweden's leading healthcare and medical technology companies were in the country recently, to scout for new business opportunities and partners in India's healthcare system. Bactiguard, Elekta, GrippingHeart, and HemoCue were part of a healthcare delegation organised by the Business Sweden and Swecare Foundation, in collaboration with the Embassy of Sweden in New Delhi and the Ministry of Health and Social Affairs. The delegation is a follow up on the contacts and dialogues initiated on a previous visit last December, where a delegation from Sweden visited the states of Maharashtra and Karnataka. India is one of the focus countries of Swecare Foundation, a semi-govern-
mental non-profit platform which acts as a facilitator for Sweden-based academia, public and private sector to enhance export and internationalisation of Swedish healthcare and life science across the world. The dialogue between the two countries on healthcare collaborations was formalised in early 2009, when Sweden and India signed a Memorandum of Understanding (MoU). The focus of the MoU is healthcare and public health. It includes three broad tracks, cooperation between public institutions, academia and private sector. The delegation trip focused on public health since there is a wish from the both governments that the Swedish private sector also develops its contacts with the Indian public sector where a lot of devel-
Maria Helling, CEO, (left) and Anna Riby, Project Manager, Swecare Foundation on their recent visit to Mumbai. opments are taking place at the moment. Since the primary focus of the MoU is public healthcare, members of the recent delegation visited public hospitals as well as interacted with state health authorities in both Maharashtra and Karnataka. The delegation visited
Bangalore on October 7-8 and Mumbai on the following two days. The visit coincided with the inauguration of the new offices of the Swedish Consulate General in Mumbai. Speaking exclusively to Express Healthcare, Maria Helling, CEO, Swecare Foundation indicated that
representatives of the companies in this delegation got positive feedback and will be developing on these leads in the coming months. On the government to government dialogue, she said that both state governments have shown keen interest in working with Swedish companies and institutions in order to develop the healthcare situation in their states. Designated areas of priority include lifestyle related diseases, cancer care, cardiovascular diseases and diabetes. The state governments have also indicated an interest to work closer to Sweden in the areas of infection control, HIV, elderly care as well as mother and child health. EH News Bureau
Consultancy opportunity for Experienced Senior Professionals in Healthcare and Medical Devices industry
We are a boutique Investment Bank based out of Mumbai mainly focusing on Healthcare and allied sectors. We mainly provide strategic growth and financial advisory services to our clients; which include M&A advisory & Private Equity Fund Raising. We are keen to tie –up on a retainer and / or success fee basis with professionals having 15-25 years of experience and strong relationships with Tertiary care Hospitals, Medical Device manufacturers, Super / Multispecialty clinics, and Pathology & Radiology labs. Professionals from the states of Gujarat, Madhya Pradesh, Andhra Pradesh, Karnataka, Tamil Nadu, Kerala, Assam, Rajasthan, Punjab, Maharashtra, NCR and Goa may contact us. The assignment need not involve your full time involvement and requisite senior promoter level introductions would also be suitably monetarily rewarded.
If interested please contact us on healthcareconsulting2013@gmail.com NOVEMBER 2013
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Transasia Bio Medicals wins coveted Global Business Excellence Award 2013 Suresh Vazirani, Chairman and Managing Director, Transasia BioMedicals and Mala Vazirani, Executive Director, Transasia Bio-Medicals receive the award
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ransasia BioMedicals has been conferred with the prestigious 'Global Business Excellence Award 2013.' The award was presented by Veerappa Moily, Senior Minister in Government of India. Suresh Vazirani, Chairman and Managing Director, Transasia BioMedicals and Mala Vazirani, Executive Director, Transasia BioMedicals received the award for Transasia BioMedicals. Initiated this year, a survey of unlisted emerging companies who have been consistently contributing to their fields and delivering nothing short of the best was conducted. The most deserving amongst them were then presented with awards in various categories under the 'Emerging Companies Excellence Survey and Awards'. As many as 526 companies from all across India were part of the survey. Vazirani said, "We are thankful to all our customers and business associates for their continuous support and trust in us and for partnering in our progress. Transasia was set up to meet the need for reliable, affordable and innovative medical diagnostic solutions. We remain committed to providing the highest quality products and services and will continue in our endeavour with the same zeal and passion.” EH News Bureau
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GE Study: Developing world faces breast cancer surge Reportedly, 15 million years of ‘healthy life’ were lost worldwide in 2008 due to women dying early or being ill with the disease
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ising breast cancer incidence and mortality represent a significant and growing threat for the developing world, according to a new global study commissioned by GE Healthcare. Bengt Jönsson, Professor in Health Economics at the Stockholm School of Economics, and report coauthor said, “Breast cancer is on the rise across developing nations, mainly due to the increase in life expectancy and lifestyle changes such as women having fewer children, as well as hormonal intervention such as postmenopausal hormonal therapy. In these regions mortality rates are compounded by the later stage at which the disease is diagnosed, as well as limited access to treatment, presenting a ’ticking time bomb’ which health systems and policymakers in these countries need to work hard to defuse.” The study confirms findings from various other studies done on growing incidences of breast cancer cases in India. Breast cancer is now the second most common cancer diagnosed in Indian women. India faces a growing breast cancer epidemic. It is estimated that by 2030 the number of new cases of breast cancer in India will raise from current 115,000 to reach just under 200,000 per year. Mortality rates for breast cancer in India are high in comparison
to incidence rates. Poor survival may be largely explained by lack of or limited access to early detection services and treatment. Terri Bresenham, President & CEO, GE Healthcare, South Asia said, “Breast cancer is one of the most deadliest diseases a woman has to battle and in India, the number of cases of breast cancer have increased by 10-15 per cent over the last decade. Stage one detection increases chances of survival to 80 per cent as compared to a Stage three detection where the chances are a mere 20 per cent. The need of hour lies in creating awareness on early detection of cancer and shifting the fight from Stage four to Stage one. As a part of our commitment towards building a healthier India, GE is working towards improving access to affordable early detection technology solutions. We are also working towards building awareness and have recently launched the ‘#GECodePink’ campaign, a social media initiative to improve awareness on breast cancer. We want to reach out to as many women as possible and educate them by providing them with access to white papers, quick stats, factoids and tips on self examination.”
Need for better consumer education The report on ‘the pre-
vention, early detection and economic burden of breast cancer’ suggests that consumer understanding about breast cancer and screening methods is putting lives at risk in the developing world. A recent study by the Asian Pacific Journal of Cancer Prevention indicated that in the urban area of Delhi, only 56 per cent women were aware of breast cancer; among them, 51 per cent knew about at least one of the signs/symptoms, 53 per cent were aware that breast cancer can be detected early, and only 35 per cent mentioned about risk factors. In rural Kashmir only four per cent of the women had received any training or education about the purpose and technique of breast self exam. Commented Claire Goodliffe, Global Oncology Director for GE Healthcare, “It is of great concern that women in newly industrialised countries are reluctant to get checked out until it is too late. This is why GE is working with a number of governments and health ministries in these regions to expand access to screening and improve consumer awareness. Some of these initiatives are making excellent progress. Recently, Wipro GE Healthcare and Maharashtra Government announced one of the largest PPPs to upgrade Government hospitals in
Maharashtra. 22 district hospitals will be equipped with state-of-the-art mammography units to improve access to breast cancer screening and diagnosis.”
Years of healthy life lost The study draws some interesting conclusions about the impact of breast cancer on sufferers’ lives. According to the most recent published data, 15 million years of ‘healthy life’ were lost worldwide in 2008 due to women dying early or being ill with the disease. According to Globocan data, India is on top of the table with 1.85 million years of healthy life lost due to breast cancer. Said Jönsson, “The report findings suggest that a worryingly high proportion of women are still dying from breast cancer across the world and this seems to correlate strongly with access to breast screening programmes and expenditure on healthcare.” Concluded Goodliffe, “This report finds a direct link between survival rates in countries and the stage at which breast cancer is diagnosed. It provides further evidence of the need for early detection and treatment which we welcome given current controversies about the relative harms, benefits and cost effectiveness of breast cancer screening.” EH News Bureau
Siemens introduces HIV Combo Assay The HIV test, mainly intended for use in blood banks or laboratories, delivers accurate results quickly and reliably he Siemens Healthcare Enzygnost HIV Integral 4 assay, an HIV test mainly intended for use in blood banks or laboratories, delivers accurate results quickly and reliably, enabling clinicians to identify HIV infection earlier and improve patient care. This new assay is an HIV combination test (or HIV Combo test), a type of assay that detects both the HIV p24 antigen and HIV antibodies,
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and is increasingly becoming the standard screening technique used by healthcare authorities in many countries within the European Union. The Enzygnost HIV Integral 4 assay reportedly delivers both excellent specificity and sensitivity. In a study of 14,169 donor samples tested at three different blood banks, initial specificity was demonstrated at 99.94 per cent. Data also show www.expresshealthcare.in
that the HIV Integral 4 assay has higher sensitivity and provides superior seroconversion performance (quicker prevalence of the antibody) compared to other currently available assays, detecting HIV infection up to 14 days earlier. "The increased sensitivity of the HIV Integral 4 assay enables clinicians to detect disease and initiate treatment earlier, and its high specificity provides our blood bank
customers with confidence that the results are precise, enhancing the accuracy of their donor screening programs,” said Stefan Wolf, CEO, Hemostasis, Hematology and Specialty Business Unit, Siemens Healthcare, Diagnostics Division The new assay is available on the Siemens laboratory systems Quadriga BeFree and BEP. EH News Bureau NOVEMBER 2013
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Moolchand Healthcare launches hospital in Agra
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o o l c h a n d Healthcare has strengthened its footprint in North India with the inauguration of its 200 bedded tertiary care hospital, Moolchand Medcity, Agra. The hospital, formerly known as Pankaj Apollo, was acquired by Moolchand Healthcare in December, 2012. "Moolchand Medcity, Agra intends to offer comprehensive tertiary care services including high-end diagnostics, emergency and critical care services. It is the intention of Moolchand to bring cutting-edge healthcare to Agra so that patients do not have to travel to Delhi for treatment," said Vibhu Talwar, MD, Moolchand Healthcare. Initially the focus specialties will include cardiology, critical care medicine, dental, dermatology, emergency & urgent care, endocrinology, ENT, Faciomaxillary surgery, gastroenterology, internal medicine, nephrology, neurology, obstetrics & gynaecology, orthopedics, ophthalmology, pathology, urology and radiology amongst other areas. In Phase 2, the hospital group intends to launch a cancer hospital and reportedly have already purchased the land adjacent to Moolchand Medcity Agra.. EH News Bureau
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EISE celebrates two decades of advancing medical education in India Over 130, 000 healthcare practitioners trained across various specialities
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ohnson & Johnson's Ethicon Institute of Surgical Education (EISE), established in 1993 to help surgeons and healthcare professionals in India to keep abreast of the emerging trends in medical and surgical care, has completed 20 years. Today, EISE is a much sought after institute, offering quality multispecialty training with new centres opened in New Delhi (2001) and Chennai (2003). The institute imparts `hands-on’ training to budding and practicing surgeons, gynecologists and paramedical staff with real life simulated situations to facilitate quality learning. Reportedly, over 130,000 healthcare practition-
ers have since been trained across various specialties in minimally invasive surgery, microsurgery, ethiskills, joint replacement, spine surgery, cardiovascular and surgical stapling procedures from across the country. The courses offered by the institutes are recognised and accredited by leading associations such as Indian Association of Gastrointestinal Endosurgeons, IAGES, Indian Society for Reconstructive Microsurgery, ISRM, Association of Surgeons of India, ASI, The Chennai institute is accredited by The Tamil Nadu Dr MGR Medical University, Chennai. “As a broadly based healthcare company, we are
privileged to serve the community of healthcare practitioners in India, by working together toward our common goal of improving the quality of care. It is heartening to know that the EISE institutes have not only trained over 130,000 healthcare practitioners in India, but also evolved into becoming a `preferred partner’ for the healthcare community over these two decades,” said Vladimir Makatsaria, Company Group Chairman, Johnson & Johnson Medical Companies, Asia Pacific at a special function held in Mumbai to commemorate two decades of EISE institutes in India. “For 20 years, our constant endeavour at EISE has been to
mentor the finest minds to clinical perfection and impart knowledge enhancement in surgical skills. Having established a strong presence in major cities in India, the institute has extended its service offerings to support healthcare practitioners in smaller cities in India and also to neighboring countries such as Bangladesh, Nepal & Sri Lanka. Every year we train over 15,000 healthcare practitioners and we aim to increase this number to over 20,000 healthcare practitioners in 2014,” added Sushobhan Dasgupta, Managing Director, Johnson & Johnson Medical India who was also present at the function. EH News Bureau
Anand Mahindra appointed Chairperson of PHFI Succeeds NR Narayana Murthy, Infosys founder, Executive Chairman he Governing Body of the Public Health Foundation of India (PHFI) unanimously elected Anand Mahindra, Chairman and Managing Director of the Mahindra Group as its next Chairperson for a term of three years. Mahindra succeeds NR Narayana Murthy, Infosys founder, Executive Chairman, who has held the position since July 2011. In his address as outgoing Chairman of PHFI, Murthy, who hands over the baton to focus on his renewed commitment to lead Infosys said, “I have been privileged to be the Chairperson of PHFI,
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which has emerged as a major transformational agent for improving public health in India. Public health cannot be the responsibility of the government alone, it requires the involvement of civil society, private sector, communities and individuals. India needs a collective response from all these stakeholders in order to realise its dream of improved health and access to healthcare for all. Hence, I am delighted that the PHFI Board has elected Mahindra as Chairperson. I am confident that his outstanding leadership will provide the inspiration and impetus that
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will enable PHFI to scale new heights of accomplishment in the pursuit of its mission to serve the Indian people.” Accepting the position as Chairperson PHFI, Mahindra said, “Since inception, the Public Health Foundation of India has contributed immensely to strengthening India’s public health capabilities and performance through a model public-private partnership. I am honoured to be appointed Chairman and look forward to working with the Foundation and the Governing Body to further its goals to achieve a better health outcome for each and
every Indian.” Dr K Srinath Reddy, President PHFI said, “We would like to take this opportunity to welcome Anand Mahindra to PHFI. Mahindra is an outstanding leader who has played a vital role in shaping the Indian industry. He has also supported many initiatives in the development sector which has promoted public welfare and equity of opportunity. His valuable guidance and strategic insights to PHFI would be valuable as we focus on our next phase of evolution and growth.” EH News Bureau
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Lokmanya Hospital, Nigdi launch Spine Centre
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okmanya Hospital has opened a specialised Spine Centre at Nigdi that boasts of state of the art infrastructure, supported by advanced technologies and modern equipment of international standards. The diagnostic and treatment facilities at the Spine Centre reportedly includes Matrix therapy, microscopic & laser surgery, microlumbar discectomy, vertebroplasty, cervical & lumbar fusion of vertebrae, nucleoplasty, cervical disc replacement etc with the help of microscope through very small incisions. These latest technology reduces the chances of infection offering faster recovery, thus reducing hospital stay for the patient. Thus the dedicated spine centre aims to bring together renowned specialists with state-of-the-art technology and extensive ancillary services all under one roof. Dr Narendra Vaidya, Executive Medical Director and HOD Orthopaedics, Lokmanya Hospitals, will lead the expert team at Spine Centre. “Back pain is a significant cause of discomfort in four out of five people today. The modern hectic lifestyle has played havoc on the health of millions around the globe. Improper eating habits, bad sitting postures, inadequate sleep, lack of quality exercise, all of this has resulted in health problems far bigger than ever imagined. Backache has become one of the most common health problemaffecting youngsters today and is second only to cold, when it comes to people visiting general physicians. Hence a super-specialty spine care centre was the need of the hour, which not only offers surgeries but alternative procedures to provide a pain free life to its patients”, said Dr Vaidya, at the launch of Lokmanya Hospital, Nigdi’s specialised Spine Centre. Lokmanya Spine Centre will reportedly offer tailormade treatment or preventive programme to fit the patients' requirement.. EH News Bureau
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Data reveals one in ten adults in India suffer from hypothyroidism Abbott’s ‘Thyroid Epidemiological Study’ helps understand disease prevalence in India
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bbott India announced the national results from a study assessing the prevalence of hypothyroidism in India published in the Indian Journal of Endocrinology and Metabolism. The team of the Thyroid Epidemiological Study was led by Dr AG Unnikrishnan, Principal Investigator of the study, CEO and Endocrinologist, Chellaram Diabetes Institute, Pune and other researchers. This study initiated by Abbott is reportedly India’s first cross-sectional and multi-city study to quantify prevalence of thyroid dysfunctions in the post iodisation phase in Bangalore, Chennai, Delhi, Goa, Mumbai, Hyderabad, Ahmedabad and Kolkata. Key results from the study: ● Hypothyroidism is highly prevalent amongst the surveyed population with one out of ten people being diagnosed with the condition. Hypothyroidism was found to be a common form
of thyroid dysfunction affecting 10.95 per cent of the study population. The older population (above the age of 35 years) seemed to be at higher risk of hypothyroidism than the younger population (13.11 per cent vs. 7.53 per cent). ● Women were three times
THIS STUDY IS REPORTEDLY INDIA’S FIRST CROSS-SECTIONAL AND MULTICITY STUDY TO QUANTIFY PREVALENCE OF THYROID DYSFUNCTIONS IN THE POST IODISATION PHASE
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more likely to be affected by hypothyroidism than men (15.86 per cent vs. 5.02 per cent), especially those in midlife (46-54 years). Almost one-third of the hypothyroid patients (3.47 per cent) were not aware of the condition and were diagnosed for the first time during the course of studyrelated screening. Hypertension (20.4 per cent) and diabetes mellitus (16.2 per cent) were the other common diseases observed in the study population. Inland cities i.e. Bangalore, Delhi, Kolkata, Ahmedabad, Hyderabad) had higher prevalence of hypothyroidism (11.73 per cent) compared to coastal cities (Chennai, Goa, Mumbai) (9.45 per cent). Kolkata recorded the highest prevalence of hypothyroidism (21.67 per cent). Approximately one-fifth of the study population had anti-thyroid peroxidase antibodies [TPO] positivity,
an established autoimmune marker pointing toward a steady risk of thyroid disorders. “Thyroid disorders in India are characterised by a high prevalence, minimal diagnosis, poor awareness and low involvement of doctors in treatment. There is a growing urgency to create awareness of thyroid disorders, the need for early and regular diagnosis and the importance of following a recommended treatment regime,” said Dr Unnikrishnan. “The study findings call for a review of current practices in the management of thyroid disorders. There should be an emphasis on active screening of endocrine function among patients at greater risk along with regular monitoring of thyroid status and dose adjustments to provide effective therapy in patients with established diagnosis,” he added. EH News Bureau
St Jude Medical announces acquisition of Nanostim The acquisition adds reportedly the world’s first and only leadless pacemaker to the St Jude Medical product portfolio
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t Jude Medical has announced the completion of its acquisition of Nanostim, a privately-owned developer of miniaturised, leadless pacemakers. The acquisition adds reportedly the world’s first and only leadless pacemaker to the St Jude Medical product portfolio and culminates a two-year partnership between the two companies during which St Jude Medical invested in and collaborated with Nanostim throughout its product development and commercialisation initiatives. The Nanostim leadless pacemaker is designed to be implanted directly into the heart via a minimally invasive procedure. The device is delivered using a steerable catheter through the femoral vein, eliminating the need to surgically create a pocket for
the pacemaker and insulated wires (called leads) that have historically been recognised as the most vulnerable component of pacing systems. The Nanostim leadless pacemaker recently received CE Mark approval and will be available soon in select European markets. It also recently received US Food and Drug Administration
ST JUDE MEDICAL PAID $123.5 MILLION TO NANOSTIM SHAREHOLDERS AT THE CLOSING OF THE TRANSACTION www.expresshealthcare.in
(FDA) conditional approval for its Investigational Device Exemption (IDE) application and pivotal clinical trial protocol to begin evaluating Nanostim leadless technology in the US. On May 3, 2011, St Jude Medical and Nanostim entered into a series of agreements pursuant to which St Jude Medical made an investment in, and obtained an exclusive option to acquire, Nanostim. This transaction results from St Jude Medical’s exercise of its exclusive option under those agreements. Under the terms of a merger agreement entered into between the parties, St Jude Medical paid $123.5 million to Nanostim shareholders at the closing of the transaction. The merger agreement also provides for additional cash payments of
up to $65 million, which are contingent upon both the achievement and timing of certain revenue-based milestones. Drew Hoffman, Nanostim CEO said, “Nanostim’s focus on bringing innovative technologies to the market closely aligns with St Jude Medical’s commitment to developing leading products and treatment options for patients and physicians worldwide. We are pleased to have recently received CE Mark approval for the Nanostim leadless pacemaker. Nanostim looks forward to now working as part of St Jude Medical to further advance our commercialisation initiatives and expand this technology into new and existing markets.” EH News Bureau NOVEMBER 2013
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Chimney stent grafts successful in treating complex aortic aneurysms Study published in the Journal of Endovascular Therapy claims that this method offers another option for patients unsuitable for open surgery or branched/fenestrated stent-grafts
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sing the chimney stent-graft technique and its periscope variation to treat patients with complex aortic aneurysms has shown great results, claims a study published in the Journal of Endovascular Therapy Open graft repair can be risky for patients with pararenal or thoracoabdominal aneurysms. This alternative technique offers emergency treatment and another option for patients unsuitable for open surgery or branched/fenestrated stent-grafts. The reports show success rates of 111 chimney and 58 periscope grafts in 77 patients. These procedures were performed over a 10year period, and follow-up examinations were conducted at 6 weeks; 3, 6, and 12 months; then annually. Most patients—95 per cent— showed decreased or stable aneurysm size. The mean length of follow-up among these patients is more than two years, providing a midterm look at the effectiveness of this procedure. The results show an average aneurysm diameter reduction of 13 percent. While 20 patients had endoleaks at discharge following the procedure, only three patients continued to have leaks at the time of follow-up. The chimney graft technique preserves blood flow to side branches of the aorta by deploying a stent or covered stent parallel to the main aortic stent-graft. It extends upwards, like a chimney, while the periscope variation of this technique is downward facing. The chimney graft method uses commercially available stent devices rather than custommade branched ones—allowing immediate use in emergency situations. An accompanying commentary emphasises that the length of the chimney grafts can present a challenge and that meticulous attention to detail is key to the success of this technique. However, the chimney grafts are proving to
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last over time, allaying initial concerns of deterioration and
type III leaks. The authors declare that the results so far
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prove the technique to be safe and effective and justify
its wider use. EH News Bureau
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PRE EVENT
Dr DY Patil University’s Dept of Business Management to organise HOSPI EXPRESS The 5th National Conference on Healthcare & Hospital Management is slated to be held on November 23, 2013
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admashree Dr DY Patil University, Department of Business Management, Navi Mumbai is organising the 5th National Conference on Healthcare & Hospital Management on November 23, 2013. Dr R Gopal, Chairman, National Organising Committee says, “Development of healthcare facilities meeting international standards is now a felt need in our country. The Union Budget for 2013-14 reflected this concern through a 21 per cent increase in allocation towards health.” The event would comprise: Session I: “Issues and Challenges in Healthcare & Hospital Administration” This session aims at highlighting the various issues and challenges faced by healthcare providers in today’s 21st century fly by night culture. With smaller hospitals and nursing homes mushrooming every day, it has become increasing difficult to fight the competition. It is medium sized healthcare settings which suffer the most. The event would be graced by Anupam Verma, President, Wockhardt
Hospitals who would be the Chief Guest and Inaugural Speaker apart from Dr Nandita Palshetkar, Dr Sanjay Oak, Vice Chancellor – Pad. Dr DY Patil University, Navi Mumbai; Rajiv Shah, Director & Chief Officer – NMIMS School of Distance Learning and Dr Vivek Desai, MD – HOSMAC India Dr Nitin Sippy, National Convener opines, “This conference aims to prepare small and medium sized healthcare providers to brace the various day to day issues and challenges of managing healthcare institutions and the second session aims to throw a light on the burning issue of Cost v/s Benefit for Quality Improvement Programs in these healthcare providers”. Session II: Panel Discussion on 'Quality Initiatives - Cost v/s Benefits for a Healthcare Service Provider' A panel of eminent healthcare experts will discuss the need of good quality of services. Whether it be NABH, ISO, JCI, etc it is important to understand the competency of the cost input
Panelists at the event ● Dr Shirish Patil
● Dr Anupam Karmakar
Panel Head (Dean, Pad. Dr DY Patil Medical College & Hospital) ● Viveka Roychowdhury Panel Member (Editor - Express Healthcare, Express Pharma & InImaging) ● Arun Diaz Panel Member (Director – Jeevanti Healhcare) ● Dr Atul Adaniya Panel Member (Asst Medical Director, Reliance Industries)
Panel Member (GM-Operations, Jaslok Hospital) ● Reny Varghese Panel Member DGM Project Consulting at Wadia Hospital ● Dr Shridhar Thakur Panel Member (Director Projects, Vasan Healthcare) ● Dr Paresh Khadtale Panel Member (Manager- Accrediation & Compliance, Hinduja Hospital)
against the benefits (outputs). In today’s ever increasing inflation and more than 70 per cent of the population choosing private health facilities, cost effective –high quality services are the need of the hour. It is expected to be a very pertinent event for hospital promoters, managing/medical directors, hospital administrators/managers/executives,clinicians/consultants/
doctors, other professionals.
healthcare
Contact: Dr Heta Mehta Ph: 9819550748 Email: hetamehta62@gmail.com Dr Abdul Shaikh Ph: 9004352693 Email: rashid683@yahoo.co.in Website: ww.hospiexpress.in, www.hospiexpress.blogspot.in
POST EVENTS Apeejay organises 2nd IOG Dr Stya Paul Awards 2013 Around 500 eminent obstetricians and gynaecologists attended the event
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peejay Stya & Svrán Group held the second A edition of the Indian Obstetrics and Gynaecology (IOG)-Dr Stya Paul Awards recently at Apeejay Campus Auditorium, Sheikh Sarai, New Delhi. The Awards have been instituted to recognise outstanding contributory articles published in the Indian Obstetrics & Gynaecology Journal for Basic & Clinical Research. Reportedly the awards ceremony was attended by around 500 eminent obstetricians and gynaecologists from various parts of the country. The IOG Dr Stya Paul Awards were presented in three categories: Best Case
Report, Best Review Article and Best Original Study. The award for the Best Case Report went to Dr Manjusha Jindal (and co-authors), www.expresshealthcare.in
Assistant Professor, Department of Obstetrics & Gynaecology, Goa Medical College. The award for the
Best Review Article was bestowed upon Dr.Prashant Joshi, Associate Professor, Department of Obstetrics and Gynaecology, Adichunchagiri Institute of Medical Sciences, Karnataka. The Best Original Study award was won by Dr Manidip Pal, Associate Professor, Department of Obstetrics and Gynaecology JNM Hospital, West Bengal. The announcement and presentation of the Awards was followed by a series of presentations by the awardees on their research. The ceremony also featured a short film on ‘Reminiscences of Dr Stya Paul’. NOVEMBER 2013
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POST EVENTS Alere India hosts Alere Biomarker Conclave 2013, introduces rapid diagnostic test system Triage Prominent cardiologists, nephrologists and other medical experts discusses latest standards in clinical application of biomarkers in cardiovascular diseases
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edical experts from all over India recently gathered at the third edition of the Alere Biomarker Conclave, to discuss the most up-to-date standards in clinical application of biomarkers for early diagnosis and better prognosis. Alere India, a leading provider of near-patient diagnostics and health information solutions, hosted the twoday annual event. On the first day, three back-to-back sessions were held on topics such as biomarkers in acute coronary syndromes, biomarkers in heart failure, and biomarkers of renal injury and failure. At the conference, Alere also showcased its Triage System, a novel, rapid diagnostic test system comprising a meter and various test devices that will supposedly improve a physician’s ability to diagnose critical diseases and health conditions. Said Program Director, Dr Alan S Maisel, Director, Coronary Care Unit and Heart
THIS YEAR IN GURGAON, THE DISCUSSIONS FOCUSED ON NEWER BIOMARKERS AND GUIDELINES Failure Program, VA San Diego Healthcare System, “I am delighted that the Alere Biomarker Conclave 2013 empowered the participants to better utilise the current standards of care associated with the application of biomarkers in cardio-vascular disease. It gave them an opportunity to review recent literature that demonstrates diagnostic, prognostic, risk stratification and monitoring of the disease via biomarkers. The attendees also got to evaluate the recent consensus document on ACS and HF for India and determine how biomarkers may
play a role in determining therapeutic targets.” Delivering the welcome note, Sanjeev Johar, CEO, Alere India, added, “Biomarkers have come to occupy an important place in our diagnostic procedures. They not only improve diagnostic accuracy, but also provide information about the present disease state, thereby aiding clinicians in deciding how aggressively the disease needs to be treated. We have been trying to create awareness about these vital investigative modalities by organising the Alere Biomarker Conclaves in various cities of India. This year in Gurgaon, the discussions focused on newer biomarkers and guidelines.” Panelists at the Alere Biomarker Conclave 2013 included Dr Maisel as Chairman, with Dr Brian Pinto, Director of Cardiology – Holy Family Cardiac Institute (Mumbai), and Dr Jamshed J Dalal, Director – Centre for
Cardiac Sciences, Kokilaben Dhirubhai Ambani Hospital, co-chairing the event. The evidence-based curriculum of the conclave included topics like: ● Latest biomarker application with natriuretic peptides ● Latest biomarker application with troponins ● Newer biomarkers in cardio-renal diseases ● A review of national databases and quality initiatives ● Update on application of necrosis, inflammatory and ischemia markers as they emerge ● Interpreting guidelines and recommendations for biomarker utility in acute and chronic cardiac care ● Markers as surrogate endpoints for clinical investigation ● Interactive and practical discussions on bio-markers applied to case studies and care pathways to expedite care.
Healthcare Federation in India ‘NATHEALTH’ launched Releases white paper on enabling access to long-term finance for healthcare in India
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eading healthcare service providers, medical technologies providers, diagnostic service providers, health insurance companies and other stakeholders came together to launch NATHEALTH (Healthcare Federation in India). The Federation was formally launched by Dr Sayeda Hameed, Member, Planning Commission, Government of India, CK Mishra, Additional Secretary - Ministry of Health & Family Welfare, WHO Representative to India, Chandrajit Banerjee, Director General, CII in the presence of Dr Prathap C Reddy, President, Shivinder Mohan Singh, Vice President and Anjan Bose, Secretary General, NATHEALTH. The launch also witnessed the release of the white paper on 'Enabling access to long-term finance
NOVEMBER 2013
for healthcare in India’ by NATHEALTH in association with PwC. Mishra said, “NATHEALTH will safeguard and nurture the good health in our country as this forum enables to work on issues like ethics and governance for the betterment of the industry. NATHEALTH and Government of India shall be working with each other. It is right time for all the stakeholders to collaborate and to supplement the advance technology as it’s just a beginning.” Dr Hameed said, “As we are contending with communicable disease, I believe NATHEALTH will bring a significant change in the healthcare sector.” Healthcare veteran Bose expressed that modelled on the lines of NASSCOM, NATHEALTH is intended to www.expresshealthcare.in
play a pivotal role in empowering Indian healthcare and bring quality healthcare closer to every Indian. Dr Reddy said, “NATHEALTH would act as a catalyst to bridge the gap, encourage development and optimise healthcare infrastructure for the progress of healthcare sector to the next level.” Bose said, “We need to come together onto a common platform and work together with decision makers to create an enabling environment that will power the next wave of progress in Indian healthcare.” “Most of the country’s health expenditure is supported by private spending and the constitution of public funds is not adequate. Despite healthcare being accorded infrastructure status, unlike roads and airports, the healthcare sector
has lagged significantly in PPP. All of this needs to change,” added Dr Rana Mehta, Leader for Healthcare, PwC India. Bose informed that already NATHEALTH have nearly 50 members and are expecting more participation in times to come. Singh said, “Our mission is to enable the environment to fund long term growth for Indian healthcare and support best practices and promote accreditation.” “Indian healthcare fraternity needs to come together today to erase the ignominy of being a disease capital of the world in many areas. I hope that NATHEALTH members will do something that is very much required in the country to bring innovative and affordable healthcare to the people,” added Dr Reddy. EXPRESS HEALTHCARE
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Medical device players throng at Medtec India 2013 Over 300 professionals from the medical device manufacturing industry attended the sessions at Medtec India 2013
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BM hosted a two-day conference Medtec India on October 3-4, 2013 at the Lalit Residency, Mumbai. The conference served as a platform for knowledge exchange between relevant stakeholders on subjects related to trends, regulations and innovative solutions to facilitate growing demand for medical devices from the Tier-1 and Tier-2 cities of the country. Some of the topics covered during the conference were: 'Government support to boost the industry', 'Regulatory Regime: Current status', 'Trend Analysis: Medical devices as industry in India' and more. Over 300 professionals from the medical device manufacturing industry attended the sessions at Medtec India 2013. Inaugurating the conference, Ajay Pitre, MD, SushrutAdler Group, spoke about the progress of the medical device sector in India. He highlighted that the concept of 'Universal access to health in India' is the key driver for growth of the sector. During his session, Pitre spoke of the opportuni-
ties and challenges faced by the medical device sector in India. He also pointed out that we cannot replicate global strategies in India as the market here is different. K r i s h n a k u m a r Sankarranarayanan, Associate Director, PwC during his session said that the industry will need to re-invent strategies to expand their businesses within the tier-II and III cities of the country. Biten Kathrani, DirectorAisa Pacific Innovation
Center, Johnson& Johnson Medical India, on the other hand spoke about the right kind of innovation needed for India. Highlighting the current reforms undertaken, Dr S Eswara Reddy, Deputy Drugs Controller, (I), CDSCO, Ministry of Health informed, “In the 12th Five Year Plan for 2012-2017, there is a proposal to pass financing of Rs 3000 crore, to strengthen the overall Indian drug regulatory system. Of the Rs 3000 crores, Rs 1800 crores will be used to
strengthen the central government regulatory body –CDSCO and Rs 1200 crores for the state government regulatory authorities. This includes human resources of close to 300 medical device officers and also tremendous financing for other infrastructure like manufacturing units, training centres, clinical trial set-ups, regulations for indigenous manufacturers, etc.” Apart from the conference, Medtec India featured a range of networking and social engagement opportunities like facilitated business networking, i-3 centre, speed networking, speed geeking etc which opened avenues for future knowledge exchange between major industry players in India. All this was accompanied by a small medical device exhibition wherein Indian and international companies like BioInteractions, Ametek Instruments India, Millenia Technologies, Martech Medical, Zeus, SMC Global and some more showcased their unique products.
ISACON organises World Anaesthesia Day conference Patient awareness website www.modernanesthesia.in launched at the conference
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he Mumbai Chapter of Indian Society of T Anesthesiologists (ISACON) organised the World Anaesthesia Day (WAD) conference in Mumbai to update doctors and the medical fraternity on the advancements in modern anaesthetic technologies. They also discussed various issues faced by anaesthesiologists at hospitals and other facilities needed to make anaesthesia even safer for the patients. One of the most important points discussed at the conference was that patient awareness is very low and they do not understand the ramifications of this process in the surgical procedure that they are undergoing. Another point raised was that technologies in anaesthesia have ensured that patient trauma and mortality rates are at an all time low. Commenting on the occasion Dr Hemant ShindeC o n s u l t a n t Anaesthesiologist, Hinduja Hospital, Khar said, “Operation poses a huge challenge for the body’s physiology (or natural functioning) to cope. These rapid
fluctuations and body’s natural responses including pain are the ones that the anaesthetist continuously monitors and treats as appropriately required. As a corollary to this, administering anaesthesia would be the natural job of the preoperative physician. This makes the job of the anaesthetist far more acute and challenging that requires a rapid response, sometimes within a few seconds.” “The rapid, spectacular and stunning progress in medicine is www.expresshealthcare.in
largely due to safe surgery. This in turn is largely due to enormous advancements in safe anaesthesia. Had it not been the perioperative physician aka anaesthetist and anaesthesia, the very foundation of modern medicine would have been weakened,” he concluded. Dr Jitu Bapat, Consultant Anaesthesiologist,Hinduja Hospital, Mahim stated, “As it is commonly believed that doctors and hospitals have to take the moral and legal
responsibility of mishaps, patients seldom give thought to the fact that some minor errors in disclosure or the belief that it does not matter could lead to some serious problems during the surgical process.” In addition to the conference, the ISACON also launched their patient awareness campaign and released a patient information booklet that will be distributed free of cost at all hospitals. They also commissioned of a website www.modernanesthesia.in that is dedicated to the education and awareness of patients on all matters pertaining to anaesthesia. Talking about the initiatives taken by ISACON, Dr Bapat said, “This initiative on patient education and awareness will go a long way in helping patients to not only understand the importance of the anaesthetic process but also ensure that they behave in a more responsible mannerduring the pre-surgery stage and take more responsibility on themselves to ensure that they undergo a safe and efficient surgery.” NOVEMBER 2013
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EVENT BRIEF Auditorium, AIIMS, Delhi
HOSPI EXPRESS Organiser: Department of Radio-diagnosis, AIIMS, New Delhi
Date: November 23, 2013 Venue: Padmashree Dr DY Patil University, Department of Business Management, CBD Belapur, Navi Mumbai Organiser: Padmashree Dr DY Patil University, Navi Mumbai Summary: 5th National Conference on Healthcare & Hospital Management which comprises: Session I: Issues and Challenges in Healthcare & Hospital Administration Session II : Panel Discussion on 'Quality Initiatives - Cost v/s Benefits for a Healthcare Service Provider' Participant profile: Hospital Promoters, Managing/Medical Directors, Hospital Administrators/Managers/ Executives, Clinicians/ Consultants/ Doctors, other healthcare professionals, students (MHA / PGDHA),
Summary: The 11th National Conference of IART will bring together experts from the field of radiology to deliberate on topics such as radiography, radiological imaging, radiology equipment, professional issues related to the subject, radiation protection, patient care and many more Contact Organising Secretary Department of Radio-diagnosis, AIIMS, Ansari Nagar, New Delhi-110029 Tel: 09868398808, 01126546230 Email: ramesh_sh@hotmail.com
Clairvoyance 2013
Contact Dr Abhiraam Mehendale, Dr Nehal Shah Tel: +919029885185/ +919869733282 Email: 2013clairvoyance@gmail.com Website: www.tiss-clairvoyance.in
66th Anual conference of Tamil Nadu and Pondicherry Chapter of IRIA Date: December 13-14, 2013
Date: December 7-8, 2013 Contact Dr Heta Mehta Tel: 9819550748| Email: hetamehta62@gmail.com Dr Abdul Shaikh Tel: 9004352693| Email: rashid683@yahoo.co.in Website: www.hospiexpress.in, www.hospiexpress.blogspot.in
Venue: Convention Centre, New Campus, Tata Institute of Social Sciences, Deonar
11th National Conference of IART Date: November 22-24, 2013 Venue: Jawahar Lal Nehru
health financing, health sector reforms, workforce management in hospitals, IT and quality in hospitals, innovations in public health, role of social determinants and international trade.These various sessions will give a perspective into the past, the present and the future of health sector in India. In keeping with the ideal of the institute, the sessions will challenge the old perceptions, evaluate the present and envisage the future.
Venue: Scudder Auditorium, CMC Campus, Bagayam, Vellore
Organisers: School of Health Systems Studies, Tata Institute of Social Sciences
Organiser: Department of Radiology, Christian Medical College, Vellore and the Vellore subchapter of the TN & PY chapter of IRIA
Summary: Clairvoyance is organised annually by the School of Health Systems Studies,Tata Institute of Social Sciences.This year the theme of the conference is ‘Re-imagining Health and Healthcare in India’ with various sessions related to
Summary: The 66th Annual conference of Tamil Nadu and Pondicherry Chapter of IRIA will lay emphasis on the ongoing and upcoming trends in the field of radiology and diagnostic imaging.
Contact: Department of Radiology, Christian Medical College, Vellore Tel: 0416 228027 Email: registration@iria2013vellore.in; radio@cmcvellore.ac.in
FICCI Health Insurance Conference 2013: “Health Insurance Vision 2020: From Regulation to Development” Date: December 13, 2013 Venue: FICCI, New Delhi Organisers: FICCI Summary: The FICCI Health Insurance conference will try to articulate the building blocks of the next paradigm which will comprise numerous structural changes including regulatory, legal, productrelated, new operating entities, partnership with providers etc. Participant profile: Government representatives, health insurance industry, life and, non- life insurance industry, healthcare providers, NBFCs, insurance brokers, agents etc Contact FICCI Health Services Division FICCI Federation House, Tansen Marg,New Delhi Tel: 011 2373 8760 - 70 (Extn. 220 / 246) Fax: 011 2332 0714, 011 2372 1504 E-mail: healthservices@ficci.com
To tie up with
for Media Partnerships Contact kunal.gaurav@expressindia.com
NOVEMBER 2013
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STRATEGY Eliminating pain problems in elderly Dr Pushpinder Singh, Associate Consultant, Pain Clinic, Indian Spinal Injuries Centre talks on pain management in elderly people and examines how effective hospital-based pain management clinics are in doing so
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The elderly population comprises the fastest growing segment of the world’s population. Even in India this population is expected to rise out of proportion to other age groups in the near future as healthcare delivery improves. Let us see where we stand in terms of management of pain problems in the elderly.
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Chronic pain affects between 20–50 per cent of elderly people and is often multi-factorial and complex. Such pains are mostly unrecognised, treated suboptimally or not treated at all. This may be related to attitudes and beliefs held by older people, which in turn affects their reporting
of pain but also due to misconceptions and educational deficits by health professionals. There is also a general failure by professionals to consider alternative pain relief options. Pain may significantly reduce quality of life and lead to depression, anxiety, increased suicide risk, increased dependence,
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PAIN MANAGEMENT MODALITIES IN THE ELDERLY
Dr Pushpinder Singh Associate Consultant, Pain Clinic, Indian Spinal Injuries Centre
reduced appetite, impaired gait, sleep disturbances and other problems. Pain problems common in the geriatric age group include joint pains (e.g. osteoarthritis, rheumatoid arthritis), low back pain (facet syndrome or degenerative disc disease), cancer pain, angina, neuropathic pains (diabetic neuropathy, post-herpetic neuropathy/ shingles), trigeminal neuralgia, peripheral vascular disease and ischemic pain. Osteoporosis is another common contributor to chronic back pain in elderly, especially in females. A pain management clinic in a hospital can help to reduce the sufferings of such elderly people and improve their quality of life. Apart from pharmacologic management, pain management clinics do offer interventional pain procedures for various pain conditions along with psychological support, physical activity and assistive devices and other complementary therapies. The complexity of pain assessment in geriatric patients often requires a multidisciplinary approach to diagnosis and management. The pain physician needs to work together with a psychologist or psychiatrist as depression is often times present in the patient with chronic pain. A physical therapist is a part of the team as well, to help with functionality. Laboratory and imaging studies may be ordered to help pinpoint a diagnosis if a detailed history and physical examination is not enough. Evaluation of the patient’s level of function is important as it affects the degree of independence, level of need for caregivers, as well as overall quality of life. Activities of daily living (ADL)—eating, bathing, dressing—and instrumental ADLs—light housework, shopping, managing money, preparing meals—are assessed. After a diagnosis is made, a consensus treatment plan is outlined that includes modalities to decrease pain perception and increase patient function.
Pain management modalities in the elderly Older people are different; the bio-physiological changes that occur with ageing, the accumulation of co-morbidities and co-prescription of medication, frailty and psychosocial changes make older NOVEMBER 2013
PHARMACOTHERAPY Drug treatment is generally the first and most widely used treatment modality to control geriatric pain
PSYCHOLOGICAL SUPPORT A solid support system including relatives and caregivers should be established
INTERVENTIONAL PAIN PROCEDURES Interventional pain modalities often alleviate the need for heavy medications use, thereby sparing the patient from unwanted side effects
PHYSICAL ACTIVITY AND ASSISTIVE DEVICES Physical activity and assistive devices encompass a wide range of interventions
people rather unique when considering treatment modalities for pain control. Treatment modalities in a pain management clinic may be categorised into the following areas: Pharmacotherapy Drug treatment is generally the first and most widely used treatment modality to control geriatric pain. It is relatively simple to implement and consists of NSAIDs, muscle relaxants, opioids especially in cancer pain and other adjuvant therapy. While paracetamol is most commonly used drug because of its safety profile in elderly, other NSAIDs and COX 2 inhibitors are resorted to for non responsive pain and opioids like morphine reserved for moderate to severe pain especially cancer pain. Longterm treatment with NSAIDs can cause gastric bleeding, deranged kidney functions and thus should be avoided. Adjuvant drug therapy such as antidepressants, anticonvulsants, muscle relaxants etc. are considered at all times to enhance the analgesic effects of other medications. Interventional pain procedures Interventional therapies in the management of chronic pain are minimally invasive procedures, mostly done as day care under image guidance in operation theatre with minimal morbidity. Interventional pain modalities often alleviate the need for heavy medications use, thereby sparing the patient from unwanted side effects associated with larger doses of drugs. Nerve blocks are some of the most commonly used interventional procedures employed by pain physicians, these help not only with diagnosis but also prognosis, preemptive analgesia, and somewww.expresshealthcare.in
times definitive therapy. Other interventions that may be used include chemical neurolysis, radio-frequency lesioning, cryoneurolysis, neuroaugmentation and neuraxial drug delivery. Depending upon the clinical diagnosis various interventions can be offered to the patients. Knee osteoarthritis is a common condition in old age and is responsible for reduced quality of life. In early stages, intra-articular hyaluronic acid is effective and appears to have a slower onset of action but lasts longer than steroids. Radio-frequency of genicular nerves has a strong scientific evidence to provide long lasting reduction in pain especially in late stages of osteoarthritis and helps in improving functionality. Chronic low back pain in elderly is mostly due to facet arthropathy or degenerative disc disease. While medial branch block and subsequent radio-frequency lesioning carry strong evidence in scientific literature, epidural steroid injections by transforaminal or caudal route are undertaken for lumbar canal stenosis. The treatment for degenerative disc disease includes percutaneous intradiscal RF therapy and Rami communicans lesioning which has good scientific evidence. Painful vertebral fractures respond well to percutaneous vertebroplasty and kyphoplasty. Neuropathic pains such as sciatica, post herpetic neuralgia do respond to specific nerve blocks and steroid injection. Trigeminal neuralgia responds excellently to radiofrequency lesioning of trigeminal ganglion and percutaneous balloon compression. Interventional pain procedures thus should be considered in management of
chronic pain especially when pharmacological treatments are ineffective or not tolerated. Psychological support Because pain is a complex sensory and emotional experience, psychological modalities should be employed in the pain management model. Pain coping strategies may include relaxation, prayer and attention diversion techniques. Depression and anxiety in geriatric patient must be addressed with psychotherapy, meditation and medication. Socio-economic variables of each patient should be adjusted to help the patient cope with pain. A solid support system including relatives and caregivers should be established. Physical activity and assistive devices Physical activity and assistive devices encompass a wide range of interventions. The available evidence supports the use of programmes that comprise strengthening, flexibility and endurance activities to increase physical activity, improve function and pain. The assistive devices are designed to assist in activities of daily living. Scientific evidence suggests that assistive devices may support community living, reduce functional decline, reduce care costs and reduce pain intensity relative to older people not provided with devices. Apart from these, some types of complementary therapy [e.g. acupuncture, transcutaneous electrical nerve stimulation (TENS), massage] have been used for older adults with painful conditions. To summarise, chronic or persistent pain is not an inevitable part of ageing but is fairly common among the elderly. The treatment of pain may be complicated by multiple problems that are far less likely to occur in younger adults. Understanding the causes of this pain, special medical needs of the elderly and the role of pain self- management can help seniors to reduce or eliminate this condition. Pain management clinics can provide appropriate analgesia in geriatric patients through proper assessment, a multidisciplinary approach and appropriate use of treatment modalities. EXPRESS HEALTHCARE
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‘‘TMG100 has become the cornerstone of my therapeutic success’’ PG 36 ‘‘TThere is still a lacuna of research in the area of diabetes in India’’ PG 37 ‘‘India has the lowest HAI rates in South Asia’’ PG 38
KNOWLEDGE INSIGHT
Conquering COPD: A collective effort Dr Sundeep Salvi, Director, Chest Research Foundation, Pune expounds on the threat that COPD poses to India and the need for a National COPD Prevention and Control Programme to tackle the menace
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Chronic obstructive pulmonary disease or COPD is the third leading cause of death in the world and the second leading cause of death in India. It costs the Indian economy more than Rs 35,000 crores every year, which is more than the annual budget allotted to the Ministry of Health and Family Welfare, Government of India. Half a million people die due to COPD every year in India. COPD causes more deaths than those due to tuberculosis, malaria and diabetes, all combined. According to the WHO, deaths due to COPD are estimated to increase by 160 per cent by the year 2030. Despite this enormous health burden, COPD remains an unknown disease in India. COPD is a chronic, progressive disease of the lungs associated with airways obstruction and destruction of the air sacs in the lung. The factors associated with damage to the lungs spill into the blood and subsequently
cause damage to the heart, skeletal muscles, bones, kidneys and brain. In fact, over two thirds of patients with COPD die due to ischemic heart disease, congestive heart failure, hypertension, skeletal muscle dysfunction, weight loss, osteoporosis and kidney failure. The Western world taught us that COPD is caused predominantly by tobacco smoking, and because it was thought to be a self inflicted disease, it remained a neglected disease in India for several decades. It is only recently that we have realised that there are several risk factors other than tobacco smoking that are responsible for the development of COPD in India. In fact, more than 50 per cent of the COPD in India occurs in non-smokers. Chronic exposure to indoor air pollution due to the burning of biomass fuels in poorly ventilated homes and high levels of ambient air pollution, largely due to motor vehicular and industrial exhausts seem to be the major risk factors for COPD in India. Other risk factors are also not uncommon – occupational exposures (farming, mining, building and construction, stone cutting, leather industry and others), a previous lung tuberculosis, poorly treated chronic asthma, poor nutrition and poor socio-economic status. The prevalence of smoking is
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growing in India, especially among women in metropolitan cities. Among tobacco smokers, although cigarettes have been shown to be harmful beyond doubt for causing COPD, other forms of smoking such as bidis and chillums, which are very common in India, are even more harmful. Hookahs are thought to be safe because of the belief that the smoke passing through water cleans up the impurities. Little do people know that hookahs are even more harmful than bidis and cigarettes. Indians have lung function values that are 30 per cent lower than Europeans, when corrected for age, gender and height. Already weakened lungs and a huge population exposed to myriad risk factors for COPD are believed to be largely responsible for the growing prevalence of this ailment in India. There are very few good quality studies that have studied the prevalence of COPD in India. Based on some of the recent data, an estimated 5-10 per cent of the adult population in India suffer from COPD. Despite the huge and growing burden of COPD in India, it remains poorly diagnosed in clinical practice. Spirometry is the gold standard diagnostic tool for COPD, but it is not available in most clinics, hospitals and
diagnostic centres. Lack of use of spirometry contributes to over 50 per cent of COPD patients being undiagnosed. It is not the cost of the tool that is responsible, but the lack of knowledge about its usefulness and the lack of knowledge about how to perform the test and interpret the test. Apart from this, the symptoms of progressive breathlessness and cough are usually insidious in onset and are often perceived by patients as age-related symptoms. Physicians too label them as symptoms of bronchitis and treat them symptomatically with antibiotics, coughs syrups and bronchodilators. The overall lack of awareness of COPD, both among patients as well as physicians, further contributes to the under-diagnosis of COPD in India. Even when diagnosed, it remains a poorly treated disease in India. As of now, there are no magic drugs that can reverse the damage that has already occurred in the COPD lungs, but there are good drugs that can significantly improve survival and improve the quality of life for COPD patients. Unfortunately, many of these drugs are not available in most government hospitals and many doctors don’t have the knowledge about how to Continued on page 35
NOVEMBER 2013
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K|N|O|W|L|E|D|G|E CAUSES OF DEATHS IN SOUTH - EAST ASIAN REGION Continued from page 30
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2000000
COPD
1800000 1600000
Total Deaths
1400000 1200000 100000 800000 600000 400000
HIV/AIDS Tuberculosis Malaria
200000 0
2008
2015
2030
Source:The Global Burden of Disease,WHO 2008)
Current and future predictions for mortality rates due to common diseases affecting the South East Asian Region 1000000 900000 800000 700000 600000 500000 400000 300000 200000 100000
COPD
Blindness
Cancer
Tobacco - Heart Respir, Cancer
Diabetes
Iodine Deficiency
Dengue
Malaria
HIV - AIDS
0 Tuberculosis
Dr Sundeep Salvi Director, Chest Research Foundation, Pune
use these drugs effectively. According to national and international guidelines, inhaled medications are the preferred routes of drug delivery because they are more effective and safe, yet many patients of COPD receive oral drugs in India that are not only poorly effective, but also more harmful. Earlier, there were not many useful drugs that could be offered to patients of COPD, but with huge investments in drug research, especially in the Western world, there are now a variety of drugs that can bring about a significant change in the quality of life and symptom relief for patients with COPD. Unfortunately, the overall nihilistic attitude towards the disease and lack of updated knowledge among primary as well as secondary care physicians still exists, and this contributes in a major way to poor quality of care being offered to patients with COPD. Acute exacerbations of COPD are the greatest cause of concern for these patients, because each of these episodes significantly deteriorates lung health, worsens quality of life and drains them of their finances. Treating these episodes and more importantly, preventing these episodes is a challenge, which many physicians do not know how to handle. There is a need for more knowledge generation and knowledge dissemination in this area of COPD management that remains badly neglected. Until recently, tuberculosis, malaria, HIV-AIDS, leprosy, filaria and dengue killed several thousands of people every year in India. With the introduction of the National Control Programmes for each of these diseases by the Ministry of Health and Family Welfare, the mortality rates have declined markedly. There are currently nine National Control Programmes that are ongoing in India, and each one has contributed immensely to reducing deaths and sufferings due to these diseases. Despite the fact that COPD is a leading cause of death and suffering in India, it has not attracted the need for a National Prevention and Control Programme. It still remains a neglected Cinderella disease. India needs a National
Annual mortality rates due to different diseases in India covered under the National Control Programmes by the Ministry of Health and Family Welfare, Government of India. COPD is not yet covered under the National Control Programmes COPD Prevention and Control Programme before the disease gets out of hand. The three key areas where major thrust will be required are (a) setting up appropriate healthcare services infrastructure in India for early and accurate diagnosis, appropriate treatment and rehabilitation programmes, (b) generating new knowledge in COPD that will be relevant to India’s needs through properly designed and funded research studies
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and (c) dissemination of knowledge regarding prevention, diagnosis, treatment and rehabilitation to healthcare providers in India so that they can improve the quality of care of patients with COPD. For this, physicians, researchers, policy makers, medical educators and healthcare providers will need to come together, devise and implement strategies that will be effective and sustainable. In a resource poor country like India, it will be a
challenge to tackle the growing burden of COPD but nonetheless we will have to stand up and face the challenge. Preventing the development of COPD will probably be the most viable long-term solution and that is where major public health initiatives will be required. But in the meantime, we will need to diagnose existing patients of COPD in India and treat them effectively with the best available drugs and care.
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‘TMG100 has become the cornerstone of my therapeutic success’ As India seeks new avenues to sports medicine, rehabilitation sciences and physiotherapy is one area that is picking up momentum. Raelene Kambli meets Stef Harley, Senior Consultant,TMGBMC to understand the advances in rehab sciences and know more about the technologies that TMG brings to India Tell us about the progress in rehabilitation sciences and physiotherapy that you have witnessed. The trend in rehab sciences and physiotherapy is to seek new ways to be more efficient and effective in treatments. More emphasis is being placed on injury prevention through screening and education.
You have identified a way to detect and prevent muscle injury and speed up recovery. Can you elaborate on this technique? TMG100 tensiomyography is based on measuring the displacement of muscle during standardised muscle contraction. From this we obtain parameters that describe the muscle function for each individual muscle that we measure. We can then compare function between the left and right side of the body, or compare injured to noninjured side. This gives us an exact insight into muscle symmetry. Muscle symmetry is important in injury prevention, improving performance and speeding up recovery. The technique has been proven, through scientific research, to show very high correlation with the invasive way of determining muscle fibre composition through biopsy and histological examination.The very basis of TMG100 tensiomyography is this ability to distinguish in a simple, fast, reliable and completely non-invasive way, the activation of fast motor units and slow motor units in muscle.This in turn gives various insights in muscle diagnostics and determining changes in muscle function throughout therapy or training. The advantage of our TMG100 technology is that it is very simple to use, entirely non-invasive, does not require any effort on the patient’s behalf which is important when there’s an injury, is portable and can be used anywhere and is considerably less costly than other state-of-the-art diagnostic equipment.
When and where was this first launched? Tensiomyography was first introduced in the late 90s as a method for measuring the dynamics of skeletal muscle by Prof Dr Vojko Valencic from the Faculty of Electrical Engineering of the University of Ljubljana (Slovenia,
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Europe). In the ensuing years, several researchers, mostly conducting their work in bio-mechanics, muscle physiology, applied anatomy and sports sciences, adopted the technology in their work and it is from there that various applications for TMG100 tensiomyography arose.The device was first commercially introduced in elite sports and sports sciences and in the last several years has found its way into mainstream medicine and rehabilitation.
Coming back to rehab science, how can one improve symmetry in the trained body and prevent injury or re-injury? How can the TMG100 help in this regard? First of all, one must have a tool to accurately and consistently quantify muscle function asymmetry. It is important to know precisely which muscles are functioning asymmetrically and asynchronously within the muscle chain, before then defining in which aspects of muscle function these deviations exactly lie.TMG100 provides a simple, noninvasive and fast way to do this. Following that precise exercises or interventions can be suggested to improve symmetry in function. Furthermore, we can continuously assess progress throughout the exercise programme or therapeutic intervention, in order to adjust there where necessary.
How can athletes or sportsmen decrease injury risk? To decrease injury risk one must understand where muscle asymmetry and weak functional symmetry is present. Where is the muscle chain broken? Once this has been defined, athletes must train these muscles in a very specific way in order to gain better symmetry. It is also essential to be able understand and objectify or quantify muscle recovery and fatigue, in order to know when an athlete can be expected to give 100 per cent again.Today’s strenuous competition schedules rarely allow athletes to fully recover from the strain of competition, let alone if there is an injury.
What is the best way to prevent re-injury after a rehab? Too early return-to-competition is the largest contributor to re-injury.This is because in many cases only subjec-
tive measures are used to make the decision to return to competition. It is then inevitable that the various motivations of athlete, medical staff coaches, managers, agents, spectators etc., prevail and increase injury risk. Our TMG100 technology helps objectify and quantify, so that subjective measures can be set aside and a more informed decision can be made. Re-injury also often occurs due to mistakes in the rehabilitation process; the wrong therapies are applied at the wrong time and rehabilitation exercises that help the athlete to return to practice are applied in the wrong phase of recovery and at the wrong dosage. Even incorrect exercise types are prescribed. By consistently monitoring muscle recovery with TMG100 this can be avoided. The same also applies to non-sports rehabilitation. People tend to think that as soon as the pain has gone that everything is alright. But in fact the battle maybe only half won.The decrease or lack of pain does not mean that the faulty movement patterns and muscle contraction properties that drive these movements has been corrected. So the risk of re-injury remains.
How can one maximise therapeutic gain from rehab sessions? Do you have examples to share? Maximum therapeutic gain is obtained when you can define exactly what is happening to the muscle in response to the intervention you are making. For example, I consistently use
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TMG100 during rehabilitation training to monitor for excessive local muscle fatigue. I’m a strong believer that local muscle fatigue in rehab training is detrimental to treatment success. When a muscle becomes overly fatigued, two things happen: ● people will adapt and compensate in that movement by activating other muscles thus motor learning of healthy movement is disturbed ● the fatigued muscle will destabilise the joint or muscle chain leading to acute pain. Acute pain leads to central pain inhibition which in itself changes muscle function by altering muscle tone and the level at which the muscle is activated. In essence, when someone has a muscle that becomes acutely fatigued and you continue to work that muscle, then there will not be any effect of the therapy, because the muscle and all systems connected to that muscle need to recover from the therapy itself. During therapy, I use TMG100 to look for signs of local muscle fatigue in specific muscles and simply stop that part of therapy when we have reached the acute muscle fatigue point. Usually, we would like for subjective signs of fatigue or the patient simply reports pain, in my opinion it is far too late at that point. I feel that the ability to monitor for local muscle fatigue with TMG100 has become the cornerstone of my therapeutic success.
Since you bring the TMG 100 to India, how are you planning to promote this technique in India? We have already established that there is interest for TMG100 tensiomyography in elite sports in India, predominantly in cricket. Several private and more innovative clinics and rehabilitation professionals have also expressed a keen interest in using the technology to offer their patients and clients something more. In Fit and Spa Solutions from Bangalore, we have found an ideal partner who understands our needs and sees the potential for TMG100 tensiomyography on the Indian market. They offer a range of products that is complementary to our device and we are confident they will be able to offer a comprehensive package for any clinic or individual who wants to stay on the state-of-the-art side in sports training, research and rehabilitation. In the next several months we have planned a series of workshops around India and have already established contacts with key opinion leaders who are keen to work with TMG100. raelene.kambli@expressindia.com NOVEMBER 2013
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‘There is still a lacuna of research in the area of diabetes in India’ M Neelam Kachhap talks to Dr Anoop Misra, Director, Diabetes and Metabolic Diseases, Diabetes Foundation (India) (DFI) to find out about new forms of diabetes and research in the area What is the density estimation of diabetics in India? In 2011, nearly 61.3 million people were suffering from diabetes in India and this figure is expected to reach 101.2 million by the year 2030. At present approximately 63 million people in the age range of 20-79 years are suffering from diabetes in India. However, with a majority of people still remaining undiagnosed, we still cannot comment on the exact figure of diabetes.
Tell us about diabetes due to genetic defects. The two most common forms of diabetes are Type 1 diabetes and type 2 diabetes. Both these are caused by genetic and environmental factors. In causation of these disorders, multiple genes are involved. However, there are other rare forms of diabetes that are directly related to defect in single gene. These include maturity onset diabetes in the young a (MODY) and diabetes due to mutations in mitochondrial DNA. Further, there are a couple of studies showing that certain genes increase the tendency to develop obesity. In our recent study we found that a particular type of gene (LMNA1908T/T) increases the tendency of obesity therefore people having this particular gene are at 5.6 times higher risk to become obese, further leading to diabetes.
Could you also tell us about cystic fibrosis-related diabetes, steroid diabetes induced by high doses of glucocorticoids, and several forms of monogenic diabetes. Cystic fibrosis (CF) is a lifethreatening genetic disorder that caus-
OVERALL INDIANS HAVE MORE ACCUMULATED FAT IN THEIR BODIES, FROM THE TIME OF BIRTH, NEARLY 1.5 TIMES MORE THAN WHITE RACE NOVEMBER 2013
es severe damage to the lungs and digestive system. It is an inherited condition affecting the cells that produce mucus, sweat and digestive juices. These secreted fluids are normally thin and slippery. But in cystic fibrosis, a defective gene causes the secretions to become thick and sticky. Instead of acting as a lubricant, the secretions plug up tubes, ducts and passageways, especially in the lungs and pancreas. Cystic fibrosis–related diabetes (CFRD) is the most common co-morbidity in people with cystic fibrosis (CF). It is primarily caused by insulin insufficiency, although fluctuating levels of insulin resistance related to acute and chronic illness also play a role. It is often clinically silent. In CF, the nutritional and pulmonary consequences of diabetes are of greater concern. CFRD is associated with weight loss, protein catabolism, lung function decline, and increased mortality, and thus regular screening is warranted. As per the guidelines of American Diabetes Association, CFRD should be managed by a multidisciplinary team of health professionals with expertise in CF and diabetes. Steroid diabetes (also known as steroid-induced diabetes) is a medical term referring to prolonged hyperglycaemia (high blood sugar levels) due to glucocorticoid (a steroid) therapy for another medical condition (e.g. severe asthma, organ transplantation, cystic fibrosis, inflammatory bowel disease, and chemotherapy for leukaemia or other cancers). The most common glucocorticoids which cause steroid diabetes are prednisolone and dexamethasone given systemically in ‘pharmacologic doses’ for days or weeks. Typical medical conditions in which steroid diabetes arises during high-dose glucocorticoid treatment include severe asthma, organ transplantation, cystic fibrosis, inflammatory bowel disease, and induction chemotherapy for leukaemia or other cancers. Monogenic diabetes: Monogenic diabetes is due to defect in a single gene. Different types of monogenic diabetes include neonatal diabetes and MODY (maturity onset diabetes of the young).
What is the incidence of the above forms of diabetes in India? There is still a lacuna of research in this area in India so far and more
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could be easily recognised and lend increased risk for development of diabetes. A ‘thrifty phenotype’ hypothesis emphasises on foetal under-nutrition leading to altered metabolic programming in adult life is an attractive hypothesis but still lacks firm evidence. ● Indian babies born small and with low birth weight had higher systolic blood pressure and adiposity at eight years of age. These data have prompted the concept that the syndrome X originates in mother’s womb and that at this time key metabolic activities may get modulated. Normal weight range in childhood are independent factors, or additive in causation of insulin resistance and the metabolic syndrome has not been investigated. ● Further, the role of micronutrient deficiencies during perinatal period (before birth) in development of chronic diseases later in life has been suggested.
What are the new concepts in Type 2 diabetes management?
studies are required to provide an accurate picture. Overall, combined together these would amount to less than three per cent of cases of diabetes.
Kindly explain thrifty genotype and the thrifty phenotype concept as applicable to diabetes. Overall Indians have more accumulated fat in their bodies, from the time of birth, nearly 1.5 times more than white race. This can be accumulated in many places, but when it gathers at the abdomen, this interferes with the body’s metabolism and becomes a health problem. As a rule, Indians tend to have greater waist circumference and also waist to hip ratios. Why Indians have higher body fat is not clear, however, it has been suggested that during centuries of famine, body has developed mechanism that enables energy to be stored in the form of fat (best storage form of energy) to be used at times of scarcity of food. Now that food is in excess, this accumulated fat has increased rapidly. We have also researched that this excess fat gets deposited in peculiar places in the body; nape of neck (akin to buffalo hump) and below chin (double chin). In fact these markers
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The dietary management of Type 2 diabetes has seen a new wave in the area of dietary management. Moving from the conventional dietary approach, a shift towards Mediterranean form of diet has been noticed [laying emphasis on fibre (coming from vegetables, fruits, whole grains and pulses) and monounsaturated fatty acids (coming from nuts and MUFA rich oils; olive, mustard, canola)]. Nearly 70 type of new drugs are being studies for diabetes, which are aimed at pathways other than those targeted by the conventional drugs (sulphonylureas, metformin); including kidneys, liver, cell inflammation, muscle energy pathways etc.
Are there any biologic drug in research for Type 1 diabetes? There are several researches going on in the field of diabetes, however, it is still too early to comment on these as they still have to successfully complete the trial phase.
What are the most important R&D projects involving diabetes in India? There are some new projects regarding drug development in India, but the overall contribution to diabetes drug development by India is minuscule. mneelam.kachhap@expressindia.com EXPRESS HEALTHCARE
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‘India has the lowest HAI rates in South Asia’ Hospital-acquired infections (HAI) infections are responsible for significant mortality and disability in patients, however, rarely does the infection rate gets revealed in the absence of a health policy mandating them to publish the same. Dr Victor D Rosenthal, Founder and Chairman of The International Nosocomial Infection Control Consortium (INICC) reveals more in an interview with Shalini Gupta Where does India rank globally and in the South Asian region when it comes to HAIs? India is one of the countries with the lowest HAI rates in the South Asian region.The known HAI rate of India is from the private sector, as an example for Central line-associated bloodstream infections (CLAB), it is around 5 CLAB per 1000 CL days; meanwhile in the US the CLAB rate is 1CLAB per 1000 CL days.The HAI rate from public sector is unknown and probably is three to four times higher than private sector.
What are the most common type of HAIs? Do they differ from region to region? The most common types of HAIs are bloodstream infection, pneumonia, urinary tract infection (UTI) and surgical site infections (SSI).There are no significant differences when comparing HAIs in different regions. Worldwide the most prevalent HAIs are the same as above. UTI and SSI are the most prevalent HAI of these four.
How much of HAIs can be attributed to antibiotic resistance? How grave an issue is it? HAI rate is not related to antibiotic resistance rather they are due to lack of compliance with infection control guidelines such as low compliance with hand hygiene, lack of antisepsis with chlorhexidine, use of femoral vascular central line, high use of three ways stop
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The new International Nosocomial Infection Control Consortium (INICC) online system was designed to keep the effective methodology it has been applying successfully since 1998 in 50 countries of Latin America, the Middle East, Asia, Africa, and Europe. INICC has published more than 300 scientific papers, book chapters, and collaborated with edition and review of bundles to prevent healthcare-associated infections (HAIs) of WHO, JCI, Argentina, Brazil, Peru, Colombia, Mexico, China,Taiwan, Hong Kong and many other countries and international organisations. INICC methods are responsible for the fast, effective and significant reduction of HAI and mortality rates worldwide, as documented, published, and expressed in papers published by different authors and organisation including WHO.The methods and definitions are those of CDC-NHSN (US), plus some extra advantages, such as validation, accuracy, identification of risk factors, measurement of extra mortality, extra length of stay and extra cost, measurement of compliance of bundles to prevent HAIs, and much more.
Physicians and hospital staff can decrease HAIs by applying a multidimensional approach which includesbundles, education, surveillance of HAIs, surveillance of compliance with guidelines, feedback of HAI rates, and performance feedback. Examples of measures that help preventing HAIs such as CLAB include hand hygiene, use of subclavian vein, maximal barriers, removing a catheter as soon as possible, skin antisepsis with chlorhexidine, chlorhexidine impregnated sponges, split septum, collapsible IV containers, single use pre-filled flushing device, and others. Other measures include: ● Adherence to hand-hygiene guidelines ● Use of noninvasive ventilation whenever possible ● Minimising the duration of ventilation ● Performing daily assessments of readiness to wean ● Maintaining patients in a semi-recum-
☛ Pneumonia ☛ Urinary tract infection ☛ Surgical site infections
bent position (30-45 elevation of the head of the bed) unless there are contraindications Avoiding gastric over-distention and unplanned extubation and reintubation Using a cuffed endotracheal tube with in-line or subglottic suctioning Maintaining an endotracheal cuff pressure of at least 20 cm H2O Orotracheal intubation is preferable to nasotracheal intubation Perform comprehensive oral care with an antiseptic solution Remove condensate from ventilatory circuits ad keeping the ventilatory circuit closed during condensate removal changing it only when visibly soiled or malfunctioning
Tell us about the surveillance tool by INICC.
How can physicians and hospital staff ensure a decrease in HAIs and what measures in particular need to be put in place? Where is India lagging?
☛ Bloodstream infection
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cock, etc. Antibiotics are responsible for higher bacterial resistance. HAI rates and bacterial resistance are independent and almost unrelated. Changing policies for antibiotics would reduce only bacterial resistance, but not CLAB rates, PNEU rates or UTI rates. Better antibiotic use could help only when used correctly for surgical prophylaxis.
Type of HAIs (Hospital-acquired infections)
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HAIS CAN BE REDUCED WITH A MULTIDIMENSIONAL APPROACH INCLUDING EDUCATION, SURVEILLANCE, COMPLIANCE WITH GUIDELINES, FEEDBACK OF HAI RATES AND PERFORMANCE www.expresshealthcare.in
What is the annual cost that HAIs incur to hospitals? The extra length of stay of each HAI is at least 10 days. In an ICU with 20 beds there are admitted around 100 patients per month. Around 1200 are admitted in ICU per year. Around 20 per cent acquire HAI representing 2400 extra bed days. If one bed day is $1000, in one year due to HAIs the annual cost incurred to hospitals is around $2,400,000. On the other hand there are surgical site infections that also are responsible for around $2,400,000 per year. Hence, at least half million dollars is the extra cost due to HAIs per hospital. shalini.g@expressindia.com NOVEMBER 2013
WEST INDIA UPDATE >>
Express Healthcare chronicles some of significant investments, trends, partnerships and initiatives undertaken in the Western region of India that have been instrumental in maintaining its position as a healthcare hub Healthspring strengthens business in Mumbai, plans countrywide expansion Kokilaben Dhirubhai Ambani Hospital launches liver transplant centre in Mumbai United Way of Mumbai and AmeriCares India organise street plays for hepatitis awareness Fortis Hospital Mulund launches Fortis Child Heart Mission Maharashtra govt in a PPP with GE Technology and Ensocare Indus Health Plus partners with Sterling Hospitals and Baroda Laparoscopy Hospital Piramal Enterprises's diagnostic division launches three instant diagnostic devices Nueclear Healthcare opens its first molecular imaging centre in Navi Mumbai
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>> The Western part of India offers lot of growth potential to big and mid-sized healthcare players. They set up centres in this area to accelerate growth and utlise the opportunities available 40
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Healthspring strengthens business in Mumbai, plans countrywide expansion The company has raised 22 crores through PE and plans to raise another Rs 50-60 crores in the next round ealthspring has established its foothold in Mumbai and has now announced the launch of four new centres at Powai, Vashi, Thane and Andheri, making a total number of seven centres across the city. Speaking about the company's financials, Kaushik Sen, CEO and Co-Founder, Healthspring informed that their centres based in Khar, Juhu and Kemp's Corner
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have achieved breakeven. The company has also strengthened its city wide 24x7 medical emergency response system with a helpline number, tied-up with ICICI Lombard to support ICICI's corporate insurance scheme and raised its second round of funding with Asian Healthcare Fund (AHF) recently investing Rs 22 crores for the company's expansion.
The company also plans to launch 10 additional centres across Mumbai by the end of this year and has set a target to branch out to other cities in India. It will be launching 200 centres across India in the next three years. It will also launch its community medical centres in cities like Delhi, Kolkata, Hyderabad, Bengaluru and Chennai by 2014. The company plans to
raise the next level of funding very soon in order to expand pan India. The company intends to raise additional Rs 50-60 crores from its existing investors that include Catamaran Ventures, Reliance Venture Asset Management and BlueCross BlueShield Venture Partners which would be utilised to expand its business across India. EH News Bureau
Kokilaben Dhirubhai Ambani Hospital launches liver transplant centre in Mumbai The centre’s equipped to treat the entire spectrum of liver disorders okilaben Dhirubhai Ambani Hospital launched a comprehensive centre for liver transplant which is equipped to treat the entire spectrum of liver disorders involving dedicated and full time specialist surgeons, physicians (haepatologists), anaesthetists, radiologists and intensivists etc. supported by dedicated operation theaters, ICUs and other high-tech infrastructure and equipment necessary for such
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complex procedures. The unit was launched by Dr Tehemton E Udwadia, eminent gastrointestinal surgeon, at the convention centre of the hospital. The team of doctors at this centre is headed by Dr Vinay Kumaran who has over a decade of experience involving over 700 liver transplants. Reportedly, the hospital is the first in Western India to be able to offer both living donor and deceased (cadav-
er) donor liver transplants for adults as well as children with end-stage liver disease. The unit also offers emergency liver transplants for patients with acute fulminant liver failure. Dr Vinay Kumaran, Head, HPB and Liver Transplant Surgery said, “The need for liver transplant in the Western India, including Mumbai, is estimated to be about 5000 - a demand almost impossible to meet through
cadaveric organ donation, emphasising the importance of the LDLT team.” “The centre of excellence for a comprehensive living donor liver transplant programme, being set up by Kokilaben Dhirubhai Ambani Hospital’s was the best way to meet the requirement of transplants for the suffering patients,” added Dr Kumaran. EH News Bureau
Total Dental Care to expand network, open 30 clinics this fiscal Plans Rs 15 crore investment for this expansion otal Dental Care, the operator of the MyDentist chain of clinics across Pune, has plans to expand its network and open 30 centres by the end of this fiscal. An investment worth Rs 15 crores is being intended to achieve this expansion. Vikram Vora, CEO, Total
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Dental Care informs, "We plan to have a total of 110 clinics, including those in Mumbai and Pune." "There is potential in tier-II cities, such as Nasik and Aurangabad, as well, but the numbers will be smaller there," said Vora. The company formed in 2009 had also raised www.expresshealthcare.in
funding worth Rs 50 crores from the Asian Healthcare Fund and Seedfund in April. Total Dental Care, incubated by Seedfund, provides medical treatments in dental care. Its services range from basic dental treatment like cleaning and polishing, to complex dental implants
worth lakhs of rupees. The company, is targetting a revenue of Rs 50 crores by March 2014. MyDentist, a large dental chain in India had recently opened their 50th dental clinic in Kharghar. EH News Bureau
NOVEMBER 2013
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INITIATIVES
United Way of Mumbai and AmeriCares India organise street plays for hepatitis awareness
>> Western India has always been in the forefront when it comes to providing quality healthcare. Several initiatives are underaken by players to improve healthcare access in the region NOVEMBER 2013
With support from the Bristol Myers Squibb Foundation, many more community-based awareness activities have been planned across Mumbai nited Way of Mumbai and AmeriCares India Foundation came forward to educate and spread awareness about hepatitis among the citizens of Mumbai. Street plays were organised by these NGOs on August 1, 2013 at Worli and Wadala. On August 2, they were organised at Malad, Jogeshwari, Andheri, Churchgate and CST. This community-based
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awareness programme is a part of project PAHAL being implemented by United Way of Mumbai, AmeriCares India Foundation and National Liver Foundation with support from the Bristol Myers Squibb Foundation. It has been carried out with the Green Ribbon Brigadiers, a group of student volunteers from well known city colleges Sydenham College and Jai
Hind College. The street plays were about the need to address the lack of awareness among the people despite more than 100,000 people dying in India due to the disease. They also aimed to educate about the ‘silent’ nature of the disease and how important it is for people to address the disease facts in the right manner. Hepatitis B and C togeth-
er affect 500 million and approximately kill one million people every year. These are indicative of insufficient awareness among people about the disease. Through such initiatives these NGOs are trying to spread awareness among the people with a goal to help them make better decisions regarding their health. EH News Bureau
Fortis Hospital Mulund launch Fortis Child Heart Mission
AHI organises free health check up camp for Mumbai Police
Introduces extensive outreach program for mothers and babies to make congenital heart defect surgery affordable in rural and semi-rural areas of Maharashtra
Over 200 Mumbai police get their health checked at the free health check up camp which included tests for blood sugar, ECG, BMI and other vital health parameters
ortis Hospital, Mulund has launched ‘Fortis Child Heart Mission’ to provide heart surgeries and treatment at an affordable cost. The programme will provide treatment and also focus on educating pregnant mothers through education campaigns and health checkup camps across the state. To start with, health camps will be conducted in Nagpur, Nashik, Aurangabad, Kolhapur and Alibaug and in several smaller towns where medical facilities is out of reach. Dr Vijay Agarwal, Chief Pediatric Cardiac surgeon, Fortis Hospital, Mulund said, “Our mission is to help ailing children and their families who cannot afford such expensive heart surgeries with the aim that no child goes untreated due to the lack of funds.” Varun Khanna, Regional Director – (West & East) Fortis Healthcare said, “An average cost of a heart surgery ranges from Rs 1, 50,000 to Rs 3,
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00,000. We have decided to operate these children and many more at a highly subsidised cost. Launch of Child Heart Mission will help all those kids, who are awaiting for surgery due to unavailability of funds.” Dr S Narayani, Facility Director, Fortis Hospital Mulund says “At Fortis we want to do our bit to help the society by helping the needy. This program is a step in the direction and we hope to reach out to many more children and ensure their speedy treatment.” Being Human – The Salman Khan Foundation is partnering with Fortis Mulund in this initiative. Alvira Agnihotri, Trustee, Being Human: The Salman Khan Foundation said, “We are happy to partner with Fortis Hospital Mulund on the “Child Heart Mission” initiative so that children with heart problems get the best possible care.” EH News Bureau www.expresshealthcare.in
sian Heart Institute (AHI), a leading hospital in cardiac care organised a free cardiac health check-up camp for Mumbai police at BandraKurla Complex (BKC) police station recently. The medical camp was reportedly a huge hit as over 200 policemen including police officers and male and female constables from seven police stations in zone 8 got their health checkup done. “We often forget to thank people who do so much for us, as a part of their duty. This is Asian Heart's way of saying
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OVER A PERIOD OF TIME THE CAMP INTENDED TO COVER OVER 1000 POLICE PERSONNEL
thank you," said Dr Ramakanta Panda, VC and Cardio-Vascular Thoracic Surgeon, AHI. Doctors checked these policemen and women for blood sugar, ECG, body mass index (BMI) and other such essential tests to evaluate their vital health parameters. Police personnel were then given consultation by doctors and dietician. Over a period of time the camp intended to cover over 1000 police personnel. “All police officers work at least 14 hours a day and many of them show little concern about their health. We are delighted with this initiative taken by Asian Heart Institute providing us with a free health check up camp. These kinds of camps help us monitor our health issues and also take positive steps in maintaining sound health,” said Chandrakant Bhosle, Sr Police Inspector, BKC police station. EH News Bureau EXPRESS HEALTHCARE
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Maharashtra govt in a PPP with GE Technology and Ensocare 22 district hospitals to be equipped with advanced diagnostic imaging facilities aharashtra has entered into a PPP with General Electric (GE), and Ensocare in which GE will act as the technology partner and Ensocare as the operating partner aims at bringing technology at an affordable price point for the people of the state. GE has invested around Rs 150 crores in this project. According to the Government, this PPP agreement is the largest in
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terms of scale and includes the installation of four units of 64 slice CT scanners, 13 units of advance 16 slice CT scanners, eight units of cutting edge 1.5T Magnetic Resonance Imaging Systems, 22 high end digital radiography systems, 39 colour Doppler’s and 39 analog X-ray units. These will be installed at 22 district hospitals so far. These imaging systems will reportedly allow the district hospitals to provide early
and accurate diagnosis on a 24/7 basis in clinical speciality areas. It will provide services at government recommended rate cards for the benefit of a broader population. Orange and Yellow ‘Below Poverty Line’ (BPL) card holders will be entitled to receive free diagnostic services under the Rajiv Gandhi Jeevandayee Arogya Yojana (RGJAY) scheme at all 22 facilities which are expected to be operational within a year.
This tri-party partnership if made successful will benefit many people within Maharashtra, especially those living below the poverty line. The partnership will provide services at a cost which will be almost 50 per cent less of the market price, informed a GE resource. Further in the pipeline is a major project for emergency services within the state. EH News Bureau
GIFT City to set up world class hospital Hinduja Hospital, Sterling, Medanta, others have evinced interes ujarat International Finance Tec-City (GIFT City), has initiated the process for setting up a world class hospital as a part of the social infrastructure to be put in place in the first phase of the project. For this hospital project, GIFT has invited bids from national as well as international players and the project will be awarded to the winning bidder by the end of this month. In response to the tender
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floated by the company, hospitals such as Hinduja Hospital, Sterling Hospital, Faith Healthcare, Columbia Asia, Medanta and other chains have shown interest for development of Hospital in GIFT City. Request for Proposal (RFP) was issued for development of minimum 200 beds state-of-the-art Hospital in GIFT City in July 2013. Explaining the project’s focus on providing health-
care in the first phase, Ramakant Jha, Managing Director, GIFT City informed that the ultra-modern hospital with design to meet international standards will be equipped to provide full range of in-patient and outpatient services. “Being a social facility, allotment of development rights for the hospital in GIFT City will be made at Rs 250 per square feet of BUA. GIFT City has earmarked a maxi-
mum of up to 50,000 sq m of Built up Area (BUA) for this hospital,” GIFT City when fully developed will generate 5 lakh direct and equal numbers of indirect jobs. GIFT City is expected to generate five lakh direct and equal numbers of indirect jobs. The healthcare sector in Gujarat is all set to grow multi-fold and become one of the biggest employment generators. EH News Bureau
>> Several significant partnerships are being made which would lead to further progress in the healthcare sector of the Western region of India
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Indus Health Plus partners with Sterling Hospitals and Baroda Laparoscopy Hospital The partnership is to offer affordable preventive healthcare packages, its expected to strengthen’s Indus Health Plus’ foothold in the state of Gujarat ndus Health Plus recently announced its partneship with Sterling Hospitals and Baroda Laparoscopy Hospital in Ahmedabad and Vadodara to offer affordable preventive healthcare packages to a wider customer base in Gujarat. The key packages on offer include EsCP (Fitness check-up), EHC (Health Check-Up Package), ECP (Essential Heart Check-up), New ECHC (New Exclusive and Comprehensive Health Check-Up Package) and
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Health Friend (Loyalty Card) among others. The tie-up is expected to help Indus Health Plus deliver high quality and timely services at both, Sterling Hospital, a multi-specialty tertiary care and The Baroda Laparoscopy Hospital. Amol Naikawadi, Joint MD, Indus Health Plus said, “Our partnership with Sterling Hospitals and Baroda Laparoscopy Hospital will only enhance our ability to provide greater value to our customers by offering a range www.expresshealthcare.in
of preventive healthcare solutions. The new alliance will help in extending our outreach and creating greater awareness and participation in the two key cities of Ahmedabad and Vadodara.” “With a growing need for preventive healthcare in India in today’s day and age, we continue with our efforts to provide accessible, available and affordable health check-ups to a wider base. Indus Health Plus is actively exploring such mutually
beneficial partnerships in order to achieve this goal.” Naikawadi added. With its existing presence in several areas across Gujarat, like the Sahayadari Hospital, Apollo Hospital, and Adit Hospital, Indus Health Plus’ recent alliance with Sterling Hospitals and Baroda Laparoscopy Hospital will help to further strengthen its foothold in Gujarat for its exclusively designed preventive health packages. EH News Bureau NOVEMBER 2013
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Piramal Enterprises's diagnostic division launches three instant diagnostic devices The QDx range of devices ensure diagnosis “Right-Here-Right-Now” iramal Enterprises’ diagnostic division has launched three new innovative devices in the QDX Range Right-here-Right-now; (a) QDx A1c - voice guided diagnostic device which measures HbA1c, (b) QDx HemoStat, to detect the level of haemoglobin and (c) QDx VitD, a device to detect Vitamin D QDx A1c reportedly measures HbA1c in less than three minutes and claims to be a reliable diabetes detection marker. The other device, QDx HemoStat is a hand-held
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>> Healthcare players consider Western India an ideal location to introduce their new products, innovative strategies and try out new trends
NOVEMBER 2013
device to quantify the levels of haemoglobin and hematocrit in blood using electrochemical biosensor technology. It is used for patients undergoing chemotherapy, dialysis etc. The main USP of the product is its strip technology which has a big grip and is more hygienic than its counter parts, claims a company release.Lastly, QDx VitD, is a whole blood Vitamin D diagnostic device that detects if a person is Vitamin D deficient. Commenting on the launch of
these three products, Vijay Shah, Executive Director and COO, Piramal Enterprises said, “The recent launch of QDx A1c, QDx HemoStat and QDx VitD is in line with our division’s vision of bringing affordable instant diagnostic solution through our point-ofcare product range. These devices are the first-of-its-kind revolutionary instant diagnostic devices in the Indian market that are poised to change traditional diagnostic methods to instant diagnosis.” The three QDx devices are
portable and affordable, delivering quantitative test results with lab accuracy, claims the company. The devices can reportedly be operated very easily with minimal training requirements. The soft launch for all three products is scheduled in July and followed by three months of test marketing phase. The launch of these products is aligned to the diagnostic division’s strategy to widen the “Point-OfCare” portfolio. EH News Bureau
Nueclear Healthcare opens its first molecular imaging centre in Navi Mumbai GE Healthcare, as technology partner, will be associated with the venture which aims to establish 120 affordable molecular imaging centres around the country ueclear Healthcare, in association with GE Healthcare as technology partner, announced the opening of its first molecular imaging centre for early, affordable cancer detection in Navi Mumbai. NHL is establishing a mega network of 120 molecular imaging centres around the country by 2015 with GE Healthcare as its technology partner. The hub and spoke model is expected to help scale up affordable access to advanced molecular imaging
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technologies such as PET/CT required early detection of cancer. NHL proposes to offer PET/CT imaging at just Rs10,000/compared to approximately Rs.18000- 25000 patients pay today for same services. John Dineen, President & CEO, GE Healthcare said “By partnering with Nueclear Healthcare, together we can be at work for a healthier India by providing access to advanced affordable early cancer detection technologies to more people of
India.” The NHL network of molecular imaging centres will have 12 medical cyclotrons that produce biomarkers required for cancer imaging and 120 GE Discovery PET/CT imaging scanners. While the first centre has opened at Navi Mumbai, five more centres is expected to be commissioned in 2013. GE Discovery PET/CT systems installed at the centre will supposedly help doctors determine whether a suspicious growth
is cancerous or benign in a single exam. Previously, doctors had to put patients through two separate scans to get similar information – with limited success. Cost has been one of the biggest barriers in advancing early cancer detection. We have removed the barrier of cost by reducing the cost to patient by half,” said Dr A Velumani, Founder & Managing Director of Nueclear Healthcare. EH News Bureau
DJO Global’s news range of non-surgical ortho rehabilitation products in Mumbai It has ten brands under its umbrella, which will be launched in India over the next five years S-based DJO Globa,l owned by the Black Stone Group, recently launched a range of non-surgical orthopaedic rehabilitation products in Mumbai. DJO Global India was incorporated in February, 2013 with the company head quarters in Chennai.
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Though DJO Global had a presence in India through a distribution network, DJO Global India enters India with direct operations now. Stephen Murphy, Executive VP, Sales and Marketing, International Commercial Business said, “We have over 1,000 www.expresshealthcare.in
medical devices that can help people throughout the entire continuum of care, from injury prevention to rehabilitation.” DJO Global International has ten brands under its umbrella, which will be launched in India in a phased manner over the next five
years. Among the several branded products, starting with Donjoy, Aircast, Chattanooga, Empi and Fast Freeze, DJO will also launch DJO surgical, orthopaedic hip, knee and shoulder implants, by the end of 2013. EH News Bureau EXPRESS HEALTHCARE
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‘We will continue to make investments across people, technology and clinical talent’ Varun Khanna, Regional Director – West and East, Fortis Healthcare, speaks to Express Healthcare about Fortis’s growth in the Western region of India and its future plans for elevating the standards of healthcare delivery in this area How has 2013 been for Fortis Mumbai? Fortis has presence in Mumbai through four facilities — Fortis Mulund, Fortis Kalyan, SL Raheja (A Fortis Associate) Hospital and Fortis Vashi. The western region is an important revenue contributor for Fortis and we continue to grow and strengthen our presence in this region.The exceptional work being done by the hospital has won the trust of millions of patients. We have been recognised for several contributions in elevating the standards of healthcare delivery. Fortis Mulund won the FICCI Award for Operational Excellence for two consecutive years, in 2013 and 2012. It also received the National Award for Energy Conservation.
What have been the most notable initiatives taken this year? There were several initiatives taken this year such as: ● We launched a new cardiac centre in Fortis in Kalyan, taking specialised cardiac care to the suburban areas of Mumbai, including Dombivali, Badlapur and Bhivandi. ● Very recently, for World Heart Day, we created an anthem ‘Mumbai Ki Dhadkan,’ and dedicated it to the spirit of the Mumbai to help create awareness and tackle heart disease among Mumbaikars. ● Significant work, both in terms of physical infrastructure as well as equipment has been undertaken at Fortis Mulund. An enhanced endoscopy unit, with in-house project management, was made operational recently. ● Fortis SL Raheja Hospital added several new facilities, including a 16-bed state-of-the-art intensive care unit, cardiac operation theatres and emergency rooms.The Department of Accident and Emergency Medicine at the hospital was inaugurated in March, 2013.The department offers advanced treatment, protocol-driven evaluation and uninterrupted management to rapidly stabilise and treat patients.The hospital also launched a new treatment, Platelet Rich Plasma (PRP) Therapy, for diabetic foot ulcers. Another new treatment, Autologous Stem Cell Therapy, was launched to treat Critical Limb Ischemia (CLI), a condition where the arteries of the lower extremities are blocked. ● Several new programmes including interventional neuroradiology, neurology and neurosurgery, and a laparo-
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INTERVIEW
We will continue to make investments across people, technology and clinical talent that will help us to stay ahead of the curve and continue to define new benchmarks in healthcare delivery.
scopic surgery programme were also launched. A sleep lab to diagnose sleep-related problems also became operational.The hospital pioneered the treatment of breast cancer with conservative breast surgery and intraoperative radio therapy (IORT). IORT is a novel technique that delivers a single high dose of radiation to the cancer-affected area.
What are the areas that need more focus to improve healthcare delivery in the Western region? What is Fortis, as a major healthcare player, doing to fill the gaps?
What are some of the CRS initiatives that the hospital has undertaken? As a responsible corporate citizen, we have also been actively promoting healthy living initiatives. In order to make adults more responsible and accountable towards their health and well-being, the four Fortis hospitals in Mumbai joined a programme spearheaded by the Fortis Foundation, Fortis’s philanthropic arm, to spread awareness of the ill-effects of tobacco, thereby drafting young foot soldiers in creating a 'tobacco-free, healthy society.' This campaign created a new Guinness World Record by collecting over 100,000 personalised greeting cards with anti-tobacco messages. A large mosaic wall of greeting cards was set up for this campaign and over 100 schools across Mumbai were involved in this initiative. Oncologists from Fortis hospitals and principals of the participating schools volunteered as the campaign ambassadors. Fortis Hospital Vashi, too, created a Guinness World Record by screening over 751 women in eight hours as part of a cervical cancer screening campaign, beating the earlier record held by Kaiser Permanente, San Diego (United States). Fortis Mulund has distinguished itself as a centre of clinical excellence. A significant number of renal transplants have been performed in the last year. Several live surgical workshops on neurology, oncology and gynaecology are conducted on an ongoing basis and an impressive array of national and international faculties participate in these sessions. A workshop on 'Advances in Critical Care' was also conducted. We have been strongly focusing on building a strong connect with the community. Prevention, as we all know, is better than cure. Fortis intends to continue to focus on spreading awareness, especially among children. For example, the 'Clean Hands to Save Life' project helped us engage with more than a lakh children to teach them the six steps to a healthy hand wash. We intend to continue with these initiatives in the future.
Any expansion plans in the offing? If yes, what kind of investment are you looking at?
What kind of success has Fortis enjoyed in the Western region vis-a-vis other regions of the country? The Western region is an important revenue contributor for Fortis and we will continue to grow and strengthen our presence in this region.
What are some of the rare clinical cases done at your Mumbai hospitals? Our team of clinical experts and doctors continue to perform rare surgeries and procedures to save the lives of many. Fortis Hospital Kalyan recently performed a successful ‘Awake Brain’ tumour removal surgery on 24year-old Jayesh Rathod, giving him a new lease of life by a team led by Dr Sunil Kutty, Neurosurgeon at Fortis. Complicated heart and cancer surgery was done simultaneously on a 76-year-old- atient at Fortis Mulund by an expert team of Dr Nilesh Maru, Cardiac surgeon and Dr SK Mathur, GI surgeon, Dr Zakia Khan, Interventional Cardiologist. A baby girl born through the IVF technique had all internal organs placed in opposite side of where they should, a condition called situs inversus. Such a complicated patient case was treated successfully by Dr Nikita Lad, gynaecologist with her team at SL Raheja Hospital. An young Iraqi female patient suffering from congenital birth defect of hip dislocation who was untreated for almost 32 years was treated successfully at Fortis Hospital Mulund by Dr Sachin Bhonsle, orthopaedic surgeon.
What projects and initiatives are underway or are planned for this region in the coming years? We have several new initiatives in the pipeline. Some of these include an Obesity Clinic , Bone Marrow Transplant Centre & Heart Failure Clinic by Fortis Hospital in Mulund.
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In the Western region, healthcare delivery can benefit from a more holistic focus. As a leading player in this field, Fortis is working on improving the service delivery, quality and quantity of communication to the patient; and in benchmarking ourselves against the globally accepted parameters. It is important for healthcare providers to move away from the traditional delivery model which started at the first point of contact and ended at discharge; and step into the arena of making the process as ‘end-to-end’ as possible, including the ease of accessibility to patients. Fortis strives to bring the first point of contact as close to “when the first need was felt by the patient” as possible; and this is the primary reason why our awareness campaigns are focused on preventive and monitoring activities. Healthcare players should look beyond the obvious and try to be 'partners in health' in addition to being 'caretakers during sickness'. Fortis aspires to raise the bar in service delivery through this shift and we believe that this will be an important factor to change the landscape in the longer run.
What are the opportunities and challenges that are peculiar to this region? How has Fortis tackled them for growth? Paediatric cardiac care is a weak link for the region. Fortis is among the few healthcare players that have a credible paediatric care facility to address this need.
Three recommendations to take healthcare in the Western region to the next level? Improving service delivery through a multi-pronged approach (including harnessing advanced monitoring tools for patient conditions, improvement of nursing skill sets), improving the quality and quantity of communication to patients; and benchmarking ourselves against the globally accepted parameters to measure quality in healthcare delivery are some of the initiatives that can take healthcare to the next level. lakshmipriya.nair@expressindia.com NOVEMBER 2013
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Alliance Hospital focuses on its diagnostics services The hospital has 30000 sq ft built up area with a capacity of 64 beds lliance Hospital is a venture of Jivdani Hospitals. This multispeciality hospital has been established nine years back at Nallasopara East. The hospital has various facilities like ICU, NICU, Radiology, Opthomology etc. with well equipped operation theatres and pharmacy shop. It has 30000 sq ft built up area with capacity of 64 beds. The medical team of the hospital consist of highly qualified doctors, consultants and surgeons who are well supported by skilled and qualified medical staff. The hospital has three shifts with facility of OPD, IPD and casualty department. The hospital provides medical care to the community at an affordable price with emphasis on quality. The major TPA’s and insurance companies have been attached to the hospital and it provides mediclaim facilities.
pital has added two more dialysis machines at their centre. Hence, the total strength of their dialysis unit has now come to seven beds.
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Dr. Sunil Joshi CEO, Alliance Hospital
NOVEMBER 2013
Strategies and plans
Recent activity Instead of increasing bed strength this year the hospital concentrated on increasing diagnostic services as it plays a vital role in medical management. Therefore, it has started in-house CT Scan services. At the same time, The hospital has upgraded
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its pathology services by collaborating with a multinational company (MDI Laboratories). As a result of this, now the hospital can get the routine as well as specialised test done under one roof in less turnaround time. Seeing the inconvenience of the dialysis patients the hos-
The hospital is now concentrating on increasing the strength of their diagnostic services. Hence there are plans to start MRI services at their centre. At the same time they are already in the process to start digital X-ray services. The hospital management is also planning to extend services in faculties like critical care and urology. In order to make the quality medical services available to maximum people they have started the process of empanelment with various Scheme like ESIC, Rajiv Gandhi Yojna. Since the aim is to provide quality medical care to the people the hospital aims to upgrade their medical facilities in future.
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RADIOLOGY HIGHLIGHTS
Siemens presents new Somatom Perspective CT scanner models Product family extended to include 16- and 32-slice configurations, flexible upgrades up to 128 slices for all systems
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Siemens Healthcare will present its two new 16- and 32-slice configurations at this year’s JFR French radiology convention (Journées Françaises de Radiologie) in Paris. These new models make numerous high-end technologies available to a broader clientele for the first time with an additional option to upgrade the systems later to the estab-
lished 64- and 128-slice configurations. For all four configurations, Siemens now offers the eCockpit technology package, which reportedly makes the Somatom Perspective not only easier and more cost-efficient to use, but also lengthens the systems’ service life. The eMode function, for example, helps reduce equipment downtime by more than 20 per cent. With the Somatom Perspective, Siemens Healthcare expands its product range in the lower and medium-priced segments. The two additional configurations will allow customers to tailor a CT system individually to fit their particular clinical needs. For example, the 16-slice configuration is suitable for routine scans but is also useful in pain
therapy to ensure that analgesics are delivered to the right place during surgery. The 32-slice configuration provides more detailed imaging for bone fractures, examinations of the inner ear, or vascular applications; whereas the 64-slice scanner boasts of fast image acquisition. The 128-slice configuration is especially suitable for diagnostics in cardiology and paediatrics. The Somatom Perspective can expand the range of scan types at a clinic or surgery at a later time. The two new models can be upgraded to 64- or 128-slice configurations whenever desired. Technologies such as Sinogram Affirmed Iterative Reconstruction (Safire) will also be available in the segment of 16- and 32-slice CT
scanners. All four models will include the eCockpit technology package, which adds two new features to the established eMode function and further reduces the costs of operating a CT scanner. If users have a Siemens Service Agreement and use eMode for more than 80 per cent of their CT scans, they will receive additional service advantages. For example, customers in Germany are given a discount of up to 10 per cent on service costs. If their Somatom Perspective is ever out of use, users in France and Australia will be reimbursed a fixed amount per missed scan. The new Somatom Perspective configurations are available from May 2014. EH News Bureau
MMC and Dept of Health meet for guidelines on disposal of sonography machines Strategy would comply with PCPNDT Act
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aharashtra Medical Council (MMC) representatives, members of Indian Medical Association (IMA) and Department of Health and Family Welfare, representatives of radiology associations and obstetrics and gynaecology societies have come together to work on guidelines for
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safe and effective disposal of used or defunct sonography machines which will comply with the PCPNDT Act. Dr Kishor Taori, MMC Chairman explained that as per the PCPNDT Act the users of sonography machines should submit a monthly report to local authorities giving details like number of tests and type of tests etc done on the machine on day-to-day
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basis. Even in the case of defunct machines, it is necessary to inform that zero tests were performed on the machine or else the doctor/s can be taken to task over it. The meeting deliberated on ways and means to dispose defunct machines and one of the suggestions put forth were sale of these machines to registered scrap dealers. The authorities are also looking at
a method by which each machine sold will have a unique identification (UID) which can later be transferred to the person who buys the machine. A new strategy is likely to be formed after deliberating on the suggestions and recommendations put forth during the meeting, informed Dr Taori. EH News Bureau
NOVEMBER 2013
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GE Healthcare introduces 'Silent Scan' technology for MRIs It is a software designed in India to remove excessive noise from MR scanning E Healthcare has introduced Silent Scan, a technology designed to address excessive acoustic noise generated during an MR scan. Conventional MR scanners can generate noise in excess of 110 decibels levels, roughly equivalent to rock concerts. GE’s exclusive Silent Scan technology is reportedly designed to reduce MR scanner noise to near ambient sound levels and thus can improve a patient’s MR exam experience. “Silent Scan is a huge breakthrough for the MR industry and for patients around the world,” said Dr Richard Hausmann, President and CEO, GE
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Healthcare MR. “Excessive acoustic noise is a major cause of patient discomfort during MR scans and GE is addressing that with Silent Scan, a new MR advanced application and a major innovation in the healthcare industry. GE is very serious about Humanizing MR and making its MR systems patientfriendly, safe, and without compromise,” he added. Noise is one of the major complaints from patients who undergo a MRI exam. Historically, medical manufacturers have addressed the noise issue by muffling it using a combination of acoustic dampening material or performance degradation to reduce the noise level. Two years ago, GE engineers initiated their quest to reduce noise during an MRI scan. They developed a software -
a new type of 3D MR acquisition, in combination with proprietary high-fidelity gradient and RF system electronics, and the noise is not merely dampened, it is virtually eliminated at the source. “We have over 200 engineers and scientists in India dedicated for developing MR technologies, both software
and hardware, working together with our engineering team in the US. We developed this new, novel approach of reducing the noise of MRI from a hammering sound to a mere whisper,” said Dr Karthik Kuppusamy, Director, MRI, GE Healthcare South Asia. “Over 50 per cent of all soft-
ware for GE Healthcare equipment from around the world is developed in India,” he added. Silent Scan is available on new as well as existing Discovery MR750w with GEM and Optima MR450w with GEM systems. EH News Bureau
Pie Medical Imaging Solutions in Coming soon: INUMAC, world's most powerful collaboration with Cardiovascular MRI scanner Research Foundation The scanner is apparently capable of lifting a 60 metric tonne battle tank
CRF Clinical Trials Center to use PMI’s solutions in their clinical research and multi-centre trials as well as support development of PMI's products for analysis and visualisation of medical images
NOVEMBER 2013
ie Medical Imaging (PMI) has signed an agreement with the Cardiovascular Research Foundation (CRF) under which the CRF Clinical Trials Center will use PMI’s solutions in their Angiographic Core Laboratory for clinical research and multi-centre trials. As part of the agreement, CRF will also support further development of PMI’s new products for analysis and visualisation of medical images. The CRF Clinical Trials Center (CTC) plans and executes clinical investigations from first-in-man studies to large, multicentre, international trials and provides expert, independent qualitative and quantitative analyses of clinical and imaging data. “We selected PMI for its well renowned software solu-
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tions for clinical trials and research in the areas of interventional cardiology, endovascular medicine and structural heart disease, as well as their ongoing and groundbreaking developments in the field of cardiovascular imaging solutions,” said Philippe Genereux, MD, Director of Angiographic Core Laboratory at the CRF Clinical Trials Center. “PMI is pleased to work with CRF, a highly recognised international research and educational institution. Our collaboration with CRF gives PMI the opportunity to leverage CRF’s knowledge to further enhance our products and in ongoing development of new state-of-the-art solutions,” said Boudewijn Verstraelen, CEO at PMI. EH News Bureau www.expresshealthcare.in
maging of Neuro disease Using high-field MR And Contrastophores (INUMAC), a scanner being built by the University of Freiburg, is being touted as the most powerful MRI scanner in the world which would reportedly enable scientists to check the human body with a far greater degree of detail than ever before. The scanner is apparently endowed with a supercon-
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INUMAC WILL HELP CHECK THE HUMAN BODY WITH A FAR GREATER DEGREE OF DETAIL THAN EVER BEFORE
ducting electromagnet that can produce a field of 11.75 Teslas and provide unprecedented images of the human brain. The standard MRIs produce 1.5 or 3 Teslas. Pierre Vedrine, Director of the project at the French Alternative Energies and Atomic Energy Commission, in Paris informs that INUMAC can image an area of about 0.1 mm, or 1000 neurons, and see changes occurring as fast as one-tenth of a second. Its other unique feature comprises a capability to generate electromagnetic fields strong enough to lift 60 metric tonnes. The MRI scanner has been under development since 2006 and is nearing completion. It will reportedly cost about $ 270 million. EH News Bureau EXPRESS HEALTHCARE
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We have two centres in Mumbai and looking to set up a few more centres. I would like to know how to go Q ahead what is the viability of our project?
Q What kind of flooring is preferable in hospitals? Dr P Shrivastava, MP
Dr Sonam, Mumbai
For any centre to start with, first you have to go ahead with the market, financial and location feasibility survey A which will help you to find out the proper location according to
A functional design can promote skill, economy, convenience and comfort,a non-functional design can A impede activities of all types, detract from the quality of
your project viability. If you want maximum outcome and durability for your project, consult any of the consultancy groups who will help you out with the market, financial and location feasibility survey.
care and raise costs to intolerable levels.The purpose of a floor is to provide horizontal clean surface,which is strong enough to bear super-imposed loads. The strength of the floor depends on the type of flooring used. Flooring can be broadly classified in to two categories, such as: a. Hard flooring includes substances like, cement/concrete, terrazzo, marble, brick, ceramic tiles, Kota stone, and wood. b. In addition to these there are some special types of flooring such as linoleum, rubber the false flooring, PVC or Vinyl flooring. Generally hospital flooring varies department vise, like: 1. OPD--Marble/Kotah Stone Vitrified/Ceramic 2. ICU--Vinyl (anti- bacterial) Joints, thermo-sealed self leveling epoxy 3. OTSelf--levelling jointless epoxy/Vinyl (anti-bacterial) static dissipative, joints. Thermo sealed 4. LaboratorySelf--levelling jointless epoxy/Vinyl (antibacterial) joints, thermo sealed/vitrified jointless 5. Day CareVinyl-- (anti-bacterial) joints thermo sealed/Self levelled
We are coming up with a 200-bed multi-specialty hospital. We are in a fix on the number of equipment Q to be placed in the hospital.
TARUN KATIYAR Principal Consultant, Hospaccx India Systems
Express Healthcare's interactive FAQ section titled – ‘Ask A Question’ addresses reader queries related to hospital planning and management. Industry expert Tarun Katiyar, Principal Consultant, Hospaccx India Systems, through his sound knowledge and experience, shares his insights and provide practical solutions to questions directed by Express Healthcare readers
Dr Sonawane, Pune
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A hospital is a healthcare institution providing patient treatment by specialised staff and equipment. Proper planning and implementation of equipment is one of the most important part of any hospital. According to the requirement of hospital and expected number of patients, equipment planning should be done. You should always concentrate on the quality, purchasing and proper implementation of equipment to enhance the quality of patient care.
Q Is Hospital Information System (HIS) really required? Elizabeth, Hyderabad
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Most professionally run hospitals and clinics now rely on HIS. It helps to manage all medical and administrative information. An effective HIS also delivers benefits such as: ● Enhances information integrity ● Reduces transcription errors ● Reduces duplication of information entries ● Optimises report turnaround times These computers are programmed to collect, process, and retrieve patient care and administrative information ensuring better quality and delivery of service. If the hospital authorities have more relevant information they can make better decisions. I am planning a 500-bed hospital. How can I do planning for my hospital? Q manpower Dr Saxena, Bhopal
Workforce planning is a systemic process to ensure that an organisation has the right talent at the right location in A order to enable innovation and cost optimisation. An effective workforce plan should: ● Align to business strategy ● Identify the changing needs of workforce in the near future, potential gaps, innovation and cost. ● Depends on the area and what kind of departments available in your hospital. ● Consider processes and changes that will impact the ability to attract and retain key talent. For planning and proper implementation of manpower planning you can go for consultancy firms. It saves your time, energy, cost and will give you accurate result.
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are the approximate nursing staff requirements hospital? Q inWhata teaching Dr Sanket, Ranchi
If we consider an approximately 150-bedded teaching hospital, then as per the recommendations by the A Nursing Council, the approximate staff requirements would be as follows: Nursing superintendent: 1 Deputy nursing superintendent: 1 Asst Nursing g superintendent: 2 Wards Medical ward Surgical ward Orthopaedic ward Paediatric ward Gynaecology ward Maternity ward
Staff nurses 1:3 1:3 1:3 1:3 1:3 1:3
Sisters 1:25 1:25 1:25 1:25 1:25 1:25
(including newborn care)
Intensive care unit Coronary care unit Special wards Operation Theatre Casualty & emergency unit
1:1
1 departmental sister or ANS for 3-4 units 1:1 1 departmental sister or ANS for 3-4 units 1:1 1 departmental sister or ANS for 3-4 units 3 for 24 hrs/ 1 departmental sister or tableANS for 4-5 OT 2-3 1departmental sister or staff nurse ANS for Casualty/EU as per no of beds/shift
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W H AT ’ S INSIDE
EHR penetration is growing at 13.5 per cent PG 50
IT@HEALTHCARE Healthcare IT VC funding totals $737 million in Q3 2013 M&A in healthcare IT totalled $1.1 billion, according to Mercom Capital Group’s report
NOVEMBER 2013
$65 million from undisclosed investors; Fitbit, a fitness and health tracker company, raised $43 million in private equity financing from Qualcomm Ventures, SAP Ventures, SoftBank Capital, Foundry Group and True Ventures; and Oscar, a technology-based health insurance and telemedicine provider, raised $40 million from Thrive, Founders Fund, General Catalyst, and Khosla Ventures. There were a total of 168 investors in Q3 2013, including VCs, accelerators, incubators and crowdfunding platforms, compared to 161 investors in Q2 2013. Six investors participated in multiple funding rounds compared to 11 in Q2 2013. Kleiner Perkins Caufield & Byers and The Social+Capital Partnership were the most active investors and participated in four deals each. The remaining top investors participated in three deals apiece. They included FirstMark Capital, Founders Fund, HLM Venture Partners and Khosla Ventures.
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Healthcare IT VC Funding Q3 2013 ■
Disdosed Amount ($M)
104
600 500 -
No. of deals
700 -
168
800 -
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400 300 200 100 0-
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Mercom Capital Group, a global communications and consulting firm, has released its report on funding and mergers and acquisitions (M&A) activity in the healthcare information technology (IT) sector for the third quarter of 2013. A total of 412 companies and investors have been mentioned in this report. Venture capital (VC) funding in the sector continued to rise in yet another record quarter with $737 million raised in 151 deals. The dollar amount of disclosed deals surpassed the second quarter total of $623 million. Year to date, the healthcare IT sector has raised a disclosed $1.85 billion. “Funding into Healthcare IT is on pace to double over last year,” said Raj Prabhu, CEO, Mercom Capital Group. “With major parts of the Affordable Care Act on the horizon, the focus is on health insurance exchanges, preventative care, wellness, population health, and a general shift from quantity to quality of care, which is reflected in this quarter’s funding transactions.” Healthcare practicefocused technology companies received $489 million in 59 deals with population health, EHR/EMR, practice management, and data analytics companies all receiving
$ in Million
M
attention this quarter. Consumer-focused companies received $248 million in 92 deals, with most funding ($161 million) going to the mobile health category, with mobile health apps and sensors receiving the most funding this quarter. The top VC funding deal in Q3 2013 went to Evolent Health, a population health management organisation which raised $100 million from The Advisory Board Company, UPMC Health Plan and TPG Growth. Other top deals in the quarter included Practice Fusion, a free webbased EMR provider, which raised $70 million from Kleiner Perkins Caufield & Byers, OrbiMed Advisors, Deerfield Management Company, Industry Ventures, Artis Ventures, Morgenthaler Ventures, Felicis Ventures, Glynn Capital Management, Band of Angels Acorn Fund, H Barton Co-Invest Fund, and Goldcrest Investments; MedSynergies, a provider of revenue and performance management solutions for healthcare providers, raised
197
301
493
623
737
Q3 2012 I Q4 2012 I Q1 2013 I Q2 2013 I Q3 2013 I Source: Mercom Capital Group, IIc
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M&A in healthcare IT totalled $1.1 billion in 45 transactions. Last quarter saw $108 million in 30 transactions. The most active categories for M&A transactions included Revenue Cycle Management with nine, followed by Practice Management with eight, and Telehealth with four transactions. There were only six disclosed M&A transactions in the third quarter, including the $644 million merger of Greenway Medical Technologies, a provider of an EHR, practice management and interoperability solution platform, and Vitera Healthcare Solutions, an EHR and practice management software provider; the $200 million acquisition of Medical Management Professionals, a medical billing and practice management company (subsidiary CBIZ), by Zotec Partners; and the $200 million acquisition of Cardiocom, a developer and provider of integrated telehealth and remote patientmonitoring services, by Medtronic. The Advisory Board Company acquired Medical Referral Source, a web-based software programme that streamlines patient referrals from primary-care doctors to specialists, for $11.5 million; and IMS Health acquired Diversinet, a provider of secure, patented mobile technologies and connected health solutions for healthcare organisations and partners, for $3.5 million. Also in Q3, Mastech Holdings’ Healthcare Unit was acquired by Accountable Healthcare Staffing for $1.15 million.
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EHR penetration is growing at 13.5 per cent India’s healthcare information technology market is expected to reach $1.45 billion in 2018, more than three times the $381.3 million reached in 2012, says a new report. Bipul Kumar Jha, Senior Consultant, Healthcare IT & Healthcare Delivery, Healthcare Practice, Frost & Sullivan gives more insight on this sector in an interview with Shalini Gupta What is the current penetration of healthcare information technology (HIT) in India vis-a-vis China and the US? Why is it low? Enumerate the barriers/challenges. There is very low penetration of HIT in India as compared to developed countries like the US. The total spending on IT by the US hospitals in 2011 amounted to $79-80 billion compared to healthcare IT spending of $305 million in India. Top challenges are underfunding of public healthcare services, limited knowledge about applications of IT, shortage of trained manpower, huge initial investments and lack of stringent regulations.
INTERVIEW
How many EMR vendors are there in India? How have the EMR standards here helped?
vendors have focused on proving return on investment on their products and improved efficiency of the system post-implementation.
By how much (in percentage terms) has the penetration of EHR, mHealth, telemedicine and web-based services increased in India over the last five years? What are the projections for the next five years? The penetration of EHR has been highest among all others, growing by 13.5 per cent. It is expected to have the same rate or increase due to improving uptake and upcoming hospital projects.
What are the growth drivers for HIT in India? How have these changed over years and how are these expected to change further?
How do you see the rise of mHealth in India? Why has this not extended itself to the use of health apps by physicians and patients which is the norm in the US?
Some of the growth factors are increasing competition among private players for healthcare excellence, ever-increasing healthcare data volumes, advent of electronic health records (EHR). Over the years, the awareness has increased among private health providers and the
mHealth market in India is at a nascent stage with a majority of the initiatives having started in the last two to three years. There are more than 20 initiatives for mHealth in India. At present the mHealth sector in India is highly scattered. There are some players who have an all-India
telemedicine to increase their reach in these cities. The focus by healthcare providers to cater to tier II and III cities’ patients will help increasing IT penetration in these cities in the future.
presence, while there are other initiatives present only in a few states or cities. Most of the mHealth applications used in India are in the wellness segment like calorie counter, heart rate counter and so on.
H IT, if accessible to tier II and III cities, could change healthcare delivery in Indian context. Although very less, the healthcare groups present in tier II and III cities have also shown an increasing trend on uptake of technology. HIT vendors also have gradually moved their targets from metro cities to these cities because of the markets getting more competitive. Some of the key healthcare groups have been using
The market has over 120 vendors with small to large scale offerings with variety of web based and client side products. There are approximately 35 domestic EMR vendors in India with multiple product portfolios. Creation of awareness, imparting training and proving ROIs are the important aspects that can be practiced more by the vendors. Consolidations (partnerships, M&As etc.) are few other trends which help in standardisation of solutions and provides greater geographic coverage.
What is being done for training and education in the field of EMR in India? What are the areas of improvement? Till date the training and education part is either handled by the healthcare groups or by the vendors supplying EMR that is specific for their clients. No public body for healthcare IT training is in place. To train the staff, government should arrange training programmes or courses to enhance their computer skills, and a step towards that can be via partnerships with the private sector for conducting such training. shalini.g@expressindia.com
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W H AT ’ S INSIDE
Synthesised 18-lead ECG: A new technology for more informative ECG exam PG 74
TRADE & TRENDS Point-of-care ultrasound to improve patient safety, enhance healthcare quality and reduce cost It enables medical professionals to perform precisionbased procedures and treatments under direct, real-time ultrasound visualisation
MARKET 13 STRATEGY 28 KNOWLEDGE 30 WEST INDIA UPDATE 39 RADIOLOGY 46 IT@HEALTHCARE 49 NOVEMBER 2013
he healthcare industry in India has grown tremendously in the recent years. This in turn has helped to increase life quality and expectancy, and counter diseases that were previously considered life threatening or terminal. Medical technology plays a vital role in delivery of healthcare and extends and improves life by diagnosing, preventing, or treating diseases. Point-of-care (POC) ultrasound technology has the potential to transform the way in which emergency units function. By consolidating and speeding up healthcare delivery as well as minimising patients’ transport, such technology can significantly improve patient safety, reduce costly hospital stays and enhance healthcare quality. The use of POC ultrasound is now not limited to departments traditionally focused on clinical imaging. Diverse specialties, such as anaesthesiology, sports medicine, dermatology, paediatrics, rheumatology, trauma, surgery, cardiology, etc. are relying on it for diagnosis and assistance with clinical procedures. It has also found its way into remote corners of the world where funds and facilities are limited, and smaller, more economical machines are desirable. Indeed, portable units have made the cost for ultrasound technology affordable to more healthcare providers overall, including numerous hospitals and medical facilities throughout India. The implementation of POC ultrasound technology by appropriately trained physicians results in improved quality of care. It enables medical professionals to perform precision-based procedures and treatments under direct, realtime ultrasound visualisation. Use of ultrasound guidance by physicians may improve success and decrease complications in regional anaesthesia (nerve blocks), lumbar puncture, I.V. placement (central and peripheral vascular access), biop-
T
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sies, thoracentesis, paracentesis, arthrocentesis, incision and drainage of abscesses, and localisation and removal of foreign bodies. FUJIFILM SonoSite, the pioneer of cutting-edge ultrasound tools, has recently launched its latest point-of-care ultrasound system, the X-Porte Ultrasound Kiosk. The state-of-the-art X-Porte introduces advanced signal processing for high resolution imaging, 3D animated clinical guides and a multigesture user interface – all unique innovations in point-of-care ultrasound. Created to serve a broad spectrum of users, the X-Porte represents an entirely new ethos for point-of-care ultrasound. Its groundbreaking visual learning guides allow ‘any user, any time’ operation, enabling simultaneous live scanning and 3D animations to maximise in-the-moment imaging performance. Proprietary Extreme Definition Imaging (XDI) technology offers a revolution in image quality, significantly reducing visual clutter from side-lobe artefacts that affect conventional ultrasound imaging, regardless of system size. To maximise the benefits of XDI technology, the X-Porte has been designed for optimised use in a variety of workflows and environments, with a multi-touch, gesturedriven user interface for userfriendly operation. Designed for a busy clinical environment, the X-Porte’s slender profile makes it easy to manoeuvre down corridors and between beds, and the ultrasound core can be easily detached from the kiosk to provide another configuration option. The instruments sleek design and sealed user interface allow rapid cleaning with a wide range of disinfectants, ensuring optimal infection control and increasing productivity. Combined with SonoSite’s robust build quality and industry-leading five-year warranty, this ensures maximum flexibility for bedside ultrasound imaging. EXPRESS HEALTHCARE
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T|R|A|D|E & T|R|E|N|D|S
Synthesised 18-lead ECG: An effective technology for more informative ECG exam 18-lead synthesised ECG is expected to be useful in detecting right side and posterior infarction
ynthesised 18-lead ECG derives the waveforms of the right chest leads (V3R, V4R, V5R) and back leads (V7, V8, V9) from the standard 12-lead ECG data. The measurement procedure is the same as the standard 12-lead ECG but more information can be obtained. 18-lead synthesised ECG is expected to be useful in detecting right side and posterior infarction.
S
What is Synthesised ECG ? Synthesised 18-lead ECG uses the 12-lead ECG waveforms to mathematically derive the waveforms of the right chest leads (V3R, V4R, V5R) and back leads (V7, V8, V9). The measurement procedure is the same as the standard 12-lead ECG but more information can be obtained. 18-lead synthesised ECG is expected to be useful in detecting right side and posterior infarction. The most common ECG exam is the standard 12-lead ECG. It is simple to measure, has low burden on the body, and observing the heart from these 12 directions provides a lot of information which has a wide range of clinical applications. However, some areas, especially pathological change in the right ventricle
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and the posterior wall cannot be observed from the 12-lead ECG. In order to actually measure the right chest (V3R, V4R, V5R) and back (V7, V8, V9) areas, it is necessary to use different electrode positions than the standard 12-lead ECG. In particular, electrodes must also be attached to the patientâ&#x20AC;&#x2122;s back so that normal suction cup electrodes cannot be used.
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Also, the patient must be turned over in some cases and in an emergency it is often difficult to use back electrodes. This complicates the exam procedure. Synthesised 18-lead ECG uses the 12-lead ECG waveforms to mathematically derive the waveforms of the right chest leads (V3R, V4R, V5R) and back leads (V7, V8, V9).
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